DS29 Dermatology’s double standard: unequal wait times for comprehensive melanoma and cosmetic care and the role of workforce composition

Abstract This study evaluated disparities in comprehensive (consultation plus procedure) and procedure-only wait times between urgent melanoma care and elective cosmetic care within the same clinics. The role of workforce composition – dermatologists and advanced practice providers (APPs) – in influencing access to care was also examined. A cross-sectional analysis of 122 dermatology clinics in the southern USA was conducted. Data were collected on workforce composition, mole evaluation, cosmetic consultation and procedure-only wait times for melanoma excisions and dermal fillers from October to December 2024 through direct clinic contact. Comprehensive melanoma wait times included mole evaluation and excision, while comprehensive filler wait times included consultation and procedure. Paired comparisons of wait times were analysed using the Wilcoxon signed-rank test. Multiple linear regression was used to assess the impact of dermatologist and APP availability on wait times, with sensitivity analyses excluding outliers. Melanoma care consistently had significantly longer wait times than dermal filler care. Comprehensive melanoma wait times (mean 45.9, SD 29.1 days) exceeded comprehensive filler wait times (mean 20.3, SD 23.1 days) in 92.9% of clinics (P < 0.001). Procedure-only melanoma wait times (mean 11.2, SD 6.4 days) also exceeded procedure-only filler wait times (mean 3.6, SD 13.3 days) in 93.1% of clinics (P < 0.001). Sensitivity analyses confirmed these disparities (P < 0.001). Regression revealed that dermatologist availability significantly reduced comprehensive filler wait times before sensitivity testing (β = −9.03, P = 0.03) but lost significance after testing. APP availability consistently reduced comprehensive melanoma wait times before (β = −7.69, P = 0.009) and after sensitivity testing (β = −6.47, P = 0.01) by 6–8 days for each increase in APP per clinic. Procedure-only wait times were not significantly influenced by staffing. Significant disparities exist in wait times for urgent melanoma care compared with elective cosmetic care, including consultation and procedure phases. APPs most likely reduce comprehensive melanoma wait times by addressing bottlenecks in consultation phases, aligning with prior research on workforce shortages (Yadav G, Goldberg HR, Barense MD, Bell CM. A cross-sectional survey of population-wide wait times for patients seeking medical vs. cosmetic dermatologic care. PLOS ONE 2016; 11: e0162767). Policymakers should expand APP roles in dermatology and prioritize resource allocation to reduce disparities while optimizing access to necessary comprehensive procedural care (Resneck JS Jr, Lipton S, Pletcher MJ. Short wait times for patients seeking cosmetic botulinum toxin appointments with dermatologists. J Am Acad Dermatol 2007; 57: 985–9).