Persistent Decline in Dermatology Service Volume in Medicare Population After Covid-19 Pandemic

Persistent Decline in Dermatology Service Volume in Medicare Population After Covid-19 Pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Persistent Decline in Dermatology Service Volume in Medicare Population After Covid-19 Pandemic Eudora Lee, Bichchau Michelle Nguyen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8368480/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract The Covid-19 pandemic resulted in a significant, acute decline in medical services nationwide, limiting patient access to care. This study used the Medicare Physician Payment (MPP) database to track nationwide changes in dermatology service (new and return visits) among Medicare beneficiaries from 2019 to 2023, analyzing recovery across states and stratified by practice size. Nationwide dermatology service volume sharply declined by 17.4% (p < 0.001) from 2019 to 2020. Although volume increased by 10.1% between 2020 and 2023 (p < 0.001), overall service volume remained 9.0% (p < 0.001) below baseline levels in 2019. During this period, the number of Medicare beneficiaries increased by 8.1%, suggesting service volume decline is likely due to fewer patients seeking care. Service recovery was uneven across practice sizes. By 2023, large practices nearly returned to baseline, with only a 0.5% net decline compared to 2019. In contrast, solo and small practices sustained significant volume deficits (-9.1% and 7.2% respectively), and medium-sized practices showed the greatest persistent decline (-20.2%). Service volume also remained below pre-pandemic levels in 45 states by 2023. This significant and persistent decline in Medicare dermatologic utilization demonstrates the enduring impact of pandemic disruptions to healthcare, and mirrors the declines seen in other specialties including primary and preventative care. As Medicare and elderly patients have a high burden of skin cancers requiring timely evaluation and monitoring, the slow recovery suggests ongoing healthcare access challenges for vulnerable populations. These results emphasize the importance of developing strategies to protect vulnerable populations and promote accessibility during public health emergencies. Figures Figure 1 Introduction The Covid-19 pandemic resulted in significant decline in medical and surgical dermatologic volume [ 7 ] due to public health measures, resulting in acutely limited access to care for patients and financial challenges for dermatologic practices [ 5 ]. Few studies have assessed whether service volume has fully recovered to pre-pandemic levels. Methods We used the Medicare Physician Payment (MPP) database to calculate changes in nationwide dermatology service volume from 2019–2020 to assess the acute impact of public health mandated service restrictions, then between 2020–2022 to track improvement in service with restrictions lifted, and between 2019–2023 to determine net service volume recovery. Service volume was defined as the sum of new and return visits (CPT codes 99202–99205, 99212–99215). Volume changes were compared across states, and stratified based on practice sizes: solo, small (2–5 billing providers), medium (6–10), and large (> 10). U.S. territories were excluded from analysis. Providers were considered to be part of the same practice if they shared the same billing address. One sample t-tests were used to determine statistical significance of volume changes across years, states, and practice sizes. Medicare beneficiaries data were extracted from Centers for Medicare and Medicaid Services (CMS) Medicare Dashboard [ 9 ]. Results Nationwide dermatology service volume declined by (-17.4%) from 2019 to 2020, p < 0.001, then increased most significantly in year 2021 (+ 7.4%, p < 0.001), stagnated in year 2022 (+ 0.13, p = 0.08) and minimally in 2023 (+ 2.3%, p < 0.01). Overall, service volume increased by 10.1% (p < 0.001) between 2020–2023, but remained well below pre-pandemic 2019 levels (-9.0%, p < 0.001). At the same time, the number of Medicare beneficiaries increased annually from 61.5 million in 2019 to 66.5 million (+ 8.1%) in 2023. Therefore, the number of visits per 10,000 Medicare beneficiary decreased from 1800 in 2019 to 1500 in 2020 and persisted at that level through 2023 (Table 1 ). In 2019, there were 11,899 providers in 7,682 practices, of which 74.7% were solo practice, 23.0% were small, 1.9% medium, and 0.5% large size. The number of providers and practices declined minimally by 1.1% and 0.8%, respectively, by 2021, but recovered and surpassed 2019 levels by 2023. Overall distribution of practice sizes remained stable throughout the examined period. The majority of dermatology visits were performed by providers in solo and small practices (5.71M, and 4.30M) rather than medium and large practices (0.90M and 0.29M). Service volume declined broadly in 2020 across all practice sizes, notably by 18.9% and 15.5% for solo and small practices, respectively. Recovery was uneven across practice sizes. For large practices, service volume