Closing Dermatology's Rural Workforce Gaps: Jane Grant-Kels, MD

Rural areas lack dermatologists, and while teledermatology is a proven tool for reducing that gap, inconsistent reimbursement makes it difficult for dermatologists to invest in these areas, explained Jane M. Grant-Kels, MD, FAAD, professor and vice chair of the Department of Dermatology at UConn Health. With new rural health funding arriving at the same time as major Medicaid cuts, patients struggle to find care, and dermatologists are deterred from practicing in these rural environments.

Teledermatology Reimbursement Problem

Teledermatology is one potential solution for patients in these environments. However, teledermatology reimbursement is inconsistent, cycling between well-covered and not. The COVID-19 pandemic was a point in time when reimbursement expanded out of necessity; however, coverage is still up to government discretion rather than that period being a permanent fix. There needs to be a reimbursement fix to benefit rural areas with a lack of dermatological care.

“You can't do a total body skin exam, but for follow-up visits for psoriasis or acne, for isotretinoin visits, for many inflammatory disease follow-ups, it's a very useful tool,” said Grant-Kels in relation to teledermatology.

Contradictory Medicaid Support

Federal and state rural health funding is important to aid these areas. However, President Donald Trump’s new bill, the One Big Beautiful Bill Act (OBBBA), it contradicts itself, Grant-Kels pointed out.

“It's counterintuitive that you're going to increase care for rural areas that are poor and, at the same time, cut Medicaid reimbursements,” she said.

Increasing Dermatology Opportunities

Structural changes such as streamlining or reducing prior authorization burdens on patients are a way to make quality changes in these rural environments. Additionally, making these environments more desirable to dermatologists could be a potential fix in closing these workforce gaps. That could mean enhanced training specifically located in rural environments and opening programs in rural states that currently have none.

“I think a combination of all of that would enhance care in these rural deserts where they have no dermatologists for hundreds of miles,” Grant-Kels closed.