The number of advanced practice providers (APPs), including physician assistants and nurse practitioners, practicing in dermatology has continued to increase, as has the number of practices hiring APPs. This trend has largely been driven by the demand for skin care services exceeding the capacity of the current dermatology workforce in many areas.
APPs are licensed medical providers that practice medicine under the collaboration of doctors. From patient education to the treatment of skin issues and cosmetic procedures, APPs are important members of a healthcare team. APPs have collaborated with dermatologists since the 1970s, helping with patient exams and diagnosing, along with the development and implementation of treatment plans including prescribing medications, ordering and interpreting lab tests and surgical management of a wide variety of dermatologic diseases.
If your practice is struggling to see new patients in a timely manner or to effectively schedule return patients for follow-up appointments, you traditionally have a few different options: don’t accept new patients, ask existing providers to increase patient load or hire an additional dermatologist. Often, none of these choices is ideal. Not accepting new patients can stunt the growth of your practice or leave patients in your community without access to care. Increasing the workload of existing providers can decrease work/life balance and ultimately lead to more burnout. Hiring another dermatologist can be an option, but can be difficult depending on practice size, location, etc.
But hiring an APP can be the right option for many. If considering this route though, it’s important to know the specifics on APP training, what task they can take on, how does insurance reimbursement work, etc. Let’s take a look at some of those specific areas and shed some light on them.
Different State Regulations
Laws regarding an APP’s scope of practice can vary from state to state. In general, APPs can take on any clinical work that is within the scope of their supervising physician. Depending on what that all entails, APPs could provide a variety of medical, surgical or cosmetic dermatology services, including exams, biopsies, excisions, laser therapy, injections, peels and more. APPs are dependent practitioners, which means they cannot see patients unless their supervising physician is available for consultation. Depending on the state, the patient’s insurance and the type of visit, the supervising physician may need to be physically present or available via telephone.
In addition, depending on the state of practice, APPs need to complete certain training and continuing education requirements in certain timeframes. For example, in Illinois – physician assistants are required to complete 50 CE hours every two years. Additionally, licensees who prescribe controlled substances must complete three hours on safe opioid prescribing practices, every two years. Licensees with Schedule II controlled substances prescriptive authority are required 10 hours of pharmacology, every two years. And beginning January 1, 2023, a health care professional in Illinois who has continuing education requirements for license registration or renewal must complete at least one hour of training on implicit bias awareness per renewal period. Other state CE requirements can be seen here.
Insurance for APPs
Before hiring an APP, it’s important to understand how insurance reimbursement and malpractice insurance coverage will work. An APP is generally covered under the malpractice coverage of his or her supervising physician, although the APP can and probably should purchase their own APP malpractice coverage. Physicians should inform their malpractice carrier if they become the supervising physician for an APP and should not assume that the APP automatically will be covered by the physician’s insurance.
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