‘It’s a travesty’: How a shortage of residency spots in dermatology is straining patient care

Canada doesn’t have enough dermatology residency spots, and that’s having a real impact on patient care. According to the Canadian Dermatology Association (CDA), there are only 1.9 dermatologists per 100,000 Canadians. That’s well under the target ratio of three per 100,000 and is far behind peer countries like Germany (7.7), France (6.1) and the United States (3.6). And for patients, that means they could have to wait months, sometimes up to a year to see a dermatologist. That can result in delayed diagnoses and treatments for diseases such as skin cancer, leading to poorer outcomes for patients.So where are our homegrown derms? Across Canada, there are only around 29 first-year residency spots each year, making this specialty among the hardest to match into. CDA president Dr. Mariusz Sapijaszko says this is improvement from the 1990s, when there would only be around five spots per year.“There is an increase in residency training positions across the country, but still, we fall woefully short of actually serving Canadian population,” he said in an interview with the Medical Post in June, during the CDA’s 2026 annual conference in Calgary.The lack of residency spots is even more pronounced in some regions than others. For instance, there is only one dermatology residency spot per year in Atlantic Canada, offered by Dalhousie University in Halifax.“Within the dermatology community, we feel it's a travesty that Atlantic Canada has only one residency position per year for dermatology to serve entire population of Atlantic Canada. We feel it's totally unacceptable,” he said. “The patients are the ones that suffer the most. They do not have the adequate service and adequate care.”An analysis of CaRMS matching data published in April in the Journal of Cutaneous Medicine and Surgery found that there have been 1,587 applicants competing for just 549 spots over the past 25 years, making it among the most competitive specialties. Out of these applicants, 1,090 had ranked dermatology as their first choice, but on average, there have been around two first-choice applicants per open spot per year. In some years, such as 2017, that ratio has gone up almost three-to-one. “Unfortunately, many outstanding applicants ultimately do not match, not because they lack the ability or commitment to become excellent dermatologists, but because there are simply too few training positions to meet the growing interest in the specialty,” B.C.-based, board-certified dermatologist Dr. Harry Liu, who was the senior author on the study, told the Medical Post over email.Dr. Liu, who is also a clinical instructor in dermatology at the University of British Columbia Faculty of Medicine, says many of the medical students he mentors are “under constant stress” due to the competitiveness.“For first- and second-year students, simply gaining exposure to dermatology can be difficult because shadowing opportunities are limited. By the time students reach their third and fourth years, securing dermatology electives is highly competitive. Beyond clinical exposure, finding mentorship for research can also be challenging, as there are relatively limited number of academic dermatologists,” he said. A catch-22The overall shortage of dermatologists in Canada also means there aren’t enough of them to be instructors.“We need to have residency training programs that have capacity to absorb and train new residents. And that has to do with number of dermatologists being able to work within hospitals, and that's still very limited,” said Dr. Sapijaszko. “In practicality, we have a hard time attracting dermatologists to work within universities to be able to train future dermatologists. So, that's a significant issue.”As an instructor, Dr. Liu says he doesn’t have any protected time for education, making it more difficult to balance teaching alongside his busy clinical practice. He says he wants to see more protected time for teaching, more full-time academic dermatology positions and incentives that enable community dermatologists to participate in medical education.“There are relatively few full-time academic dermatology positions in Canada where teaching is a major component of a physician's role. At the same time, the majority of dermatologists practice in the community, where they are focused on providing patient care and managing increasingly high clinical volumes,” he said. “Expanding residency programs therefore requires more than simply creating additional residency positions.”But dermatology isn’t the only specialty competing for limited provincial dollars, and Dr. Sapijaszko says the jostling priorities in healthcare present “significant barriers to our advocacy.”“There's a competition for many physician groups, including cardiology, radiology, primary care, psychiatry, and so on. At the same time, we need to recognize that dermatology is one of the key areas that patients seek within primary care,” he said.“If the primary care is a focus of Canadian policymakers, the dermatology should be a significant part of that as well.”

‘It’s a travesty’: How a shortage of residency spots in dermatology is straining patient care

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