Diagnosis of skin disease by nondermatologists

Objective: To determine how often primary care physicians diagnose and trea t skin disease and to compare their experience with that of dermatologists. Study Design: Retrospective review of National Ambulatory Medical Care Surv ey data. Methods: We reviewed data from the 1990-1994 National Ambulatory Medical Ca re Survey on outpatient visits to physicians for both dermatologic and nond ermatologic disorders. Results: Dermatitis is the most common dermatologic problem diagnosed by in ternists, family physicians, and pediatricians and is the 35th, 17th, and 1 5th most common diagnosis made by these providers, respectively. Dermatolog ists had 728 and 352 office visits per year for acne and contact dermatitis , respectively, whereas internists averaged 3 and 9 visits, family physicia ns averaged 8 and 27 visits, and pediatricians averaged 8 and 37 visits. Ov erall, dermatologists spent 930 outpatient hours per year with patients wit h dermatologic conditions, compared with 21, 53, and 56 hours per year for internists, family physicians, and pediatricians. Conclusions: Although most visits for skin disease are managed by primary c are physicians, these physicians treat few cases of individual skin conditi ons. The different levels of experience between dermatologists and nonderma tologists may affect the quality of dermatologic care and may explain in pa rt the greater expertise dermatologists have in diagnosing and treating ski n disease. This should be considered in decisions about the delivery of der matologic healthcare services and in planning educational programs designed to improve dermatologic care.