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")

And then you have the ARNP, and schools who are speedrunning people from the street into ARNPs. Oh, you need an RN? We'll have you in our "Accelerated RN" course, getting your RN in parallel with other studies.

In some places, it is possible to go from high school to ARNP within 6 years.

And while supervision requirements for PAs might vary in terms of actual oversight, ARNPs are ostensibly fully fledged independent providers.

And I'll also say that you see the same pre-hospital too. In the PNW, while there are valid criticisms that can be leveled against two of the pre-eminent paramedic programs (Harborview, and Tacoma Community), there are far, far, too many "strip mall schools" in other states that will take you from "zero to hero" in 4 or 5 months (of 6 days a week, 8 hours a day, of just class time), and dump you out on the world with just enough retained knowledge to pass your NREMT and the barest amount of ride time to meet DOT mandated minimums. It's scary, to be blunt. These people go out with no clinical experience and are now expected not just to work as a team on a 911 call, but to lead it.