was nearly back at 2019 baseline level by 2023. Solo and small practices still had a 9.1% and 7.2% volume decline compared to 2019, while medium size practices showed persistently large reductions in service volume of 20.2% by 2023. Service volume declined in all states except for AK (+ 1.55%) from 2019 to 2020, ranging from 26.55% (MI) to -7.14% (WY), with an average decrease of -16.2% among all states. Subsequently, service volume increased from 2020 to 2023 in 41 areas ranging from + 0.11% (SC) to + 35.75% (MT). By 2023, service volume remained lower than pre-pandemic 2019 level in all states except for AK, CO, HI, MT, WY. AK showed the best net recovery at 15.77%. Net decline was highest for WV (-40.06%) and ID (-25.64%) in the US. Discussion Our study showed a significant and persistent decline in Medicare dermatologic service volume nationwide, and across states and practice sizes. Service volume recovered to varying extents by 2023 but remained lower than the 2019 baseline in 45 states, highlighting the long-lasting impact of pandemic-related disruptions. Both numbers of providers and beneficiaries increased between 2019 and 2023 by + 2% and + 8% respectively, suggesting service volume decline is likely due to fewer patients seeking care or fewer visits per patient annually. The persistent decline in service volume was observed in all but 5 states, and across solo, small and medium-size dermatology practices. The persistent decline in Medicare dermatologic service volume by 2023 reflects an incomplete recovery that is generally consistent with utilization patterns observed in other non-acute medical services. Although overall Medicare outpatient volume stabilized by 2023, specialties that serve high-risk and older populations such as in primary care, behavioral health, and cancer screening, still show meaningful, persistent underutilization. One analysis comparing utilization trends across specialties found that primary care and behavioral health visit volumes remained at 11% and 18% below 2019 baselines, respectively [ 4 ]. Physician office visits for Medicare beneficiaries with diabetes declined by 12.6% across 2021 and 2022 [ 8 ]. Cancer preventive services such as screening rates for mammography and low-dose computed tomography scan rates were 4% and 14% lower than expected from March 2021 to February 2022 among Medicare enrollees [ 1 ]. The decline in dermatology services (-9%) is in line with those observed with primary care (-11%) nationwide, possibly because both specialties manage chronic diseases, cancer screening, and episodic non-acute illnesses where patients can delay or defer care without immediate health impact. The recovery in dermatology service was highly dependent on practice size, highlighting disparities in how different practice structures managed pandemic disruptions. By 2023, while large practices had nearly returned to their 2019 baseline volume, showing only a 0.5% net decline, solo practices and small practices maintained a 9.1% and 7.2% volume deficit. The greatest sustained reduction was observed in medium-sized practices, which showed a persistent decline of 20.2% in service volume by 2023. Large practices, such as hospital-based or multispecialty groups, may have larger financial, staffing and technology reserves that facilitate quick transition to telehealth during the pandemic and pivot back to in-person service after. Large groups may also have more stable referral networks and patient outreach programs that help increase patient volume back to 2019 levels more quickly. Smaller practices with limited cash and staff reserves may find it more challenging to rehire staff, rebuild referral networks and restore full-service capacity post pandemic. The persistent decline in dermatology services among Medicare beneficiaries is concerning since Medicare patients, especially those age > 65 years old, have a high burden of skin cancers [ 3 ]. Early detection of skin cancers, and appropriate management of chronic actinic damage and actinic keratoses, known risk factors for skin cancers, require timely dermatologic evaluation. Patients with prior skin cancers need to be seen regularly to detect new or recurrent skin cancers. Other commonly diagnosed dermatologic conditions in the Medicare population include infections and dermatitis which can significantly impact quality of life [ 2 , 6 ]. Our findings are consistent with the trend of pervasive, long-lasting impacts of the pandemic on non-acute care for Medicare beneficiaries, which will have long-term consequences on the management of chronic illnesses. As a greater proportion of Medicare beneficiaries rely on solo or small-sized practices in dermatology, the slower recovery of service volume may reflect an ongoing challenge for vulnerable populations in accessing necessary management, surveillance, and evaluation, especially given the high burden of skin cancers and other dermatologic conditions in this population. Table 1 Summary statistics of Medicare enrollments, number of visits, and number of practices. Changes in number of visits are