Advanced Practitioner Dermatology Training Program

[ddcg]

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Official website for the University of Miami Leonard M. Miller School of Medicine

med.miami.edu

This is scary, especially with independent practice.

 

[qwerty89]

lol they charge $50,000 for the year.

"Participants will observe patient care and will not have directly care for patients."

 

[scoopdaboop]

Bet the university was like “half of the money goes to you doc”.

 

[Slack3r]

Boomer greed knows no bounds.

I don’t know why I’m surprised, but this is ridiculous. An ACGME accredited program shouldn’t be able to demand a certain level of competence from the residents and turn around and “train” mid levels with a half assed shadowing experience to the tune of $50k “tuition”. Should email and complain to the ACGME, AADA, AAD, etc. Dinehardt got pushed out at AAD for trying to start a PA licensing board, not sure how this is all that different.

 

[dieABRdie]

"Participants will observe patient care and will not have directly care for patients."

At least not until they open their own derm clinic in south FL.....

 

[Dral]

So they will shadowing and likely attend lectures, journal club, grand rounds, etc. with residents that are already scheduled and in place....for $50k a year.

It would make some sense if the clinicians who they shadow are scheduled fewer patients so they can teach more. Hopefully that's how it works.

 

[PhillyMed777]

It’s very difficult to actually learn if you arnt “owning the patients” including forming your own plans, caring for your own inbox, doing all your own patient calls/call backs and follow ups

 

[Splenda88]

Medicine is being attacked on all sides.

How Private Equity Is Ruining American Health Care

Investors have been buying up doctor’s offices, cutting costs, and, critics say, putting pressure on physicians in ways that hurt patients. The pandemic could make things even worse.

www.bloomberg.com

 

[Skindoc83]

Boomer greed knows no bounds.

I don’t know why I’m surprised, but this is ridiculous. An ACGME accredited program shouldn’t be able to demand a certain level of competence from the residents and turn around and “train” mid levels with a half assed shadowing experience to the tune of $50k “tuition”. Should email and complain to the ACGME, AADA, AAD, etc. Dinehardt got pushed out at AAD for trying to start a PA licensing board, not sure how this is all that different.

Who do we report this to at the AAD?

 

[deleted941485]

In my area, The derm MDs dont even see patients anymore the PA sees them biopsies and refers.

 

[reno911]

What do the Derm MDs do in your area?

My guess would be some combination of Mohs, cosmetics, and reading dermpath.

 

[sylvanthus]

Check the EM forum for the future of all specialties. Were all gonna be in trouble down the road. No specialty is safe.

 

[ddcg]

The practice extenders have a hammer and everything is a nail and PE loves it!

 

[deleted941485]

My guess would be some combination of Mohs, cosmetics, and reading dermpath.

Also using their own superficial x-ray machines to treat skin cancers. The non mohs ones anyway.

 

[doctalaughs]

I once watched a dermpath friend read for a bit and it was insane what some of the PAs and NPs were sending to him. Like reams of specimens A through F in a single patient, all benign. I asked him about it and he was like “oh yeah, a lot of these mills send in like a 5% abnormal rate. They just biopsy a bunch of stuff randomly”

Not sure if that’s just to drive up reimbursement, or sheer incompetence— probably both. But its mutilating patients (and their finances). Sad.

I would say my benign to malignant ratio is probably 40/60 which is what it should be. And I’m counting mild/mod ATN in the benign category.

If you are like 1 in 20 — might as well be the janitor doing your biopsies.

 

[PhillyMed777]

I once watched a dermpath friend read for a bit and it was insane what some of the PAs and NPs were sending to him. Like reams of specimens A through F in a single patient, all benign. I asked him about it and he was like “oh yeah, a lot of these mills send in like a 5% abnormal rate. They just biopsy a bunch of stuff randomly”

Not sure if that’s just to drive up reimbursement, or sheer incompetence— probably both. But its mutilating patients (and their finances). Sad.

I would say my benign to malignant ratio is probably 40/60 which is what it should be. And I’m counting mild/mod ATN in the benign category.

If you are like 1 in 20 — might as well be the janitor doing your biopsies.

Spot on, the mid levels biopsy everything.

From my experiences at least, it’s incompetence and lack of confidence.

 

[Nilf]

I once watched a dermpath friend read for a bit and it was insane what some of the PAs and NPs were sending to him. Like reams of specimens A through F in a single patient, all benign. I asked him about it and he was like “oh yeah, a lot of these mills send in like a 5% abnormal rate. They just biopsy a bunch of stuff randomly”

Not sure if that’s just to drive up reimbursement, or sheer incompetence— probably both. But its mutilating patients (and their finances). Sad.

I would say my benign to malignant ratio is probably 40/60 which is what it should be. And I’m counting mild/mod ATN in the benign category.

If you are like 1 in 20 — might as well be the janitor doing your biopsies.

Not only PAs are way too trigger-happy with a blade, but the main problem is that their biopsies are much more likely to be nondiagnostic, and may prompt further work-up. This is how it works:

PA takes 3-6 biopsies of random stuff. Writes 'R/o malignancy' or 'nub' on everything (no pun intended). The biopsies tend to be small, superficial, fragmented and squished. Therefore oftentimes the final report includes some sort of hedge, like, 'deeper biopsy recomended', SCC cannot be ruled out etc. Which engenders a new visit, which generates more biopsies, billing etc. Oh and it also quadruples my work.

Yes it's very hard to escape the impression that the big derm mills do this for $$$.

 

[deleted941485]

Not only PAs are way too trigger-happy with a blade, but the main problem is that their biopsies are much more likely to be nondiagnostic, and may prompt further work-up. This is how it works:

PA takes 3-6 biopsies of random stuff. Writes 'R/o malignancy' or 'nub' on everything (no pun intended). The biopsies tend to be small, superficial, fragmented and squished. Therefore oftentimes the final report includes some sort of hedge, like, 'deeper biopsy recomended', SCC cannot be ruled out etc. Which engenders a new visit, which generates more biopsies, billing etc. Oh and it also quadruples my work.

Yes it's very hard to escape the impression that the big derm mills do this for $$$.

IF thats the way they are gonna do it then force the NP and the PA to train the ancillary staff to do it as well like the LPNs.

 

[sore eye asses]

We actually cut out the middle men and literally trained our janitor to do biopsies. He seemed very passionate at the opportunity to wield a blade, just like the PAs. Now we have sparkling toilets and plenty of fresh biopsies to keep investors happy.

 

[Kuratz]

Wow as a non-dermatologist that’s exactly what happened to my wife: saw PA (no MD ever) -> shave biopsy “indeterminate” -> punch biopsy “atypical cells” but also didn’t seem entirely diagnostic -> expensive huge whack to remove it.

This might be a cash cow now but the second CMS feels like they are spending too much aggregate $ on derm biopsies they will drive the rate down. Overutilization is bad in the medium to long run. Reimbursement for CT scans go down a hair every year despite increasing daily Rads requirements because everyone gets pan scanned and the government is obtuse and just looks at absolute numbers. I’d bet if this is a widespread practice you’ll see something similar in Derm. Awful, really

 

[ddcg]

And then there's the "Derm" NMDs...

Dr. Amy Duong

Naturopathic recommendations for eczema, acne and other inflammatory conditions. Holistic approach to cure eczema and achieve clear skin.

www.naturalskindr.com