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Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
Microsoft Word - Dermatology Practice Profile Survey Report w ...
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Microsoft Word - Dermatology Practice Profile Survey Report w ...

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  • 1. Survey work is conducted for the benefit of and is owned by the American Academy of Dermatology Association. Copyright © October 2007 American Academy of Dermatology Association Prepared by: James Kostecki, MS Department of Science and Research October, 2007 Dermatology Practice Profile Survey 2007 Report
  • 2. Copyright © 2007 American Academy of Dermatology Table of Contents Executive Summary................................................................................................1 Introduction and Methods .......................................................................................3 Profile of Survey Respondents ...............................................................................4 Practice Characteristics & Activities........................................................................5 Type of Practice and Community Served Dermatology Workforce Issues: Physician Supply, Wait Times Physician Patient Encounters, Work Load, Procedures Performed Physician Extenders ...............................................................................................8 Employment of Physician Extenders: Present and Future Predictors of the Employment of Physician Extenders Physician Extender Patient Encounters and Level of Supervision Physician Extender Dermatology Training and Next Employer Support for Academy Services/Benefits for Physician Extenders Office Accreditation and Hospital Privileging ..........................................................12 Reimbursement Sources and Commercial Insurance.............................................12 Job Satisfaction.......................................................................................................13 Conclusions ............................................................................................................14 Appendix A: Statistical Tables ................................................................................15 Appendix B: Survey Instrument ..............................................................................34
  • 3. Page 1Copyright © 2007 American Academy of Dermatology American Academy of Dermatology Association Dermatology Practice Profile Survey 2007 Report Executive Summary The American Academy of Dermatology’s Dermatology Practice Profile Survey (DPPS) is a national survey of Academy members designed to collect information on the nature of and trends characterizing dermatology practice. The 2007 Dermatology Practice Profile Survey included sections related to dermatology practice characteristics and activities, office accreditation and hospital privileging, reimbursement sources and commercial insurance, and job satisfaction. This year’s survey also included a number of questions related to physician assistants and nurse practitioners used in the dermatology practice. Of the random sample of 3,965 members, a total of 1,243 practicing dermatologists completed the survey for a response rate of 31.3%. After removing retirees and those not active in patient care, responses from 1,146 completed surveys were used in the statistical analysis. The representative sample of 1,146 respondents yields a margin of error of less than 3% with 95% confidence. Profile of Dermatology Practices • The average age of the survey respondents is 51 years old; 64% are male and 36% female. • More than half (55%) of the dermatologists practice in a suburban community, 34% practice in an urban community, and 9% in a rural setting. • 44% of the dermatologists work in a solo practice, 33% in a dermatology group practice, 11% in a multispecialty group practice, and 8% in an academic setting. • Of the average 38 hours per week spent on patient care, 24 hours are spent in medical dermatology, 10 hours in non-cosmetic surgical dermatology, and 4 hours in cosmetic dermatology. Dermatology Workforce • Overall, 45% of dermatologists reported that the supply of dermatologists in their community is less than required. The shortage is reported to be greatest in rural settings with 66% reporting the supply is less than required. • On average, appointment wait times for new and established patients are reported at 33.2 and 19.5 days, respectively. Physician Extenders • 30% of dermatologists reported that they presently employ at least one physician extender. Physician assistants are employed at 23% and nurse practitioners at 10% of the offices. • 12% of dermatologists are currently seeking to hire a physician extender. An additional 7% of dermatologists plan to hire physician extenders within the next 3 years. • Overall, if future hires are realized, nearly 38% of dermatologists could potentially employ physician extenders in the next three years; 28% employing physician assistants and 13% employing nurse practitioners. • When the physician extender is engaged in patient care, a physician is reportedly on site 92% and off site 8% of the time, on average.
