‘Big Access Week’ Big Success at Shortening Waitlist at Dartmouth Dermatology Clinic | AAD 2025

Too many patients, too few dermatologists. The result is delayed or canceled care for patients with skin health issues and long waiting lists at dermatology clinics.

Dermatologists at Dartmouth Health in Lebanon, New Hampshire, may have come up with a way for clinics to work through the backlog that could be applied to other specialties besides dermatology. Dylan J. Parker, M.D., a research fellow at Dartmouth Health, presented findings about the clinic’s “big access week” effort in a poster at the 2025 annual meeting.

In an interview and during his presentation of the poster, Parker explained that Dartmouth’s dermatologists serve a large, primarily rural area that encompasses New Hampshire, Vermont, Maine and northern Massachusetts. Normally, the Dartmouth dermatologists see approximately 1,200 patients per week, of whom approximately 5% are new patients.

That pace, combined with the high demand for dermatological care, meant a longer and longer wait to be seen by dermatologists at the Dartmouth Hitchcock Clinics Heater Road. By September 2023, the list had grown to 3,654 unseen patients.

According to Parker, the chair of the dermatology, M. Shane Chapman, M.D., MBA, came up with the notion of a weeklong surge of access for new patients. To prepare for that effort, the clinic grouped patients into stat, urgent and priority and targeted the priority group for the week of enhanced access.

“If it was a stat visit, someone who needed to be seen that day or that week, we would have them come in. But we were looking for patients who could maybe wait a couple weeks,” Parker said.

The clinic sent letters to approximately 2,000 patients, notifying them of the opportunity to be seen the week of Dec. 11-15, 2023. The letter also aimed to set expectations about the length of the visits. The staffing at the clinic consists of 12 board-certified dermatologists, nine residents, registered nurses and medical assistants, and one nurse practitioner. For “big access week,” they were organized into six teams consisting of one of the board-certified dermatologists, three residents or nurses, and three other staff members. Two providers were available for more complicated cases that needed longer visits.

“We used the same numbers of staff, but we just put them in different positions,” explained Parked. “We had patients come in, say, 17 at a time, and whoever was free at the time would take on the patient. So it wasn't like a patient was assigned to a specific provider.” As soon as the providers were done seeing a patient, they would be free to see the next one. “It was rapid turnover,” said Parker.

18 melanoma cases

Normally, the clinic staff sees approximately 1,200 patients per week, approximately 5% of whom are new patients. During the week of enhanced access, they saw just over 1,500 patients, nearly 80% of whom were new patients, or about one-third of those on the waiting list. With the bolus of visits, the number of people on the waitlist dropped precipitously, and in the five months afterward, it was 308 or less. Another way to frame the numbers is that the clinic staff increased the number of new patients they were seeing twentyfold (60 in the normal week compared with 1,200 during the big access week).

The visits were split fairly evenly between residents and the faculty: 808 patients were seen by residents and 750 were managed directly by the faculty members, according to the data presented in the poster.

Full skin exams were performed on 539 patients, but spot areas of concern were the reason for the visit in 607 cases.

Primary diagnoses included inflammatory skin disease lesions for 396 patients, malignant/pre-malignant lesions for 278, autoimmune-related skin disease for 57 patients, and infectious lesions for 82. The clinic staff performed 314 biopsies, and cancer was found in 124 cases, or 40%. Of those cancers, 67 were identified as basal cell carcinoma, 39 as squamous cell carcinoma, and 18 as melanoma. Eighty-seven patients were referred for Mohs surgery, and three received it on the same day. “They just walked down the hall and had their procedure done,” said Parker.

After the December 2023 week of enhanced access and the shrinking of the waitlist for several months, the numbers started to creep up, so the clinic is now putting special efforts into seeing new patients every month or two, according to Parker. The clinic is now facing the problem of scheduling follow-ups because the number of patients being seen has increased with the shrinking of the waitlist. “We do provide food and drinks and coffee... obviously it's a hard week for everyone, but it does increase our access,” he said.