corpsman89 Posted April 19, 2018 Share Posted April 19, 2018 http://triblive.com/news/healthnow/13551514-74/study-physician-assistants-less-accurate-in-diagnosing-early-skin-cancer New Article. "Study: Physician assistants less accurate in diagnosing early skin cancer" Link to comment Share on other sites More sharing options...
AbeTheBabe Posted April 19, 2018 Share Posted April 19, 2018 “I wanted to look at the bigger picture,” said Ferris, whose study was backed by the National Institutes of Health. “Dermatology is one of the biggest users of nurse practitioners. The role of the PA has evolved from physician's assistant to physician.” Huh?! So many things wrong here. Link to comment Share on other sites More sharing options...
corpsman89 Posted April 19, 2018 Author Share Posted April 19, 2018 29 minutes ago, AbeTheBabe said: “I wanted to look at the bigger picture,” said Ferris, whose study was backed by the National Institutes of Health. “Dermatology is one of the biggest users of nurse practitioners. The role of the PA has evolved from physician's assistant to physician.” Huh?! So many things wrong here. I have yet to find any article that accurately depicts anything about PAs. Like... Our title What we do How we are trained How we differ from NPs How we differ from MDs How we recertify The list goes on and on. Link to comment Share on other sites More sharing options...
corpsman89 Posted April 19, 2018 Author Share Posted April 19, 2018 Another thing. Type in Physician Assistant in google, and click news. Mostly, stuff about new schools, and lawsuits against PAs. Now, type in Nurse Practitioners in google, click news. Mostly articles praising NPs, and how they are increasing access to rural areas, and how they are winning bill after bill in the legislature. Its depressing. Link to comment Share on other sites More sharing options...
cbrsmurf Posted April 19, 2018 Share Posted April 19, 2018 Read the article. link: https://jamanetwork.com/journals/jamadermatology/fullarticle/2678685 Some significant points: The dermatologists had more clinical years/experience. No difference in detecting non-melanomas and invasive melanomas. Significant difference in detection/biopsy of melanomas and melanoma in situ Link to comment Share on other sites More sharing options...
corpsman89 Posted April 19, 2018 Author Share Posted April 19, 2018 I get it. But does it really matter? Not many people actually read the entire article, and not many people understand what goes into an properly conducted study. The title says it all. These sort of articles need to be refuted by AAPA, and not in a low key sort of way. Link to comment Share on other sites More sharing options...
lkth487 Posted April 19, 2018 Share Posted April 19, 2018 The methodology is decent - at least if you compare it to all the other articles that show clinical outcomes by provider type. I think, with a lot of these articles, you can find what you want by looking at it a certain way. If you looked at a complete panel of patients seen by a PA vs a dermatologist, I bet there is a good chance you'd see similar overall mortality outcomes for both. But if you pick a certain rare diagnosis and work backwards to see whether pediatricians or primary care PAs diagnosed pseudohypoaldosteronism type 2 more accurately in a pediatric population, maybe you'll see a difference. Or maybe you wouldn't. You can keep massaging your inputs to get the output you want in studies like these, one way or another. The real question is "what does this mean for clinical practice?" Or for OTP, which I know is a hot topic on this forum - and I think the answer is "not much". Given the need and the number of patients that need to be seen, there is no way around it. Link to comment Share on other sites More sharing options...