  • 4. AADA Dermatology Practice Profile Survey – 2007 Report Page 2Copyright © 2007 American Academy of Dermatology Physician Extenders (continued) • The majority of dermatologists report that their physician extenders see established patients with new problems (85%) and new patients (77%). On average, 47% of new patients and 37% of follow-ups with new problems are formally presented to a physician during the visit. Support for Academy Services / Benefits for Physician Extenders • Overall, there is less support for allowing physician extenders to attend education sessions restricted to dermatologists with approximately 32% of dermatologists supporting and 46% opposing their attendance. For the dermatologist offices who employ physician extenders, 51% support the physician extenders attending these meetings. For those who do not employ extenders, only 21% support their attendance. • Overall, there is more support to develop and provide separate education sessions for physician extenders with 57% of dermatologists supporting and 22% opposing the development of these sessions. For the practices that employ physician extenders, 81% support this program. For those who do not employ extenders, 43% support the program • Overall, the respondents are split as to the creation of a new AAD membership category for physician extenders with 43% of dermatologists supporting and 35% opposing the creation of the new membership category. For the practices who employ physician extenders, 64% support their membership. For those who do not employ extenders, only 30% support the creation of the new membership category. Accreditation • Of the 238 offices that are accredited for surgical procedures, 57% obtained accreditation using the JCAHO, 39% obtained accreditation though their state, 32% obtained accreditation with Medicare, and 18% used the AAAHC to obtain this accreditation. • Of the 49 dermatologists who own (or are part owner of) an Ambulatory Surgical Center, 25 (51%) obtained accreditation though Medicare, 23 (47%) obtained accreditation though their state, 15 (31%) used the AAAHC, and 10 (20%) used the JCAHO to obtain their ASC accreditation. Insurance • Most (89%) dermatologists report that they accept self-pay patients. Traditional Medicare is accepted by 88% of the practices, private fee-for-service by 87%, managed Medicare HMOs by 67%, Tricare by 56%, and Medicaid by 38% of the responding dermatologists. • For those practices that have current commercial insurance contracts (CICs), dermatologists were asked how the average payment rate compares with the Medicare fee schedule. More than half (56%) of the dermatologists responding to this question reported that, on average, the CIC payment rates are above those of Medicare, 16% reported that they were the same, and 28% reported that the average CIC payment rate is below that of Medicare. Job Satisfaction • The majority (85%) of dermatologists reported that they are satisfied and only 10% said that they are unsatisfied with their overall career.
  • 5. Page 3Copyright © 2007 American Academy of Dermatology American Academy of Dermatology Association Dermatology Practice Profile Survey 2007 Report Introduction The American Academy of Dermatology’s Dermatology Practice Profile Survey (DPPS) is a national survey of Academy members designed to collect information on the nature of and trends characterizing dermatology practice. It is conducted to collect credible information on dermatology practice to inform advocacy, membership, and program development decisions. Two surveys were conducted in 2002 and the latter part of 2005, and the latest was undertaken in May of this year. Care is taken to ensure these surveys are conducted to yield statistically significant, representative results that accurately portray key aspects of dermatology practice. This year’s survey focused on questions that relate to the use, supervision and training of physician assistants (PAs) and nurse practitioners (NPs) in dermatology practice. Data from the 2002 and 2005 surveys are included for comparison purposes. Methods Sample The survey population included associates, life, and honorary Academy members and excluded international members, retirees, and those older than 72 years. From the 9,796 members meeting the inclusion criteria, a stratified random sample of 3,965 was selected to participate in this year’s survey. The sample size was selected in order to achieve a margin of error within 3% with 95% confidence and assumes a response rate of no less than 25%. The sample was stratified by age, gender, and region (state) of the members’ primary practice site to increase the likelihood that the results would be representative of the members meeting the inclusion/exclusion criteria, the Academy’s U.S. membership of practicing dermatologists. Survey Instrument The 2007 Dermatology Practice Profile Survey questionnaire included sections related to dermatologic practice characteristics and activities, office accreditation and hospital privileging, reimbursement sources and commercial insurance, and job satisfaction. Practice characteristics consisted of patient load, procedures performed, dermatology workforce issues, and office staff. This year’s survey also included a number of questions related to physician assistants and nurse practitioners used in the dermatology practice. These physician extender questions related to the current and future employment of each type of physician extender, patient encounters, types of dermatology training, and their level of supervision. Questions related to the support for AAD programs and benefits for physician extenders were also included in the survey. These questions asked about the members’ support for the attendance of physician assistants (PAs) and nurse practitioners (NPs) at existing AAD education sessions currently restricted to dermatologists, the development of professional education sessions for physician extenders, and the creation of a new AAD membership category for these non-physician providers. Two versions of the survey instrument were developed; paper and online. The online version of the survey included a number of field validation rules that increase the chance for improved data quality and minimizing the data cleanup effort.
