Certain areas of the United States, including the Midwest and Mountain regions, have an especially hard time holding on to dermatologists, according to a new study.

While most skin doctors who did their residencies in the South or on the West coast, for instance, stayed nearby to practice, other states lost dermatologists -- potentially creating underserved areas where patients have trouble getting care.

"There is a shortage of dermatologists in most areas," study author Dr. Jack Resneck, from the University of California, San Francisco School of Medicine, told Reuters Health in an email.

Across much of the country, he said, "wait-times for dermatology appointments are too long, and more practices are looking for dermatologists than the number being trained."

Consulting a database of more than 7,000 dermatologists in the U.S., Resneck's team found that 43 percent of skin doctors work within 100 miles of the place where they did their residency training after medical school.

But that number varies a lot by region, they report in Archives of Dermatology. In the New York/Pennsylvania area, 59 percent of residents stay close-by to practice, and 55 percent do so on the West coast. That compares to just 26 percent of residents who train in parts of the Midwest including Minnesota and Kansas.

"The Midwest was a net exporter of residents to the West and South," the researchers wrote.
Demand for doctors to treat skin cancer or perform cosmetic surgery may be driving more of them toward sunny and urban areas. But that leaves holes in other parts of the country, researchers said.

"Rural areas are certainly underserved by dermatologists and many other specialties," said Dr. Robert Brodell, a dermatologist from Northeast Ohio Medical University in Rootstown, in an e-mail to Reuters Health.

"Patients in these areas may have to drive many miles to obtain specialty care and primary care physicians feel more pressure to provide specialty services. At the least this is inconvenient, and, perhaps more significantly, patients in some rural areas may not be able to access some services," added Brodell, who was not involved in the new research.

Researchers said that residency programs could address some of these gaps by picking new doctors who come from underserved areas -- and hoping they'll return there to practice -- or looking for other "personality traits" that hint at a desire to go to, or stay in, those less popular regions.

Most residencies are funded by the federal government, which allocates a certain amount of money to individual universities or hospitals, then institutions divide up their funds among different specialties. Extra slots are also bankrolled by grants from groups including pharmaceutical companies, and in some cases, institutions fund their own residents.

That system could also be tweaked to direct more money toward programs that would place new doctors in underserved areas, researchers proposed.

"Most of the residency programs are in big cities where they have university hospitals," Brodell said in a phone interview. "It's certainly a theory that makes more sense -- if the government funded additional residences for dermatology and other specialties in underserved areas, maybe that might lead to more of them staying."

Still, he added, the problem remains that skin doctors, even those trained in the Midwest or rural areas, are drawn to "the good life" in New York City, Florida and California.