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Late detection and specialist referral result in poor oral cancer outcomes globally. High-risk LRMU populations usually do not have access to oral medicine specialists, a specialty of dentistry, whose expertise includes the identification, treatment, and management of oral cancers. To overcome this access barrier, there is an urgent need for novel, low-cost tele-health approaches to expand specialist access to low-resource, remote and underserved individuals. The goal of this study was to compare the diagnostic accuracy of remote versus in-person specialist visits using a novel, low-cost telehealth platform consisting of a smartphone-based, remote intraoral camera and custom software application. A total of 189 subjects with suspicious oral lesions requiring biopsy (per the standard of care) were recruited and consented. Each subject was examined, and risk factors were recorded twice: once by an on-site specialist, and again by an offsite specialist. A novel, low-cost, smartphone-based intraoral camera paired with a custom software application were utilized to perform synchronous remote video/still imaging and risk factor assessment by the off-site specialist. Biopsies were performed at a later date following specialist recommendations. The study's results indicated that on-site specialist diagnosis showed high sensitivity (94%) and moderate specificity (72%) when compared to histological diagnosis, which did not significantly differ from the accuracy of remote specialist telediagnosis (sensitivity: 95%; specificity: 84%). These preliminary findings suggest that remote specialist visits utilizing a novel, low-cost, smartphone-based telehealth tool may improve specialist access for low-resource, remote and underserved individuals with suspicious oral lesions.

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BACKGROUND: The percentage of female dermatologists has increased from 6.9% in 1970 to 48.9% in 2017. Despite the changing gender composition of the dermatologist workforce, it is unknown whether there are gender-based differences in dermatology practice locations. OBJECTIVE: This study aimed to characterize gender-based differences in dermatology practice locations across the United States. METHODS: A cross-sectional study of all dermatologists in the 2020 Centers for Medicare and Medicaid Services Physician Compare Database was performed. The number of self-identified female dermatologists and total dermatologists in each county and state was tabulated, and Spearman's correlation coefficients between county-level demographic and socioeconomic characteristics and female practices were calculated. RESULTS: Among 11,911 dermatologists, 5945 (49.9%) self-identified as female and 5966 (50.1%) as male. Of the 1052 counties with a dermatologist, 291 (27.7%) had no female dermatologist and 149 (14.2%) had no male dermatologist. The percentage of female dermatologists in each state ranged from 18.4% to 62.2%. Female dermatologists practiced more in areas with a higher percentage of democratic voters (r = +0.22) and higher median household income (r = +0.18), and less in rural counties (r = -0.18) or counties with higher uninsured rates (r = -0.11). CONCLUSION: Female dermatologists remain significantly underrepresented in some regions in the United States, particularly in the Mountain states and rural counties. As women continue entering the dermatologist workforce, these results can inform workforce planning strategies to improve the distribution and accessibility of dermatologists across the United States.

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BACKGROUND /OBJECTIVES: Although 82% of pediatricians report that their patients have difficulty accessing pediatric dermatologists, the regions with greatest need for the specialty are not well-defined. We aimed to determine the geographic distribution of pediatric dermatologists relative to the number of children and pediatric generalists. METHODS: We performed a cross-sectional study of all US board-certified pediatric dermatologists, generalists (defined as pediatricians and family medicine physicians), and children in 2020. Data were obtained from the Society for Pediatric Dermatology, American Board of Pediatrics, Centers for Medicare and Medicaid, and US Census Bureau. Number of children, pediatric dermatologists, and pediatric generalists were tabulated in each county and state, and the distributions of pediatric dermatologists and generalists relative to the population of children were quantified with the Gini coefficient. RESULTS: Of 317 pediatric dermatologists, 243 (76.7%) were women and 311 (98.1%) worked in a metropolitan county. A pediatric dermatologist was present in 41/50 (82%) states and 142/3228 (4.4%) counties. Not a single pediatric dermatologist was found in 54/92 (58.7%) counties with 100 000-199 999 children, 15/53 (28.3%) counties with 200 000-499 999 children, and 4/13 (30.8%) counties with ≥500 000 children. The Gini coefficient for the state-level distribution of pediatric dermatologists relative to population of children was 0.488 compared to 0.132 for that of pediatric generalists. CONCLUSION: There is a maldistribution of pediatric dermatologists, resulting in children with unmet dermatologic needs in nine states and 96 heavily populated counties. These results can inform initiatives to recruit pediatric dermatologists and to expand telehealth access to specific high-density areas.

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