The association of physician-specialty density and melanoma prognosis in the United States, 1988 to 1993

J Am Acad Dermatol. 2009 Jan;60(1):51-8. doi: 10.1016/j.jaad.2008.08.040. Epub 2008 Oct 19.


Background: Studies suggest physician workforce may influence cancer outcomes.

Objective: We sought to quantify the effect of physician-specialty density on melanoma prognosis.

Methods: Data from 17,702 melanoma cases reported to the Surveillance, Epidemiology, and End Results program from 1988 to 1993 were merged with sociodemographic data (1990 US Census) and dermatologist, family practitioner, and internist density data (Area Resource File). Linear and logistic regression analyses were used to model prognosis (melanoma mortality to incidence ratio).

Results: A higher density of dermatologists was associated with better prognosis (lower mortality to incidence ratio) (beta = -50 x 10(-4); SE 8 x 10(-4)). Internist density was also a significant predictor of better prognosis whereas increased family practitioner density was associated with worse prognosis. Controlling for sociodemographics, physician density remained a significant predictor of the mortality to incidence ratio.

Limitations: Socioeconomic factors were estimated. Physician density was examined by county.

Conclusion: Controlling for sociodemographic factors, physician-specialty density predicted melanoma prognosis. This suggests that specialist health care availability may affect melanoma outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dermatology*
  • Family Practice*
  • Humans
  • Internal Medicine*
  • Melanoma / epidemiology
  • Melanoma / mortality*
  • Melanoma / therapy*
  • Prognosis
  • SEER Program
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / mortality*
  • Skin Neoplasms / therapy*
  • United States
  • Workforce