In a new paper, researchers using Google Trends data were able to show that areas with the highest patient demand almost always had the lowest access to dermatology care.

The research is the first to pair patient interest “with workforce data to quantify supply and demand at the state level,” co-author Adam Friedman, MD, professor and chair in the Department of Dermatology at the School of Medicine and Health Sciences, George Washington University (GWU) in Washington, DC, told Medscape Medical News.

Patient demand has previously been quantified indirectly by measuring dermatologist density and “downstream outcomes like delayed diagnoses,” and through workforce surveys, said Friedman. “What’s been missing is a real-time, patient-driven signal of demand,” he said.

Those metrics “captured perceived demand through the lens of the practicing physician, not the patient seeking care,” lead author Yagiz Matthew Akiska, an MD/PhD candidate at GWU’s School of Medicine and Health Sciences told Medscape Medical News.

Akiska and colleagues analyzed Google Trends data over a 20-year period (2004-2023). First, they quantified demand, defined as monthly search volumes for “dermatologist” in each state, divided by total monthly searches in the state, which were then averaged into a relative search volume (RSV). The results were published in the Journal of Drugs in Dermatology.

Supply was defined as density of dermatologists per 100,000 state residents. The authors then created a demand index (DI) for clinicians, calculated by dividing the RSV by dermatologist density. A relative DI (RDI) was then created by dividing each state’s DI by the largest DI and multiplying by 100.

A higher RDI (on the 0-100 scale) suggests a shortage of clinicians, whereas a lower one indicates more dermatologists.

The RDI methodology — which has been used to analyze other specialties — “does not just ask where dermatologists are; it asks where people appear to be looking for them relative to how many are available,” Akiska said.

Surprising Outliers

Many of the researchers’ findings were not unexpected.

The highest concentrations of dermatologists were in Washington, DC, Rhode Island, and Massachusetts, whereas the lowest were in Oklahoma, Nevada, and Nebraska.

The authors found highest search volumes in New Jersey, Alabama, and New York, with the lowest in Maine, North Dakota, and Vermont.

States with the highest RDI were Alabama (100 out of 100), Mississippi (98), and Delaware (92). Since rural states tend to have fewer dermatologists, it was not unusual that Alabama and Mississippi had such RDIs, said the authors.

But Delaware is urbanized and still had high demand, which “reinforces that geography alone doesn’t guarantee access,” said Friedman. “Workforce distribution matters more.”

The dermatologist supply in Delaware’s neighboring states may drive some patient demand, said the authors. That was seen in Idaho and Nebraska, where patients might have been looking for clinicians in neighboring states. But the authors could not “directly trace cross-border care-seeking,” said Akiska.

States with the lowest RDI (typically, lower demand and higher dermatologist density) were Vermont (25), Massachusetts (21), and Washington, DC (21). In general, states with higher urbanization were linked with lower RDI. Vermont seems to be an outlier because despite fewer dermatologists, demand was lower, also, said the authors.

An ‘Important First Step’

The paper corroborates much of what is known about the dermatology workforce, including that demand is higher in states with lower clinician density, said Hao Feng, MD, MHS, associate professor of dermatology at UConn Health, Farmington, Connecticut, when asked to comment on the paper.

Additionally, it is not clear that Google search volume is “a truly accurate reflection of actual patient demand,” said Feng, who has studied workforce issues. More typically, patients are referred to dermatology by a primary care physician and are not using Google, he said.

Access is usually measured at the county level, whereas this study is state-based. “It loses the important granularity,” he said, adding that could be especially important in a state as large as California.

Both Friedman and Akiska said they’d like to extend their work to the county level, but that there are some difficulties in doing that currently.

Feng said their paper was “an important first step.” He added, “wait time is probably the best indicator of patient demand,” and that means calling clinical practices, which is a “much more difficult project.”

The paper shows “there’s still a lot of demand for areas with existing little access,” said Feng. Solutions are needed to help ameliorate disparities for these patients who live in those areas, he said.

The authors reported having no conflicts of interest.

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.