  • 6. AADA Dermatology Practice Profile Survey – 2007 Report Page 4Copyright © 2007 American Academy of Dermatology Results Survey Respondents Of the random sample of 3,965 members, a total of 1,243 completed the survey for a response rate of 31.3%. Of these completed questionnaires, 1,038 (84%) were completed on paper and 205 (16%) were completed online. Of the 1,243 respondents, 69 are retired and 28 do not currently see patients. Removing these cases, a total of 1,146 respondents were used in the data analysis. Potential response bias was investigated by comparing the respondents’ age, gender and geographic location with that of the survey population (Academy’s U.S. membership of practicing dermatologists). As seen in Table 1, the differences between the two groups are small, suggesting the respondent group is highly representative of all members who met criteria for inclusion in the study. Thus, the survey respondents are representative of the Academy’s U.S. membership of practicing dermatologists. The representative sample of 1,146 respondents yields a margin of error of approximately +/- 2.7% with 95% confidence. Background Information Demographics The average age of the survey respondents is 51 years old; 64% are male and 36% female. As seen in Figure 1, over the past three surveys, the percentage of female respondents is increasing. One third (33%) of U.S. dermatologists practice in the South, 27% practice in the Northeast, 19% in the Midwest, 14% in the Pacific, and 7% in the Rocky Mountain regions of the U.S. See Table 1 for additional details. Figure 1 Gender of Survey Respondents By Survey Year 70.3% 66.0% 64.1% 29.7% 34.0% 35.9% 0% 25% 50% 75% 100% 2002 2005 2007 Survey Year Female Male
  • 7. AADA Dermatology Practice Profile Survey – 2007 Report Page 5Copyright © 2007 American Academy of Dermatology Residency and Fellowships Nearly 18% of survey respondents reported to have completed another residency program in addition to dermatology. Of the 202 dermatologists who have completed another residency program, 67% reported completing programs in internal medicine, 14% in pediatrics, and 8% in family practice. Most (89%) of those completing another residency program are also board certified in these programs. (See Table 2 for details.) Of those who had completed post-residency fellowships, 109 reportedly completed fellowships in Mohs surgery, 50 in dermatopathology, and 19 in cosmetic surgery. See Table 3 for a list of other fellowships completed. Practice Characteristics and Activities Type of Practice and Community Served More than half (55%) of the dermatologists practice in a suburban community, 34% practice in an urban community, and 9% in a rural setting. As seen in Figure 2, the type of community served is not significantly different over the past three survey years. The largest percentage (44%) of dermatologists reported that their primary practice setting is a solo practice, 33% is a dermatology group practice, 11% is a multispecialty group practice, and 8% is an academic setting. As might be expected, the type of practice varies by community. More than half (52%) of the practices in a rural setting are solo practices compared with only 38% in an urban setting. See Table 4 for details. On average, respondents reported that their practice has two physicians. However, the number of physicians varies significantly with type of practice, or work setting. On average, dermatology group practices have 3 physicians, multispecialty group practices have 52 physicians, and academic settings have 10 physicians. Figure 2 Community of Primary Practice By Survey Year 38% 37.4% 33.7% 52% 53.3% 54.8% 10% 9.2% 9.4% 0% 25% 50% 75% 100% 2002 2005 2007 Survey Year Rural Suburban Urban
  • 8. AADA Dermatology Practice Profile Survey – 2007 Report Page 6Copyright © 2007 American Academy of Dermatology Dermatology Workforce Issues: Physician Supply, Patient Wait Times Approximately 45% of dermatologists reported that the supply of dermatologists in their community is less than required. Not surprisingly, the shortage is reported to be greater in rural settings (66%) than in suburban (42%) and urban (44%) settings. (See Table 5 and Table 6.) When compared with results from the 2005 and 2002 surveys, dermatologists’ perceptions of shortages in their communities remain relatively unchanged. (See Figure 3 and Table 7.) About a third (34%) of dermatologists report that they are seeking to add an average of 1.6 dermatologists to their practice. Figure 3 Reported Supply of Dermatologists By Survey Year 50% 44% 45% 31% 33% 32% 19% 22% 23% 0% 25% 50% 75% 100% 2002 2005 2007 Survey Year Greater than required Correct supply Less than required On average, wait times for new and established patients are reported at 33.2 and 19.5 days, respectively. Compared to previous survey years, these average patient wait times are relatively stable. (See Figure 4 below.) Figure 4 Average Patient Appointment Wait Times By Survey Year 35 34.4 33.2 20 18.8 19.5 10 15 20 25 30 35 40 2002 2005 2007 Survey Year Avg#ofDays New patients Established patients
  • 9. AADA Dermatology Practice Profile Survey – 2007 Report Page 7Copyright © 2007 American Academy of Dermatology Physician Patient Encounters, Work Load, and Procedures Performed On average, dermatologists reportedly see 136 patients per week during an average of 38 hours per week, 4.1 days per week and 47.6 weeks per year. The overall patient load is not significantly different from the last survey year (2005) where dermatologists reported seeing an average of 142 patients per week during an average of 3.9 days per week and 47.3 weeks per year. See Table 8. Of the average 38 hours per week spent on patient care, an average of 24 (65% of total) hours are spent in medical dermatology, 10 (25% of total) hours in non-cosmetic surgical dermatology, and 4 (10% of total) hours in cosmetic dermatology. (See Table 9.) Most dermatologists spend some time treating patients in each of these areas. Although more than half (54%) of dermatologists spend time in cosmetic dermatology, 40% of these dermatologists