title: Who else is providing care in dermatology practices? Trends in the use of nonphysician clinicians.
abstract: BACKGROUND
  The US dermatology workforce, which is affected by a physician shortage, has reportedly seen a rapid and substantial influx of physician assistants (PAs) and nurse practitioners (NPs). Little is known about which dermatology practices use these practitioners, how they are supervised, and the services they are providing.
  
  
  METHODS
  We analyzed results of the American Academy of Dermatology's 2007 practice profile survey to learn more about patterns of nonphysician clinician (NPC) use. Of 3965 surveys mailed, responses were obtained from 1243 dermatologists (31% response rate). Comparison data were drawn from previous surveys conducted with a similar methodology in 2002 (35% response rate) and 2005 (30% response rate).
  
  
  RESULTS
  Overall, 325 responding dermatologists (29.6%) reported using PAs, NPs, or both in their practices in 2007, a 43% increase from the proportion in 2002 (20.7%). PAs were more prevalent than NPs (23% vs 10%). By the year 2010, 36.2% of respondents plan to hire these NPCs. Younger cohorts of dermatologists were significantly more likely to use NPCs (P = .006), as were those in group and academic practices (P < .0001). Respondents seeking to hire additional dermatologists (P < .0001) and those with surgical or cosmetically focused practices (P < .001) were much more likely to use NPCs. Respondents reported supervising their NPCs on-site 92.8% of the time, but 31% were off-site 10% of the time or more. Most dermatologists allowed their NPCs to see new patients and established patients with new problems, and a minority of these patients were formally presented to a physician during extender visits. NPCs spent the majority of their time seeing medical dermatology patients, even if their supervising dermatologist was primarily engaged in surgical or cosmetic dermatology.
  
  
  CONCLUSIONS
  Survey respondents might have inaccurately reported practice characteristics or might not be representative of all US dermatologists.
  
  
  CONCLUSIONS
  In the setting of persistently long patient wait times and difficulty recruiting new physician staff, dermatologists have rapidly turned to PAs and NPs to help meet patient demand for care. These NPCs are primarily caring for new and established medical dermatology patients under indirect supervision. In the absence of explicit consensus or policy as to how the field should ensure future access to care for patients with skin disease, growth in the use of NPCs has continued, with significant variation in use and supervision patterns.
authors.affiliation: Department of Dermatology, and Institute for Health Policy Studies, University of California, San Francisco School of Medicine, San Francisco, California 94143-0316, USA.
authors.forename: Jack S
authors.initials: JS
authors.lastname: Resneck
authors.forename: Alexa B
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D003880:Dermatology; D019538:Health Care Surveys; D006801:Humans; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010823:Physician Assistants / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce