Geographic Distribution and Rural Access to General and Pediatric Dermatology in Canada

BACKGROUNDIn Canada, pediatric dermatology faces challenges with workforce shortages, geographic maldistribution, and limited rural access, yet national data on provider distribution are lacking.

OBJECTIVESThis study aimed to visualize the geographic distribution of general and pediatric dermatologists across Canada, assess 10 year temporal changes, and examine associations between service availability, rurality, and socioeconomic deprivation.

METHODSGeospatial analysis was conducted using Canadian Institute of Health Information billing data and provincial College of Physicians and Surgeons data. Dermatologists were mapped at the census subdivision (CSD) level or economic region (ER) level in Quebec. Pediatric and adolescent care were defined using billing thresholds. Spatial distribution and Canadian Index of Multiple Deprivation indicators were visualized using a geographic information system (ArcGIS).

RESULTSEighty-eight of 3879 CSDs nationally contained at least 1 dermatologist, including a single rural CSD. In Quebec, 15 of 17 ERs had at least 1 dermatologist, including 4 rural ERs. Pediatric and adolescent dermatology care was confined to a small number of urban CSDs, with no rural coverage. Over 10 years, growth in the general dermatology workforce was restricted to large metropolitan areas and did not translate into increased pediatric or adolescent care. Known pediatric dermatologists (n = 55) were centralized in urban academic centers, and services were disproportionately located in socioeconomically advantaged areas.

CONCLUSIONPediatric dermatology access is marked by urban concentration, minimal rural availability, and persistent socioeconomic inequities. General dermatology workforce expansion alone has not improved pediatric care access, highlighting the need for equity-oriented workforce planning and improved national tracking.

Abstract from PubMed