spend less than 10% of their time in cosmetic dermatology. (See Table 10.) As seen in Figure 5, dermatologists are spending, on average, slightly more of their total patient care time in cosmetic dermatology and slightly less in medical dermatology than in the 2005 survey. Figure 5 Patient Care Time By Area of Dermatology By Survey Year 66.4% 65.2% 25.4% 25.3% 8.1% 10.0% 0% 25% 50% 75% 100% 2005 2007 Survey Year %TotalPatientCareTime Cosmetic Non-cosmetic Surgical Medical Approximately one half (51%) of dermatologists reported that they perform chemical peels, 49% perform cosmetic Botox injections, and 47% perform UV light therapy. Forty-four percent (44%) and 38% of the dermatologists reported that they perform collagen/filler injections and cosmetic laser surgery, respectively. Only 2% of the respondents reported performing hair transplants. See Table 11 for a complete list of dermatology procedures performed. On average, dermatologists spend 11 hours per week on activities outside of patient care. Most (98%) of the dermatologists responding to this question reported spending an average of 7 hours per week on administration, paperwork, or correspondence. Less than half (44%) of dermatologists report spending an average of about one hour per week on hospital consults and lecturing or teaching. See Table 12 for details. Office Staff Most (99%) of the dermatologists reported employing an average of 6.0 full-time-equivalent (FTE) administrative staff positions. The majority (77%) of dermatologists employ an average of 4.1 (FTE)
  • 10. AADA Dermatology Practice Profile Survey – 2007 Report Page 8Copyright © 2007 American Academy of Dermatology medical assistants, nearly half (49%) employ an average of 3.6 nurses, 23% employ an average of 1.5 physician assistants (PAs), 10% employ an average of 1.9 nurse practitioners (NPs), 23% employ an average of 1.6 aestheticians, and 5% employ an average of 1.8 technicians. See Table 13 for details. Physician Extenders Employment of Physician Extenders: Present and Future Approximately 30% of dermatologists reported that they presently employ at least one physician extender (including PAs and NPs, but excluding estheticians). Physician assistants are employed at approximately 23% and nurse practitioners at about 10% of the offices. As seen in Figure 6, the percentage of dermatologists who employ physician extenders has increased by 2% (up from 28%). This increase is explained by the growth in the employment of PAs as the number of NPs remains relatively flat. Figure 6 Dermatologists that Presently Employ Physician Extenders By Survey Year 28.0% 29.8% 21.0% 23.1% 9.9% 9.9% 0% 5% 10% 15% 20% 25% 30% 35% 40% 2005 2007 Survey Year %Respondents PA and/or NP PA NP Approximately 12% of dermatologists reported that they are currently seeking to hire a physician extender with 9% seeking to add at least one physician assistant and 4% seeking to add at least one nurse practitioner. In addition to those currently seeking extenders, approximately 7% of dermatologists plan to hire physician extenders in the near future (within three years). About 5% expect to hire physician assistants and 2% expect to hire nurse practitioners. Overall, nearly 38% of dermatologists presently employ or expect to hire physician extenders within the next three years. Physician assistants are employed or expected to be employed at approximately 28% and nurse practitioners at about 13% of the offices. Based on this data, Figure 7 shows the current employment of physician extenders and the potential growth over the next three years if those practices who seek to hire succeed in doing so.
  • 11. AADA Dermatology Practice Profile Survey – 2007 Report Page 9Copyright © 2007 American Academy of Dermatology Figure 7 Potential Growth of Physician Extender Employment By Type of Extender 37.8% 22.3% 27.8% 9.6% 13.2% 28.8% 0% 5% 10% 15% 20% 25% 30% 35% 40% Current Employment Potential Future Employment %Practices PA and/or NP PA NP Predictors of the (Present/Future) Employment of Physician Extenders As seen in Table 15, solo practices are least likely to hire a physician extender with 29% of these practices presently employing or seeking to hire a physician extender. Approximately 45% of dermatology and 44% of multi-specialty group practices employ or plan to hire physician extenders. More than half (51%) of academic settings employ or plan to hire physician extenders. Respondents that reported the supply of dermatologists in the community as less than required are more likely to hire a physician extender than those that reported a surplus. Approximately 44% of dermatologists that reported a shortage employ or plan to hire a physician extender compared with only 32% of those that reported a surplus. Those practices that are seeking to add a dermatologist are more likely to hire a physician extender. More than half (52%) of practices that are currently seeking to add a dermatologist employ (or plan to hire) a physician extender. Of the practices that are not seeking to add a dermatologist, only 30% employ or plan to hire at least one physician extender. There are no statistically significant differences in the employment of physician extenders between male and female dermatologists. Thirty-nine percent (39%) of the male and 36% of the female dermatologists reported that their practice employs or plans to hire at least one physician extender. Dermatologists that are 60+ years old are less likely to hire a physician extender than younger dermatologists. No statistically significant differences are detected among dermatologists in other age groups. Approximately 28% of those 60 years or older employ (or seek to hire) physician extenders compared with 41% of younger dermatologists. Physician Extender Patient Encounters and Level of Supervision Approximately 32% of dermatologists reported that they currently employ or have recently employed physician extenders in their practice. Of these, the following describe the use, supervision, and patient encounters of these physician extenders. Summary statistics are provided in Table 16.
