Vancouver Island is short of dermatologists, and the Times Colonist reports the gap is widening because many specialists on the Island have switched their practices toward cosmetic procedures. The shift leaves patients with medical skin conditions — psoriasis, eczema, skin cancer and acne among them — facing longer waits for specialist care.

The core tension is economic and structural. Cosmetic dermatology runs on private payment, flexible scheduling and predictable clinic hours. Medical dermatology depends on provincial billing, high patient volumes and, in many cases, hospital or surgical time. When a dermatologist moves even part of a practice into aesthetics, the medical side of the schedule shrinks, and referral backlogs grow.

What does this mean for medical patients?

For Islanders, the practical consequence is access. Skin conditions that demand specialist input — moderate-to-severe psoriasis requiring systemic therapy, eczema that fails topical treatment, suspicious lesions needing excision and staging — can't be handled in a cosmetic clinic. The fewer physicians available for referred medical work, the longer the queue.

Skin cancer is the sharpest concern in any dermatologist shortage. Delayed assessment of a suspicious melanoma can mean a thicker tumour at diagnosis, and Breslow thickness at excision remains the single strongest prognostic factor. Access delays anywhere in that pathway carry real clinical cost.

Why the pull toward cosmetic work?

The Times Colonist framing points to a pattern familiar across Canadian and U.S. markets. Aesthetic services — neuromodulators, fillers, laser and energy-based treatments — generate revenue the fee schedule can't match, without hospital overhead or on-call obligations. For an individual physician, the switch is rational. Aggregated across a region as geographically constrained as Vancouver Island, it produces a medical-care deficit.

Island patients also can't easily offset the shortage by travelling. Ferry-dependent access to mainland specialists adds cost and delay to every referral, which raises the stakes of retaining medical dermatologists locally.

What comes next?

Recruitment, retention incentives and expanded roles for nurse practitioners and family physicians in skin-care pathways are the standard levers health authorities reach for in regions with this profile. Whether British Columbia deploys them fast enough to keep medical dermatology viable on the Island will determine whether this shortage becomes a chronic access gap.