camoman1234 Posted April 19, 2018 Share Posted April 19, 2018 You cannot expect a PA to be on par with a BC derm doc. The training is VASTLY different and the derm. doc is MUCH more prepared than PAs and NPs are. That is why we have CP to help back us up. I am all about OTP, but you have to be trained by a good residency or CP as a PA in derm and if that is not completed then of course we are inferior to a derm doctor. If there are PAs in derm out there that think they are trained the same as a dermatologist then they are crazy. Now do I think a PA in derm with good training good as his/her job, well YES, but you (most likely) do not know everything that dermatologist has learned in residency which sets the MD/DOs a part from us (as well that MS1 and MS4). Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 19, 2018 Moderator Share Posted April 19, 2018 It would be more interesting to see how many of the PAs have formal training with a dermatoscope, years of experience, and compare to FM physicians who also commonly perform biopsies (because you could make the same argument against them I bet but you don’t hear them being vilified). ETA: furthermore, by this logic, family medicine should do biopsies (if they do it equally well, then why refer at all), only endocrinologists should treat diabetes, only cardiologists should manage heart failure, only neurosurgeons (and not ortho spine) should do spinal surgeries, only OMFS should do oral surgery, only nephrology should manage hypertension. EM docs shouldn’t manage critical patients because it’s been shown that critical patients boarding in the ED do worse. I don’t suspect anyone would agree with these either Link to comment Share on other sites More sharing options...
lkth487 Posted April 19, 2018 Share Posted April 19, 2018 5 hours ago, LT_Oneal_PAC said: It would be more interesting to see how many of the PAs have formal training with a dermatoscope, years of experience, and compare to FM physicians who also commonly perform biopsies (because you could make the same argument against them I bet but you don’t hear them being vilified). ETA: furthermore, by this logic, family medicine should do biopsies (if they do it equally well, then why refer at all), only endocrinologists should treat diabetes, only cardiologists should manage heart failure, only neurosurgeons (and not ortho spine) should do spinal surgeries, only OMFS should do oral surgery, only nephrology should manage hypertension. EM docs shouldn’t manage critical patients because it’s been shown that critical patients boarding in the ED do worse. I don’t suspect anyone would agree with these either But are we talking about patients who are seen by a primary care PAs and comparing them to a boarded dermatologist (that would be more accurate comparison with FM docs), or those who were referred for whatever reason, and were seen by a specialist? I think that's the difference. If the wait time for a specialty is four months on average, you have to do what you can in the meantime. That's what I mean about how this doesn't change anything in real life. If it takes six months to see a dermatologist, and only three months if there are lots of other people also seeing derm patients, then overall you still come out well ahead because there is less of a time lag between referral and being seen by someone, even if that someone happens to do more biopsies than the boarded dermatologist. Link to comment Share on other sites More sharing options...
ProSpectre Posted April 26, 2018 Share Posted April 26, 2018 So the AAPA responded to the study JAMA recently put out, and provided a pretty good breakdown of some of the limitations and flaws of the study. https://www.aapa.org/news-central/2018/04/jama-dermatology-study-fundamentally-flawed/ A dermatologist, Dr. Matthew Zirwas, also provided his thoughts on the flaws of the study to the Society of Dermatology PAs, and I think he makes some good points. I can only hope other dermatologists share his thoughts on the matter as well. http://dermcast.tv/dr-matthew-zirwas-responds-to-jama-dermatology-study/ Link to comment Share on other sites More sharing options...
corpsman89 Posted April 27, 2018 Author Share Posted April 27, 2018 Sadly, all the news article that are coming out are using the initial study to basically take a dump on PAs. I love how NPs are never even mentioned in the whole thing. How do they escape stuff like this? Is their lobby THAT powerful? Link to comment Share on other sites More sharing options...
corpsman89 Posted April 27, 2018 Author Share Posted April 27, 2018 4 minutes ago, FriendlyNP said: @corpsman89 We do not escape any criticisms. However, the findings of that article seem to be valid in my personal experience Of course its valid! It compares PAs with an average of 6.9 years to Dermatologists with 16.5 years of experience (if you include residency) The MAJOR problem is that the title is void of this fact, even the abstract. Which, you and I both know, is what most people will read. It's just plain fraudulent and purposefully misleading providers, and the public alike. As Dr. Zirwas stated the title of the research article should have been “Physician Assistants with Less than 7 Years Experience Diagnose NMSC as well as Dermatologists with Over 16 Years Experience." http://dermcast.tv/dr-matthew-zirwas-responds-to-jama-dermatology-study/ Link to comment Share on other sites More sharing options...
sas5814 Posted April 27, 2018 Share Posted April 27, 2018 Link to comment Share on other sites More sharing options...
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