  • 12. AADA Dermatology Practice Profile Survey – 2007 Report Page 10Copyright © 2007 American Academy of Dermatology On average, one physician assistant sees 87 patients per week and one nurse practitioner sees 74 patients per week. On average, 79% of the physician extender’s patient care time is spent on medical dermatology, 12% on cosmetic dermatology, and 9% is spent on non-cosmetic dermatology. See also Table 17. When the physician extender is engaged in patient care, a physician is reportedly on site 92% and off site 8% of the time, on average. However, almost a third (31%) of the physicians report to be off-site at least 10% of the time. A few dermatologists (6%) are supervising off-site at least 50% of the time. Most dermatologists (99%) report that their physician extenders see established patients with on- going, stable conditions. On average, 25% of these patients are formally presented to a physician during the visit. A smaller majority of physician extenders are permitted to see established patients with worsening conditions (72%). Of these, more than half (54%), on average, are formally presented to a physician during the visit. The majority of dermatologists report that their physician extenders see established patients with new problems (85%) and new patients (77%). Of these types of patients, more than half are not being presented to the physician during their visit. On average, 47% of new patients and only 37% of follow-ups with new problems are formally presented to a physician during the visit. Note that this result conflicts with the Academy’s position statement on the use of non-physician office personnel that states: “All new patients and significant new problems in established patients should be seen by dermatologists in a face-to-face manner”. Physician Extender Dermatology Training and Next Employer Most (94%) dermatologists reported that their physician extenders receive dermatology training on- the-job in their offices, 82% report that they receive this training by attending CME meetings and courses sponsored by professional societies, 54% by a dermatology rotation in school, and 51% by attending external lectures by pharmaceutical / device industry. More than a third (36%) of the extenders receives training via a formal curriculum of lecture and/or reading defined by the dermatology practice and 12% via a formal dermatology training program at a teaching institution. (See Table 18.) When physician assistants leave the practice, the top two most commonly reported subsequent employers reported are another dermatologist office (55% of practices with PAs) and a medical practice of another specialty (9%). Of the 167 dermatologists responding to this question, 55% reported that their PA left to accept a position at another dermatologist office and 14% reported that they accepted a position at a medical practice of another specialty. Another 11% reported that their subsequent employer is unknown. See Table 19 for additional listings. Support for Academy Services / Benefits for Physician Extenders All respondents were asked to what degree they would support that the AAD offer the following services / benefits for dermatology physician assistants and / or nurse practitioners in their practice: • Allow physician assistants and nurse practitioners to attend existing education sessions at the AAD meetings that are currently restricted to dermatologists. • Develop and provide professional education sessions just for physician assistants and nurse practitioners. • Create a new AAD membership category for physician assistants and nurse practitioners.
  • 13. AADA Dermatology Practice Profile Survey – 2007 Report Page 11Copyright © 2007 American Academy of Dermatology Overall, there is less support for allowing physician extenders to attend education sessions restricted to dermatologists with approximately 32% of dermatologists supporting and 46% opposing their attendance. However, there is a significant difference in support between those practices that hire physician extenders and those that do not. For the dermatologist offices who employ (or are seeking to employ) physician extenders, 51% support the physician extenders attending these meetings. For those who do not employ extenders, only 21% support their attendance. See Table 20a and Figure 8a. Figure 8a Allow Physician Extenders to Attend Sessions Currently Restricted to Dermatologists Overall, there is more support to develop and provide separate education sessions for physician extenders. Over half (57%) of the dermatologists support and only 22% oppose the development of these sessions. Again, the support is even greater for those practices that employ physician extenders. For the practices that employ (or are seeking to employ) physician extenders, 81% support this program. For those who do not employ extenders, 43% support the program. See Tables 20b and Figure 8b below. Figure 8b Develop Professional Education Sessions Just for Physician Extenders
  • 14. AADA Dermatology Practice Profile Survey – 2007 Report Page 12Copyright © 2007 American Academy of Dermatology Overall, the respondents are split as to the creation of a new AAD membership category for physician extenders. Approximately 43% of the dermatologists support and just over a third (35%) oppose the creation of the new membership category. However, the support is greater for those practices that employ physician extenders than for those that do not. For the practices who employ (or are seeking to employ) physician extenders, 64% support their membership. For those who do not employ extenders, only 30% support the creation of the new membership category. See Table 20c and Figure 8c. Figure 8c Create New Membership Category for Physician Extenders Office Accreditation and Hospital Privileging Nearly 80% of responding dermatologists report that their office laboratory has a current CLIA certificate. Provider performed microscopy is reportedly performed in 76% of the offices, high complexity tests are performed in 44%, and moderate complexity tests are performed in 40% of the offices. Of the survey respondents, 91% reported that they hold hospital privileges in a medical facility and 17% in the surgical/operation room. See Table 21 for details. Of the 238 offices that are accredited for surgical procedures, more than half (57%) obtained accreditation using the JCAHO, 39% obtained accreditation though their state, 32% obtained accreditation with Medicare, and 18% used the AAAHC to obtain this accreditation. See Table 22. Of the 49 dermatologists who own (or are part owner of) an Ambulatory Surgical Center, 25 (51%) obtained accreditation though Medicare, 23 (47%) obtained accreditation though their state, 15 (31%) used the AAAHC, and 10 (20%) used the JCAHO to obtain their ASC accreditation. Reimbursement Sources and Commercial Insurance Most (89%) dermatologists report that they accept self-pay patients. Traditional Medicare is accepted by 88% of the practices, private fee-for-service by 87%, managed Medicare HMOs by 67%, Tricare by 56%, and Medicaid by 38% of the responding dermatologists. (See Table 23.)
