Comparison of dermatology procedures performed by physician assistants/associates in dermatology and dermatologists for Medicare beneficiaries in 2021

Background: Integrating physician assistants/associates (PAs) into dermatology practice has been a significant step toward addressing the shortage of dermatologists in the United States. Yet, studies focusing primarily on procedures performed by dermatology PAs are scarce. Objective: This research aims to determine the number and types of procedures performed by dermatology PAs and how these compare with those performed by dermatologists/Mohs surgeons for Medicare Part B beneficiaries. Study Design and Methods: This study examined 2 national data sources: the 2021 Medicare Physician and Other Practitioner by Provider and Service and the 2021 PA Professional Profile from the National Commission on Certification of PAs (NCCPA). The analytical sample included 3299 dermatologists/Mohs surgeons and 1493 dermatology PAs, reflecting a ratio of 2.2 dermatologists/Mohs surgeons to 1 dermatology PA. We compared dermatology procedures performed by PAs practicing in dermatology and dermatologists/Mohs surgeons. Results: Our study found that 28,636,263 dermatologic procedures were performed by dermatologists and dermatology PAs in 2021. Dermatologists performed 24,769,741 (86.5%) of dermatology procedures, and PAs practicing in dermatology performed 3,866,522 (13.5%). The procedures most frequently billed by PAs were excision of benign lesions (313,580; 15.3%), biopsy codes (570,197; 14.2%), destruction of premalignant lesions (2,823,110; 14.1%), and shaving of skin lesions (52,999; 12.6%). In contrast, dermatologists billed for more procedures, including more than 90% of repairs, flaps, tissue transfers, and excisions of malignant lesions. PAs in dermatology also billed under these procedure codes, but at much lower rates than dermatologists. Conclusions: PAs provide integral dermatologic care, particularly in the diagnosis of skin lesions. Although this is the first study to focus solely on comparing the dermatology procedures performed by dermatologists and PAs practicing in dermatology, further studies should examine the number and complexity of procedures performed by dermatology PAs and patient outcomes using a more nationally representative patient population.