given in percentage and show significance based on percentage changes at the state level National Dermatology Service Volume 2019 2020 2021 2022 2023 Number of visits (in millions) 11.2 9.3 9.9 10.0 10.2 Year over year % change in number of visits -17.4% *** 7.4% *** 0.1% 2.3% ** % change in number of visits c/t 2019 -17.4% *** -11.2% *** -11.1% *** -9.0% *** Medicare beneficiaries (in millions) 61.5 62.8 63.9 65.1 66.5 Number of visits per beneficiary (annual % change c/t 2019) 0.18 0.15 (-18.7%) 0.15 (-14.9%) 0.15 (-15.7%) 0.15 (-15.8%) Number of Practices (%) Solo 5736 (74.7%) 5661 (74.0%) 5661 (74.3%) 5759 (74.5%) 5878 (74.6%) Small (2–5) 1764 (23.0%) 1809 (23.6%) 1790 (23.5%) 1790 (23.2%) 1825 (23.2%) Medium (6–10) 146 (1.9%) 148 (1.9%) 138 (1.8%) 141 (1.8%) 134 (1.7%) Large (> 10) 36 (0.5%) 36 (0.5%) 34 (0.4%) 36 (0.5%) 39 (0.5%) Total number of practices (% change c/t 2019) 7682 7654 (-0.4%) 7623 (-0.8%) 7726 (+ 0.6%) 7876 (+ 2.5%) Total number of providers (% change c/t 2019) 11899 11930 (+ 0.3%) 11770 (-1.1%) 11907 (+ 0.1%) 12160 (+ 2.2%) Number of visits by practice size in millions (annual % change c/t 2019) Solo 5.71 4.63 (-18.9%) 5.00 (-12.4%) 5.05 (-11.6%) 5.19 (-9.1%) Small (2–5) 4.30 3.63 (-15.5%) 3.94 (-8.4%) 3.89 (-9.4%) 3.99 (-7.2%) Medium (6–10) 0.90 0.74 (-17.0%) 0.74 (-17.4%) 0.74 (-17.1%) 0.72 (-20.2%) Large (> 10) 0.29 0.25 (-15.8%) 0.26 (-11.3%) 0.26 (-10.5%) 0.29 (-0.5%) * p < 0.05, ** p < 0.01, *** p < 0.001; c/t: compared to Declarations Author Contribution EL drafted the main manuscript text and BMN revised it critically for important intellectual content and approved the version for publication. EL acquired and analyzed the data and prepared figure 1 and table 1. References Doan C, Li S, Goodwin JS (2023) Breast and lung cancer screening among Medicare enrollees during the COVID-19 pandemic. JAMA Netw Open 6:e2255589 Farage MA, Miller KW, Berardesca E, Maibach HI (2009) Clinical implications of aging skin: cutaneous disorders in the elderly: Cutaneous disorders in the elderly. Am J Clin Dermatol 10:73–86 Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, Bernabei R, Peris K (2017) Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging Dis 8:643–661 Lee JD, Chun E, Chang C-H, Liu T, Dunn RL, McCullough JS, Thompson MP, Ellimoottil C (2025) Telehealth and outpatient utilization: Trends in evaluation and management visits among Medicare Fee-for-Service beneficiaries, 2019–2024. medRxiv 2025.03.05.25323449 Litchman GH, Marson JW, Rigel DS (2021) The continuing impact of COVID-19 on dermatology practice: Office workflow, economics, and future implications. J Am Acad Dermatol 84:576–579 Loo DS (2004) Cutaneous fungal infections in the elderly. Dermatol Clin 22:33–50 Mafi JN, Craff M, Vangala S, Pu T, Skinner D, Tabatabai-Yazdi C, Nelson A, Reid R, Agniel D, Tseng C-H, Sarkisian C, Damberg CL, Kahn KL (2022) Trends in US ambulatory care patterns during the COVID-19 pandemic, 2019–2021. JAMA 327:237–247 Zhou X, Andes LJ, Rolka DB, Imperatore G (2023) Changes in health care utilization among Medicare beneficiaries with diabetes two years into the COVID-19 pandemic. AJPM Focus 2:100117 Medicare Enrollment Dashboard In: Centers for Medicare & Medicaid Services Data. https://data.cms.gov/tools/medicare-enrollment-dashboard . Accessed 12 Dec 2025 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Feb, 2026 Reviews received at journal 07 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor assigned by journal 17 Dec, 2025 Submission checks completed at journal 17 Dec, 2025 First submitted to journal 15 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8368480","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":585139696,"identity":"ee0dc6ec-7b25-42a8-ae78-bf32724212ff","order_by":0,"name":"Eudora Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie3NsQrCMBCA4ROhXU6ypiD6CimCOBTyKilCJ50K4uAQKehSnBV8iSzOguBU924qglMHJ3UQ0QrSLermkH8I4ciXAzCZ/jOWH1WA8hLAKyYfCQJYvoSA/UTQ/Y4Q2laH/gCQ2PHlgOLGwY4WVEecaRC6yRrQiTcqQsF8ieuelrC003SkBcjSrooqVyaAdppawl/kDsi32T7fwqGe6Ql7/ukMR88tFEs5KUmKekKTY+gOJxRpErizuWj4IwzClo6QcVvt5dmrkfFqd8pEjRN7pVIdeS8rrtYXz00mk8n0oQdAYEAOmQ748gAAAABJRU5ErkJggg==","orcid":"","institution":"Tufts University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Eudora","middleName":"","lastName":"Lee","suffix":""},{"id":585139697,"identity":"e3573af6-2ac8-4783-937d-7c228c39882b","order_by":1,"name":"Bichchau Michelle Nguyen","email":"","orcid":"","institution":"Tufts Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Bichchau","middleName":"Michelle","lastName":"Nguyen","suffix":""}],"badges":[],"createdAt":"2025-12-15 16:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8368480/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8368480/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101940388,"identity":"d20339ce-1336-402f-bd5a-48ceb4f6d272","added_by":"auto","created_at":"2026-02-05 09:14:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":433553,"visible":true,"origin":"","legend":"\u003cp\u003eBar plot showing percentage changes in total service volume grouped by state, sorted alphabetically, from A. 2019 to 2020; B. 2020 to 2023; C. 2019 to 2023\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8368480/v1/6e7dd93a13b53d23235e602b.png"},{"id":101940391,"identity":"40e97b99-0282-4034-8402-b3399477d621","added_by":"auto","created_at":"2026-02-05 09:14:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":976622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8368480/v1/acdcae84-d377-4e24-96df-591bd9a7d954.