  • 15. AADA Dermatology Practice Profile Survey – 2007 Report Page 13Copyright © 2007 American Academy of Dermatology The vast majority (88%) of dermatologists accept Medicare Part B in their primary practice. Only 5% of the dermatologists who responded have been audited by Medicare and 7% by a private insurer. For those practices that have current commercial insurance contracts (CICs), dermatologists were asked how the average payment rate compares with the Medicare fee schedule. More than half (56%) of the dermatologists responding to this question reported that, on average, the CIC payment rates are above those of Medicare, 16% reported that they were the same, and 28% reported that the average CIC payment rate is below that of Medicare. (See Table 24.) Job Satisfaction The majority (85%) of dermatologists reported that they are satisfied and only 10% said that they are unsatisfied with their overall career. Dermatologists were most satisfied with their choice of dermatology as a specialty and least satisfied with the balance of work and personal life, and with their income. Most (88%) of dermatologists responding to this question reported that they were satisfied with their choice of specialty. When asked to rate their satisfaction with the balance of work and personal life, 66% said that they were satisfied and 17% dissatisfied. When asked about their income, 66% were satisfied and 16% dissatisfied. (See Table 25.) In the 2005 survey, dermatologists were also most satisfied with their choice of specialty and least satisfied with the work-life balance and income. However, the overall satisfaction levels in all aspects in their career were higher in 2005 than in 2007. See Figure 9 below. Figure 9 Satisfaction with Career By Survey Year
  • 16. AADA Dermatology Practice Profile Survey – 2007 Report Page 14Copyright © 2007 American Academy of Dermatology Conclusions Despite ongoing growth in the use of physician extenders, data suggest little change in the shortage of dermatologists and resulting delays in patient access. Survey results indicate that many dermatologists are currently seeking or plan to hire physician extenders in the next few years, suggesting that growth in the number of extenders in dermatology offices will continue. Supervision of these extenders continues to vary. Conflicting with the Academy’s position statement on the use of non-physician office personnel, the majority of new patients or established patients with new problems seen by the physician extenders are not formally presented to a physician during the patient visit. Questions regarding support for a variety of proposals on extender education and membership revealed a divided membership without clear consensus. Just over half of the practices support the development of education sessions for physician extenders. However, there is less broad support for the creation of a new AAD membership category for physician extenders or to allow attendance at AAD education sessions currently restricted to dermatologists. The dermatology practices that hire physician extenders report a higher level of support for all three services or benefits. The Dermatology Practice Profile Survey collected information on the nature of and trends characterizing dermatology practice in the United States. The information is useful in providing information for advocacy, membership, and program development decisions. The intent of this report is to highlight many of the relationships among the responses and to present trends by comparing results from previous survey years. Further investigation of the data is encouraged. Please send inquiries to James Kostecki, Sr. Manager, Survey Research at the American Academy of Dermatology in the Science and Research Department.
