Seven years after the government was warned of a shortage of dermatologists in the public sector, health workers say the situation is now beyond crisis point.
Some district health boards don't have a dermatologist meaning those with chronic skin issues are having to travel a long way for treatment or in some cases are simply going without.
The Dermatology Workforce Service Forecast which was published in 2014 said the vision for 2020 would be that patients would have equitable access to an integrated consultant-led service that delivered high quality health care.
Dr Paul Jarrett who is the New Zealand Dermatological Society's immediate past president said that's not happening.
"It's hard to say what the exact figures are but there are only about 18 full time equivalent dermatologists working in the public sector."
At the time of the 2014 report there were 16 full time equivalent specialists - meaning there has only been an increase of two in the last seven years.
Dr Jarrett who has worked in public service for 20 years said young doctors coming through training want to work for DHBs but there's simply not enough jobs so they move into private practice.
"It's astonishing that we do not have a funded and effective public dermatology service, fundamentally nothing has changed in the last 20 years. New Zealand is a first world country with a third world level of care.
"I hear of children who don't go to school for months at a time because their skin is so bad and even patients who have had to travel from the South Island to the North Island because there is no dermatologist in their area," Dr Jarrett said.
He said an international benchmark for adequate care is about one dermatologist per 80,000 people - but estimates in this country there is one specialist for about 270,000 people.
Northland DHB doesn't have a dermatologist and outsources services to a private provider.
Canterbury District Health Board has one full time equivalent (FTE) and one part-time dermatologist on fixed term contracts.
It budgets for 3.5 FTE dermatologists and said it is recruiting to boost capacity, Hutt Valley and Capital and Coast DHBs have two part-time dermatologists and like the CDHB, they are recruiting for two dermatology roles.
Dr Jarrett said the 2014 report was thorough and showed how the system could work but nothing had been done.
"There is a dawning recognition that there is a crisis in the funding and provision of public dermatology. I don't know how long a crisis can go on for but this has been ongoing for years."
He said dermatologists deal with skin diseases including cancer, psoriasis and eczema which can have severe effects on people's lives.
The government needed to take a high-level approach and enact the Health Workforce NZ report, he said.
Association of Salaried Medical Specialists executive director Sarah Dalton said the needs of the community were increasing but the workforce was not keeping up.
"Working in public I think is the most demanding work that they do and certainly the most rewarding, but what bothers us, based on our recent burn-out findings, is that the stresses and frustrations are starting to outweigh the satisfaction so that's a real concern for us, especially in small specialities like dermatology.
"It takes a long time to train a dermatologist. It is a very complex speciality and we are in no way keeping up with training of the consultant dermatologists we do have. There aren't enough of them to run training programmes all around the country so training opportunities for junior doctors are limited," Dalton said.
Shortage part of 'crisis' in cancer care - Dr Chris Jackson
New Zealand has some of the highest rates of melanoma in the world.
Cancer Society medical director and oncologist Dr Chris Jackson said the lack of dermatologists is part of a wider shortage of specialists in cancer care.
"We know there is a looming crisis in the provision of cancer care coming. There's going to be a 50 percent increase in the number of people affected by cancer over the next 15 years.
"The issues in dermatology are repeated in just about every speciality involved with diagnosing and treating cancer in our public health system and unless we have a thoughtful and systematic approach to how we plan and deliver our workforce needs, then we are going to hit a cliff in terms of cancer delivery in the next 10 years," Dr Jackson said.
The Ministry of Health acknowledged it needed to increase the number of dermatologists, stating that one of the obstacles to increasing the workforce is the number of dermatologists who work in the private sector.
"The Ministry of Health has held several meetings recently with representatives from the dermatology sector including senior dermatologists and primary care. We will be engaging directly with them to embark on a co-design process for future focused models of care
"We have also discussed the role that other health professionals in primary care - including GPs and pharmacists - can play in providing dermatological care," a ministry spokesperson said.