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Pediatric dermatology is a critical yet underserved specialty. Substantial disparities exist in access to care for children with skin conditions. Understanding these disparities is essential for improving outcomes and addressing barriers to care. Objective To evaluate appointment access and wait times for pediatric patients presenting to general and pediatric dermatology clinics with common childhood skin conditions. Design Cross-sectional mystery caller study. Setting Physicians were contacted across 30 states during standard working hours over one week in October 2024, representing a mix of general and pediatric dermatologists. Participants A total of 374 unique board-certified dermatologists identified from the American Academy of Dermatology and Society for Pediatric Dermatology patient-facing databases were contacted. Main Outcomes and Measures The primary outcomes were the number of business days until the first available appointment and the proportion of general dermatologists accepting pediatric patients. Secondary outcomes included wait time differences by city, physician demographics, and factors influencing the acceptance of pediatric patients. Results Of 585 phone calls made, 363 (62%) were successfully connected. General dermatologists were significantly less likely to accept pediatric patients (57.7%) than pediatric dermatologists (p<0.01). Private practice settings were associated with shorter wait times (IRR: 0.68, 95% CI: 0.62–0.75, p < 0.001) compared to university settings, and city-specific factors accounted for 28% of the variability in wait times. Pediatric dermatologists had a significantly longer median wait time of 89 days compared to 53 days for general dermatologists (IRR: 1.68, 95% CI: 1.60–1.70, p < 0.01). City-specific differences were substantial, with median wait times for general dermatologists ranging from 21 to 78 days and for pediatric dermatologists from 45 to 123 days. Pediatric dermatologists’ wait times were up to 80% longer than those for general dermatologists. Conclusions and Relevance Children with skin conditions face significant disparities in access to dermatologic care. These disparities are characterized by prolonged wait times and the limited availability of general dermatologists accepting pediatric patients. These findings underscore the urgent need for targeted interventions, including improved residency training and expanded teledermatology services, reducing barriers and ensuring timely care for pediatric patients.