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To draw attention to the need for improved access to dermatologic care, Canadian dermatologists recently offered skin cancer screening to members of the public on Parliament Hill in Ottawa. The Canadian Dermatology Association (CDA) and Melanoma Canada organized the event, which featured a mobile unit staffed with dermatologists. Meanwhile, leaders of the CDA met with members of Parliament.

“We are lacking dermatologists and lacking dermatology care for Canadians, and that manifests in many ways,” Mark Kirchhof, MD, PhD, CDA president and head of dermatology at the University of Ottawa and the Ottawa Hospital, told Medscape News Canada. “One of them is long wait times. The average wait time is 5-6 months to see a dermatologist.”

One of the CDA’s proposed solutions is to train more dermatologists. Canada has 800 dermatologists serving a population of 40 million. An analysis by the Canadian Institute for Information, a not-for-profit Ottawa-based organization, has calculated that there are 1.9 dermatologists per 100,000 population.

This ratio indicates that Canada offers substandard access to dermatological care, said Kirchhof. He asserted that there should be at least three dermatologists per 100,000 population, a ratio like that in Germany and Australia.

“We have a lack of dermatology training spots and a lot of interest, so we can easily increase the number of spots,” said Kirchhof.

Welcoming International Graduates

Permitting international medical graduates who practiced dermatology to enter the Canadian dermatology workforce is another part of a multipronged approach to improving the availability of dermatologic care, according to Kirchhof.

“We know that there are a lot of people who want to come to Canada, and we will make sure that they go through the examinations and processes to confirm that they are of an acceptable quality for the Canadian public,” he said.

The CDA also advocates team-based care involving primary care providers. “You want a dermatologist to provide you with a diagnosis and a good treatment plan, then the patient would be in the care of a primary care provider, and then if something goes wrong, the primary care provider can always refer the patient back to the dermatologist,” said Kirchhof.

Technology also can remove barriers to dermatologic care, according to Kirchhof. “Technology is very important in virtual care,” said Kirchhof. “You need reliable internet access and robust video conferencing technology in [underserved] communities to allow us to interact and provide care.” Kirchhof also acknowledged that AI will be an important part of the solution.

Expanding Virtual Care

By itself, creating more residency positions in dermatology will not respond adequately to the current lack of dermatologic care, Rosalie Wyonch, associate director of research at the Toronto-based C.D. Howe Institute, an independent not-for-profit research institute, told Medscape News Canada. She proposed virtual care as one solution to expand access.

“If we aren’t currently keeping up with population growth [in terms of the number of dermatologists], it will still take quite a few years for those doctors to be able to practice,” said Wyonch. “Virtual care is one of the ways to make more efficient use of a limited number of practitioners. Virtual care is a way that we can essentially enable specialist care in areas where specialists aren’t located.”

Virtual care can also allow primary care providers to offer dermatologic care while reserving more complex care that requires in-person visits for dermatologists, said Wyonch.

Primary care providers “can consult with a specialist and provide basic dermatologic care, and that means specialists [ie, dermatologists] can consult on lower acuity cases,” said Wyonch. “Basic dermatologic care can be provided in the primary care setting, and specialists can focus their time on the patients that truly need specialist-level care.”

Wyonch supported the notion of integrating international medical graduates into the dermatology workforce. “Creating more opportunities to recognize the credentials of foreign-trained medical graduates is absolutely something that Canada should do,” she said, noting that the same approach could increase the number of family physicians. “There have been some actions in that space, but we absolutely could go further.”

Kirchhof and Wyonch reported having no relevant financial relationships.