Let’s talk about leading care teams and other elephants in the room
Theodore Rosen, MD, who recently completed his term as AAD vice president, takes on an interview with Dermatology World Weekly to unpack the varying and passionate opinions dermatologists have about non-physician clinicians and the role of board-certified dermatologists leading care teams. The Academy's position statement on the Practice of Dermatology: Protecting and Preserving Patient Safety and Quality Care provides guidance to members on the role of non-physician clinicians on care teams led by a board-certified dermatologist.
Recognizing the trend in medicine toward care teams, the AAD Board of Directors included a goal in the AAD 2019 Strategic Plan that aims to enhance resources for those board-certified dermatologists that lead care teams. Whether members employ non-physician clinicians or not, the appropriate role of non-physician clinicians continues to be a very controversial topic for the specialty. However, Dr. Rosen doesn’t back down, challenging the Academy to provide better, and more meaningful, resources to those board-certified dermatologists leading care teams.
DWW: A hot topic to say the least, there are many differing opinions about the role board-certified dermatologists should or shouldn’t play when leading care teams. While we understand that perfect consensus is not always possible, we work toward the same goal of the highest quality and compassionate dermatologic care. Let’s be transparent: How do dermatologists really feel about leading care teams?
Dr. Rosen: You’re right. This is an area in the specialty where dermatologists may straddle the road, so to speak.
Some of my colleagues are totally against educating physician assistants while others in the specialty are fine with rudimentary education. Yet others think that anyone providing care to dermatology patients should receive comprehensive education and training. There are some dermatologists who work alongside PAs every day, assigning less experienced PAs simple tasks, like acne follow-ups or wart treatment, and highly skilled PAs complex medical and surgical tasks. AAD members are also widely split on the subject of supervision. Some feel that direct, on-site supervision is absolutely necessary, whereas others think being available by phone and text message will suffice. AAD members who station PAs at offices peripheral to a central hub feel one way; those who only have PAs stationed at the main office feel another way; and those who do not and will not ever employ a PA feel yet a different way.
Recently, in this series about the AAD 2019 Strategic Plan, my fellow AAD Board Member Seemal R. Desai, MD, discussed the importance of being united in the specialty, particularly because unity facilitates delivering the highest quality, compassionate patient care. The AAD approaches our work with a positive intent and welcomes diversity, tolerance, and participation for the common good of dermatology. That said, I think all board-certified dermatologists want the very best for their patients and are doing what they believe is best no matter where they stand on or how they feel about leading care teams.
DWW: Do you see any significant barriers to implementing the strategic plan as it pertains to support for board-certified dermatologists leading care teams?
Dr. Rosen: While the strategic plan mentions the board-certified dermatologist as the “head” of a dermatology care team, members of the team working in a state that allows them to have more-or-less independent practice don't necessarily desire supervision from a board-certified dermatologist. So, what can you do? We have to be mindful that PAs, for example, have a large, active organization that is already providing extensive educational meetings and a diplomate fellow track. Dermatologists need to think about innovative ways to motivate a non-physician clinician to be a part of a collaborative team, and the Academy must address the specific educational needs and wants of non-physician team members.
DWW: Speaking of educational needs, is the Academy supporting you in your leadership role for a care team? If so, what programs, resources, or processes do you find most useful? If not, what can the AAD do to provide better support for members?
Dr. Rosen: I have to admit that I think the AAD could be supporting board-certified dermatologists in a more meaningful way to assure that they will serve as effective heads of dermatology care teams. Now, that doesn’t mean that the strategies that AAD President George J. Hruza, MD, MBA, and former AAD President Henry W. Lim, MD, are implementing alongside other Academy leaders during the upcoming program assessment won’t build a solid foundation to better support this part of the strategic plan.
While the Leadership Institute helps to provide principles and practices on being an effective leader at the local, state, or national level, I think tools and direction on how to lead a care team should be emphasized here. This is one example of how the Academy can support board-certified dermatologists in a meaningful way to assure that they will serve as responsible and responsive leaders of care teams.
The AAD website has interactive content that elaborates on the practice of medicine by ancillary personnel. But this only gives members a legal perspective based on their state’s medical practice. This absolutely will help dermatologists make informed decisions should they choose to construct a care team. To go a step further, though, the Academy needs to also provide tools and resources that give dermatologists tangible guidance on the business-related elements they need to efficiently lead a care team so that patient care is not compromised.
Finally, the AAD has a position statement on the Practice of Dermatology: Protecting and Preserving Patient Safety and Quality Care. Some members are guided by the content and approach the Academy outlines. The position statement, though, was last revised in 2016 and, in this fast-changing health care environment, needs updates that are more inclusive of the professionals it addresses. I would encourage current Academy leaders to engage the Society of Dermatology Physician Assistants, Inc. (SDPA) when they next revise the position statement — this collaborative effort could yield cooperative teamwork that continues to focus on providing high quality patient care through board-certified dermatologist-led care teams.
DWW: What are practical ways members can enhance effectiveness of care team members who work in dermatology practices?
Dr. Rosen: Providing the highest quality compassionate patient care is an extension of adequate training that goes beyond the basics and requires more than a license or permit. Dermatologists should feel financially responsible for providing opportunities for their care team members to attend local, state, regional, or national conferences. These experiences expose care team members to components of the specialty and patient care pearls that may not have been part of their traditional training or licensure requirements, thus expanding the effectiveness and proficiency of the care team as a whole.
DWW: What educational programs and resources would you like to see expanded or enhanced to assist care team members led by a board-certified dermatologist to provide high quality and compassionate patient care? Are there educational programs or resources that aren’t currently available that you would find beneficial for your care team members?
Dr. Rosen: I personally believe that care team members should be allowed to participate in all AAD educational offerings at Annual and Summer Meetings without the restrictions that limit sessions to board-certified dermatologists. Academy meetings offer premier educational content that fuel patient care and update physicians, and others, on research and treatment options coming down the pipeline. Not to mention, many attendees engage in rare networking opportunities and share insight on how policy and legislative issues impact practice. When sessions are opened to physician assistants, nurse practitioners, and non-physician clinicians, you present a collaborative space that yields a more efficient team and high quality care for patients.
I also think that the board-certified dermatologist, as the team head, has an obligation to nurture the professional development of care team members. Team members should have access to the AAD’s most relevant and innovative content and practice management tools. Leaders of care teams should be willing to take financial responsibility to provide such resources.
DWW: Do you feel comfortable in leading a care team? If not, what skills or knowledge base would assist you to be the best care team leader possible?
Dr Rosen: I'm not sure that board-certified dermatologists possess such skills inherently. They learn “on the job” how and what to delegate to whom. At some point, it may be helpful to document best practices from a “model care team” and share it with members. Again, our goal should be to provide the resources needed for board-certified dermatologists to lead effective care teams to provide superb quality and compassionate care for our patients.
Learn more about the AAD 2019 Strategic Plan.
