Members encouraged to enroll NPCs in AAD’s DermCare Team

CareTeam growth chart

In this evolving health care environment, the physician-led team-based approach is helping many dermatologists provide patient-centered care. With each passing year, non-physician clinicians (NPCs: physician assistants and nurse practitioners) and nurses have been playing an increasing role in the care of dermatology patients. Recent studies from the American Academy of Dermatology indicate that by 2017, nearly 50 percent of dermatologists are expected to have a NPC working under their supervision as part of a care team.

As more dermatologists develop their care team, the Academy has taken a more comprehensive approach to providing education and resources needed to ensure a successful team approach to patient care through its new AAD DermCare Team affiliation.

In May, the AAD’s Board of Directors approved a revised position statement related to the supervision of NPCs: The Practice of Dermatology: Protecting and Preserving Patient Safety and Quality Care. The revised statement supports a collaborative care team approach under the direction of a board-certified dermatologist. It states that the optimum degree of dermatologic care is delivered when a board-certified dermatologist provides direct, on-site supervision to all non-dermatologist personnel. However, it also recognizes that the efficient use of a non-physician clinician may, at times, involve allows for off-site supervision with the dermatologist available by phone, email, or other methods of electronic communication when NPCs are caring for patients. This aligns the AAD DermCare Team with the practices of the majority of our members that employ non-physician clinicians.

Robert T. Brodell, MD, a member of the AAD Board of Directors and professor and chair of the Department of Dermatology at the University of Mississippi, spoke to Member to Member about his experience training and supervising NPCs.

MTM: What has been your experience with NPCs?

robert_brodell.jpgDr. Brodell: I come from a solo private practice background and for 27 years I did not have any NPCs in my practice. When I moved to the University of Mississippi, I inherited two nurse practitioners. These individuals trained for years with dermatologists full time.

During their early years in dermatology, they helped with electronic medical records and assisted the dermatologists in educating their patients and performing common procedures As they became more expert in the management of common dermatology problems, we established a scheduling template for each NP so that they could see their own patients down the hall from the dermatologist. They did a really good job.

Over time, we came to recognize that they could take care of a broader range of issues. Now, we've gotten to a point where we have them see most patients that call in. We do not schedule them with patients referred to the university by a dermatologist. Whenever a referring physician would like to have their patients seen by a faculty member, rather than a NPC, this is accommodated.

Our nurse practitioners now practice at a pretty high level. Of course, they don't have all the training of a dermatology resident, and they don't have four years of medical school. They are individuals who understand their limitations, freely ask questions, and come to our dermatology grand rounds. As a result, they have become a valuable part of our DermCare Team.

MTM: Your nurse practitioners were reluctant to enroll in the Academy as AAD DermCare Team members when membership was first offered last year. How did they respond to the revised statement, which supports off-site supervision of NPCs, at times, by a dermatologist?

Dr. Brodell: There were some issues with the first iteration of the AAD DermCare Team position statement. But with the revised position statement, my nurse practitioners have become interested in joining the AAD DermCare Team. The revised statement is more open than the previous one. It still states that a dermatologist is ultimately responsible for the care and safety of patients in his or her practice, and is responsible for the training and continuing education of all providers under his or her supervision. However, it allows that efficient utilization of a NPC that may, at times, involve off-site supervision. The physician is immediately available—by phone, email, or by using teledermatology. This will allow the AAD DermCare Team to offer the best possible care to the patient even if the dermatologist is not physically present.

MTM: Why is it important for NPCs to join the AAD as DermCare Team members?

Dr. Brodell: I would like my nurse practitioners to not only get an apprenticeship education in our clinics at the University of Mississippi, but to improve themselves by getting the high-quality educational programming offered by the Academy. I encourage AAD members to investigate the opportunities offered through the ADD DermCare Team affiliation opportunity.

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