Tracy Callahan had been seeing a dermatologist regularly all her life. Then her husband noticed an unusual-looking spot on the right side of her neck in August 2013.
A self-described “mole-y person,” Callahan didn’t think too much of it when she scheduled an appointment to get the spot checked out—or when she was told she’d have to wait four months to get in to see her dermatologist.
“I almost canceled that appointment 20 times over,” she tells Health, reflecting on the four months she had to wait to get the spot looked at. When the appointment finally rolled around, her dermatologist’s physician’s assistant immediately started taking pictures of her. Callahan remembers thinking, “Why is she taking so many pictures of this?”
About two hours after that appointment, the head of the melanoma program at her dermatologist’s office called her. Callahan was told she’d have to have a biopsy the next day. She did, and she left that appointment with 15 stitches. That’s when it hit her. “Maybe this is more than a little mole,” she thought.
She was told by someone at her dermatologist’s office, “I have good news. [You] have melanoma, but we caught it early.”
The diagnosis shocked her. “It took me quite a bit of time to digest that that was ‘good’ news,” Callahan says. Eventually, though, she understood how fortunate she was. “I really was lucky that it was caught early,” she says.
However, this wasn’t Callahan’s last experience with melanoma, which is considered the most serious type of skin cancer. In fact, her journey was just beginning. One year to the day when she was diagnosed with melanoma the first time, she was re-diagnosed. The second melanoma showed up on her ankle. A third appeared in December 2014 on her arm, and a fourth appeared on her face in November 2017.
Ever since the first melanoma spot, Callahan has seen a dermatologist multiple times a year. “Every three to four months I get naked, and every nook and cranny of my body is examined,” she explains. Callahan knows her opportunity to be seen regularly is a blessing. When she goes to see her dermatologist she has what’s called total body photography, which means her body is regularly photographed. This allows her dermatologist to identify new and changing spots on her body. This was how her second, third, and fourth melanomas were identified.
Callahan understands that the access that she has to her dermatologist is a privilege. A report out today explains just how much of a privilege it is.
The report is from the Greater Access for Patients Partnership (GAPP), and it includes some alarming statistics about how difficult it is to be seen by a dermatologist in the U.S. The average wait time for a dermatology appointment is 32 days, according to the report, and 40% of patients wait between one and six months to be seen by a dermatologist.
If you’re seeing a dermatologist about a cosmetic procedure, a long wait time might not affect you too much. But if you’re waiting to have a potentially life-threatening melanoma checked out, as Callahan was, a long wait time could be fatal. Callahan says that if a melanoma’s caught sooner rather than later, it could mean “the difference between living and fighting for your life.” She speaks about a 22-year-old friend who developed 26 brain tumors from a melanoma, emphasizing that many patients aren’t as fortunate as she’s been.
“A crisis of long waits for dermatology appointments causes emotional, financial, and physical stress for patients and caregivers,” a press release for the new report says. It goes on to highlight some of the areas of the country where the crisis is especially bad. “The average wait time in Philadelphia is 78 days and even worse in Cedar Rapids, Iowa, at 91 days.” The report notes that it’s even more difficult for rural and minority patients to get fast access to dermatology care, and that these patients “experience higher rates of melanoma mortality.”
“I think we’ve known for a while now that we have long wait times. Unfortunately, in dermatology, they’re getting longer,” says Joleen Volz, president of the Society of Dermatology Physician Assistants, who works with GAPP.
What shocked Volz about the new report is the impact of long wait times on patients. “According to the report, 91% of patients said their skin condition impacted their daily life,” the press release says, not to mention “58% worried their skin condition would worsen while waiting, and half of the patients surveyed experienced anxiety from their untreated skin condition while waiting for care.”
“I guess what is most alarming is that the patients are actually feeling it,” Volz says. “Patients [are] reporting more anxiety. Even depression and sadness.” She notes that the wait times could negatively impact people who have skin conditions that are noticeable to others. “They’re missing certain events. They’re sitting at home, nervous about the spot they have. It’s causing anxiety; they’re worried their spot is getting worse,” she says.
Volz advises asking for an appointment with an available physician’s assistant if your dermatologist can’t see you soon enough. She also mentions that one of the potential solutions to this problem could be “getting primary care [doctors] more comfortable with more dermatological lesions that may be worrisome.”
A referral from a primary care doctor might expedite a patient’s treatment, Volz says. “If a primary care [doctor] calls me, I’m more apt to be able to get [their patient] in. If I have to stay late that night I would do that. However, it’s not always feasible,” she says. Another potential solution to this problem could be telemedicine since “dermatology tends to be visual,” Volz explains.
Callahan worries about a particularly dangerous side effect of long wait times at the dermatologist’s office: They might signal to patients that they shouldn’t worry about their skin. “When you have that wait time, you think it must not be that important, which is a big misconception. Because of those wait times people don’t think it’s important and, therefore, fall off the map,” Callahan says.
She says that if you’re worried about a skin condition and are told you’re going to have to wait a very long time to be seen by your dermatologist, it’s worth it to speak up and say, “I need to be seen sooner than that.”
“Patients need to advocate for themselves,” she says. “If you have a spot of concern and you’re seen quickly, it could save your life.”
Get more on melanoma here.
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