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Persistent Decline in Dermatology Service Volume in Medicare Population After Covid-19 Pandemic","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe Covid-19 pandemic resulted in significant decline in medical and surgical dermatologic volume [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] due to public health measures, resulting in acutely limited access to care for patients and financial challenges for dermatologic practices [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Few studies have assessed whether service volume has fully recovered to pre-pandemic levels.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eWe used the Medicare Physician Payment (MPP) database to calculate changes in nationwide dermatology service volume from 2019\u0026ndash;2020 to assess the acute impact of public health mandated service restrictions, then between 2020\u0026ndash;2022 to track improvement in service with restrictions lifted, and between 2019\u0026ndash;2023 to determine net service volume recovery. Service volume was defined as the sum of new and return visits (CPT codes 99202\u0026ndash;99205, 99212\u0026ndash;99215). Volume changes were compared across states, and stratified based on practice sizes: solo, small (2\u0026ndash;5 billing providers), medium (6\u0026ndash;10), and large (\u0026gt;\u0026thinsp;10). U.S. territories were excluded from analysis. Providers were considered to be part of the same practice if they shared the same billing address. One sample t-tests were used to determine statistical significance of volume changes across years, states, and practice sizes. Medicare beneficiaries data were extracted from Centers for Medicare and Medicaid Services (CMS) Medicare Dashboard [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eNationwide dermatology service volume declined by (-17.4%) from 2019 to 2020, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, then increased most significantly in year 2021 (+\u0026thinsp;7.4%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), stagnated in year 2022 (+\u0026thinsp;0.13, p\u0026thinsp;=\u0026thinsp;0.08) and minimally in 2023 (+\u0026thinsp;2.3%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Overall, service volume increased by 10.1% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) between 2020\u0026ndash;2023, but remained well below pre-pandemic 2019 levels (-9.0%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At the same time, the number of Medicare beneficiaries increased annually from 61.5\u0026nbsp;million in 2019 to 66.5\u0026nbsp;million (+\u0026thinsp;8.1%) in 2023. Therefore, the number of visits per 10,000 Medicare beneficiary decreased from 1800 in 2019 to 1500 in 2020 and persisted at that level through 2023 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2019, there were 11,899 providers in 7,682 practices, of which 74.7% were solo practice, 23.0% were small, 1.9% medium, and 0.5% large size. The number of providers and practices declined minimally by 1.1% and 0.8%, respectively, by 2021, but recovered and surpassed 2019 levels by 2023. Overall distribution of practice sizes remained stable throughout the examined period.\u003c/p\u003e \u003cp\u003eThe majority of dermatology visits were performed by providers in solo and small practices (5.71M, and 4.30M) rather than medium and large practices (0.90M and 0.29M). Service volume declined broadly in 2020 across all practice sizes, notably by 18.9% and 15.5% for solo and small practices, respectively. Recovery was uneven across practice sizes. For large practices, service volume was nearly back at 2019 baseline level by 2023. Solo and small practices still had a 9.1% and 7.2% volume decline compared to 2019, while medium size practices showed persistently large reductions in service volume of 20.2% by 2023.\u003c/p\u003e \u003cp\u003eService volume declined in all states except for AK (+\u0026thinsp;1.55%) from 2019 to 2020, ranging from 26.55% (MI) to -7.14% (WY), with an average decrease of -16.2% among all states. Subsequently, service volume increased from 2020 to 2023 in 41 areas ranging from +\u0026thinsp;0.11% (SC) to +\u0026thinsp;35.75% (MT). By 2023, service volume remained lower than pre-pandemic 2019 level in all states except for AK, CO, HI, MT, WY. AK showed the best net recovery at 15.77%. Net decline was highest for WV (-40.06%) and ID (-25.64%) in the US.