Dermatologist Brett Sloan, MD, is not only a veteran, he’s also long cared for his fellow Veterans during his military service, at UConn Health, and at the VA Clinic in Newington, CT. Here, he is shown earlier this year with fellow veteran and longtime patient Michael Puttin. UConn Health press release photo by Tina Encarnacion
FARMINGTON, CT — The VA is one of the largest integrated healthcare systems in the United States, serving nearly 8 million enrolled veterans. Yet, despite veterans’ elevated risk of skin disease and skin cancer, few national studies have examined who VA-affiliated dermatologists (VADs) are or where they practice.
For the authors of a 2023 cross-sectional analysis of the VA dermatology workforce, the issue was both personal and professional. “Many of us at UConn actively research, write about, and lecture on dermatologic healthcare disparities in various underrepresented groups,” said Brett Sloan, MD, professor of dermatology at UConn. Given recent research showing a significant increase in skin cancer mortality in veterans, “we were interested in analyzing possible contributing factors.”
The study, published in the Journal of the American Academy of Dermatology, provides a first-of-its-kind national snapshot of the distribution and characteristics of VA-affiliated dermatologists across the United States, highlighting both strengths and gaps in access.
Using VA Specialty Care Programs Office data from April 2023, supplemented by the 2023 Medicare National File, Sloan and his colleagues identified 708 VA-affiliated dermatologists and 12,440 non-VA-affiliated dermatologists nationwide. Practice locations and fellowship training were verified through multiple sources.
Clear differences emerged between the two groups. Compared with non-VADs, VA-affiliated dermatologists were more likely to hold an MD degree (96.5% vs. 91.6%), nearly 4 times as likely to hold a PhD (11.2% vs. 2.9%), and more likely to have completed fellowship training, including Mohs surgery (16.2% vs. 11.5%) and dermatopathology (6.6% vs. 3.7%).
That specialization carries clinical significance. “More training generally translates into better care,” said Sloan, who recently retired from the Connecticut VA, where he served as dermatology site director. For example, he says, “[B]eing trained in Mohs allows the dermatologist to take care of more advanced skin cancers, and dermatopathology training allows a dermatologist to help diagnose inflammatory skin diseases and uncommon forms of skin cancer that may be difficult for general pathologists.”
Overall, the findings suggest VA-affiliated dermatologists represent a highly trained, academically oriented workforce. The authors noted that “higher rates of fellowship training among VAD likely reflect academic affiliations” and that their geographic distribution generally mirrors the broader dermatologist workforce, with most practicing near cities and academic centers.
At the state level, however, substantial disparities emerged. Using a benchmark of four dermatologists per 100,000 patients to indicate adequate access, the authors found that “over half of states fall below this threshold for VAD.” Some states fell far below that mark.
“I was surprised that over 50% of states fall below the threshold for VA-affiliated dermatologists per 100,000 veterans,” Sloan told U.S. Medicine. “It was not surprising that most of these are in very rural areas. Kansas, Wyoming, Nevada, and Hawaii had less than 1 per 100,000 veterans.”
For veterans in those states, the consequences may be serious. “It likely means longer wait times to see a dermatologist, which could result in significant increases in morbidity and mortality from delayed skin cancer diagnosis,” Sloan explained. Rural veterans also face increased transportation time and cost to see a dermatologist.
The VA has attempted to address access gaps through the Veteran’s Choice Program, now part of the Community Care Network, which allows veterans to receive care outside the VA. While dermatologic procedures were “significantly more frequent in VA-purchased care,” the study raised concerns about fragmentation and continuity.
“For the most part, the quality of VA-purchased care is very good, especially in urban/suburban areas where VA purchases care from university systems and the care is vetted,” Sloan said. “Unfortunately, many non-VA dermatologists have little understanding of the unique dermatology needs of veterans. … Continuity of care can be disrupted by administrative burdens and non-VAD lack of understanding of the VA formulary.”
These issues are amplified amid proposed budget reductions, including a planned $10 billion cut to VA-purchased care in the 2025 budget. Strengthening the internal workforce remains critical. “It is very important. Not only does the VA dermatology workforce have a better understanding of the unique needs of veterans, but many veterans prefer the care they receive at the VA, and traveling outside the system places an additional barrier to care,” Sloan said.
The authors acknowledged limitations, noting the study “is limited by its single timepoint and inability to characterize Veteran’s Choice Program [providers] who contribute substantially to care.” Still, they conclude that “the study provides foundational data of VAD distribution across the United States and highlights regions of potential underservice.”
Nevertheless, the study could help guide policy, recruitment, and resource allocation. Sloan emphasized the need for targeted solutions in underserved regions. “The need to increase the VAD workforce in rural areas,” he said. “While telemedicine helps fill these gaps, it is not an adequate tool for skin cancer screening or complex dermatologic conditions. Huge factors limiting the ability of the VA to hire dermatologists are significant pay discrepancies, lack of adequate support staff (scribes, medical assistants, and nurses) and clinical space, and an outdated electronic medical record system.”
By identifying where needs are most acute, the study highlights an opportunity to close access gaps, strengthen specialized care within the VA system, and ensure that geography does not determine a veteran’s chance of early diagnosis and effective treatment.
- Humen S, Sahin S, Gronbeck C, Beltrami E, Sloan B, Feng H. Practice characteristics of Veterans Affairs-affiliated dermatologists in the United States: A national comparative study. J Am Acad Dermatol. 2025 Oct 30:S0190-9622(25)03132-9. doi: 10.1016/j.jaad.2025.10.132. Epub ahead of print. PMID: 41176256.