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Medicaid reimbursement below Medicare rates, combined with lower work relative value units for pediatric encounters, creates financial pressure that disproportionately affects academic centers serving publicly insured children. These barriers contribute to delayed specialty care, emergency department use, and geographic inequities. Sustainable payment parity, payer\u2010stratified access research, teledermatology, and coordinated professional advocacy are needed to improve equitable access.<\/jats:p>","DOI":"10.1111\/pde.70380","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:25:08Z","timestamp":1791415508000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Invisible Waiting Room: How Insurance Status Shapes the Pediatric Dermatology Access Crisis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3872-1415","authenticated-orcid":false,"given":"Maria Gnarra","family":"Buethe","sequence":"first","affiliation":[{"name":"Department of Dermatology University of California  Irvine California USA"},{"name":"Division of Dermatology Rady Children's Hospital Orange County  Orange California USA"},{"name":"Department of Pediatrics University of California  Irvine California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Society for Pediatric Dermatology Workforce Committee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2026.0120"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2025\u2010075749"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2012.09.040"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2024.01530"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2020.5173"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2022.3609"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.16044"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.70026"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2025.114604"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2022.4610"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.1912"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1413299"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010019\u201005160\u2010x"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.70232"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2016.0938"}],"container-title":["Pediatric Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pde.70380","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pde.70380","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pde.70380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:25:09Z","timestamp":1791415509000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pde.70380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":15,"alternative-id":["10.1111\/pde.70380"],"URL":"https:\/\/doi.org\/10.1111\/pde.70380","archive":["Portico"],"relation":{},"ISSN":["0736-8046","1525-1470"],"issn-type":[{"value":"0736-8046","type":"print"},{"value":"1525-1470","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"assertion":[{"value":"2026-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pde.70380"}}