SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 118 

RESIDENT COMPETITION RESEARCH ARTICLE 

 
 

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

Justin W. Marson, MD1, Graham H. Litchman, DO, MS2, Darrell S. Rigel, MD, MS3 
 
1National Society for Cutaneous Medicine, New York, NY 
2Department of Dermatology, St. John’s Episcopal Hospital, New York, NY 
3Department of Dermatology, NYU Grossman School of Medicine, New York, NY                  
 

 

 
 

 
 
The COVID-19 pandemic has significantly 
affected clinical practice worldwide.1,2 

However, the degree to which US regions 

and therefore local healthcare systems were 
affected varied during the initial pandemic.3 
The purpose of this study was to determine 
the COVID-19 pandemic’s differential impact 
on dermatologic outpatient care in urban 
versus rural areas in the United States.  

ABSTRACT 

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. 

INTRODUCTION 



SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 119 

 

 
 
Data were analyzed from the first 1000 
responses to 3 pre-validated surveys of 
9891 practicing US dermatologists collected 
for the week of February 17th, March 16th 

(Survey 1), April 13th (Survey 2) and May 
18th, 2020 (Survey 3). Results compared 
outpatient volumes and scheduling issues 
between these time points. The first 3 digits 
of US zip codes (section code) were 
compared to US Census Bureau data4 to 
determine “Urban/Rural” status. Section 
codes containing counties with both 
designations were assigned based on 
predominate designation within that region. 
Representativeness with AAD membership 
was confirmed with 95% confidence 
intervals (CI) (Tables 1,2). Statistical 
significance was calculated using chi-square 
with Marascuilo procedure for categorical 
data and two-tailed independent t-test with 
unequal variance/ANOVA with post-hoc 
Tukey-Kramer testing for continuous data.  
 

 
 
There were significantly more urban 
respondents in regions with section codes 
beginning with 1,8 and 9 and more rural in 
regions 2,4, and 5 (Table 1). Practice 
mix/type was similar between urban/rural 
practices and across surveys (Table 2). In 
April 2020 urban practices predicted 
significantly larger patient volume decreases 
over the next 2 weeks(-45.2%; 95%CI -47.9 
to -42.4 vs -31.4%; 95%CI -37.9 to -24.9, 
p<0.0001), and practice closures in the 
following 2 weeks(11.9%; 9.7% - 14.1% vs 
2.5%; 0.0% - 5.4%, p<0.0001) and reported 
more closed practices (21.4%;18.6%-24.1% 
vs 5.8%;1.6%-10.1%,p<0.0001) (Table 3). 
Urban practices also obtained fewer 

biopsies of suspicious-pigmented lesions 
(2.7;2.4-3.1 vs 4.8;3.4-6.2) however this 
finding only trended towards significance 
after post-hoc testing.  
 
In May 2020, both urban and rural practices 
predicted similar increases in practice 
volume. However, urban areas saw 
significantly fewer patients/week (90.9; 81.6 
- 100.2 vs 142.4; 105.0-179.8, p<0.0001) 
and larger decreases in patient volume 
relative to May 2019(-49.4%;-51.2% to -
47.6% vs -35.1%; -39.6% to -30.6%, 
p<0.0001). Furthermore, a significantly 
larger proportion of rural practices reported 
being already back to baseline volume 
compared to urban practices (Mean 
Difference 6.2%, 2.7%-9.8%). Urban 
practices had a median predicted to 
baseline patient volumes by August (5.7%, 
2.1%-9.3%) or were unsure (5.6%, 1.6%-
9.7%) (Table 4). Urban practices conducted 
a significantly higher percentage of visits via 
telemedicine (27.0%; 24.7% - 29.3% vs 
15.1%; 10.3% - 19.8%, p<0.0001). Urban 
areas also predicted a higher percentage of 
telemedicine usage in June 2020 (21.8%; 
19.9% - 23.7% vs 12.2%; 9.1% - 15.4%). 
 

