Can path-trained dermatopathologists function as dermatologists as well?

[imsobadatpickingnames]

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Let's say a pathologist went on to do a dermatopathology fellowship, could said dermatopathologist function as a dermatologist as well? For example, could they do their own biopsies, skin cancer screenings, get patient interaction, etc.?

 

[asmallchild]

Let's say a pathologist went on to do a dermatopathology fellowship, could said dermatopathologist function as a dermatologist as well? For example, could they do their own biopsies, skin cancer screenings, get patient interaction, etc.?

no they still will not have clinical derm training

 

[imsobadatpickingnames]

no they still will not have clinical derm training

That's basically what I thought, but I have heard several students say that this is their plan. Can dermpaths work in derm offices and have limited patient interaction (not the full scope of dermatology)?

 

[doctalaughs]

That's basically what I thought, but I have heard several students say that this is their plan. Can dermpaths work in derm offices and have limited patient interaction (not the full scope of dermatology)?

I don’t think you are understanding.... can a heme/path trained pathologist go practice heme/onc in an oncology clinic? What if they only administer some chemo but not all of it?

 

[asmallchild]

That's basically what I thought, but I have heard several students say that this is their plan. Can dermpaths work in derm offices and have limited patient interaction (not the full scope of dermatology)?

no, dermpath is not a back door entrance into dermatology

those students are wrong (and lazy)

 

[imsobadatpickingnames]

I don’t think you are understanding.... can a heme/path trained pathologist go practice heme/onc in an oncology clinic? What if they only administer some chemo but not all of it?

Well the reason I'm asking is because I don't know. I'd never even heard of dermatopathology until I heard fellow classmates talking about it. I know there are derm NPs who do some dermatology (usually acne), but of course they can't do the full scope of what a real dermatologist can do. I was wondering if dermpaths could have a similar role in a derm office. Like performing their own biopsies. I'm personally more interested in plastics, but I was curious because I've heard many people say this is their plan and it confused me.

 

[werd]

Well the reason I'm asking is because I don't know. I'd never even heard of dermatopathology until I heard fellow classmates talking about it. I know there are derm NPs who do some dermatology (usually acne), but of course they can't do the full scope of what a real dermatologist can do. I was wondering if dermpaths could have a similar role in a derm office. Like performing their own biopsies. I'm personally more interested in plastics, but I was curious because I've heard many people say this is their plan and it confused me.

as others have mentioned above... no, that's not a thing. the classmates you mention may be confused by the fact that many dermatopathologists also practice dermatology. those are the dermpaths that did a derm residency first. cheers.

 

[MOHS_01]

Not even close. Next question.

 

[Sushirolls]

The correct answer is yes, yes you could. You would have an independent medical license, and that would permit you to practice full scope medicine if you wish.

However, the likelihood of being able to get paneled by insurance using the taxonomy code as a dermatologist is unlikely. And trying bill E&M codes as a Dermpath taxonomy code will likely get flagged by insurance companies and denied. That would then restrict you to cash only patients. Would you have what it takes to compete in a cash only market against the board certified residency trained dermatologists? Would you be able to get insurance carrier willing to cover your liability insurance?

Personally, I would prefer to be seen by a dermpath putting themselves out there as a dermatologist over an ARNP or PA any day; but thankfully I'm able to get in with an actual Dermatologist.

So the answer is yes, but as the others skipped to, the reality is likely no.

 

[asmallchild]

The correct answer is yes, yes you could. You would have an independent medical license, and that would permit you to practice full scope medicine if you wish.

However, the likelihood of being able to get paneled by insurance using the taxonomy code as a dermatologist is unlikely. And trying bill E&M codes as a Dermpath taxonomy code will likely get flagged by insurance companies and denied. That would then restrict you to cash only patients. Would you have what it takes to compete in a cash only market against the board certified residency trained dermatologists? Would you be able to get insurance carrier willing to cover your liability insurance?

Personally, I would prefer to be seen by a dermpath putting themselves out there as a dermatologist over an ARNP or PA any day; but thankfully I'm able to get in with an actual Dermatologist.

So the answer is yes, but as the others skipped to, the reality is likely no.

I realize we are veering off topic but no, you wouldn't

You would realize that as the path-trained dermpath was approaching you to administer the anesthetic before any procedure

Much like the VIP patient during my MS3 clinical rotations who insisted on the chair of OBGYN removing her staples instead of the MS3 who had been doing it daily x 1 month (yours truly)

tl;dr = you could hear the screams from the next hallway

 

[reno911]

I realize we are veering off topic but no, you wouldn't

You would realize that as the path-trained dermpath was approaching you to administer the anesthetic before any procedure

Much like the VIP patient during my MS3 clinical rotations who insisted on the chair of OBGYN removing her staples instead of the MS3 who had been doing it daily x 1 month (yours truly)

tl;dr = you could hear the screams from the next hallway

This is all extremely hypothetical, but I think that the important part of sushiroll's statement was the "putting themselves out there as a dermatologist" part.

Sure you might take a PA or NP over a random path/dermpath or even most path/dermpaths. However, one that is actually choosing to practice in this manner is very likely quite certain of their ability to do what they say they can do. There is non-trivial liability involved (far more than for a PA, for example), and it is very unlikely that they would offer services that they couldn't deliver properly.

As I said, it's all just speculation on an almost completely hypothetical scenario. I've only met one such individual and I don't know this person well enough to assess their derm ability.

