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Does private equity ownership impact wait times in derm? Our study on Insurance Acceptance & Wait Times in Derm in @JAMADerm led by Andrew Creadore w/support frm @SheenaDesai3, @sara_j_li, @CJoyceBiostats, @JackResneckMD &senior author @KiraSeiger. 
1/9 https://jamanetwork.com/journals/jamadermatology/article-abstract/2774798
1/9 https://jamanetwork.com/journals/jamadermatology/article-abstract/2774798
In 2006 (!) I was trying to figure out whether I should go into derm, scoured @JAMADerm & @JAADjournals &read this now-classic @JackResneckMD article that found 39 day wait for derm, 28 for extenders. Well, imitation is the sincerest form of flattery
2/9 https://pubmed.ncbi.nlm.nih.gov/16781292/
2/9 https://pubmed.ncbi.nlm.nih.gov/16781292/
The goal of the study was to determine appointment success in wait times by insurance type (private, Medicare, Medicaid) & by practice ownership ( #privateequity versus non-academic non-PE) using a secret shopper design calling practices w/ script about pt w/ a changing mole 3/9
We created a cohort matched on geography, 1:2 PE to private, ultimately identifying 611 clinics that were called from Feb 24-28 (pre COVID, phew) for total of 1833 (!!!) calls. 4/9
It was easy to make appts for private (98.5%) & Medicare (97.5%) pts, but incredibly difficult for Medicaid pts (17%). Wait times were 7 days for Private/Medicare & 13 days for Medicaid. These results were similar between private equity and non-PE clinics. 5/9
PE clinics more likely to offer new appts with non-physician clinician than non-PE, confirming patterns previously identified by @juleslipoff https://pubmed.ncbi.nlm.nih.gov/32413452/ 6/9
The benefit of more non-physician clinicians? 
next-day availability (30% v. 21%) at PE over non-PE
Summary:
1) Overall wait times < previously published.
2) We need better access for Medicaid everywhere.
3) PE may have more access, but this is created with non-physicians 7/9
next-day availability (30% v. 21%) at PE over non-PE Summary:
1) Overall wait times < previously published.
2) We need better access for Medicaid everywhere.
3) PE may have more access, but this is created with non-physicians 7/9
Lots of talk about systemic inequities, and lack of sufficient Medicaid compensation to allow access for indigent patients is a critical one that is more likely to affect BIPOC communities, a trend identified by @AdeAdamson and others: https://pubmed.ncbi.nlm.nih.gov/28979974/ 8/9
Although we have discussed potential concerns around rapid growth of private equity in dermatology before, @ present PE practices are not differential from non-PE non-academic derm. Multi-year pattern of extenders in derm needs to be examined further 9/9 https://pubmed.ncbi.nlm.nih.gov/31339521/
extenders in derm needs to be examined further 9/9 https://pubmed.ncbi.nlm.nih.gov/31339521/
