Originally Posted by vicinihil
The PA"s and NP's I've seen in academic derm offices have mainly been allowed to see wound care, routine skin checks, med checks, and other very very basic and mundane dermatology. Anything that makes even 1 hair stand on end requires a real dermatologist. Maybe this is just what I've observed?
That has been my experience as well.
Out of all the academic programs I've seen (med school home dept, 2 away rotations, intern year derm rotation, and my current residency program) only one place employed any midlevels. In that case, the PA only saw routine postop wound checks in the Mohs clinic, a task which I consider to be appropriate for midlevels.
Originally Posted by Dermpath
Sadly, I don't think that most midlevels really are doing much to keep the field alive. Just like in anesthesia, they are gaining ground, and now even have their own cosmetic practices as well. I don't think it will be long before they are able to independently see patients. In reality, most midlevels see patients on their own now with little to no MD involvement. When a field says well a nurse can do the same job I do for a lot less, you are in trouble. Look at what's happening in anesthesia.
I don't think that issue is unique to dermatology and anesthesia. Almost any field that involves clinic has room for midlevel encroachment on basic, "bread & butter" type cases.
That said, in all honestly, I'm not sure ANY physicians need to lose sleep over being "replaced" by midlevels. Based on the kinds of referrals we get from local private practice PAs/NPs, the knowledge deficit is pretty evident, especially when any case veers away from basic, primary-care level dermatology (for example, referral for "AKs not responding to Efudex," when in reality patient has obvious immunobullous disease).