Dermatologic Training and Practice in Canada: A Historical Overview—Reader Comment

Dear Editor,

Mydlarski et al present a needed discussion on the state of dermatology in Canada. ¹ Their article mentions a number of studies on the dermatology workforce, which are essentially survey-based studies having both limited accuracy and utility except to suggest some trends in broad brush-strokes. They fail to identify that one of their references ² was a supply-based environmental scan of every province on the dermatology workforce referenced to census population data. Also not mentioned was the most recent and most accurate updated dermatology workforce study from 2014 by the Canadian Association of Psoriasis Patients. ³ These two studies teased out the actual fee-for-service workloads of dermatologists by province based on medicare billings thereby endeavoring to correct for part-time dermatologists. The more recent study compared changes in the workforce from the earlier Canadian Skin Patient Alliance study and also commented on needs, albeit mostly based on supply and population. Nevertheless, it pointed out the disconnect between supply and wait times in some jurisdictions, which highlights the fact that the ideal workforce study should look at needs-based data at the local geographic level in order to assess patients’ access to care, the most fundamental issue in healthcare delivery. We expectantly await just such a study.

However, a caveat needs to be considered with regard to wait times. The critical shortage of dermatologists in British Columbia (BC) has been worsening over the past several years. Wait times have increased but there is a new phenomenon of no available measurable wait time in the several cities that no longer have a dermatologist!

The comparison of the Royal College’s 1998 National Specialty Physician Review (NSPR) ⁴ supply-based statistics to American dermatologist-to-population benchmarks is not a relevant consideration due to the differences in the Canadian medical specialty referral system compared to the American system of direct access to specialists and tendency of specialists in the United States to also practice primary care. Indeed, I have back-checked dermatologist-to-population ratios in BC into the past when wait times were a more appropriate 3-5 weeks and found a ratio more aligned to the Royal College’s value of 1 full-time dermatologist to a population of 62 500.

The relevance of the comments regarding supply-based versus needs-based and wait time data is that Quebec meets the recommended NSPR ratio but their wait times are very long, ³ suggesting lack of patient access to dermatologic care and an actual dermatologist shortage as opposed to abundance in Quebec.

Yours truly,