Persistent Decline in Dermatology Service Volume in Medicare Population After Covid-19 Pandemic

The Covid-19 pandemic resulted in a significant, acute decline in medical services nationwide, limiting patient access to care. This study used the Medicare Physician Payment (MPP) database to track nationwide changes in dermatology service (new and return visits) among Medicare beneficiaries from 2019 to 2023, analyzing recovery across states and stratified by practice size. Nationwide dermatology service volume sharply declined by 17.4% (p < 0.001) from 2019 to 2020. Although volume increased by 10.1% between 2020 and 2023 (p < 0.001), overall service volume remained 9.0% (p < 0.001) below baseline levels in 2019. During this period, the number of Medicare beneficiaries increased by 8.1%, suggesting service volume decline is likely due to fewer patients seeking care. Service recovery was uneven across practice sizes. By 2023, large practices nearly returned to baseline, with only a 0.5% net decline compared to 2019. In contrast, solo and small practices sustained significant volume deficits (-9.1% and 7.2% respectively), and medium-sized practices showed the greatest persistent decline (-20.2%). Service volume also remained below pre-pandemic levels in 45 states by 2023. This significant and persistent decline in Medicare dermatologic utilization demonstrates the enduring impact of pandemic disruptions to healthcare, and mirrors the declines seen in other specialties including primary and preventative care. As Medicare and elderly patients have a high burden of skin cancers requiring timely evaluation and monitoring, the slow recovery suggests ongoing healthcare access challenges for vulnerable populations. These results emphasize the importance of developing strategies to protect vulnerable populations and promote accessibility during public health emergencies.