 
 
The initial COVID-19 pandemic had a 
heterogeneous impact on dermatologic 
practices, wherein urban practices 
experienced significantly more practice 
losses and a slower recovery. These results 
suggest “hot-spots” likely played a larger 
role than dermatology density in modulating 
relative impact as more heavily 
populated/urban areas had more active 
cases and generally stricter 
governmental/institutional regulations earlier 
in the pandemic.3,5 The recovery pattern 

METHODS 

RESULTS 

DISCUSSION 



SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 120 

Table 1. Geographic representation by Urban/Rural designation compared to AAD membership data. Per survey, overall regional demographics congruent 
with national data. Notably, increased proportions of respondents from urban areas in regions 1,8 and 9 while there were increased proportions of 
dermatologists in rural areas in regions 2,4 and 5. 

 

 
Survey 1 

% (95%CI) 
Survey 2 

% (95%CI) 
Survey 3 

% (95%CI) 
p-value 

 
% AAD US 

Membership 
Overall 

 
Urban 

(n = 847) 
Rural 

(n = 118) 
Overall 

Urban 
(n = 875) 

Rural 
(n = 120) 

Overall 
Urban 

(n = 742) 
Rural 

(n = 87) 
 

9.6 
9.4 

(7.5-11.3) 
9.9 

(7.9-12.0) 
5.9 

(1.6-10.3) 
8.4 

(6.6-10.2) 
9.3 

(7.3-11.2) 
2.5*‡ 

(0.0-5.4) 
9.8 

(7.7-11.9) 
10.1 

(7.9-12.3) 
8.2 

(2.3-14.2) 
0.1524 

12.8 
14.0 

(11.8-16.2) 
15.7 

(13.2-18.2) 
2.5*‡ 

(0.00-5.4) 
15.8 

(13.5-18.1) 
17.0 

(14.5-19.6) 
7.5 

(2.7-12.3) 
17.5 

(14.9-20.1) 
18.4‡ 

(15.5-21.2) 
11.8 

(4.8-18.8) 
<0.0001 

10.4 
11.0 

(9.0-12.9) 
9.2* 

(7.2-11.2) 
24.6‡ 

(16.6-32.5) 
10.9 

(8.9-12.9) 
8.9* 

(7.0-10.8) 
25.8‡ 

(17.8-33.8) 
8.9 

(6.9-10.9) 
7.3 

(5.4-9.2) 
23.5 

(14.3-32.7) 
<0.0001 

13.8 
12.3 

(10.2-14.4) 
12.4 

(10.1-14.7) 
11.9 

(5.9-17.8) 
12.4 

(10.3-14.5) 
12.0 

(9.8-14.2) 
15.8 

(9.1-22.5) 
11.5 

(9.3-13.7) 
11.3 

(9.0-13.7) 
14.1 

(6.6-21.7) 
0.3030 

8.4 
7.6 

(5.9-9.3) 
7.0 

(5.2-8.7) 
12.7 

(6.6-18.8) 
8.6 

(6.8-10.4) 
7.9 

(6.0-9.7) 
14.2 

(7.8-20.5) 
6.3 

(4.6-8.0) 
5.8 

(4.1-7.5) 
11.8 

(4.8-18.8) 
0.0056 

5.0 
3.9 

(2.7-5.1) 
3.1 

(1.9-4.3) 
10.2 

(4.6-15.7) 
4.2 

(2.9-5.5) 
3.4 

(2.2-4.7) 
10.0 

(4.5-15.4) 
3.7 

(2.4-5.0) 
3.2 

(1.9-4.5) 
8.2 

(2.3-14.2) 
<0.0001 

6.5 
6.6 

(5.0-8.2) 
6.5 

(4.8-8.2) 
7.6 

(2.7-12.5) 
6.2 

(4.7-7.7) 
6.3 

(4.6-7.9) 
5.8 

(1.6-10.1) 
6.6 

(4.9-8.3) 
5.9 

(4.2-7.7) 
12.9 

(5.7-20.2) 
0.3594 

10.0 
10.0 

(8.1-11.9) 
9.3 

