Increasing supplies of dermatologists and family physicians are associatedwith earlier stage of melanoma detection

Background: Physicians are important in the early detection of melanoma. We investigated whether primary care physician supply and the supply of derma tologists were related to stage at diagnosis for malignant melanoma. Methods: From the state tumor registry in Florida in 1994, we identified in cident cases of malignant melanoma for which stage at diagnosis was availab le (N = 1884). Data on physician supply was obtained from the 1994 American Medical Association Physician Masterfile. Logistic regression determined t he effects of physician supply (at the ZIP code level) on the odds of early -stage diagnosis controlling fur patients' age, gender, race/ethnicity mari tal status, education level, income level, comorbidity, and type of health insurance. Results: Each additional dermatologist per 10,000 population was associated with a 39% increased odds of early diagnosis (odds ratio = 1.39, 95% confi dence interval [CI] 1.09-1.70, P = .010). For each additional family physic ian per 10,000 population, the odds of early diagnosis increased 21% (odds ratio = 1.21, 95% CI 1.09-1.33, P < .001). Each additional general internis t per 10,000 population was associated with a 10% decrease in the odds of e arly-stage diagnosis (odds ratio = 0.90, 95% CI 0.83-0.98, P =.009). The su pplies of general practitioners, obstetrician/gynecologists, and other nonp rimary care specialists were not associated with stage at diagnosis. Conclusions: Increasing supplies of dermatologists and family physicians we re associated with earlier detection of melanoma. In contrast, increasing s upplies of general internists were associated with reduced odds of early de tection. Our findings suggest that the composition of the physician work fo rce may affect important health outcomes and needs further study.