Physician extenders help to combat shortage of practitioners in dermatology

Key Points

National report - Dermatologists are increasingly turning to "extenders" - physician assistants and nurse practitioners - to combat a shortage of doctors in the specialty. These mid-level providers and the physicians who hire them say teamwork and training are among the keys for successful collaborations.

Hiring extenders is a growing trend, says Karen E. Edison, M.D., chairwoman of the American Academy of Dermatology's workforce task force.

"We have seen a steady increase of the use of mid-level providers in the past five to 10 years," she says. "More than one-third of dermatology practices (now) include a mid-level provider."

Robert Greenberg, M.D., says that hiring two physician assistants has helped to bring down appointment wait times at his Vernon, Conn., practice. "We had more patients than we could accommodate in a timely fashion," he says. "Our appointments were getting stretched out three to six months."

Now, he says, the practice usually can accommodate patients with more serious skin issues the same or following day.

The PAs, according to Dr. Greenberg, are valuable team members, who are well qualified to care for patients with common, often straightforward, dermatologic conditions, such as warts and acne.

"Mid-level providers are able to spend time with patients; they're very well received by patients, and often establish their own patient following," he says.

The numbers

According to the American Academy of Physician Assistants, 83,466 PAs were in clinical practice as of 2010, including about 2,800 in dermatology practice. That figure may now be low, according to Keri Holyoak, PA-C, M.P.H., president of the Society of Dermatology Physician Assistants, which offers formal continuing medical education (see Priming, p. 20).

Median total earnings for PAs in dermatology at the national level in 2010 was $103,000, according to the AAPA 2010 Census Report.

A 2011 survey of nurse practitioners working full-time in dermatology indicated an annual income range of $51,000 to $325,000, with an average of $116,056, as reported by 89 respondents, according to the July/August 2011 newsletter of the Dermatology Nurses Association.