"DermCare" Team

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ehlersdanlos said:
Just curious as to what people think about this issue/thread that popped up in the allopathic forums yesterday:

http://forums.studentdoctor.net/threads/dermcare-team.1171362/

Is the same thing that has been happening to anesthesiology going to happen to dermatology?
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I don't know about the same thing as anesthesiology but it's a slippery slope and not a good trend IMO

I work at a practice that employs a large number of NPs and PAs. The knowledge gap is quite frankly shocking and not something that is easily picked up by patients (which is a similar thing I hear about anesthesiologists and CRNAs)

That being said, you would be surprised at the number of patients who refuse to see a midlevel and ask to see the doctor. The more "complex" the case (complex general derm case, cosmetics, surgery, etc), the more they shy away from the NP/PA
 
ehlersdanlos said:
Just curious as to what people think about this issue/thread that popped up in the allopathic forums yesterday:

http://forums.studentdoctor.net/threads/dermcare-team.1171362/

Is the same thing that has been happening to anesthesiology going to happen to dermatology?
Click to expand...

Agree- its a trend that I'm glad we are taking action against early. I've only met one militant derm NP (at the VA) but thats how things start. I'm happy to train PAs but I'd be very hesitant to ever train an NP given their disgusting political power-grab in other fields. It always starts with greed- if we dont train them, they have no power. So a standard of care established by the academy is important for the future.

The main difference between anesthesiology and dermatology is that patients by and large have a big "say" who they go see (and can easily switch). Not so much if you show up for your surgery and a CRNA walks in the room an hour pre-op.
 
Last time I went to a dermatologist, an NP saw me. Needless to say, I won't be going back to that practice.
 
doctalaughs said:
Agree- its a trend that I'm glad we are taking action against early. I've only met one militant derm NP (at the VA) but thats how things start. I'm happy to train PAs but I'd be very hesitant to ever train an NP given their disgusting political power-grab in other fields. It always starts with greed- if we dont train them, they have no power. So a standard of care established by the academy is important for the future.

The main difference between anesthesiology and dermatology is that patients by and large have a big "say" who they go see (and can easily switch). Not so much if you show up for your surgery and a CRNA walks in the room an hour pre-op.
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When patients have to wait months to be seen by a Dermatologist, I think they will me more amenable in general to seeing a midlevel. This is where the tight control of residency spots hurts Derm in the long-run.

Furthermore, as all of health care gets consolidated (insurers, hospitals, etc) who is the say that the patient actually has much of a choice in the first place?

Not a good trend. Will take a while to fully play out and Derm is much better positioned than Anesthesia for many reasons. But still not good.
 
qwerty89 said:
When patients have to wait months to be seen by a Dermatologist, I think they will me more amenable in general to seeing a midlevel. This is where the tight control of residency spots hurts Derm in the long-run.

Furthermore, as all of health care gets consolidated (insurers, hospitals, etc) who is the say that the patient actually has much of a choice in the first place?

Not a good trend. Will take a while to fully play out and Derm is much better positioned than Anesthesia for many reasons. But still not good.
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I'm not sure derm is as "in need" as it was before. Like MOHS said in the past, it's not that much more a wait to see a PCP than it is a derm. 5 years ago, it took me 3 months to get in with a derm. This year, it took me 3 weeks. However, I had to call around to 4 different practices before I was able to find a PCP who was "taking new patients." THEN I had to wait two months to see her. I live in a large metropolitan area in the Midwest btw.
 
bronx43 said:
I'm not sure derm is as "in need" as it was before. Like MOHS said in the past, it's not that much more a wait to see a PCP than it is a derm. 5 years ago, it took me 3 months to get in with a derm. This year, it took me 3 weeks. However, I had to call around to 4 different practices before I was able to find a PCP who was "taking new patients." THEN I had to wait two months to see her. I live in a large metropolitan area in the Midwest btw.
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Just like most other things, it is location dependent.
 
I'm just not totally convinced of said trend. I'm not denying that it's not trending, but I haven't seen it in the 'n of 6' places I'm familiar with...again, could just be due to location effect, and I just haven't been where it's happening.

