The full-time effort of 1,740 (95% CI: 1,340-2,220) clinicians is required to care for skin cancer and other skin tumors each year. Furthermore, 3.48 (95% CI: 2.68-4.44) million hours are devoted annually to the management of skin cancers.
Clinical Pearls
This study was a population-based, cross-sectional analysis inputting data from two major national surveys between the years of 2007 to 2016. The authors were seeking to understand the workforce requirements of dermatologists treating cutaneous malignancies.
The results displayed that the full-time effort of 1,740 (95% CI: 1,340–2,220) clinicians is required to care for skin cancer and other skin tumors each year. Furthermore, 3.48 (95% CI: 2.68-4.44) million hours are devoted annually to the management of skin cancers.
Specifically, the full-time effort years required for the treatment of melanoma (p= .006), keratinocytic carcinoma (p< .0001), actinic keratosis (p< .0001), and all skin neoplasm (p< .0001) increased significantly in the nine-year time period of this study.
The time necessary for managing cutaneous malignancies has increased and is likely attributed to the increased incidence and prevalence of skin cancer in an aging population with an expanding access to whole-body skin examinations.
Discussion:
The clinical workload of dermatologists in the United States treating cutaneous malignancy is substantial. With an aging U.S. population and increasing demand of clinicians, understanding the current workforce demands of dermatology providers can help us prepare to meet the requirements of a changing patient population and execute appropriate workplace planning.
This study used two major surveys, the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), in a population-based cross-sectional analysis to determine the time spent by physician and non-physician providers in treating cutaneous malignancies. The authors studied data between the years of 2007 to 2016 and used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to specifically analyze skin cancer visits. The time physically spent by each provider in seeing patients was extrapolated from both surveys. This interval did not include time spent by providers reviewing patient medical records, test results, or entering Current Procedural Terminology (CPT) and Evaluation and Management (E&M) codes.
The authors found that the time managing skin cancer and other cutaneous tumors increased significantly (245%) from the year 2007 to 2016. The full-time effort necessary for providing care for skin cancers required approximately 1,740 (95% CI: 1,340–2,220) physician and non-physician providers. When analyzed by subtype, keratinocytic carcinoma required the most full-time effort years (1,040 years, 95% CI: 786-1,320), followed by actinic keratosis (611 years, 95% CI:496-829), and melanoma (272 years, 95% CI: 155-240).
The growing population of elderly in our country and increased rates of melanoma and non-melanoma skin cancer contribute to the increased demand of clinician effort in treating skin cancers. Future studies investigating the likelihood of an upcoming workplace deficit in treating skin cancer and strategies to reduce the burden of disease, cost, and time expended by providers may be of particular benefit.
One major limitation of this study is the potential for an inaccurate representation of clinical hours spent providing care for skin cancers. Specifically, the variables used to estimate time spent providing care did not include time used for reviewing patient medical records and test results or entering CPT and E&M codes. This may provide a conservative but inaccurate appearance of time-effort in the study. Another important limitation is the fact that if two diagnoses were recorded for a single visit, the visit time was split in half between both diagnoses in analysis. This may also compromise the accuracy of time-effort calculated in the cohort used for this study.
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