Myth #4: Private Equity Is Driving the Overuse of PAs and NPs

PE-backed group practices are hiring nurse practitioners (NPs) and physician assistants (PAs)—but so is every other type of dermatological practice. According to the 2018 American Academy of Dermatology Association Member Profile, nearly half of all Dermatologists employ a PA or NP, and those physicians work in non-PE-backed group practices, multispecialty groups, solo practices, and academic medical centers as well as PE-backed groups. Dermatologists in PE-backed practices make up only about 8% of the total number of Board-certified Dermatologists.

The myth here, then, is to trace a broader trend in Dermatology to a single practice setting.

PE-backed group practices were not the first practices to use PAs and NPs, nor are they the biggest users now. In fact, the proportion of Dermatology practices looking to hire PAs and NPs has held steady since the mid-2000s.

Pinning the use of PAs and NPs on private equity just confuses the tough discussions we need to have as a specialty—discussions about the proper ratio of Board-certified Dermatologists to PAs and NPs, for one, but also a broader conversation about the relationship between quality and access, and about where Board-certified Dermatologists are willing to work.

We are already having the conversation about PA and NP training, use, and supervision at Forefront. One of our core decisions as a group is to maintain an appropriate ratio of Board-certified Dermatologists to PAs and NPs, a formal commitment that distinguishes us from other groups (of all kinds, not just those backed by PE). We made this commitment in the best interest of our patients: a responsible ratio allows for thorough supervision and optimal collaboration between Forefront’s Dermatologists and our invaluable PA and NP partners. It also helps us maintain our self-definition as a group of specialists providing expert, Board-certified dermatological care.