(7.3-11.3) 
14.4 

(7.9-20.9) 
8.7 

(6.9-10.5) 
8.7 

(6.8-10.6) 
9.2 

(3.9-14.4) 
9.9 

(7.8-12.0) 
10.8 

(8.5-13.1) 
3.5 

(0.0-7.5) 
0.1658 

6.2 
8.4 

(6.6-10.2) 
8.9 

(6.9-10.8) 
5.1 

(1.0-9.1) 
7.7 

(6.0-9.4) 
8.0 

(6.2-9.8) 
5.8 

(1.6-10.1) 
6.6 

(4.9-8.3) 
6.9 

(5.0-8.7) 
3.5 

(0.0-7.5) 
0.0262 

17.3 
16.3 

(13.9-18.7) 
18.1 

(15.4-20.7) 
5.1*‡ 

(1.0-9.1) 
16.5 

(14.2-18.8) 
18.5 

(15.9-21.1) 
3.3*‡ 

(0.1-6.6) 
18.2 

(15.5-20.9) 
20.2 

(17.3-23.2) 
2.4*‡ 

(0.0-5.6) 
<0.0001 

*significantly less than corresponding value from same survey, p<0.05 
‡significantly different from AAD membership data 
95% CI – 95% Confidence Interval 



SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 121 

Table 2. Practice Demographics Comparing Urban and Rural Respondents to National Data. Across Surveys, similar practice type and levels of experience. 
Increased urban respondents reporting cosmetic practice compared to rural likely reflecting increased demand as well as natural increase in cosmetic 
practice since 2014. 
 

*Source: American Academy of Dermatology. Practices mix/types not available. 
**Source: Margosian E. Medical vs. cosmetic dermatology: Who is doing what?. Dermatology World.2019. 
http://digitaleditions.walsworthprintgroup.com/publication/?m=12468&i=552514&view=articleBrowser&article_id=3267519&search=practice%20profile&ver=html5. No data 
available for dermatopathology 
95% CI – 95% Confidence Interval 

Demographics Survey 1 Survey 2 Survey 3 
AAD 

Membership 
 Urban Rural Urban Rural Urban Rural  

Practice Type  
%(95%CI) 

       

Private 
88.5 

(86.5-90.7) 
92.4 

(87.5-97.3) 
89.1 

(87.0-91.2) 
93.3 

(88.8-97.9) 
89.7 

(87.5-92.0) 
90.6 

(84.2-96.9) 
- 

University/Academic/ 
Government 

11.5 
(9.3-13.6) 

7.6 
(2.7-12.5) 

10.9 
(8.8-13.0) 

6.7 
(2.1-11.2) 

10.3 
(8.0-12.5) 

9.4 
(3.1-15.7) 

- 

Years of Experience 
%(95%CI) 

       

1-10 
21.6 

(18.8-24.4) 
20.3 

(12.9-27.7) 
18.5 

(15.9-21.1) 
21.7 

(14.1-29.2) 
15.0 

(12.4-17.6) 
24.7 

(15.3-34.1) 
27.0% 

11-20 
26.0 

(23.0-29.0) 
32.2 

(23.6-40.8) 
25.1 

(22.2-28.1) 
30.8 

(22.3-39.3) 
22.3 

(19.2-25.3) 
25.8 

(16.4-35.4) 
27.5% 

21-30 
26.8 

(23.8-29.8) 
23.7 

(15.9-31.6) 
29.8 

(26.7-32.9) 
25.8 

(17.8-33.8) 
30.1 

(26.7-33.5) 
27.1 

(17.4-36.7) 
21.8% 

>30 
25.6 

(22.6-28.6) 
23.7 

(15.9-31.6) 
26.5 

(23.5-29.5) 
21.7 

(14.1-29.2) 
32.7 

(29.2-36.1) 
22.4 

(13.3-31.4) 
23.7% 

Practice Mix 
%(95%CI) 

      
AAD Practice 
Profile 2017 

Medical 
62.8 

(61.2-64.4) 
64.5 

(60.7-68.3) 
60.0 

(58.3-61.8) 
62.2 

(58.0-66.4) 
61.2 

(59.5-63.0) 
62.8 

(57.4-68.3) 
63% 

Surgical/Oncology 
26.3 

(24.7-27.9) 
30.2 

(26.5-34.0) 
25.6 

(23.9-27.4) 
27.4 

(23.2-31.6) 
22.8 

(21.0-24.5) 
27.9 

(22.5-33.4) 
25% 

Cosmetic 
15.5 

(13.9-43.3) 
9.8 

(6.0-21.9) 
12.0 

(10.2-32.3) 
8.0 

(3.7-15.5) 
13.6 

(11.8-37.3) 
7.0 

(1.6-10.2) 
12% 

Dermatopathology 
4.9 

(3.3-6.5) 
1.6 

(0.0-5.4) 
2.4 

(0.6-4.1) 
2.4 

(0.0-6.7) 
2.4 

(0.6-4.1) 
2.2 

(0.0-7.6) 
- 



SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 122 

Table 3. Retrospective (from February to May 2020) and prospective impact of COVID-19 pandemic on 
dermatologic practices. Urban practices had significantly larger decreases in patient volume and were more likely to 
be closed during the height of the initial pandemic and saw significantly less patients even as practices began to 
reopen. Urban practices reporting significantly more sustained use of telemedicine than Rural practice as practices 
reopened and adapted to new operating procedures. 
 

 
 

Week of 
February 17, 

2020 

Week of 
March 16, 

2020 

Week of 
April 13, 2020 

Week of 
May 18, 2020 

p-value* 

How many days 
did you practice?  
(mean; 95%CI) 

Rural 
4.2 

(4.0-4.4) 
3.4A 

(3.0-3.7) 
3.5A 

(3.3-3.8) 
3.9 

(3.7-4.2) 
<0.0001 

Urban 
4.2 

(4.1-4.3) 
3.0A 

(2.9-3.2) 
3.5A,B 

(3.4-3.6) 
3.6A,B 

(3.5-3.7) 
How many 
patients were 
seen in your 
primary practice 
location? 
(mean; 95%CI) 

Rural 
171.3 

(139.5-203.1) 
85.5A 

(68.4-102.5) 
40.0A 

(29.4-50.5) 
142.4B,C 

(105.0-179.8) 

<0.0001 

Urban 
146.6 

(135.9-157.2) 
60.5A 

(54.5-66.5) 
26.6A,B 

(23.3-30.0) 
90.9A,B,C,D 

(81.6-100.2) 

How many 
biopsies did you 
perform for 
suspicious 
pigmented skin 
lesions? 
(mean; 95%CI) 

Rural 
20.1 

(14.2-25.9) 
10.5A 

(6.4-14.5) 
4.8A 

(3.4-6.2) 
11.9A 

(7.4-16.4) 

<0.0001 

Urban 
19.8 

(17.9-21.8) 
7.4A 

(6.4-8.4) 
2.7A,B 

(2.4-3.1) 
7.4A,C 

(6.6-8.2) 

Did you 
selectively 
postpone non-
essential 
appointments? 
(%Yes; 95%CI) 

Rural 
32.3 

(22.7-39.7) 
68.4A 

(57.8-79.1) 
95.8A,B 

(92.2-99.5) 
68.2A,C 

(58.1-78.3) 

<0.0001 

Urban 
35.9 

(32.1-39.7) 
80.8A 

(77.4-84.1) 
100.0A,B 

-- 
74.2A,C 

(71.0-77.4) 

How many 
biopsies were 
postponed?  
(mean; 95%CI) 

Rural 
3.4 

(1.4-5.4) 
10.2 

(4.9-15.5) 
7.5 

(4.8-10.2) 
3.8 

(1.1-6.6) 
<0.0001 

Urban 
4.0 

(3.1-4.9) 
10.8 A 

(9.2-12.4) 
7.9A,B 

(6.8-9.0) 
3.7B,C 

(2.8-4.5) 
Prospective 
Estimates 

  March 16-20 April 13-18 May 18-23 p-value** 

If appointments 
were postponed 
during the week, 
when did you 
primarily 
reschedule them? 

Weeks 
postponed 
(mean; 
95%CI) 

Rural 
5.5 

(4.3-6.6) 
8.1B 

(7.4-8.7) 
4.8C 

(3.9-5.8) 
<0.0001 

Urban 
6.5 

(6.1-6.8) 
7.5B 

(7.2-7.7) 
4.4B,C 

(4.2-4.7) 
% Not 
rescheduled 
at this time 
(%; 95%CI) 

Rural 
18.7% 

(0.7%-27.7%) 
19.3% 

(21.1%-26.6%) 
13.1% 

(5.7%-20.5%) 
<0.0001 

Urban 
26.7% 

(23.0%-30.5%) 
19.3% 

(12.1%-26.6%) 
10.7%B,C 

(8.4%-12.9%) 
If biopsies were 
postponed when 
did you primarily 
reschedule them? 

