Rise in physician extenders hasn't yet impacted workforce balance

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New York - Results from the American Academy of Dermatology Association (AADA) practice profile survey document relative stability in metrics of workforce balance but show signs of shifting sands, said Alexandra Boer Kimball, M.D., M.P.H., at the 2007 AADA Summer Meeting.

"We are seeing some profound changes in use of physician extenders, but without any significant impact on appointment wait times, productivity or physician hiring. However, the situation bears careful watching. Just because there have been no changes to date does not mean they cannot happen soon. There are a lot of people coming into our field, and that raises issues about supervision, training and competition that warrant our attention so that we maintain our identity," says Dr. Kimball, associate professor of dermatology, Harvard Medical School.

The survey

The increase in use of nonphysician clinicians was the most striking trend, and it is consistent with data from professional societies, says Dr. Kimball, who is also director, Clinical Unit for Research Trials in Skin, Massachusetts General and Brigham and Women's Hospitals, Boston.

"Between 2000 and 2004, the number of physician assistants in the dermatology workforce rose 49 percent, compared with an increase of only 2 percent for M.D.s and 9.2 percent for D.O.s," she explains.

In the AADA practice profile survey, 29 percent of respondents in 2005 reported employing either a nurse practitioner (NP) or physician assistant (PA), with 21 percent having one or more PAs and 10 percent having one or more NPs on staff. In 2002, only 15 percent of survey respondents had a PA and only 8 percent had an NP. The proportion of practices reporting an aesthetician on staff nearly doubled, from 10 percent in 2002 to 19 percent in 2005.

"There are significant shortages projected across all of medicine in the U.S., and we are at the tip of the iceberg in documenting that phenomenon earlier and being impacted by it earlier. A rapid growth in use of physician extenders is clearly occurring, due to rising patient demand and a low barrier to entry for these nonphysician clinicians, and it is likely this trend will continue at least in the short run," Dr. Kimball tells Dermatology Times.

However, the change in personnel did not seem to be impacting patient wait-times. The mean wait time for a new patient was 36 days in 2002 and had decreased by only two days to 34 days in 2005. Similarly, there were only slight decreases between 2002 and 2005 in the proportions of new patients waiting more than 30 days or more than 60 days for an appointment.

"An impact on reducing wait times would depend on a huge increase in the workforce, and there is a limit to how many extra personnel a physician is able to supervise," Dr. Kimball says.

In both 2002 and 2005, about one-third of practices were looking to hire one or more new associates. Compared with 2002, practices were spending longer in 2005 looking for a physician, 16 vs. 20 months. The mean wait time for a new patient appointment in both years was almost twofold longer for practices looking for a new associate compared with those that were not, but for both practice categories the mean wait time for a new patient appointment was similar, comparing the data from 2002 and 2005.

"These results show we have not met the demand in hiring, and the longer wait times in practices looking for a new associate is a testament to the internal validity of the data," Dr. Kimball says.

Practice patterns

Questions relating to practice work patterns showed, in 2005, dermatologists were seeing an average of 142 patients per week and an estimated 6,717 patients per year. Those numbers were up just slightly, compared to 2002. The number of hours worked per week remained stable at 32, as did the average number of weeks worked per year (47).