Dermatology physician assistants' ranks, responsibilities grow

Key Points

Mid-level caregivers are taking on an ever-larger role in dermatologic care.

According to professional organizations, about 11,500 board-certified dermatologists practice in the United States. In addition, there are about 3,000 dermatology physician assistants and 1,650 nurse practitioners working in dermatology offices - or the equivalent of about one mid-level dermatological caregiver for every 2.5 dermatologists.

Some dermatologists say they like to keep tight control over what their physician extenders are doing, but they acknowledge that the longer they work with their assistants, the more confident they become in these mid-level providers' abilities.

Opinion expands

Robert K.P. Chow, M.D., is an 11-year practitioner with a solo practice in Burien, Wash. He's added two physician extenders in recent years, and he acknowledges that working with them has expanded his opinion of what they can do.

"Before they joined me, it took longer to get in, and every day meant trying to fit people in, running overtime, and staying very, very late," he says.

Dr. Chow admits he didn't expect the extenders to handle as much as they do.

Dr. Chow says his nurse practitioner has been with the practice longer, but has less experience. "She does biopsies, but not procedures, unless they're very simple; whereas my PA, who has 10 years of dermatology experience, is capable of doing most everything I do, including excisional surgeries," he says.

"As long as that degree of supervision takes place, I'm OK with it."

Dr. Chow offers his definition of supervision.

"I'm always available for, and they are constantly reminded, that if there's anything they aren't sure of," the practitioners should check with him, he says. "I would rather fall behind by a few minutes than have something happen."