GD02 Addressing dermatology access barriers: the impact of community economic distress on clinic services

Abstract This study aimed to assess how clinic-level characteristics, specifically operating hours, teledermatology availability and Medicaid acceptance, vary across communities with different levels of socioeconomic distress, as measured by the Distressed Communities Index (DCI). It also assessed how these variations impact access to dermatology care in the southern USA. This cross-sectional study evaluated 122 medical dermatology clinics in the southern USA, excluding surgical-only and cosmetic-only dermatology clinics. Clinics were identified using the American Academy of Dermatology and MediFind directories, and were verified via Google Maps and hospital directories. The DCI is a composite measure that combines indicators of economic distress such as income, employment, education and housing [Economic Innovation Group. Distressed Communities Index (DCI). Available at: https://eig.org/distressed-communities (last accessed 6 March 2025)]. It was used to categorize communities into quintiles, from the most prosperous (1) to the most distressed (5). The 122 medical dermatology clinics were categorized by DCI quintile and contacted for data on operating hours, teledermatology availability and Medicaid acceptance in August 2024. Clinics in more distressed communities had fewer access opportunities. Operating hours decreased by 1.3 h per week with each increase in DCI quintile (β = −1.34, P < 0.001), with the most distressed areas operating 5.4 fewer hours weekly than the most prosperous areas (36.1 vs. 41.5 h, respectively). The proportion of clinics offering teledermatology also decreased by 6.4% per quintile (β = −6.36, P = 0.003), showing a 25.4% decline from prosperous (54.8%) to distressed areas (29.3%). Medicaid acceptance did not significantly vary across DCI quintiles (P = 0.07). These findings demonstrate how economic distress limits access to dermatology care, particularly in underserved communities. Expanding teledermatology and optimizing clinic hours could improve access, while innovative solutions such as mobile units and AI-driven triage systems may further reduce barriers (Gwillim EC, Azzawi S, Aigen AR. Underserved populations and health equity in dermatology: digital medicine and the role of artificial intelligence. Clin Dermatol 2024; 42: 498–506). Addressing these challenges can enhance healthcare equity not only in economically distressed regions of the USA but also in underserved communities globally, where similar access disparities may exist.