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study showed a significant and persistent decline in Medicare dermatologic service volume nationwide, and across states and practice sizes. Service volume recovered to varying extents by 2023 but remained lower than the 2019 baseline in 45 states, highlighting the long-lasting impact of pandemic-related disruptions. Both numbers of providers and beneficiaries increased between 2019 and 2023 by +\u0026thinsp;2% and +\u0026thinsp;8% respectively, suggesting service volume decline is likely due to fewer patients seeking care or fewer visits per patient annually. The persistent decline in service volume was observed in all but 5 states, and across solo, small and medium-size dermatology practices.\u003c/p\u003e \u003cp\u003eThe persistent decline in Medicare dermatologic service volume by 2023 reflects an incomplete recovery that is generally consistent with utilization patterns observed in other non-acute medical services. Although overall Medicare outpatient volume stabilized by 2023, specialties that serve high-risk and older populations such as in primary care, behavioral health, and cancer screening, still show meaningful, persistent underutilization. One analysis comparing utilization trends across specialties found that primary care and behavioral health visit volumes remained at 11% and 18% below 2019 baselines, respectively [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Physician office visits for Medicare beneficiaries with diabetes declined by 12.6% across 2021 and 2022 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Cancer preventive services such as screening rates for mammography and low-dose computed tomography scan rates were 4% and 14% lower than expected from March 2021 to February 2022 among Medicare enrollees [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The decline in dermatology services (-9%) is in line with those observed with primary care (-11%) nationwide, possibly because both specialties manage chronic diseases, cancer screening, and episodic non-acute illnesses where patients can delay or defer care without immediate health impact.\u003c/p\u003e \u003cp\u003eThe recovery in dermatology service was highly dependent on practice size, highlighting disparities in how different practice structures managed pandemic disruptions. By 2023, while large practices had nearly returned to their 2019 baseline volume, showing only a 0.5% net decline, solo practices and small practices maintained a 9.1% and 7.2% volume deficit. The greatest sustained reduction was observed in medium-sized practices, which showed a persistent decline of 20.2% in service volume by 2023. Large practices, such as hospital-based or multispecialty groups, may have larger financial, staffing and technology reserves that facilitate quick transition to telehealth during the pandemic and pivot back to in-person service after. Large groups may also have more stable referral networks and patient outreach programs that help increase patient volume back to 2019 levels more quickly. Smaller practices with limited cash and staff reserves may find it more challenging to rehire staff, rebuild referral networks and restore full-service capacity post pandemic.\u003c/p\u003e \u003cp\u003eThe persistent decline in dermatology services among Medicare beneficiaries is concerning since Medicare patients, especially those age\u0026thinsp;\u0026gt;\u0026thinsp;65 years old, have a high burden of skin cancers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Early detection of skin cancers, and appropriate management of chronic actinic damage and actinic keratoses, known risk factors for skin cancers, require timely dermatologic evaluation. Patients with prior skin cancers need to be seen regularly to detect new or recurrent skin cancers. Other commonly diagnosed dermatologic conditions in the Medicare population include infections and dermatitis which can significantly impact quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Our findings are consistent with the trend of pervasive, long-lasting impacts of the pandemic on non-acute care for Medicare beneficiaries, which will have long-term consequences on the management of chronic illnesses. As a greater proportion of Medicare beneficiaries rely on solo or small-sized practices in dermatology, the slower recovery of service volume may reflect an ongoing challenge for vulnerable populations in accessing necessary management, surveillance, and evaluation, especially given the high burden of skin cancers and other dermatologic conditions in this population.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary statistics of Medicare enrollments, number of visits, and number of practices. Changes in number of visits are given in percentage and show significance based on percentage changes at the state level\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNational Dermatology Service Volume\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of visits (in millions)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear over year % change in number of visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-17.4%\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.4%\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.3%\u003cb\u003e**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% change in number of visits c/t 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-17.4%\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-11.2%\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-11.1%\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-9.0%\u003cb\u003e***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare beneficiaries (in millions)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of visits per beneficiary (annual % change c/t 2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003cp\u003e(-18.