Rebecca Wang and Tue “Felix” Nguyen

The Importance of Dermatologic Access for Lower Socioeconomic Communities

By Christina Pierce, Rebecca Wang and Tue “Felix” Nguyen

What role does low socioeconomic status have in access to care for dermatologic conditions?

Dermatologic complaints are common in the United States, with 85 million patients in 2013 visiting physicians for their skin complaints. Dermatologic care can help reduce mortality and hospitalization for patients with skin conditions.1 However, access to dermatologists is widely variable and dependent on many factors such as poverty, rurality, insurance status, age, sex and travel burden. One study found that poor, near-poor, and low-income individuals were less likely to have a dermatology visit in one year compared to middle-income individuals. Additionally, uninsured patients or those with Medicaid or Medicare had fewer odds of visiting the dermatologist than privately insured patients.1 Based on the 2020 Census, 17.6% of the San Antonio population are persons in poverty, and 19.3% of individuals under the age of 65 in San Antonio were without health insurance. Lack of health insurance and lower income decrease the likelihood of these individuals receiving dermatologic care. Dermatological conditions and diseases, such as squamous cell carcinoma and melanoma, are prevalent. Lower socioeconomic status (SES) creates a barrier for patients to seek and receive the care or treatment they need. Fortunately, there are studentrun free clinics affiliated with UT Health San Antonio that are of no cost to those seeking care and serve as a resource to address dermatological concerns. However, we are advocating that awareness of these free clinics be more widespread to inform patients who would benefit from visiting.

Where are these clinics located, and what do they offer?

Travis Park Dermatology Clinic is a free dermatology clinic run by students and faculty within the UT Health San Antonio system located in downtown San Antonio. This clinic is open on the second and fourth Tuesday of every month, between 3:45 to 6:00 pm and is a walkin clinic with an effort to see all patients who need care. Travis Park also serves as a valuable learning opportunity for medical students, they are able to manage the dermatologic concerns of many patients by conducting focused skin histories, and physical exams and reporting their findings to the present dermatology residents and attendings. The team then formulates a treatment plan with the patient’s financial situation in mind. Therefore, free clinics serve as a resource that increases accessibility to quality care and enriches the medical school curriculum by allowing students to assess and treat patients holistically.

While Travis Park is an excellent opportunity for patients with lower income or unstable healthcare to address their skin complaints, many still encounter barriers that prevent them from seeking care. Some of these barriers include lack of transportation, mistrust of the medical system, other time constraints and language barriers. Additionally, knowledge of these free clinics may not be available to everyone in San Antonio who may benefit from visiting these clinics.

What can we do to improve access?

An idea we suggest to improve accessibility and address barriers to care would be establishing more operating clinic locations in the San Antonio area, especially in communities that lack healthcare. This proposition could be accomplished by using a geographical mapping tool such as PHATE to identify lower SES regions that may greatly benefit from having a clinic nearby. Once the clinic locations have been chosen, students and faculty will set a date and time to provide consistency. For example, the free clinic will be open on the first Wednesday of every month at 3:00 pm at the south side location and on the third Wednesday of every month at 3:00 pm at the downtown location. This scheduling would provide more opportunities and options for patients

of disadvantaged communities to pursue having their skin concerns addressed without the burden of worrying about transportation, payments or other time obligations. Eventually, with the medical institution's support, establishing more available clinic times would provide flexibility and reliability to cultivate stronger relationships with our patient communities.

Another way to increase the utility of free clinics is to broadcast their existence to primary care practices. Many free clinics are often only known by word-of-mouth, so many primary care practices may not be aware of these resources. At Travis Park, patients occasionally walk in after being referred to by their primary care providers. These patients were typically referred because they could not afford a visit to a regular dermatology practice or get an appointment until much later; however, they still needed treatment for their skin conditions. Thus, improving free clinic visibility to the San Antonio medical community may help provide physicians with more options to recommend to their patients.

Closing thoughts - how can we stand together?

Addressing dermatological concerns or questions is essential for all patients. However, by recognizing the barriers that exist, it is imperative to ensure that patients with lower SES have the opportunity to have access to dermatology providers. With this article, we hope to encourage awareness and stand together as medical professionals, healthcare volunteers and community service providers to improve community health and patient wellbeing.

References: 1. Tripathi, R., Knusel, K. D., Ezaldein, H. H., Scott, J. F., & Bordeaux,

J. S. (2018). Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology

Services in the United States. JAMA dermatology, 154(11), 1286–1291. https://doi.org/10.1001/jamadermatol.2018.3114 2. U.S. Census Bureau quickfacts: San Antonio City, Texas. (n.d.). Retrieved November 21, 2022, from https://www.census.gov/quickfacts/fact/table/sanantoniocitytexas/LND110210

Medicine.

Christina Pierce, Rebecca Wang and Tue “Felix” Nguyen are all medical students at UT Health San Antonio Long School of