title: Practice models and roles of physician extenders in dermatologic surgery.
abstract: BACKGROUND
  The prevalence of physician extenders (PEs) has increased significantly in dermatologic surgery over the last decade.
  
  
  METHODS
  An analysis was performed of the staff in dermatologic surgery practices, roles of PEs, and level of supervision.
  
  
  RESULTS
  Mohs fellowship-trained (MMSFT) dermatologic surgeons were more likely to employ registered nurses (n=85, 73.9%) than non-fellowship-trained (NMMSFT) surgeons (n=65, 50.0%, p<.05) (dermatologists who reported performing Mohs without having completed a Mohs College fellowship). NMMSFT surgeons (n=46, 35.4%) were 33% more likely to employ physician assistants than MMSFT surgeons (n=30, 26.1%, p=.05). Both surgeon types reported that their physician assistants and nurse practitioners spent the majority of their time treating medical dermatology patients, but NMMSFT surgeons were twice as likely as MMSFT surgeons to have their PEs involved in performing or assisting with cosmetic procedures. MMSFT surgeons (38.5%) were twice as likely to have direct supervision of their PEs as NMMSFT surgeons (16.1%, p=.01).
  
  
  CONCLUSIONS
  PEs are highly prevalent in dermatologic surgery practices and are playing direct roles in the delivery of dermatologic care. Promoting patient safety through appropriate extender supervision and reporting of patient outcomes are highly needed as this sector of the dermatologic surgery workforce continues to expand.
authors.affiliation: Department of Dermatology, School of Medicine, Boston University, Boston, Massachusetts 02111, USA. etierney29@gmail.com
authors.forename: Emily P
authors.initials: EP
authors.lastname: Tierney
authors.forename: C William
authors.initials: CW
authors.lastname: Hanke
authors.forename: Alexa Boer
authors.initials: AB
authors.lastname: Kimball
mesh_terms: D016009:Chi-Square Distribution; D003880:Dermatology; D006801:Humans; D015580:Mohs Surgery; D010823:Physician Assistants; D012380:Role; D013043:Specialties, Surgical; D011795:Surveys and Questionnaires; D000078329:Workforce