Time-efficiency of nondermatologists compared with dermatologists in the care of skin disease

Background: It has been suggested that using an established primary care do ctor potentially could be a more efficient use of physician time than a new visit to a dermatologist for patients seeking care for skin diseases. Objective: We test the hypothesis that seeing an established primary care d octor for a skin problem is a more efficient use of physician-time resource s than a new visit to a dermatologist. Methods: The duration (in minutes) of outpatient visits for dermatologic co nditions was obtained from the National Ambulatory Medical Care Survey from 1990 to 1994. To control for the complexity of visits, the analysis was li mited to the 62% of these visits in which a single dermatologic condition w as the only condition being treated. Results: For all outpatient dermatologic visits combined, dermatologist vis its for patients is years old or younger were 1.5 minutes (12%) shorter tha n nondermatologist visits, and dermatologist visits for patients older than 18 years were 3.1 minutes (20%) shorter than nondermatologist visits. Comp ared with nondermatologists, dermatologists have a shelter average visit du ration for new, first-time patient encounters and for encounters with estab lished patients. A significant difference in outpatient visit duration does not exist when comparing new, first-time visits for dermatologists to esta blished visits for nondermatologists (P = .3). Conclusion: A visit to an established primary care provider for treatment o f a skin problem is not a more efficient use of physician resources than a new or return visit to a dermatologist.