  • 17. Page 15Copyright © 2007 American Academy of Dermatology APPENDIX A STATISICAL TABLES
  • 18. 2007 Dermatology Practice Profile Survey Background Information Page 16Copyright © 2007 American Academy of Dermatology Table 1 Comparison of Survey Population, Sample and Respondents Demographic Survey Population Survey Sample Survey Respondents Difference Between Respondents and Population (n = 9796) (n = 3965) (n = 1146) n % n % n % Gender Male 6067 62.0% 2447 61.8% 729 64.1% +2.1% Female 3726 38.0% 1515 38.2% 409 35.9% -2.1% Age 28-39 1860 19.0% 747 18.8% 191 16.9% -2.1% 40-49 2814 28.7% 1141 28.8% 321 28.3% -0.4% 50-59 2784 28.4% 1133 28.6% 363 32.0% +3.6% 60-72 2337 23.9% 944 23.8% 258 22.8% -1.1% Mean Age 50.5 50.5 50.7 +0.2 Median Age 50 50 51 +1.0 Region Midwest 1765 18.0% 716 18.1% 212 18.7% +0.7% Northeastern 2509 25.6% 1012 25.5% 306 27.0% +1.4% Pacific 1772 18.1% 714 18.0% 154 13.6% -4.5% Rocky Mountain 599 6.1% 246 6.2% 81 7.2% +1.0% Southern 3081 31.5% 1246 31.4% 368 32.5% +1.1% Other 70 0.7% 30 0.8% 11 1.0% +0.3%
  • 19. 2007 Dermatology Practice Profile Survey Background Information Page 17Copyright © 2007 American Academy of Dermatology Table 2 Residency Programs Completed Outside of Dermatology Specialty Completed Program Board Certified n % n % Family Practice 16 7.9% 14 6.9% Internal Medicine 135 66.8% 121 59.9% Pediatrics 29 14.4% 26 12.9% Other 22 10.9% 22 10.9% Total # with another specialty 202 17.6% 179 88.6% Table 3 Post-Residency Fellowships (% of all survey respondents) Fellowships Completed Respondents n % Mohs Surgery 109 9.5% Dermatopathology 50 4.4% Cosmetic Surgery 19 1.7% Dermatological immunology 14 1.2% Procedural Dermatology 12 1.0% Laser Surgery 12 1.0% Pediatric Dermatology 10 0.9% Cutaneous Oncology 8 0.7% Other Surgical Fellowship 4 0.3% Other 49 4.3%
  • 20. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 18Copyright © 2007 American Academy of Dermatology Table 4 Work Setting by Community Served Work Setting Type of Community Served Total Urban Suburban Rural n % n % n % NR n % Solo 146 37.8% 294 46.8% 56 51.9% 10 506 44.2% Dermatology Group 119 30.8% 228 36.3% 26 24.1% 6 379 33.1% Multispecialty Group 32 8.3% 68 10.8% 21 19.4% 1 122 10.6% Academic 65 16.8% 19 3.0% 4 3.7% 88 7.7% Veterans Administration 8 2.1% 4 0.6% 0 0.0% 12 1.0% Military 6 1.6% 6 1.0% 0 0.0% 12 1.0% Other 1 0.3% 5 0.8% 0 0.0% 6 0.5% NR 9 2.3% 4 0.6% 1 0.9% 7 21 1.8% Total 386 33.7% 628 54.8% 108 9.4% 24 1146 100.0% Table 5 Supply of Dermatologists by Community Served Supply of Dermatologists in Community Type of Community Served Total Urban Suburban Rural n % n % n % NR n % Much greater than required 47 12.2% 57 9.1% 4 3.7% 108 9.4% A little greater than required 45 11.7% 95 15.1% 10 9.3% 2 152 13.3% Correct supply 122 31.6% 210 33.4% 22 20.4% 7 361 31.5% A little less than required 119 30.8% 195 31.1% 45 41.7% 1 360 31.4% Much less than required 52 13.5% 67 10.7% 26 24.1% 7 152 13.3% NR 1 0.3% 4 0.6% 1 0.9% 7 13 1.1% Total 386 33.7% 628 54.8% 108 9.4% 24 1146 100.0%
  • 21. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 19Copyright © 2007 American Academy of Dermatology Table 6 Dermatology Workforce Trends Workforce Item (*self-reported) Respondents n % Supply of Dermatologists in Community* Greater than required 260 22.7% Correct supply 361 31.5% Less than required 512 44.7% NR 13 1.1% Seeking to Add Dermatologist to Practice?* No 753 65.7% Yes 384 33.5% NR 9 0.8% Patient Wait Times* New patients < 14 days 365 31.8% 14-27 days 261 22.8% 28-55 days 227 19.8% > 55 days 236 20.6% NR 57 5.0% Average 33.2 Established patients < 14 days 536 46.8% 14-27 days 261 22.8% 28-55 days 196 17.1% > 55 days 81 7.1% NR 72 6.3% Average 19.5
  • 22. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 20Copyright © 2007 American Academy of Dermatology Table 7 Workforce Trends by Survey Year Workforce Item (*self-reported) 2002 Survey 2005 Survey 2007 Survey Supply of Dermatologists in Community* Greater than required 19% 22.0% 22.7% Correct supply 31% 33.0% 31.5% Less than required 50% 44.0% 44.7% Patient Wait Times Average wait time for new patients 35 34.4 33.2 Average wait time for established patients 20 18.8 19.5 Seeking to Add Dermatologists Percentage of offices seeking to add 31% 33.2% 33.5% Average number to dermatologists to add N/A 1.4 1.6 Average number of months for search >6 20.6 20.0
