PAs Do More Biopsies, Find Less Early Melanoma than Dermatologists

MedicalResearch.com Interview with:

Laura Korb Ferris, MD, PhD Associate Professor, University of Pittsburgh Clinical and Translational Science Institute Director of Clinical Trials, Department of Dermatology University of Pittsburgh Medical Center

Dr. Laura K. Ferris

Laura K. Ferris MD, PhD
Associate Professor, University of Pittsburgh Clinical and Translational Science Institute
Director of Clinical Trials, UPMC Department of Dermatology
University of Pittsburgh

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Dermatology is one of the greatest utilizers of physician extenders, including physician assistants (PAs) in medicine. The scope of practice of PAs has also expanded over time from a role in assisting the dermatologist to taking a more independent role and many PAs now do skin cancer screening examinations and make independent decisions about which lesions are suspicious for skin cancer and need to be biopsied.

Our main findings were that, overall, in comparison to board-certified dermatologists, PAs were more likely to perform biopsies of benign lesions. For every melanoma that they found, PAs biopsied 39 benign lesions whereas dermatologists biopsied 25.

In addition, PAs were less likely than dermatologists to diagnose melanoma in situ, the earliest and most curable, but also hardest to identify and diagnose, form of melanoma. However, PAs had a similar rate of diagnosing the more clinically-obvious forms of skin cancer, including invasive melanoma, basal cell carcinoma, and squamous cell carcinoma.

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Nonphysician Clinicians Provide Wide Variety of Dermatology Services To Medicare Patients

MedicalResearch.com Interview with:

Adewole Adamson, MD, MPP Department of Dermatology UNC – Chapel Hill North Carolina

Dr. Adamson

Adewole Adamson, MD, MPP
Department of Dermatology
UNC – Chapel Hill North Carolina 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nurses practitioners and physician assistants, collectively known as non-physician clinicians (NPCs), provide many dermatology services, some which are billed for independently. Little is known about the types of these services provided. Even less is known about where these independently billed services are provided. Given that there is a purported shortage of dermatologists in the United States (US),  NPCs have been suggested as way to fill in the gap.

In this study, we found that NPCs independently billed for many different types of dermatology associated procedures, including surgical treatment of skin cancer, flaps, grafts, and billing for pathology. Most of these NPCs worked with dermatologists. Much like dermatologists, NPCs were unevenly distributed across the US, concentrating mostly in non-rural areas.

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Physicians, PAs and Nurse Practitioners Provide Similar Amount of Low Value Care

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Division of General Internal Medicine and Health Services Research Department of Medicine, Ronald Reagan UCLA Medical Center Los Angeles, CA

Dr. John N. Mafi

John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.

We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.

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