Should Non-Physicians Perform Cosmetic Procedures?

Practice Models and Roles of Physician Extenders in Dermatologic Surgery

“…The increasing reliance upon PEs in cosmetic and surgical procedures has raised the concern of many dermatologists and patient advocacy groups about the appropriate level of training and supervision for PEs 1–3,6 . The AAD survey data reported herein suggest intrinsic differences between MMSFT surgeons and NMMSFT surgeons in both practice models and use of PEs in cosmetic and noncosmetic surgical procedures.…”

“…Although the level of supervision of PEs is probably multifactorial, relating to the training level and experience of the PE and the practice model and training of the dermatologic surgeon, the reasons for greater supervision of PEs by MMSFT surgeons is unclear and will be addressed in future studies by our group. Similar to concerns of the lack of appropriate supervision by dermatologists supervising PEs in satellite offices located at a distance from their practice, 1–3,6 11.3% of NMMSFT surgeons reported only off‐site supervision of PEs. Given the demands on physicians' time associated with a dermatologic surgical practice, the safety and training of PEs located at a distance from the dermatologic surgeon they are practicing under needs to be addressed.…”

“…The increased prevalence of nonphysician and nondermatologist physician providers in the delivery of U.S. dermatologic health care has been documented in a number of recent workforce studies 1–4 . The number of physician extenders (PEs), including physician assistants (PAs) and nurse practitioners (NPs), has grown exponentially in dermatology over the last decade, given higher reimbursement levels for extenders in dermatology than in other specialties, patient demand for dermatologic health care, and the overall shortage of dermatologist physicians.…”

State medical board regulation of minimally invasive cosmetic procedures

“…The rising numbers of mid-level providers, such as physician assistants (PAs) and nurse practitioners, have increased the urgency of the need for clear rules to define their scope of practice. [1][2][3] In the context of so-called minimally invasive cosmetic procedures (MICP), the issues are particularly opaque. MICP as defined include but are not limited to cutaneous laser (excluding full-face ablative resurfacing, but including fractional nonablative and ablative resurfacing) and light procedures, radiofrequency and ultrasound procedures, injectable prepackaged soft-tissue augmentation materials, botulinum toxin injection, and superficial to mid-depth chemical peels.…”