Physician Extenders Can Modestly Reduce Wait Times For a Dermatology Appointment Interview with:

Eliot N. Mostow, MD, MPH Professor & Chair, Dermatology Section Department of Internal Mediciine Northeast Ohio Medical University

Dr. Mostow

Eliot N. Mostow, MD, MPH
Professor & Chair, Dermatology Section
Department of Internal Mediciine
Northeast Ohio Medical University What is the background for this study? What are the main findings?

Response: The background for the study is my continued interest in what is sometimes called health services research. That is, how do we improve our ability to deliver optimal medical care from a healthcare system perspective? Simply put, one of the most frequent criticisms about getting a dermatologist to see if patient is that there are delays in scheduling (wait times are too high). I’m not sure this is really justified, as it seems to take a long time to get into psychiatrists, gynecologists, and other specialists in our community as well.

That being said, since I’m in the dermatology community and our community has been utilizing physician assistants and nurse practitioners more frequently for many years now, we thought it was worthwhile to explore whether this was having an impact on wait times to get a visit in a dermatologist’s office. What should clinicians and patients take away from your report?

Response: There are a couple of important points to take away from this article. One is that one third of dermatology offices in Ohio utilize what is sometimes described as a “physician extender”. Appointments to see these physician assistants or nurse practitioners can be had with less wait time. That being said, overall, offices that utilize extenders seem to have slightly reduced time to see the dermatologist, although that difference between offices that did not use the extender was not statistically significant (60 days versus 48 days).

The key point that I like to emphasize in any sort of research is whether there is a story to tell. I think the story here is that dermatologists are trying to address wait times by hiring and working with physician assistants and nurse practitioners. Perhaps it’s not working perfectly, but it seems to have significant benefits for patients and practices that have embraced the collaboration, hopefully working to make sure the quality of care always stays high with good communication and oversight. What recommendations do you have for future research as a result of this study?

Response: There are many more areas that could be addressed in similar and related research. Others have published models of the benefits of physician assistants and nurse practitioners to address what some see as a shortage of dermatologists. Other research into the benefits of telemedicine and enhanced education of primary care clinicians might serve important purposes as well, but proof of this could be addressed with research.

Finally, as a society, we don’t really have a perfect benchmark on the ideal and reasonable wait time. I think that someday will probably use a mix of telemedicine for better triage of those patients at greater risk and need for more urgent care, addressing certain problems with less frequent patient visits. Again, research is ideal to make sure that changes to the healthcare system are studied for both beneficial and adverse effects. Thank you for your contribution to the community.


Zurfley F, Mostow EN. Association Between the Use of a Physician Extender and Dermatology Appointment Wait Times in Ohio. JAMA Dermatol. Published online September 27, 2017. doi:10.1001/jamadermatol.2017.3394

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 

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Last Updated on November 1, 2017 by Marie Benz MD FAAD