The Differential Impact of COVID-19 on Urban Versus Rural Dermatologic Practice Logistics and Recovery: A Cross-Sectional Investigation of the First Wave

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Justin W. Marson
Graham Litchman
Darrell Rigel


COVID-19, Coronavirus, Socioeconomics, Urban, Rural, Telemedicine, Teledermatology


Background: COVID-19 materially delayed patient visits and potential skin cancer biopsies/diagnoses among US dermatology practices. However, given a likely heterogenous impact across the US, this study sought to determine COVID-19’s effect on urban versus rural dermatology practices.

Methods: Data were analyzed from the first 1000 responses to 3 pre-validated surveys of 9891 practicing US dermatologists comparing outpatient volumes and scheduling issues for the week of February 17th to the week of March 16th (Survey 1), April 13th (Survey 2) and May 18th, 2020 (Survey 3). First 3 US zip-code digits were compared to US Census Bureau data to determine “Urban/Rural” status. Representativeness with AAD membership was confirmed. Statistical significance was calculated using chi-square with Marascuilo procedure and two-tailed independent t-test/ANOVA with post-hoc Tukey-Kramer testing.

Results: In April 2020 urban practices reported more closed practices (21.4% vs 5.8%, p<0.0001) and predicted significantly larger patient volume decreases (-45.2%  vs -31.4%, p<0.0001) and practice closures (11.9% vs. 2.5% p<0.0001) in the following 2 weeks. In May 2020, urban areas saw significantly fewer patients/week (90.9 vs 142.4 p<0.0001), larger decrease in patient volume relative to May 2019 (-49.4% vs -35.1%, p<0.0001), and conducted more telemedicine visits (27.0% vs 15.1%, p<0.0001). Significantly more rural practices reported already being at baseline volume (Mean Difference 6.2%, 95% CI 2.7%-9.8%) while urban practices predicted return to baseline volume by August (5.7, 95% CI 2.1%-9.3%) or were unsure (5.6, 95% CI 1.6%-9.7%).

Conclusion: The initial COVID-19 pandemic differentially affected urban dermatology practices. The effects of the pandemic were mitigated in part by increased use telemedicine. Future studies may further elucidate COVID-19’s effect on clinical practice and highlight areas for improvement in practice logistics and patient care.


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