Perspectives From Care Seekers and Non-Care Seekers on Challenges and Recommendations to Improve Dermatologic Care in Puerto Rico

Introduction Barriers to dermatologic care remain a persistent challenge in Puerto Rico, where specialist shortages, long wait times, and high poverty rates limit access. While these obstacles have been described among patients who seek care, the perspectives of individuals who do not attempt to seek dermatologic evaluation remain underexplored. Methods We conducted a cross-sectional survey of adults in Puerto Rico recruited through community events and social media. The 18-item questionnaire assessed insurance type, care-seeking behavior within the past five years, perceived barriers to care, and recommendations for improving access. Results Among 456 respondents, 329 (72.1%) sought dermatologic care, while 127 (27.9%) did not. Non-care seeking was most common among uninsured respondents, with eight of 11 (72.7%) indicating that they had not sought dermatologic care, compared with 26 of 78 (33.3%) publicly insured participants and 93 of 367 (25.3%) privately insured participants (χ² = 13.34; p = 0.0013). Among non-care seekers, lack of perceived need was the most frequently reported reason for not pursuing dermatologic care (87/127; 68.5%), although many respondents also selected additional barriers. Beyond perceived need, non-care seekers and care seekers converged in identifying dermatologist scarcity and prolonged wait times as the most prominent obstacles. Subsequent barriers differed, with care seekers more commonly reporting difficulty contacting office staff to schedule appointments (165/329; 50%) and non-care seekers more often citing limited knowledge of where to seek care (19/127; 15.0%). In recommending solutions, both groups prioritized increasing the number of specialists, reducing wait time for appointments, and improving insurance coverage. Non-care seekers additionally emphasized raising awareness about skin health, while care seekers stressed improvements in scheduling processes. Conclusion These findings illustrate how structural shortages intersect with informational gaps, particularly among uninsured populations. Addressing these challenges through workforce expansion, streamlined scheduling systems, broader insurance participation, and culturally adapted education will be essential for achieving equitable dermatologic care across Puerto Rico.