On July 14, 2010 Booth Durham, Rod Kaufmann, David Wrone, and myself testified in front of the New Jersey Board of Medical Examiners in support of our Petition for Rulemaking. Below are the main points we discussed.
- The Dermatological Society has heard numerous complaints about various physicians holding themselves out as dermatologists, when in fact they received no dermatology-specific training.
- In addition, several New Jersey dermatology practices allow physicians not formally trained in dermatology to train and supervise physician assistants and other extenders engaged in the practice of dermatology.
- Physician assistants, estheticians, general practice doctors and internists do not necessarily have the expertise and additional years of training for treating the biggest organ of the body — the skin.
- Board-certified and Board-eligible dermatologists are uniquely qualified because they undergo extensive training to evaluate and manage patients with benign and malignant disorders and cancers of the skin, contact dermatitis and other allergic and nonallergic skin disorders, and are experienced in the recognition of the skin manifestations of systemic and infectious diseases.
- Allowing non-dermatologists to practice the specialty and further, to supervise physician assistants engaged in the practice of dermatology, not only provides a lower quality of dermatologic care, but increases the risk of misdiagnoses and harm to patients.
We also provided some rebuttal points to the issues raised at the public hearing at the NJ BME’s May 12, 2010 meeting:
- In his statement to the Board on May 12, 2010, Dr. Geffner stated that the patients in the state are not receiving sufficient dermatological services. First, he did not provide any studies or facts to substantiate his position. At best, he provided only anecdotal information. As the Dermatological Society, we are unaware of complaints about the inability of patients to see qualified Dermatologists. A recent article in the JAAD (June 2009) has studied the wait time for dermatologic appointments in Boston.
- http://www.eblue.org/article/S0190-9622%2809%2900085-1/abstract
The Boston area is in many ways similar to New Jersey, being a large North-Eastern metropolitan area. Patients making one call to each dermatologic practice on average obtained an appointment in 18 days. Patients calling two practices were offered an appointment on average in 7 days. Patients calling 3 practices were also offered an appointment in 1 week.
This experience is similar to what is happening in New Jersey. Some areas in the center of the country do experience shortage of dermatologists. In our area the supply and demand appear to be matched.
- The opposition of Christopher Hanifin, PA centers on the fact that he believes that PAs are over-regulated in New Jersey. While we certainly do not wish to burden any professionals with additional unnecessary regulations, we do not feel that our proposal is unreasonable. If a regulation is needed to protect the patients of New Jersey, then the regulation should be enacted.
- An additional point raised at the May 12, 2010 meeting was that we did not obtain evidence about the harm caused by improperly supervised PAs and non-dermatology trained practitioners advertising themselves as dermatologists. The evidence like this is difficult to obtain. The time for melanoma recurrence, or the time for melanoma or other missed skin cancers to kill the patient can take many years. It is the consensus opinion among our members that patients can be harmed if we continue to allow improperly supervised PAs and non-dermatology trained practitioners to mislead patients into thinking they are dermatological specialists; this is especially true when it comes to serious cancers; patients should not be misled into thinking the practitioner they are seeing is fully qualified to treat these diseases.
- Because of these concerns, the state of Florida recently adopted similar, even somewhat more stringent regulations to protect their patients. Our patients deserve similar protection.
- At the May 12, 2010 meeting, Matthew McQuillan, PA raised the issue on whether other specialties will be impacted by our petition. We have emphasized to the BME that the purpose of our petition is limited to regulating physicians and physician-extenders who hold themselves out as specialty trained in dermatology when they lack such qualifications. It is not our intent to unreasonably regulate other health care professionals who are not holding themselves out as specialists in dermatology.
On behalf of the Dermatological Society, we strongly urged the Board to adopt our proposed regulations. The Society also offered its assistance and expertise to the Board in its consideration of our petition.
The Board also heard from several physician assistants opposing the petition. The main talking point of these speakers was that they are not happy with any additional regulation of their profession. They felt that existing laws preventing false advertising are sufficient to fix the existing problems. They also stated that changes in one specialty (dermatology) may create a slippery slope of regulation of other specialties.
We feel that these arguments are without merit. Clearly, the existing laws are not being enforced. Additionally, if a regulation is needed to protect the patients of New Jersey, then the regulation should be enacted. There is a clear danger to patients from the status quo. We feel that the legal loopholes need to be closed to protect the patients in New Jersey.
Our fight for quality dermatological patient care is at a crucial juncture. To improve our chances of success we need the support of those whom we are trying to protect: our patients. Please post the documents in your waiting rooms for patient signatures. We need to collect as many signatures as possible. As soon as the signatures are collected, please fax to them to NJBME (609) 826-7117 and to the Dermatological Society at (856) 546-5601 . Remember, our opponents are being very aggressive in collecting signatures. We should be too.
I have found that an explanatory flyer is very helpful in describing our goals. Patients are becoming very angry at the present situation. They are extremely willing to support our petition.
Please put your practice name on the page with collected signatures.
Thanks for your support for our cause,
Alexander Doctoroff, DO
President DSNJ