Annually I make an appointment to have my Dermatologist examine me for potential skin problems. At the last appointment the office called and said the PA would be doing these screenings going forward. I'm wordering what Dermatologists think of this practice? Why should I settle for a PA screening me for skin problems over a Board Certified Dermatologist?
In my (unrealistic) personal opinion, midlevels in dermatology should
never be allowed to perform a total body skin exam that isn't 100% re-checked by a board certified dermatologist. (I acknowledge that this is purely wishful thinking and will never happen, but I'll explain my reasoning).
A total body skin exam could theoretically reveal one or more of hundreds to thousands of different dermatology diagnoses, the majority of which a midlevel probably hasn't even heard of. Sure they can play "guess the atypical nevus" or find the "pink bump" or "brown bump" and biopsy
every single one, but that is garbage medicine, and they are just playing guess and check. They will consistently miss important findings and scar patients with their shotgun biopsy method. The more and more dermatology patients that midlevels see for skin checks, the worse they disfigure and scar the general public and the number of missed or delayed diagnoses increases.
When a board certified dermatologist examines you head to toe during a skin check, they are evaluating your skin in its totality. They have studied pure dermatology for 3 years, passed some of the most rigorous board exams, and are aware of the vast majority of cutaneous pathologies.
When a dermatolgoist looks at your skin they aren't just looking for pink or brown bumps: Are there any spots suspicious for cutaneous neoplasms? What pigmentation changes are present and what could they represent? Are there areas where the skin is xerotic, scaly, or excoriated? Is that subtle thin pink papule an amelanotic melanoma, an inflammatory papule, or a funny looking SK? Could an underlying systemic disease be responsible for an increased number of benign skin findings that otherwise wouldn't be worrisome (Leser-Trelat, Stigmata of Liver Disease)? Are nail changes present, and if so what do they represent? For numerous uncommon benign findings that can be found on skin exams, is there any further exploration that needs to be done or other diseases to search for? Has the literature shown that benign finding to be associated with a systemic or underlying disease, and if so what additional questions should you ask the patient? Based on their medical history are there additional areas that should be checked or other specific ROS questions to be asked during the exam?
The list goes on and on... but the point is that a midlevel could never do this, not with even with 30+ years of experience? So no I would never ever go to a midlevel for a skin check.
At least for a dermatology visit with a specific complaint, the midlevel knows what the chief complaint is and can take a stab at it even if they are completely wrong. Hopefully they call in their supervising physician if they are confused or if there is any uncertainty, or eventually after several round of mismanagement a physician will finally get involved. But how could a midlevel involve a physician in your care when they didn't even pick up the problem to begin with on a routine skin exam? They can't
TLDR; Don't go to a midlevel for a skin check