Main Article Content
COVID-19, Coronavirus, Socioeconomics, Urban, Rural, Telemedicine, Teledermatology
Background: COVID-19 materially delayed patient visits and potential skin cancer biopsies/diagnoses among US dermatology practices. However, given a likely heterogenous impact across the US, this study sought to determine COVID-19’s effect on urban versus rural dermatology practices.
Methods: Data were analyzed from the first 1000 responses to 3 pre-validated surveys of 9891 practicing US dermatologists comparing outpatient volumes and scheduling issues for the week of February 17th to the week of March 16th (Survey 1), April 13th (Survey 2) and May 18th, 2020 (Survey 3). First 3 US zip-code digits were compared to US Census Bureau data to determine “Urban/Rural” status. Representativeness with AAD membership was confirmed. Statistical significance was calculated using chi-square with Marascuilo procedure and two-tailed independent t-test/ANOVA with post-hoc Tukey-Kramer testing.
Results: In April 2020 urban practices reported more closed practices (21.4% vs 5.8%, p<0.0001) and predicted significantly larger patient volume decreases (-45.2% vs -31.4%, p<0.0001) and practice closures (11.9% vs. 2.5% p<0.0001) in the following 2 weeks. In May 2020, urban areas saw significantly fewer patients/week (90.9 vs 142.4 p<0.0001), larger decrease in patient volume relative to May 2019 (-49.4% vs -35.1%, p<0.0001), and conducted more telemedicine visits (27.0% vs 15.1%, p<0.0001). Significantly more rural practices reported already being at baseline volume (Mean Difference 6.2%, 95% CI 2.7%-9.8%) while urban practices predicted return to baseline volume by August (5.7, 95% CI 2.1%-9.3%) or were unsure (5.6, 95% CI 1.6%-9.7%).
Conclusion: The initial COVID-19 pandemic differentially affected urban dermatology practices. The effects of the pandemic were mitigated in part by increased use telemedicine. Future studies may further elucidate COVID-19’s effect on clinical practice and highlight areas for improvement in practice logistics and patient care.
2. Litchman GH, Marson JW, Rigel DS. The Continuing Impact of COVID-19 on Dermatology Practice: Office Workflow, Economics and Future Implications. J Am Acad Dermatol. 2020 Sep 30:S0190-9622(20)32658-X. doi: 10.1016/j.jaad.2020.08.131. Epub ahead of print. PMID: 33010326; PMCID: PMC7526524.
3. America is Reopening. But Have We Flattened the Curve? Johns Hopkins University & Medicine Coronavirus Resource Center. https://coronavirus.jhu.edu/data/new-cases-50-states
4. County Rurality Level 2010. US Census Bureau. www2.census.gov/reference/County_Rural_Lookup. Accessed 27 October 2020
5. Glazer AM, Rigel DS. Analysis of Trends in Geographic Distribution of US Dermatology Workforce Density. JAMA Dermatol. 2017 May 1;153(5):472-473. doi: 10.1001/jamadermatol.2016.6032. PMID: 28296988; PMCID: PMC5470415.
6. Ehrlich A, Kostecki J, Olkaba H. Trends in dermatology practices and the implications for the
workforce. J Am Acad Dermatol. 2017;77(4):746-752. doi:10.1016/j.jaad.2017.06.030.