Dermatopath Fellowship

[wasatch]

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Can dermatopathologist remove skin lesions and do all the path workup themselves? What is the scope of work that dermatopathologists do?

 

[Pathmonster]

Can dermatopathologist remove skin lesions and do all the path workup themselves? What is the scope of work that dermatopathologists do?

I don't know for sure, but I bet that reading out dermpath cases is more lucrative than all the other stuff in dermatology except the cosmetic stuff. But I bet you don't get to do none of that other stuff without doing the derm residency.

Does anyone have a list of all dermpath fellowships in the us?

 

[ny skindoc]

I don't know for sure, but I bet that reading out dermpath cases is more lucrative than all the other stuff in dermatology except the cosmetic stuff. But I bet you don't get to do none of that other stuff without doing the derm residency.

Does anyone have a list of all dermpath fellowships in the us?

The AMA frieda website should have such a list.
The scope of practice is determined by the route one enters this specialty.Those who enter from a path residency generally read slides and do not do the actual lesion removal.Dermatologists who do a path fellowship sometime blend a clinical practice with reading of slides.

 

[PathOne]

Dermpath fellowships contain cross-training (or, rather, exposure to) the "other" specialty, i.e. Derm for Paths and Path for Derms. However, that in no way makes a Pathologist a Dermatologist, or vice versa. (Dermpath is a one-year fellowship, sometimes with an added research year).

It's true that some Dermpaths with a Derm background elects to maintain some clinical exposure. However, as Dermpath is generally more lucrative than clinical Derm, it's relatively rare. However, Dermpaths from both backgrounds does sometimes see patients, especially in some of the more perplexing cases (either in person (rare) or through photos).

As regards the scope of this subspecialty, it's basically the dx'ing of diseases of the skin and hair, from innocent nevi to highly malignant melanomas, and yes, Dermpath boarding allows a Dermatologist to do the entire path workup and sign-outs him/herself.

Finally, remember, that it's really the insurance co. or healthcare organization/hospital that decides the scope of work a physician can do. If you have a valid medical license, you're free to perform everything from dermpath to open-heart surgery, even if you're trained in FP or Psych. But it'll probably be expensive for you to try it.

 

[Brian Pavlovitz]

From what I gathered during my dermpath rotation, there is ongoing controversy about dermatologists who are trained in dermpath doing both an excision and reading the biopsy, so-called "self-referral". I'm not certain, but something tells me an insurance carrier might have a hard time seeing the same physician billing for both.

Bernie Ackerman had an interesting editorial on this very subject back in October...I forget which journal it was...I'll look for it and let you know.

 

[Brian Pavlovitz]

It's the October, 2005 issue of the Journal of the American Academy of Dermatology. Interesting discussions on scope-of-practice issues. Reading Bernie Ackerman always makes me chuckle! 😉

 

[PathOne]

Bernie's one of a kind. You may not agree with him (many don't), but there's no arguing that he's personally trained more great doctors than probably anybody else. Unfortunately, he retired last year -- well, at least he said he retired, but you'll still be able to meet him sometimes at the 27(!)-headed microscope at his academy in NYC.

 

[LADoc00]

Part of the aspect for dermatologists is the ability to "gobal bill" for skins, meaning they bundle the technical and professional component into 1 charge. The technical component is generally MORE than the professional component, that is the reimbursement for making a glass slide is more than actually reading it. What dermies do is outsource slide making for around 6 bucks a shot, read it and bill for everything. They are in essence billing about 70 bucks (roughly the technical component of 88305) for a service they didnt even provide and were only charged 6 bucks for! This is a quirk of the system and will soon be illegal, trust me. There is pending legislation in many states, and big insurance companies want to see these greedy fools get theirs. This is a highly unethical practice and dermatologists who biopsy/self refer/read then global bill should have their medical licenses used as toilet paper.

....there's no justice like mob justice...

 

[yaah]

yeah I agree - this is part of the reason the special "colonoscopy clinics" and similar things will also have their loopholes closed eventually. I think derm will always be more lucrative than other fields of path simply because of the volume and the way the lawyers have ****ed everyone by making interpreting a melanoma slide akin to juggling loaded shotguns.