Dermatologists and PA's

[meanderson]

When patients with moderate acne have a dermatology appt in my area, it is not uncommon for the PA to handle the entire office visit(1-3 mins) and write the script without the patient even seeing the dermatologist. Why would a patient make an appointment with a derm office at all in this case? The whole point of making an appt with a derm to treat moderate acne instead of a FP is that the derm. might catch something in the type and pattern of acne that leads to a slightly different medication. The FP could have a written a script for minocycline just as well as the PA can, so why would patients go through the trouble of trying to get a derm appt(sometimes a long wait) when they could just swing by their fp the next day?

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[eddieberetta]

Because patients don't know that is going to happen to them when they go to the dermatologist office! And, if all goes well, they wont know it happened after they leave the office either.

 

[Sophie]

After that initial visit, I hope the patient would complain or just not go again. That's negligent on the part of the Dermatologist... unless you live in a remote area where there's only one Dermatologist and he/she just can't handle the volume of patients and has to choose the most serious cases.

How would a patient not know they had seen a PA instead of a doctor? Every doctor's visit I go to I check their info badge.

 

[ny skindoc]

The use of PAs and physician extenders is common in many types of medical practices and patients are increasingly getting used to them.As Dermatologists have put more focus on surgical and cosmetic types of procedures,routine acne follow up visits often go to PAs or nurse practitioners.Most acne in the US is in fact treated by FPs but alot of them dont want to deal with derm problems.An experienced PA who is seeing all sorts of acne cases everyday under supervision,and is familiar with many types of acne meds, is doing cyst injections,removal of comedones etc is going to be better at it than a primary care doc who sees it as a hassle.The Dermatologist gets called into the exam room for more complex problems and evaluations.Derms who have large HMO practices commonly use assistants in this manner.

 

[eddieberetta]

Originally posted by ny skindoc
An experienced PA who is seeing all sorts of acne cases everyday under supervision,and is familiar with many types of acne meds, is doing cyst injections,removal of comedones etc is going to be better at it than a primary care doc who sees it as a hassle.

Well perhaps, but I hardly consider it "supervision" when the mid-level provider is seeing a patient, diagnosing the problem and providing/prescribing a treatment -- all while the dermatologist is in the other room -- But this is rapidly becoming standard.

However it will work itself out. If this practice continues, dermatologists will no longer be paid to supervise the mid-levels (as with CRNAs); perhaps they will have to be "consulted" on an as-needed basis as determined by the mid-level. Who knows where it will end... maybe they will not be paid for routine procedures that can be done cheaper by someone else.

I know this sounds gloomy, but as with many other specialties that are in this position, the argument will be made that you do not need to be an "MD" in order to handle 90% of skin problems... you just need to know about skin stuff. And for that other 10%, you can consult someone. It's a slippery slope, and one that we as doctors are not handling well. No one seems to care about providing the best quality care to the patient!

 

[ny skindoc]

Good points you make,but the payments from HMOs are often so low for a routine visit it does not pay for the physician to be rendering certain types of services.In the days of "fee for service" medicine,Dermatologists saw every patient and there was no need of PAs.