Advanced Practice Professionals Performing More Dermatologic Procedures

Doctor placing patches on eyes
Doctor placing patches on eyes
The most common procedures that APPs performed in 2015 were destructions of benign neoplasms, biopsies, and destructions of malignant neoplasms.

The number and range of dermatology procedures that are performed by advanced practice professionals (APPs) such as nurse practitioners and physician assistants are increasing over time, according to results published in JAMA Dermatology.

As the types of procedures that APPs are performing can be difficult and invasive, these results indicate the need for further studies to determine how this trend affects patient outcomes and the potential need for more formal training.

The study included data from the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File from 2012 through 2015. This file includes information on nearly all outpatient procedures paid for by Medicare Part B in the United States and includes the type of clinician who conducted the procedure. The researchers used these data to determine the total number of each dermatology procedure that was performed by APPs compared with dermatologists.

The total number of all dermatologic procedures increased from 30.7 million in 2012 to 33.9 million in 2015. Of these, APPs performed 8.8% (n=2.69 million) of procedures in 2012 and 13.4% (n=4.54 million) in 2015.

The most common procedures that APPs performed in 2015 were destructions of benign neoplasms (3.6 million), biopsies (788,834), and destructions of malignant neoplasms (48,982).

The data also indicated that the number of patch tests, removals of benign and malignant neoplasms, intermediate and complex repairs, flaps, and surgical pathologic specimen examinations by APPs increased each year from 2012 to 2015 and at a much higher rate than procedures billed by dermatologists.

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“Given the large and growing amount of procedures being performed by APPs, it would be beneficial if training and qualification guidelines for APPs, such as a minimum number of supervised procedures documented and the education and testing of APPs on the skin diseases necessitating procedures, were better defined,” the researchers wrote.


Zhang M, Zippin J, Kaffenberger B. Trends and scope of dermatology procedures billed by advance practice professionals from 2012 through 2015. [published online July 11, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.1768