Recently, the New York Times published an article on excessive costs incurred by mid-level providers over-treating benign skin lesions. According to the piece, more than 15% of biopsies billed to Medicare in 2015 were done by unsupervised PA’s or Nurse Practitioners. Physicians across the country are becoming concerned mid-levels working independently without proper specialty training. Dr. Coldiron, a dermatologist, was interviewed by the Times and said, “What’s really going on is these practices…hire a bunch of P.A.’s and nurses and stick them out in clinics on their own. And they’re acting like doctors.”
They are working “like” doctors, yet do not have training equivalent to physicians. As a pediatrician, I have written about a missed diagnosis of an infant by an unscrupulous midlevel provider who embellished his pediatric expertise. This past summer, astute physician colleagues came across an independent physician assistant, Christie Kidd, PA-C, boldly referring to herself as a “dermatologist.” Her receptionist answers the phone by saying “Kidd Dermatology.”
The Doctors, a daytime talk show, accurately referred to Ms. Kidd on a May 7, 2015 segment as a “skin care specialist.” However, beauty magazines are not held to the same high standard; the dailymail.com, a publication in the UK, captioned a picture of “Dr. Christie Kidd”, as the “go-to MD practicing in Beverly Hills.”
The article shared how Ms. Kidd treats the Kardashian-Jenner family, “helping them to look luminous in their no-make-up selfies.”
In November, at Quantified Self Europe, Martha Rotter, who lives in Ireland, gave a talk about how she cured her acne by self-experimentation. She summarizes her talk like this (slides here):
When I moved to Ireland in 2007, I began to have skin problems. It began gradually and I attributed it to the move, to stress, to late nights drinking with developers and clients, to travel, to whatever excuses I could think of. The stress was multiplied by the anxiety of being embarrassed about how my face looked, but also because my new job in Ireland involved me being on stage in front of large audiences constantly, often several times a week. A year later my skin was perpetually inflamed, red, full of sores and very painful. When one spot would go away, two more would spring up in its place. It was a tough time. I cried a lot.
Frustrated, I went to see my hometown dermatologist while I was home for holidays. He told me that a) this was completely normal and b) there was nothing I could do but go on antibiotics for a year (in addition to spending a fortune on creams and pills). I didn’t believe either of those things.
I was not interested in being on an antibiotic for a year, nor was I interested in Accutane (my best friend has had it multiple times and it hasn’t had long term results, plus it can be risky). What I was interested in was figuring out why this was happening and changing my life to make it stop. I refused to accept my dermatologist’s insistence that what you put in your body has no effect on how you look and feel.