Canadians seeking medical dermatology care face months-long waits, while cosmetic procedures like Botox are readily available within days or weeks. This two-tiered system is creating a public health crisis, with more than 80,000 Canadians diagnosed with skin cancer annually struggling to access timely specialist care.

Why Are Dermatology Wait Times So Long in Canada?

The root cause is a severe shortage of dermatologists. Canada currently has approximately 800 dermatologists practicing, which equals 1.9 specialists per 100,000 people on average. According to the Canadian Dermatology Association (CDA), the country is short about 460 dermatologists and will need another 465 by 2033 to meet demand from an aging population and replace retiring physicians.

The shortage is compounded by limited training capacity. In 2023, there were only 29 first-year residency positions available across Canada for dermatology, a bottleneck that prevents the profession from expanding quickly enough to meet patient needs.

When CBC News called dermatology clinics in Toronto, Windsor, and Edmonton, the disparity was stark. Botox appointments were available within a day or a few weeks, while medical appointments for skin checks and mole removals had reached full capacity or required waits of at least a month for referral processing, followed by another three weeks for the actual appointment.

How Does the Financial Incentive Drive Dermatologists Away From Medical Care?

The shift toward cosmetic procedures is driven by economics. Dermatologists receive approximately $80 to $90 for medical appointments with referrals, while cosmetic consultations start at $200 to $400. This financial gap creates pressure, especially for physicians managing overhead costs and facing burnout.

"A large percentage of our membership are just trying to survive economically in the system that we live in. And so supplementing their medical work with cosmetic work is very common," said Dr. Mark Kirchhof, president of the Canadian Dermatology Association.

Dr. Mark Kirchhof, President of the Canadian Dermatology Association

Based on member surveys, Kirchhof noted that while a majority of CDA members still practice medical dermatology, approximately 30 to 40 percent dedicate a large portion of their practices to cosmetics. Some dermatologists also charge fees for virtual services that provide faster access to diagnosis and treatment of conditions like acne and rosacea, further fragmenting the public system.

This exodus from public medicine to private, for-profit care raises ethical concerns. Dermatologists receive taxpayer-funded training with the expectation they will serve their communities, yet some transition entirely to cosmetic work. Kirchhof called for outdated provincial fee schedules to increase, arguing that better compensation for medical work is essential to keep dermatologists engaged in public care.

What Are the Real Consequences for Patients?

The delays can be life-threatening. Carole McArthur, a 67-year-old from Ottawa, noticed a concerning spot on her face in 2022 but waited eight months to see a dermatologist. By the time she was diagnosed with basal cell carcinoma, the most common type of skin cancer, the cancer had grown significantly. She required multiple layers of skin removed from her face, losing part of her cheek and cartilage in her nose.

"I feel like they are throwing me away and I don't matter," McArthur said, reflecting on her experience and her concerns about future recurrence monitoring.

Dr. Andrew Simone, a Toronto dermatologist who opens his clinic at 4 a.m. on Saturdays to accommodate patients without requiring referrals, has witnessed the human cost of delays. He has treated patients from different provinces who traveled to his clinic specifically to avoid months-long waits elsewhere. "You have to understand the anxiety when a doctor says, 'I think this is serious cancer.' I don't think any human would want to wait four months," Simone explained.

How to Build a Skin Care Routine That Supports Skin Health

While access to dermatologists remains challenging, understanding proper skin care can help prevent some conditions and catch problems early. Dermatologists recommend starting with essentials and adding targeted treatments based on individual needs.

• Gentle Cleansing: Use a mild cleanser once or twice daily. Over-washing or using harsh scrubs can irritate the skin barrier and worsen conditions like acne and eczema, even though acne is not caused by poor hygiene alone.
• Daily Moisturizing: All skin types, including oily skin, benefit from moisturizer. Skipping this step can leave the skin barrier compromised and may encourage use of harsher products that increase redness and flaking.
• Broad-Spectrum Sunscreen: Apply daily sunscreen year-round, not just at the beach. Ultraviolet radiation reaches the skin on cloudy days and during routine activities like driving or sitting near windows, contributing to premature aging, dark spots, and skin cancer risk.
• Introduce Active Ingredients Slowly: If using retinoids, exfoliating acids, or acne treatments, introduce one product at a time over one to two weeks. This approach makes it easier to identify what helps and what causes irritation.
• Patch Test New Products: Apply a small amount to a discreet area like behind the ear for several days before broader use to catch obvious irritation early.

Which Skin Care Ingredients Help, and Which Can Irritate?

Dermatologists recommend focusing on ingredients with strong evidence of safety and efficacy. Helpful ingredients that support skin health include ceramides, glycerin, hyaluronic acid, niacinamide, and broad-spectrum sunscreen filters. These work by hydrating the skin, supporting the skin barrier, and protecting against ultraviolet damage.

Other targeted ingredients may address specific concerns. Retinoids help with acne, texture, and signs of aging; salicylic acid can help oily or acne-prone skin by unclogging pores; azelaic acid may help with acne and redness; and vitamin C is an antioxidant that may brighten uneven tone.

However, many effective ingredients can irritate if introduced too quickly or used too often. Common irritants include fragrance, essential oils, alcohol-heavy formulas, strong exfoliating acids, scrubs with rough particles, benzoyl peroxide, and higher-strength retinoids. "Natural" does not automatically mean gentle; plant extracts and essential oils can trigger allergic reactions and contact dermatitis in sensitive individuals.

Signs of true irritation include burning, persistent stinging, new redness, peeling, swelling, itching, or a rash. If these symptoms are pronounced or continue despite stopping the product, medical evaluation is important, as some people may be experiencing allergic contact dermatitis or underlying conditions like eczema that require professional assessment.

What Common Skin Care Myths Are Misleading Patients?

Several widespread beliefs can lead people to use ineffective or harmful practices. One major myth is that oily skin should be dried out completely. In reality, oily skin still needs moisture support; skipping moisturizer can leave the skin barrier uncomfortable and may encourage harsher products that worsen irritation.

Another misconception is that acne results solely from poor hygiene. Acne develops through a combination of oil production, clogged pores, inflammation, and hormones. Over-washing the face or using strong scrubs can actually irritate the skin and worsen breakouts by damaging the skin barrier.

Price is also not a reliable indicator of effectiveness. Many affordable cleansers, moisturizers, and sunscreens contain ingredients that dermatologists commonly recommend. What matters most is whether a product contains useful ingredients in a suitable formula and whether the person can use it regularly without irritation.

Finally, the myth that pores can "open" and "close" is misleading. Pores do not have muscles that allow them to open or close. They may appear more noticeable when filled with oil or debris, and they may look less visible after cleansing or exfoliation, but warm water does not literally open them.

For persistent acne, rashes, eczema, unusual pigmentation, non-healing sores, or changing moles, professional medical evaluation is essential rather than continued home experimentation. As Canada's dermatology shortage continues, early detection and prevention through proper skin care become even more critical.