I was reading at throwaway journal when I came across this gem called the Elephant in the room of dermatology. It was written by Brett Coldiron MD who is a past-president of the American Academy of Dermatology. In the piece, Coldiron explains what rich dermatologists are doing to get richer:
- I have become increasingly dismayed by reports of dermatologists who allow their nurse practitioners and physician assistants to practice independently That is, the employing dermatologists only see the patients, new or established, if they are asked to, and often are not even on the premises. In fact, they might be thousands of miles away.
- When Congress authorized their independent payment in 1997, they envisioned primary care nurses traveling the hills, hollers, and inner cities improving health care. Unfortunately, this hasn’t happened, and instead they have moved into suburban America, and increasingly, are practicing specialty medicine.
- It can be argued that decreased access to primary care, which was the reason midlevels were created, is more important than is access to dermatology.
- There will be an estimated 10,000 “dermatology” nurse practitioners and physician assistants next year.
- We have nurse practitioners buying retiring dermatologists’ practices, physician assistants independently setting up remote clinics then hiring “supervising” dermatologists to visit once a week to sign and review charts, and independent “dermatology” clinics with a doctor thousands of miles away available, if really needed, by telephone or the Internet.
- These extenders are listed as dermatologists on the Internet, or they hide behind the name of a dermatologist, and when you call their offices, and ask if you will see a “real” dermatologist, the answer is often “Oh, don’t worry, our nurse or PA specializes in dermatology.”
- The “collaborating” dermatologists enabling these extenders are renting out the good name of our specialty.
- I think it is unfair to the medical system who pays for the less informed opinion and unnecessary procedures.
Wow. This guys puts it on the line and I am sure the other dermatologists are going to be pissed at him. Will it matter? I doubt it because he mentions that some dermatologists make $200,000 a year off their PA while they are not even there. $200K! Family docs don’t even smell this level of income.
I am glad he blasts his own people while also blasting the altruistic NP/PA orgs that were going to go into rural areas to improve access*. Many have and that’s great but who is criticizing that ones that haven’t? Why has this gone unnoticed?
Coldiron does mention checking the websites of your big dermatologist practices for the names of the extenders they employ. You can then go to the Medicare data and look up their extenders and see if they bill independently for dermatologic procedures. “I think you will be very disturbed”, he says.
*Yes, I am quite aware that all the militant NPs and PAs will attack me again for criticizing them here. How dare I? Meanwhile, I hammer doctors (dermatologists) in this blog entry and my own profession mercilessly in other ones but that goes unnoticed. So go ahead, spread it around (yeah, that means you Dave) to your sites so they can send hate email to me again. I am used to it and will delete it.