Are PAs and NPs undergoing enough dermatologic training?

NPs and PAs are independently performing 2.6 million dermatologic procedures in the United States.

Are PAs and NPs undergoing enough dermatologic training?
Are PAs and NPs undergoing enough dermatologic training?

Almost 30% of dermatologists report using a nurse practitioner or physician assistant within their practices, a 40% increase over the prior five years, according to an editorial by H. Ray Jalian, MD, of the University of California, Los Angeles, and colleagues in JAMA Dermatology.

Of the 5 million procedures performed independently by nurse practitioners and physician assistants, 2.6 million were dermatologic procedures. The most common procedures performed were the destruction of premalignant lesions and biopsy of a single lesion, procedures that are “facing challenge by CMS with the concern of overutilization by physicians,” according to Jalian.

Dermatologists complete nearly 10,000 hours of clinical training throughout a three-year residency compared with the 500 to 900 hours of clinical training required of NPs and PAs.

“While the AAD [American Academy of Dermatology] has recommendations regarding the training of non-physician providers, there are neither specific training guidelines nor examination processes to verify the qualifications of said providers,” wrote the authors.

Many nurse practitioners and physician assistants who practice dermatology are trained by a supervising physician, although “there are neither specific training guidelines nor examination processes to verify the qualifications of said providers," according to Jalian.

The AAD released its own position statement on the topic stating, “at certain times, and under the supervision of a board-certified dermatologist, the practice of dermatology requires a team approach and may include other providers.”

In contrast, the American Board of Dermatology enforces a thorough process for dermatologic trainees involving evaluations, procedure logs, and a comprehensive board exam. “Perhaps a more comprehensive approach would hold all providers who practice and bill independently to the same standard,” wrote the authors.

“This would be a great way to step forward in standardizing the quality of care delivered to dermatologic patients.”

References

  1. Jalian H et al. JAMA Dermatology. 2014; doi: 10.1001/jamadermatol.2014.1922
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