 

[Solodyn]

Hypothetically, a path trained dermpath, after completion of PGY-1 Internship with an unrestricted medical license, can perform Mohs Surgery and be reimbursed by Medicare. Dermatology and Pathology are the only specialties allowed to receive CLIA number. CLIA number is what you need to be reimbursed for Mohs surgery by Medicare. That is why Plastic/ENT/General Surgeons cannot get paid for Mohs Surgery in the United States; they are not eligible for CLIA number.

 

[reno911]

Hypothetically, a path trained dermpath, after completion of PGY-1 Internship with an unrestricted medical license, can perform Mohs Surgery and be reimbursed by Medicare. Dermatology and Pathology are the only specialties allowed to receive CLIA number. CLIA number is what you need to be reimbursed for Mohs surgery by Medicare. That is why Plastic/ENT/General Surgeons cannot get paid for Mohs Surgery in the United States; they are not eligible for CLIA number.

There is something missing from above. I'd need to research it more to figure out the intricacies, but I know that there are a handful of non-dermatologists that did Mohs fellowships a long time ago, and they absolutely can and do bill for Mohs. But they are neither dermatologists or pathologists.

 

[imsobadatpickingnames]

Hypothetically, a path trained dermpath, after completion of PGY-1 Internship with an unrestricted medical license, can perform Mohs Surgery and be reimbursed by Medicare. Dermatology and Pathology are the only specialties allowed to receive CLIA number. CLIA number is what you need to be reimbursed for Mohs surgery by Medicare. That is why Plastic/ENT/General Surgeons cannot get paid for Mohs Surgery in the United States; they are not eligible for CLIA number.

As someone who is interested in plastics, I didn't know this. Very interesting.

 

[Solodyn]

I actually have met a dermpath guy doing Mohs. It is not common, but it happens. But most Dermpaths makes enough money to put their licenses at risk to try to perform Mohs surgery on Medicare patients only. Private insurances won't allow a dermpath to be on the panel as a Mohn surgeon or a dermatologist.

With an unlimited medical license, you can do open heart surgery if a hospital credential you and if you can get patients or insurance companies to pay you. The only thing that stops plastics or ENTs doing Mohs in United States is the CLIA number. Without a CLIA number, not only insurances won't pay you, it is illegal to perform Mohs without a CLIA certified lab.

However, outside of the United States, ENT and plastics do Mohs all the time and they train others. I know there are many plastic surgeons doing lots of Mohs surgeries in Australia. Thanks to CLIA we have enjoyed tremendous turf protection in the United States as Mohs surgeons.

 

[reno911]

I actually have met a dermpath guy doing Mohs. It is not common, but it happens. But most Dermpaths makes enough money to put their licenses at risk to try to perform Mohs surgery on Medicare patients only. Private insurances won't allow a dermpath to be on the panel as a Mohn surgeon or a dermatologist.

With an unlimited medical license, you can do open heart surgery if a hospital credential you and if you can get patients or insurance companies to pay you. The only thing that stops plastics or ENTs doing Mohs in United States is the CLIA number. Without a CLIA number, only insurances won't pay you, it is illegal to perform Mohs without a CLIA certified lab.

However, outside of the United States, ENT and plastics do Mohs all the time and they train others. I know there are many plastic surgeons doing lots of Mohs surgeries in Australia. Thanks to CLIA we have enjoyed tremendous turf protection in the United States as Mohs surgeons.

There are definitely a handful of plastic surgeons who did Mohs fellowships and subsequently do Mohs and bill for Mohs. It absolutely happens, so there has to be more to it that what you're saying.

 

[Solodyn]

I run a solo practice so I am involved with the cumbersome requirement of CLIA. 🙁 Mohs surgery is considered a high complexity test and thus the Laboratory Director needs one year of path during the residency training. Dermatology is the only specialty that qualifies. My guess that it is conceivable that an ENT or Plastic join a derm group or path lab work in their office to bill under their High Complexity CLIA laboratory. But there is no way for ENT/Plastic to setup an ancillary lab in their own office unless they get additional path training. That is probably why it is a handful of Plastic/ENT doing Mohs rather than an army of them.

It is under the same logic that derm can process their own slides in their office and get TC from Medicare. Derm can have their own in house ancillary CLIA certified lab.

 

[reno911]

I run a solo practice so I am involved with the cumbersome requirement of CLIA. 🙁 Mohs surgery is considered a high complexity test and thus the Laboratory Director needs one year of path during the residency training. Dermatology is the only specialty that qualifies. My guess that it is conceivable that an ENT or Plastic join a derm group or path lab work in their office to bill under their High Complexity CLIA laboratory. But there is no way for ENT/Plastic to setup an ancillary lab in their own office unless they get additional path training. That is probably why it is a handful of Plastic/ENT doing Mohs rather than an army of them.

It is under the same logic that derm can process their own slides in their office and get TC from Medicare. Derm can have their own in house ancillary CLIA certified lab.

I can tell you that your guess is wrong. I can think of two plastic surgeons who have standalone Mohs practices in which they were the only Mohs surgeon (or even MD) for years. Now these people did do ACMS accredited fellowships a long time ago, so presumably it is something they were adequately trained to do.

Maybe it's possible that they got someone else's name on some paperwork so they could get the lab certified. If the work around you suggest (i.e., joining a group and billing under their lab) is viable, it's conceivable they could just pay someone to be their figurehead lab director. I have no idea how they do it, but whatever they did, these people do Mohs and bill for Mohs.

 

[MOHS_01]

I think you should have to do an accredited Mohs fellowship, but I'm an dingus who believes nurses should be nurses and assistants should be assistants too, so.....