Experts are calling for increased telehealth usage and upskilling nurses as a way of balancing the 'supply and demand' of skin cancer care in the sunshine state.
Queenslanders living outside the southeast region have limited access to specialist dermatology services, leaving GPs to shoulder the skin cancer burden.
Australia has one of, if not the, highest rates of skin cancer in the world. While dermatologists play an important role in the screening, diagnosis and management of skin cancer, most patients are managed in primary care. Despite the ever-increasing need for skin cancer clinicians, the Department of Health, Disability and Ageing has previously predicted that Australia will be 90 full time dermatologists short of where the workforce should be by 2030.
This presents a particularly pertinent challenge for Queensland, which has a higher rate of skin cancer than any other Australian state or territory. To support future workforce planning, a team of researchers from the sunshine state have used supply-, demand- and needs-based modelling to determine the number of skin cancer clinicians and their clinical workloads, estimate their skin cancer caseloads and figure out if and where geographic disparities in said workforce exist.
“There is an insufficient number of qualified dermatologists working in Queensland, particularly outside of [Southeast Queensland], meaning a high proportion of skin cancer medicine is performed by GPs,” the researchers concluded in the Australasian Journal of Dermatology.
“Preferential selection for specialist dermatology training of clinicians more likely to work outside SEQ and greater use of teledermatology may help create a suitable and appropriately dispersed workforce for the rising burden of skin cancer in Queensland.”
Based on data for 2023 from the National Health Workforce Dataset, Queensland had 7179 GPs and 124 dermatologists servicing its 5.5 million residents. After accounting for the estimated skin cancer-related workloads, these figures fell to 852 full-time equivalent GPs and 71 FTE dermatologists. This equates to an estimated 17 FTE skin cancer clinicians per 100,000 population across the state.
Unsurprisingly, there was an uneven distribution of skin cancer clinicians. The Statistical Area Level 4 regions of Moreton Bay – North, Central Queensland, and Logan – Beaudesert had the lowest rates (all 12 FTE clinicians per 100,000 population), while Brisbane Inner City (36 per 100,000) and Queensland – Outback (27 per 100,000) had the highest.
Every SA4 region had GPs working in the area, but ten regions did not have any dermatologists working within them: Brisbane – East, Logan – Beaudesert, Moreton Bay – North, Moreton Bay – South, Toowoomba, Central Queensland, Darling Downs – Maranoa, McKay – Issac – Whitsunday, Outback Queensland and Wide Bay.
“Almost half [the dermatologists were] concentrated in Brisbane Inner City and none in central or western Queensland,” the researchers wrote. “While there is no ‘gold standard’ number of clinicians required for a given population size… [this] highlights a possible workforce deficit across Queensland.”
“Without expanding training capacity or importing suitably qualified dermatologists from overseas, Australia’s dermatology workforce may struggle to meet the healthcare needs from rising skin cancer cases.”
There were an estimated 8894 people diagnosed with incident melanoma in 2023 across Queensland. Most of these were in situ melanoma (5165), with the remainder being invasive (3729). The highest melanoma incidence rates were seen in Brisbane – East (227/100,000 population), Wide Bay (213.2) and the Sunshine Coast (210.5).
The analysis of Medicare item number claim data revealed there were 19,313 melanoma excisions, 20,106 excisions for lesions suspicious of melanoma, 303,593 keratinocyte skin cancer excisions, 115,674 cryotherapy/curettage procedures and 3833 Mohs surgeries performed throughout the state in 2023.
“If no GPs were working in skin cancer, each FTE dermatologist would have performed between 34 and 1375 melanoma excisions, 35 and 1431 excisions of lesions suspicious of melanoma, 534 and 21,610 KC excisions, 203 and 8234 cryotherapy/curettage procedures and 7 and 273 Mohs surgeries on average in 2023, for a total of between 813 and 33,247 procedures,” said the researchers.
The researchers felt that technology could help address the low number of skin cancer specialists working in remote areas of the state.
“The increasing use of teledermatology and outreach fly-in fly-out accredited skin cancer doctor models of care may improve access to specialist advice for skin cancer management and subsequent outcomes,” they wrote.
“Additionally, the emergence of artificial intelligence may assist clinicians detect and diagnose skin cancer earlier. Improved patient access to screening is seen as one of the major benefits of artificial intelligence, yet its use in clinical practice remains limited.”
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There were also calls for further training and broadening the scope of practice for other healthcare professionals.
“All Australian GPs graduate with a basic understanding of skin cancer diagnosis and management, but few pursue further training, limiting their ability to manage complex cases. In recent years, more avenues for accredited training for medical professionals interested in skin cancer have become available, including courses offered by Skin Cancer College Australasia and The University of Queensland,” they wrote.
“This has led to an increase in the number of GPs who ‘specialise’ in skin cancer medicine and GP-led skin cancer clinics across Australia. [But an] increased reliance on GPs for skin cancer medicine may further strain a profession already experiencing high levels of burnout. GPs, particularly those working remotely, manage a diverse range of conditions and a high workload. Having a high skin cancer caseload may detract from a GP’s ability to effectively manage other conditions.
“Training other health professionals, including nurse practitioners and other clinical assistants, in the detection and initial diagnostic procedures for skin cancer may lighten the workload for GPs and/or dermatologists, who could deal with more complex cases and provide follow-up care as needed.”
