How dermatology became the 'it' job in medicine

When my primary care doc referred me to a dermatologist for a suspicious mole, I could not find an actual dermatologist who would see me in less than ~8 months. I ended up seeing a physician's assistant, which I'm still uneasy about since there's been a study that shows that PA's seem to have a lower success rate vs. doctors [1], and the educational requirements are very different for PAs.

As a layperson, it seems like we (patients / society) would benefit from having more doctors, i.e. opening up more residency slots and admitting more people to med school, but there's probably a lot I don't understand about the issue. Not sure if it's a lack of political willpower to do this, or if there are other reasons why the number of doctors we train is so restricted.

[1] https://pubmed.ncbi.nlm.nih.gov/29710082/ ("PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists")

(Pretty familiar with PA's.)

Biopsy stats might differ because PA's are used in large (cough private equity) practices to do a lot of checks esp. in old-folks homes, and medicare pays. Patients per week can average 120+; no doctor does that. Plus, the PA is supposed to err on the side of caution, meaning more biopsies. DR's are more willing to ignore possible risks.

That said, most anyone (Dr. or PA) who is recently trained at a good school is often better than people with 15+ years of experience.

Also, derm exam skills are not enhanced by the depth of medical education or even much by experience (by contrast to the cardio exam). It's mostly a function of pattern recognition and patient skills.