A Shared, Not Competitive, Goal of Patient Care

The mission of the Society of Dermatology Physician Assistants (SDPA) is to advance the care of patients through the education and empowerment of dermatology PAs. As such, the SDPA submits the following commentary in response to a recently published spotlight article in The Dermatologist featuring Heather Downes, MD, FAAD. Dr Downes reports that “the biggest danger facing dermatology is the misuse of physician assistants (PAs) and nurse practitioners (NPs).”¹

PAs agree that the “misuse” of any medical provider is a problem. Newly graduated PAs should not be put in a position for which they are not adequately prepared. With training from a board-
certified dermatologist and the undertaking of a cost-effective,
robust training program such as the SDPA’s Diplomate Fellowship certificate, PAs can become highly skilled diagnosticians in dermatology who can be safely deployed to areas that are underserved.

Dr Downes also expressed concern about a lack of standardized training for PAs. The SDPA developed the Diplomate certificate to specifically address the lack of standardization in specialty dermatology training for PAs. The program was developed with psychometricians and dermatology professionals, including board-certified dermatologists, with rigorous review to ensure relevance to dermatology PAs. She also voiced her concern about the public’s confusion due to the use of terminology such as “residency” and “fellowship” training of PAs. There is simply no evidence-based data revealing patient confusion or misrepresentation of PAs in this realm. Additionally, there are state laws that prohibit PAs from representing themselves in any way that might mislead patients. The terms “residency” and “fellowship” are commonly used in professions of podiatry, dentistry, veterinary medicine, psychology, medical genetics, optometry, and pharmacy in
addition to medicine. 

According to a 2017 Merritt Hawkins Survey, the average wait time to receive a dermatology appointment is 32.3 days, which is a 46% increase since 2009.² A survey by the American Academy of Dermatology found that 33% of dermatologists (and 48% in rural areas) reported that the number of dermatologists in their community was not enough to meet patient demand.³ The PA profession evolved to fill a void in patient care for underserved rural and urban populations in the United States. When Drs Eugene Stead and Richard Smith crafted the PA profession, they utilized the skills of highly trained medical corpsmen to develop a medical training program for PAs as generalists. The benefit of being trained as generalists is that PAs can pivot to fill the gap of medical care where needed. For example, during this COVID-19 crisis, PAs who had been practicing in specialized areas of medicine, including dermatology, have been able to fill a void in places across the country where there was a need for providers. 

While PAs can laterally move to other specialties, they are bound to limit their scope of practice to the new specialty and must undertake the appropriate additional training to become proficient in that area, an apprenticeship model upon which medical residencies are built. Like physicians, PAs require postgraduate training. PAs pass certifying exams, are required to obtain continuing medical education, and recertify every 10 years. 

PAs have the same goal as physicians: quality patient care for all. Physicians and PAs also have common ground in that we desire proper representation of our skills and training by health care systems and media. Medicine thrives in a multidisciplinary setting with a variety of health professionals. We see this as the future of medical care in the United States.

References
1. Barankin B, ed. A conversation with Heather Downes, MD, FAAD. The Dermatologist. 2020;28(8):17. Accessed September 20, 2020. https://www.the-dermatologist.com/article/spotlight0820
2. 2017 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. Merritt Hawkins; 2017. Accessed September 20, 2020. https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Content/Pdf/mha2017waittimesurveyPDF.pdf
3. Ehrlich A, Kostecki J, Olkaba H. Trends in dermatology practices and the implications for the workforce. J Am Acad Dermatol. 2017;77(4):746-752. doi:10.1016/j.jaad.2017.06.030