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003cp\u003e(-14.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003cp\u003e(-15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003cp\u003e(-15.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Practices (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5736 (74.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5661 (74.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5661 (74.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5759 (74.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5878 (74.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1764 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1809 (23.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1790 (23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1790 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1825 (23.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium (6\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e141 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e134 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge (\u0026gt;\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of practices (% change c/t 2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7654\u003c/p\u003e \u003cp\u003e(-0.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7623\u003c/p\u003e \u003cp\u003e(-0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7726\u003c/p\u003e \u003cp\u003e(+\u0026thinsp;0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7876\u003c/p\u003e \u003cp\u003e(+\u0026thinsp;2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal number of providers (% change c/t 2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11930\u003c/p\u003e \u003cp\u003e(+\u0026thinsp;0.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11770\u003c/p\u003e \u003cp\u003e(-1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11907\u003c/p\u003e \u003cp\u003e(+\u0026thinsp;0.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12160\u003c/p\u003e \u003cp\u003e(+\u0026thinsp;2.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of visits by practice size in millions (annual % change c/t 2019)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.63\u003c/p\u003e \u003cp\u003e(-18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003cp\u003e(-12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.05\u003c/p\u003e \u003cp\u003e(-11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.19\u003c/p\u003e \u003cp\u003e(-9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmall (2\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.63\u003c/p\u003e \u003cp\u003e(-15.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.94\u003c/p\u003e \u003cp\u003e(-8.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.89\u003c/p\u003e \u003cp\u003e(-9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.99\u003c/p\u003e \u003cp\u003e(-7.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium (6\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003cp\u003e(-17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003cp\u003e(-17.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003cp\u003e(-17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003cp\u003e(-20.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge (\u0026gt;\u0026thinsp;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003cp\u003e(-15.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003cp\u003e(-11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003cp\u003e(-10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003cp\u003e(-0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003e* p \u003c 0.05, ** p \u003c 0.01, *** p \u003c 0.001; c/t: compared to\u003c/p\u003e\n\u003cp\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEL drafted the main manuscript text and BMN revised it critically for important intellectual content and approved the version for publication. EL acquired and analyzed the data and prepared figure 1 and table 1.