As Match Day ended in March, 554 medical students celebrated their selection — out of some 1200 applicants — to a highly coveted dermatology residency slot. Many will eventually pursue advanced training — perhaps in dermatopathology or Mohs surgery — but as few as a dozen will move on to subspecialize in pediatric dermatology.
The number of clinicians in training who choose pediatric dermatology has been low for decades and continues to flatline, even as need skyrockets and older clinicians are retiring. Meanwhile, up to a third of visits to a pediatrician involve a skin issue, often one that needs the specific skillset of a pediatric dermatologist. They are few and far between, which creates major access bottlenecks.
“It is the smallest, smallest specialty,” said Thy N. Huynh, MD, assistant professor of dermatology at the University of Mississippi School of Medicine, Jackson, Mississippi, speaking at the American Academy of Dermatology (AAD) 2025 Annual Meeting in March. Huynh feels those small numbers acutely. She is the only board-certified pediatric dermatologist in Mississippi.
Lengthy training, a potentially high debt load — followed by lower compensation — demanding work hours, and a lack of awareness about the subspecialty all contribute to an abiding lack of interest, said clinicians and pediatric dermatology leaders.
“Some doctors, let alone parents and caregivers, still don’t even know that we exist as a subspecialty,” said Sheilagh Maguiness, MD, associate professor of dermatology at the University of Minnesota Medical School, Minneapolis and immediate past president of the Society for Pediatric Dermatology (SPD).
The 4-5 years of subspecialty training that pediatric dermatologists undergo “is very meaningful,” Maguiness told Medscape Medical News. But, she added, “It takes a special kind of person to want to do extra training and make less money.”
Maguiness and colleagues have struggled to figure out how to attract more medical students and residents to their field. She and others have gone to fellowship and residency meetings to hand out SPD brochures that give details on what’s involved in the subspecialty and salary information. “Building up career awareness is really important so that people know that we’re here,” said Maguiness.
Some academic medical center dermatology programs don’t have a pediatric dermatologist, which means students and residents may never be exposed to the subspecialty. SPD has helped move along an effort where some residency programs — such as at the University of Pennsylvania, Philadelphia — “earmark” a residency spot for someone who’s interested in pediatric dermatology. They then can be channeled into the fellowship they’ll need to get certified.
Growth Not Matching Need
The number of pediatric dermatologists has grown, but not exponentially. In 2010, there were 196 board-certified pediatric dermatologists, according to a review published in 2014. A 2021 survey indicated that there were 336 board-certified pediatric dermatologists practicing in the United States and that, on average, six pediatric dermatologists practice in each state, but seven states did not have one.
There are about 4.3 pediatric dermatologists per million children, according to a 2021 study in Cutis. The vast majority practice in urban areas and on the coasts.
“There is a huge access problem,” Huynh said at the AAD meeting. Huynh, originally from Montgomery, Alabama, completed pediatric training in Los Angeles and a pediatric dermatology fellowship in Boston. However, she did her dermatology residency at the University of Mississippi and said that she “came back to Mississippi to build” better access to pediatric dermatology in the state.
Her wait time is 4-6 months, but she is still seeing new patients, unlike some pediatric dermatologists who hit the pause button on new consults. Some colleagues in other locations have a wait time of up to a year, said Huynh.
“Delayed care is a problem,” said Maguiness, adding that it can be costly for some patients. For instance, untreated infantile hemangiomas can ulcerate and become cosmetically disfiguring. She’s seen children who have struggled for years with atopic dermatitis despite the availability of new and effective therapies.
Pediatric dermatologists’ value may be under-recognized. Pediatricians are great at addressing common skin conditions like viral rashes and diaper rashes or mild eczema, said Maguiness. But they aren’t as well versed in the thousands of general skin diseases and are less attuned to genetic or autoimmune conditions or complicated vascular anomalies that pediatric dermatologists see regularly, she noted.
“I see more zebras,” said Huynh, adding that being exposed to those rarities — and knowing what they are — is part of the job when she is the only specialist for some 700,000 children in Mississippi.
Is the Long Path to Practice a Deterrent?
As for many subspecialties, the road to that expertise is a long one.