Our press-ganey where I did residency for time to be seen from time of calling to make an appt was like 4%. Pretty bad. 🙁
 
I was convinced of the emerging trend in 2003, long before there was much lip service to the topic -- and the trend was set up long before the explosion of midlevels entering the mix. Around that time there was a massive push for expanding residency slots in dermatology against the backdrop of both rising total derm practitioners as well as derm😛opulation ratios. A variety of spurious arguments were put forth, ranging from poor data such as surveys and opinion polls to huckster math cherry picking demographic and geographic data. There were only a handful - two or three, really - dermatologists active and vocal enough on the national level pointing this out; they were shouted down as protectionists (way to demonize your opponents, academic ****s) and, as a resident, I was "instructed" to sit down and shut my mouth.

Here's the rub: it's basic math. I don't give two ****s if you are a 27 yo resident or a 60 yo chair, math is math.... and apparently the 27yo resident had a much firmer grasp of the concept of equilibrium dynamics than did the sheltered and insulated referral center chair who had spent 30 years in that practice setting - heh.

Everyone eventually reaps what is sown... and we are no different. Yes, we continue to have it better than the majority of the house of medicine.... and that may continue for some time (well, until FFS is dead and bundled payments are the norm)... but you are deluding yourself in an effort toward intellectual pacification if you believe things are as they were or that we have not lost more than most. If this was not the case one would not see the consolidation and acquisition activity sweeping the country that we do right now; it's not the cardiologist or gastro groups being bought up left and right with PE monies, is it.
 
Dral said:
I'm just not totally convinced of said trend. I'm not denying that it's not trending, but I haven't seen it in the 'n of 6' places I'm familiar with...again, could just be due to location effect, and I just haven't been where it's happening.

Our press-ganey where I did residency for time to be seen from time of calling to make an appt was like 4%. Pretty bad. 🙁
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Yes - it most certainly is location dependent - for now. All distribution problems are geographic in nature by definition... but, much like electricity, running water, and telecom services, trends that start in any given region will spread in a predictable fashion out to formerly protected / underserved areas. Proof in point is the erosion of fee schedules / pricing power in "underserved" areas. Ugh on that ****, too.
 
MOHS_01 said:
I was convinced of the emerging trend in 2003, long before there was much lip service to the topic -- and the trend was set up long before the explosion of midlevels entering the mix. Around that time there was a massive push for expanding residency slots in dermatology against the backdrop of both rising total derm practitioners as well as derm😛opulation ratios. A variety of spurious arguments were put forth, ranging from poor data such as surveys and opinion polls to huckster math cherry picking demographic and geographic data. There were only a handful - two or three, really - dermatologists active and vocal enough on the national level pointing this out; they were shouted down as protectionists (way to demonize your opponents, academic ****s) and, as a resident, I was "instructed" to sit down and shut my mouth.
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I think these are two different issues. I know of many academic derms who have advocated for more residency slots, but I haven't heard of any of them advocating for more midlevels. Maybe I just never encountered them.

In fact, several times I've heard the argument that we need more residency slots precisely to prevent midlevels from filling the void.
 
reno911 said:
I think these are two different issues. I know of many academic derms who have advocated for more residency slots, but I haven't heard of any of them advocating for more midlevels. Maybe I just never encountered them.

In fact, several times I've heard the argument that we need more residency slots precisely to prevent midlevels from filling the void.
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Sorry, I was not clear; I was speaking purely about the number of dermatologists (I incorrectly assumed that the "long before the explosion of midlevels" phrase conveyed that... I guess it only did in my head). The trend I was speaking to was the training > carrying capacity transformation that was happening; we were adding more providers to the pool than the pool was expanding, relatively speaking, and there were calls for ever greater increases in the number of training slots.
 
They should have a separate designation for nurse practitioners, its really deceptive IMO. I vote for Noctor with the short form being Nr :laugh: (but actually kinda srs). Reading her education history wants to make me :barf:knowing what kind of hard work it actually takes to get a real derm residency.
 
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