Should NPs and PAs perform in-office surgeries? Study raises questions

Mid-level providers like nurse practitioners and physician assistants are performing millions of in-office dermatological surgeries, and a recent study calls this practice into question.

Researchers analyzed 2012 Medicare data and found that NPs and PAs billed independently for more than 4 million procedures, and more than half (54.8 percent) were dermatology procedures, according to the study, published in JAMA Dermatology.

Even though the "intent for mid-level nurse practitioners was to give primary care," lead author Brett Coldiron, MD, told KHN, the surgical billing suggests they are providing more specialized care. He said he was unsure whether the providers were trained to provide these services.

"It would be prudent to temper widening the scope of practice of mid-level providers by recognizing that mid-level providers are not solely limited to primary care, and may involve procedures for which they may not have formal training," the study's authors concluded.

Ken Miller, president of the American Association of Nurse Practitioners, disagrees, telling KHN that many NPs who perform these procedures have specialized training and that there are "no real studies" showing care provided by NPs is less safe than care provided by physicians.

This discussion is especially important in light of the nation's physician shortage, as many states have discussed expanding the scope of care for mid-level providers to fill in the gap caused by the low supply of physicians.

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