As the dermatology workforce welcomes the next class of graduating residents, I thought this would be a perfect time to address the issue of “the shortage of dermatologists.” Much has been written about the shortage of physicians in both the medical and popular press. Most recently, Kimball and colleagues outlined the shortage of academic dermatologists in particular.1 A more generalized shortage of dermatologists was outlined by Resneck and Kimball in 2004. This study concluded that “there is an inadequate supply of dermatologists to meet the demand for services.”2 A Less Productive Workforce?A recent Los Angeles Times article presented a story of a patient with a previous history of “skin cancer” who had to wait 2 months to see a dermatologist for “worrisome lesions” (which thankfully turned out to be benign).3 This article pointed out that younger physicians, male and female, are less likely to work the “slavish” hours typical for physicians. Therefore, according to this source, future physicians are expected to be 10% less productive than our predecessors.Practicing Defensive MedicineAside from lifestyle issues, such as family life, there are several reasons, I believe, why many physicians choose to work less or switch to another profession altogether. More and more, physicians are forced to practice “defensive” medicine. Ideally, we cannot and should not allow medical-legal problems to change our practice habits. But having finished medical school in Philadelphia, a city with a real medical malpractice crisis, this is easier said than done! This issue certainly influences all physicians, young and seasoned alike.Physicians may also feel like they are not in control of their patients’ care due to the ever-increasing influence insurance companies have on the way we treat our patients. From prior authorization forms to payment denials for medically necessary services, the endless amount of paperwork we deal with is overwhelming at best. Hence, physicians spend more time on paperwork and less time taking care of their patients. Moreover, physicians who take care of complicated patients are not reimbursed as well as those who have a more procedural practice. This certainly contributes to a shortage of purely medical dermatologists.A Bright FutureWhile it is possible for me to believe that there simply are not enough physicians to take care of our aging society, it is difficult for me to believe that the fellow residents I’ve been privileged to meet during the past 3 years will be less productive than the previous generation of dermatologists. The fellow dermatology residents I’ve met are extremely intelligent, energetic, caring, compassionate and productive — based on these qualities, the future of our specialty is extremely bright. We do, however, need to address the issues I outlined above, as well as others, such as improving access to healthcare for all members of our society, decreasing the cost of medical care, and encouraging patients to be more responsible for their own health and well being.