Weeks 
postponed 
(mean; 
95%CI) 

Rural 
7.0 

(6.1-7.9) 
6.5 

(6.0-7.1) 
1.5B,C 

(0.9-2.1) 
<0.0001 

Urban 
7.2 

(6.9-7.5) 
6.3B 

(6.1-6.6) 
2.0B,C 

(1.8-2.2) 



SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 123 

 % Not 
rescheduled 
at this time 
(%; 95%CI) 

Rural 
65.3 

(54.3-76.3) 
42.5 

(33.5-51.5) 
7.1B,C 

(1.5-12.6) 
<0.0001 

Urban 
53.8 

(49.6-58.1) 
36.5B 

(33.2-39.7) 
8.8B,C 

(6.7-10.9) 
Relative to your 
practice volume 
this week, what 
do you 
anticipate your 
schedule for the 
next 2 weeks will 
look like?  
(mean %; 95%CI) 

%Change 
Rural 

-58.3 
(-64.9 to -51.7) 

-31.4B 
(-37.9 to -24.9) 

17.5B,C 
(8.5 to 26.6) 

<0.0001 
Urban 

-57.3 
(-60.1 to -54.5) 

-45.2B,D 
(-47.9 to -42.4) 

13.0B,C 
(9.6 to 16.3) 

“Completely 
closing 
practice” 

Rural 
7.9 

(1.7-14.1) 
2.5 

(0.0-5.4) 
2.4 

(0.0-5.6) 
<0.0001 

Urban 
20.3 

(16.9-23.8) 
11.9B,D 

(9.7-14.1) 
3.0B,C 

(1.7-4.2) 

What was your 
patient volume 
this week 
compared to a 
typical April 
(Survey 2) or May 
(Survey 3) week 
in your practice? 
(mean %; 95%CI) 

 
% Decrease 
 

Rural - 
-68.1 

(-72.1 to -64.0) 
-35.1C 

(-39.6 to -30.6) 
<0.0001 

Urban - 
-71.9 

(-73.4 to -70.4) 
-49.4C,D 

(-51.2 to -47.6) 

“I was 
closed this 
week” 

Rural - 
5.8 

(1.6-10.1) 
3.5 

(0.0-7.5) 
<0.0001 

Urban - 
21.4D 

(18.6-24.1) 
8.1C 

(6.1-10.1) 

What percentage 
of appointments 
did you do using 
telemedicine (0-
100%)? 
(Mean %; 95%CI) 

 Rural - 
42.1 

(35.5-48.7) 
15.1C 

(10.3-19.8) 

<0.0001 

 Urban - 
49.5 

(46.8-52.2) 
27.0C,D 

(24.7-29.3) 

In the next 
month, what 
percentage of 
your patient visits 
will be done 
using 
telemedicine 
because of 
COVD-19? 
(Mean %; 95%CI) 

 Rural 
29.9 

(23.0-36.7) 
41.3 

(35.2-47.4) 
12.2B,C 

(9.1-15.4) 

<0.0001 

 Urban 
38.9 

(35.9-41.9) 
46.5B 

(44.2-48.9) 
21.8B,C 

(19.9-23.7) 

*p-value from ANOVA, Tukey-Kramer calculated at α = 0.05  
**p-value from ANOVA or Chi-square, Tukey-Kramer calculated at α = 0.05, Marascuilo calculated at α 0.05 
Asignificantly different from February 2020 
Bsignificantly different from March 2020 
Csignificantly different from April 2020 
Dsignificantly different from value of the same date from Rural/Urban counterpart  
95% CI – 95% Confidence Interval 

 

noted in urban areas may also reflect 
increased and continued use of 
telemedicine, which was nearly nonexistent 
prior to COVID-19.6 
 

Limitations include retrospective estimations 
and “free-time” bias for Dermatologists with 
significant decreases in patient volume. 
However, a consistent and sufficiently large 
sample size with responses restricted to a 



SKIN 
 

March 2021     Volume 5 Issue 2 
 

Copyright 2021 The National Society for Cutaneous Medicine 124 

window of time accounts for these biases. 
The study period captured a “snapshot” of 
COVID-19’s impact on the US, during which 
time urban areas had more positive cases 
and regional COVID-19 impact on recovery 
rates/clinical practice may parallel regional 
shifts in COVID-19 caseloads.  
 