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDoan C, Li S, Goodwin JS (2023) Breast and lung cancer screening among Medicare enrollees during the COVID-19 pandemic. JAMA Netw Open 6:e2255589\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarage MA, Miller KW, Berardesca E, Maibach HI (2009) Clinical implications of aging skin: cutaneous disorders in the elderly: Cutaneous disorders in the elderly. Am J Clin Dermatol 10:73\u0026ndash;86\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, Bernabei R, Peris K (2017) Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging Dis 8:643\u0026ndash;661\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee JD, Chun E, Chang C-H, Liu T, Dunn RL, McCullough JS, Thompson MP, Ellimoottil C (2025) Telehealth and outpatient utilization: Trends in evaluation and management visits among Medicare Fee-for-Service beneficiaries, 2019\u0026ndash;2024. medRxiv 2025.03.05.25323449\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLitchman GH, Marson JW, Rigel DS (2021) The continuing impact of COVID-19 on dermatology practice: Office workflow, economics, and future implications. J Am Acad Dermatol 84:576\u0026ndash;579\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoo DS (2004) Cutaneous fungal infections in the elderly. Dermatol Clin 22:33\u0026ndash;50\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMafi JN, Craff M, Vangala S, Pu T, Skinner D, Tabatabai-Yazdi C, Nelson A, Reid R, Agniel D, Tseng C-H, Sarkisian C, Damberg CL, Kahn KL (2022) Trends in US ambulatory care patterns during the COVID-19 pandemic, 2019\u0026ndash;2021. JAMA 327:237\u0026ndash;247\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou X, Andes LJ, Rolka DB, Imperatore G (2023) Changes in health care utilization among Medicare beneficiaries with diabetes two years into the COVID-19 pandemic. AJPM Focus 2:100117\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMedicare Enrollment Dashboard In: Centers for Medicare \u0026amp; Medicaid Services Data. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.cms.gov/tools/medicare-enrollment-dashboard\u003c/span\u003e\u003cspan address=\"https://data.cms.gov/tools/medicare-enrollment-dashboard\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 12 Dec 2025\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8368480/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8368480/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe Covid-19 pandemic resulted in a significant, acute decline in medical services nationwide, limiting patient access to care. This study used the Medicare Physician Payment (MPP) database to track nationwide changes in dermatology service (new and return visits) among Medicare beneficiaries from 2019 to 2023, analyzing recovery across states and stratified by practice size.\u003c/p\u003e \u003cp\u003eNationwide dermatology service volume sharply declined by 17.4% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) from 2019 to 2020. Although volume increased by 10.1% between 2020 and 2023 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), overall service volume remained 9.0% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) below baseline levels in 2019. During this period, the number of Medicare beneficiaries increased by 8.1%, suggesting service volume decline is likely due to fewer patients seeking care. Service recovery was uneven across practice sizes. By 2023, large practices nearly returned to baseline, with only a 0.5% net decline compared to 2019. In contrast, solo and small practices sustained significant volume deficits (-9.1% and 7.2% respectively), and medium-sized practices showed the greatest persistent decline (-20.2%). Service volume also remained below pre-pandemic levels in 45 states by 2023.\u003c/p\u003e \u003cp\u003eThis significant and persistent decline in Medicare dermatologic utilization demonstrates the enduring impact of pandemic disruptions to healthcare, and mirrors the declines seen in other specialties including primary and preventative care. As Medicare and elderly patients have a high burden of skin cancers requiring timely evaluation and monitoring, the slow recovery suggests ongoing healthcare access challenges for vulnerable populations. These results emphasize the importance of developing strategies to protect vulnerable populations and promote accessibility during public health emergencies.\u003c/p\u003e","manuscriptTitle":"Persistent Decline in Dermatology Service Volume in Medicare Population After Covid-19 Pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-05 09:13:47","doi":"10.21203/rs.3.rs-8368480/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-16T20:14:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-07T16:00:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26530365577748154813917603523386335584","date":"2026-02-03T13:11:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T05:05:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T14:46:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T14:45:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-12-15T16:19:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"8be5c9cd-9ea2-461f-8dea-296c21487ade","owner":[],"postedDate":"February 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T23:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-05 09:13:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8368480","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8368480","identity":"rs-8368480","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}