After a 3-year dermatology residency and passing the general dermatology board exam, a 1-year fellowship at an Accreditation Council for Graduate Medical Education (ACGME)–accredited pediatric dermatology fellowship program is required. There are 34 accredited pediatric dermatology fellowship programs in the United States, according to the ACGME.
Fellowship slots often go unfilled. At the University of Minnesota, there has been only one pediatric dermatology fellow in the past 6 years, said Maguiness.
Those who complete a fellowship must then obtain board certification in pediatric dermatology. The American Board of Dermatology certified 23 pediatric dermatologists in 2024 — a relatively high number.
A 2014 overview of the field by Brea Prindaville, MD, and colleagues published in Pediatric Dermatology reported that a previous survey found that the majority of pediatric dermatologists had made the decision to pursue the field in medical school or in pediatric — not dermatology — residency.
That was true for Stephen Humphrey, MD, a dermatologist at Children’s Wisconsin and associate professor of dermatology at the Medical College of Wisconsin, Milwaukee. He knew in medical school that he wanted to go into a pediatrics-related field.
“I was really interested in taking care of kids,” he told Medscape Medical News. Once he became aware of pediatric dermatology, he shifted his focus because he really enjoyed his dermatology rotations.
Humphrey said the 5 years of training that he had did not deter him, “especially when compared to some of our surgical colleagues, who I feel like are still in training, and I’ve been out in practice 9 years.”
Maguiness agreed. “I don’t think the training is the impediment,” she said, adding that medical students recognize that extra training is needed for any subspecialty.
Lack of Procedures Equals Less Reimbursement
Pediatric dermatologists point to reimbursement as an issue that might discourage some from diverting from the more lucrative general dermatology path.
“Pediatric dermatology is far more cognitive than procedural and focused on preventative and maintenance care,” wrote Prindaville and co-authors.
“The time spent educating and counseling and doing preventative care, and all of the things that go into the pediatric subspecialty, don’t get paid or reimbursed at the same level,” said Maguiness.
But, she added, “If you’re comparing us to a general pediatrician, I think the salary would look quite attractive.”
Humphrey agreed that reimbursement might discourage some from joining him in his field. “At the end of the day, there is a financial thing that people think about,” he said, noting that someone might accumulate $500,000 in debt from college and medical school. An extra year of training for pediatric dermatology means another year without income, he said.
High Demand a Challenge
Pediatric dermatologists must get used to being in high demand. Humphrey, who is based in Milwaukee, gets referrals from all over Wisconsin and Northern Illinois.
“I work in a city that actually has a lot of pediatric dermatologists, comparatively speaking,” he said. But his next available new patient appointment is in 4-5 months. He still makes room for emergencies.
A survey of 118 pediatric dermatologists published in Pediatric Dermatology in 2024 found that 89% of respondents said they see one to 10 new consults each week and 71% said they don’t have protected time during the week to provide inpatient consults. More than a third said they perform all inpatient consults without assistance from other clinicians, including on evenings and weekends.
Maguiness said she takes calls for everyone in Minnesota and does telephone consults for patients in North Dakota, South Dakota, and part of Iowa, where there are no pediatric dermatologists. Even so, she said, “I would actually make the claim that it’s a pretty good lifestyle.”
She said she can “strike a balance” between work and home life, even though it’s busy.
Humphrey agreed. He said he’s been able to find a good work-life balance, which he said is crucial to being human. Humphrey chose the subspecialty in part because he wanted to practice in an academic environment and in a hospital system. Being a pediatric dermatologist “exposes you to challenging or more rare cases,” he said.
“It comes down to — do you love what you do? Do you love who you’re seeing? And if you do, the hours don’t matter so much,” he said.
“At the end of the day, you’ll find that pediatric dermatologists are extremely happy with their career,” said Maguiness.
“What makes a great career? Lifelong learning and having a purpose and helping others — those are the three things that really lead to personal fulfillment and satisfaction,” Maguiness said.
Huynh, Maguiness, and Humphrey reported no relevant disclosures.
Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in many health and science publications, including Smithsonian.com. You can find her on X @aliciaault and on Bluesky @aliciaault.bsky.social.