The American Academy of Physician Assistants (AAPA) and the Society of Dermatology PAs (SDPA) have issued a response to an article published in JAMA Dermatology.

The authors of the study, titled “Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared with Dermatologists in a Large Health Care System,” concluded that PAs are less accurate when diagnosing melanoma compared with dermatologists.

In a response to this study, the AAPA and SDPA listed components of the analysis that they believe led to flaws and overall inaccurate results. The first issue noted is the use of number needed to biopsy (NNB), a diagnostic tool used in the study to measure accuracy, which the AAPA writes is “controversial even among dermatologists.”

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The other listed concerns include the small sample size in the clinical trial (15 PAs and 15 dermatologists), the number of years of experience between PAs and dermatologists, patience preference, and the comprehension of PA–physician relationships.

The study isolates both clinical roles as individual entities, according to the joint statement. Furthermore, “the physician is liable for the care that the PA provides. Therefore, in the data, there is no way to fully separate the decision making of the PA from the decision making of the physician,” the AAPA and SDPA wrote.

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The response ends with a note from Jane Mast, PA-C, MPAS, president of SDPA who stated, “There is a wealth of research that highlights improved patient outcomes form the high-quality care that PAs provided… But this flawed study, which would have benefited from PA involvement, does the practice of dermatology—and dermatology patients—a disservice.”



JAMA Dermatology study fundamentally flawed: AAPA and SDPA respond to April 18 article. AAPA. URL: Accessed: May 16, 2018

Original article:

Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK. Accuracy of skin cancer diagnosis by physician assistants compared with dermatologists in a large health care system. [published online April 18, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.0212