Table 4. Urban Versus Rural Predictions for Full Re-
Opening. Significantly more Rural practices are 
practicing at full capacity at time of survey (May 
2020) compared to Urban practices while a larger 
proportion of Urban practices predict August or are 
unsure. 
 

 
Urban 

% 
Rural 

% 

Mean % 
Difference 
% (95% CI) 

When do 
you think 

your 
practice 

will 
return to 
baseline? 

 

Already 
back to 
baseline 

2.0 8.2 
-6.2  

(-9.8, -2.7)* 

June 7.3 9.4 
-2.1  

(-5.8, 1.5) 

July 11.5 15.3 
-3.8  

(-7.8, 0.1) 

August 13.9 8.2 
5.7  

(2.1, 9.3)* 

September 10.5 11.8 
-1.2  

(-5.0, 2.6) 

October 6.1 5.9 
0.2  

(-3.2, 3.5) 

November 2.4 1.2 
1.3  

(-1.1, 3.6) 

December 0.8 1.2 
-0.4  

(-2.7, 2.0) 
1/2021 or 
beyond 

16.3 15.3 
1.0  

(-2.9, 5.0) 

Unsure 29.1 23.5 
5.6  

(1.6, 9.7)* 
*absolute value of mean difference > 0 
95% CI – 95% Confidence Interval 

 

 
 
These findings demonstrate the significant 
and differential impact COVID-19 had on 
urban versus rural dermatology practices. 
Telemedicine has had a mitigating effect, 
and may continue to supplement patient 
volumes as practices recover. However, 
telemedicine’s role and further integration 

into practice post-pandemic remains 
uncertain. Further studies may better 
elucidate the COVID-19’s evolving impact 
on clinical practice in various practice 
settings. These results provide insight into 
disparities between practices and can 
potentially highlight areas for improvement 
in both practice logistics as well as patient 
care. 
 
Conflict of Interest Disclosures: None 
 
Funding: None 
 
Corresponding Author: 
Justin W. Marson, MD 
National Society for Cutaneous Medicine 
35 E 35th St. #208 
New York NY, 10016 
Email: justin.w.marson@gmail.com 

 
 
References: 
1. Litchman GH, Rigel DS. The immediate impact of 

COVID-19 on US dermatology practices. J Am 
Acad Dermatol. 2020;83(2):685-686. 
doi:10.1016/j.jaad.2020.05.048 

2. Litchman GH, Marson JW, Rigel DS. The 
Continuing Impact of COVID-19 on Dermatology 
Practice: Office Workflow, Economics and Future 
Implications. J Am Acad Dermatol. 2020 Sep 
30:S0190-9622(20)32658-X. doi: 
10.1016/j.jaad.2020.08.131. Epub ahead of print. 
PMID: 33010326; PMCID: PMC7526524. 

3. America is Reopening. But Have We Flattened 
the Curve? Johns Hopkins University & Medicine 
Coronavirus Resource Center. 
https://coronavirus.jhu.edu/data/new-cases-50-
states 

4. County Rurality Level 2010. US Census Bureau. 
www2.census.gov/reference/County_Rural_Look
up. Accessed 27 October 2020 

5. Glazer AM, Rigel DS. Analysis of Trends in 
Geographic Distribution of US Dermatology 
Workforce Density. JAMA Dermatol. 2017 May 
1;153(5):472-473. doi: 
10.1001/jamadermatol.2016.6032. PMID: 
28296988; PMCID: PMC5470415. 

6. Ehrlich A, Kostecki J, Olkaba H. Trends in 
dermatology practices and the implications for 
the workforce. J Am Acad Dermatol. 
2017;77(4):746-752. 
doi:10.1016/j.jaad.2017.06.030.  

CONCLUSION 

mailto:justin.w.marson@gmail.com
https://coronavirus.jhu.edu/data/new-cases-50-states
https://coronavirus.jhu.edu/data/new-cases-50-states