Despite Acceptance of Medicaid by Pediatric Dermatologists, Access Issues Remain

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Approximately 78% of pediatric dermatologists accept Medicaid, according to recent findings, though there are major differences in acceptance based the region of a clinical practice, median household income, the type of practice, and density of pediatric dermatologists in a given area.¹

These findings resulted from new research into patients’ access to dermatologic care among individuals in the pediatric population. The investigators of this study noted that access may be limited, given a reported shortage of pediatric dermatologists in the current landscape.

This research was led by Madeleine Tessier-Kay, MPH, from the department of dermatology at the University of Connecticut Health Center in Farmington, Connecticut. The investigators highlighted a 2015 survey which evaluated rates of Medicaid acceptance among the workforce of pediatric dermatologists, noting that 79% accepted Medicaid.²

“This cross-sectional study aims to provide an updated, comprehensive characterization of Medicaid acceptance among board-certified pediatric dermatologists in the United States, stratified by physician and practice characteristics,” Tessier-Kay and colleagues wrote.¹

Study Design and Findings

The research team sought to determine status of Medicaid acceptance among dermatologists, evaluating available data on both traditional and managed plans. They did this by using online searches of practice websites when clearly stated. In circumstances when this information was not explicitly highlighted, such data was confirmed by the team through direct calls to practices.

The investigators looked at numbers of practicing pediatric dermatologists through the use of the Society for Pediatric Dermatology's available database. Their board certification in pediatric dermatology was verified via the Certification Matters database.

The fact that the aforementioned inquiries using phone calls by the investigators were a part of a research study was not made apparent by the team. Information related to clinician and practice characteristics were drawn by the team through the use of the US Census American Community Survey as well as traditional searches of the Internet.

Given the research team’s reliance on publicly-accessible online datasets, the study did not meet the predetermined criteria for human subject research. Consequently, they did not need to provide institutional review board approval at the University of Connecticut Health Center.

Overall, the investigators identified that among the 352 board-certified pediatric dermatologists who were currently practicing, 78.1% of these subjects were shown to take Medicaid. They noted the variability of Medicaid acceptance rates by several factors, including by type of practice, specifically highlighting that 98.7% were within academic practices and 43.1% were within private practices (P < .001).

In the Midwestern US, Medicaid acceptance was shown by the team to have been 90.9%, a higher percentage than that of the West (71.4%) and the Northeastern US (71.8%; P = .005). The investigators’ logistic regression analysis showed that there were higher odds within the Midwest of Medicaid acceptance versus the Northeast (OR, 5.25; 95% CI, 1.76–15.65) or the West (OR, 5.26; 95% CI, 1.88–14.66), adding that this was true even controlling for type of practice.

The investigators noted that pediatric dermatologists who practiced within non-metropolitan regions located in New Hampshire, Georgia, and Wisconsin all allowed Medicaid. Those with practices found in areas showing lower median household incomes as well as higher densities of pediatric dermatologists were also noted as more likely to allow Medicaid (P = .001).

The research team did not find any major distinctions based on years since a clinician’s medical school date of graduation, clinician gender, fellowship training, or whether one’s practice had been in or a state with Medicaid-to-Medicare fee ratios which were above the US median or in a Medicaid-expanded state.

“Limitations include potential incomplete capture of board-certified physicians, as not all board-certified pediatric dermatologists may be members of the Society for Pediatric Dermatology, and potential inaccurate capture of physician characteristics and Medicaid acceptance status,” the investigators wrote.

References

1. ^{Tessier-Kay M, Beltrami E, Sinha S, Feng H. Characteristics of board-certified pediatric dermatologists accepting Medicaid. Pediatr Dermatol. 2024; 1-4. doi:10.1111/pde.15656.}
2. ^{Fogel AL, Teng JM. Medicaid acceptance among pediatric dermatologists. J Am Acad Dermatol. 2015; 72(1): 191-193.}