Physician Assistants Help Fill Provider Gaps in Dermatology


ST. LOUIS — Physician assistants are playing an increasingly large role in dermatology practices, providing both direct patient care and ancillary services that free the dermatologist to see more patients.

"Over the past 2 decades, we've seen substantial growth in the number of patients seeking dermatology care, but at the same time, the number of residents entering derm training programs has remained stagnant," Emily P. Tierney, M.D., said at the annual meeting of the Society of Investigational Dermatology. "PAs and [nurse-practitioners] have been well-poised to take advantage of these opportunities, as they are able to move into a dermatology practice and with a couple of months of on-the-job training, see patients with limited physician supervision."

Dermatologists have been struggling for several years with their workloads, Dr. Tierney said. A 2004 study noted that one-third of practices were seeking one or more new associates, and of that group, one-third were seeking two or more new associates.

A 2002 study noted the impact these vacancies have on patient care. "The patient waiting time [for an appointment] was 53 days for dermatology practices with vacancies, compared to 28 days for those without vacancies—and the mean time to filling those vacancies was about 16 months."

PAs have been particularly useful in easing these provider shortages, said Dr. Tierney of Brigham and Women's Hospital, Boston. "They are popular because they are highly cost effective and work with dermatologists in a cooperative environment, where they are not competitors." The number of PAs in dermatology has increased by 49% over the past 2 years, while the number of medical doctors in dermatology has increased by only 2%. In 1993, there were only 6 PAs in dermatology practices; in 2004, there were more than 1,600.

"In 2003, PAs saw 2.9 million dermatology patients each year. That is equivalent to 1 in every 32 visits." PAs are seeing an average of 22 patients per day, compared with 35–40 patients per day seen by dermatologists, she said.

The 2002 Dermatology Practice Profile Survey by the American Academy of Dermatology concluded that large and multispecialty practices are most likely to use a PA as a physician extender. More than 51% of dermatologists in these practices reported using PAs, while only about 35% of private solo practices or small groups employed them

These different practices also used PAs in different ways, Dr. Tierney said. "In larger practices, over 90% of the PAs are used to evaluate and treat medical dermatology patients. In the smaller practices, their primary function seems to be assisting with cosmetics, and ancillary and administrative duties, thus allowing the physician to see more patients."

The survey also contained information about another interesting trend, she said. Dermatologists are performing more and more cosmetic procedures in the office, and those who spend a lot of time on cosmetics are much more likely to hire a PA or NP.

"Among dermatologists who do 10 or more hours a week of cosmetics, 74% had a PA or NP, compared with only 26% of those who do less than 10 hours per week of cosmetics," Dr. Tierney said.

The number of noncosmetic procedures, like Mohs' surgery, wasn't affected by the presence of a physician extender, however.

"This implies that the physician extender is actually doing the cosmetic procedure, or that having one allows the dermatologist to leverage other treatments to the extender, so the physician can focus on the cosmetics," she said.

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