  • 23. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 21Copyright © 2007 American Academy of Dermatology Table 8 Dermatologist Patient Load by Survey Year Patient Load 2005 Survey (n = 1497) 2007 Survey (n = 1146) n % n % Patients / week Less than 50 70 4.9% 73 6.4% 51 to 100 213 15.0% 309 27.3% 101 to 200 881 62.0% 652 57.6% More than 200 256 18.0% 98 8.7% Mean 142.4 136.2 Median 130.0 127.5 Days / week 0.5 - 1 38 2.6% 17 1.5% 1.5 - 3 307 20.7% 160 14.0% 3.5 - 5 1072 72.2% 932 81.8% 5.5 - 7 68 4.6% 31 2.7% Mean 3.9 4.1 Median 4.0 4.0 Weeks / year 30 or less 14 1.0% 8 0.7% 31-39 13 0.9% 12 1.1% 40-43 70 4.8% 66 5.9% 44-46 318 21.8% 244 21.7% 47-48 566 38.8% 457 40.6% 49-50 420 28.8% 298 26.5% 51-52 56 3.8% 40 3.6% Mean 47.3 47.6 Median 48.0 48.0
  • 24. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 22Copyright © 2007 American Academy of Dermatology Table 9 Patient Care Time per Week Area of Dermatology Mean Hours per Week Mean % of Patient Care Time Physicians who Treat Patients in Each Area (n = 1124) n % Medical dermatology 23.9 65.2% 1082 94.4% Non-cosmetic surgical 10.2 25.3% 977 85.3% Cosmetic 3.8 10.0% 620 54.1% Total 37.8 100.0% Table 10 Patient Care Time by Dermatologic Area % of Total Patient Hours Physicians who Treat Patients in Each Area Medical Non-Cosmetic Surgical Cosmetic n % n % n % 1-9% 13 1.2% 129 13.2% 250 40.3% 10-19% 40 3.7% 282 28.9% 165 26.6% 20-29% 38 3.5% 231 23.6% 99 16.0% 30-39% 46 4.3% 109 11.2% 46 7.4% 40-49% 62 6.3% 71 7.3% 21 3.4% 50% or more 883 81.6% 155 15.9% 39 6.3% Total Physicians 1082 100.0% 977 100.0% 620 100.0% Mean % 67.7% 29.1% 17.3%
  • 25. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 23Copyright © 2007 American Academy of Dermatology Table 11 Dermatology Procedures Performed Procedure Respondents (n=1146) n % Chemical Peels 589 51.4% Cosmetic Botox Injections 563 49.1% UV Light Therapy 543 47.4% Collagen/Filler Injections 507 44.2% UV Light Therapy performed Onsite 504 44.0% Sclerotherapy 504 44.0% Cosmetic Laser Surgery 444 38.7% Photodynamic Therapy (PDT) 280 24.4% Mohs Micrographic Surgery 219 19.1% Dermabrasion 163 14.2% Liposuction 63 5.5% Hair Transplants 26 2.3% Table 12 Activities Outside of Patient Care Activity (Outside of Patient Care) Mean Hours per Week Physicians who Spend Time in Each Area (n = 1124) n % Administration/Paperwork/Correspondence 6.9 1101 98.0% Dermatopathology 1.1 325 28.9% Hospital consults 0.7 496 44.1% Lecturing/Teaching 1.3 493 43.9% Research 1.0 191 17.0% Total 11.0
  • 26. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 24Copyright © 2007 American Academy of Dermatology Table 13 Additional Staff Employed in Office Staff Average # of FTEs # of Offices n % Administrative 6.0 1099 99.2% Medical Assistant 4.1 850 76.7% Nurse 3.6 546 49.3% Nurse Practitioner 1.9 110 9.9% Physician Assistant 1.5 256 23.1% Aesthetician 1.6 251 22.7% Technician 1.8 59 5.3% Other 1.8 24 2.2% Table 14 Practices that Hire Physician Extenders By Type of Physician Extender Present and Future Employment of Physician Extenders Type of Physician Extender PA NP PA and/or NP n % n % n % Present Currently employ a physician extender 256 22.3% 110 9.6% 330 28.8% Immediate Future Currently seeking to hire physician extender(s) 105 9.2% 46 4.0% 139 12.1% Near Future Planning to hire PE in next 3 years 58 5.1% 26 2.3% 75 6.5% Present or Future Present or future employment of PE 319 27.8% 151 13.2% 433 37.8%
  • 27. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 25Copyright © 2007 American Academy of Dermatology Table 15 Factors that Correlate with Employment of Physician Extenders Practice Characteristic Practice Employs Physician Extender? Total No Yes n % n % n % Work Setting Solo 361 71.3% 145 28.7% 506 44.2% Dermatology Group 210 55.4% 169 44.6% 379 33.1% Multispecialty Group 68 55.7% 54 44.3% 122 10.6% Academic 43 48.9% 45 51.1% 88 7.7% Veterans Administration 3 25.0% 9 75.0% 12 1.0% Military 11 91.7% 1 8.3% 12 1.0% Other 4 66.7% 2 33.3% 6 0.5% NR 13 61.9% 8 38.1% 21 1.8% Supply of Dermatologists in Community Much greater than required 79 73.1% 29 26.9% 108 9.4% A little greater than required 99 65.1% 53 34.9% 152 13.3% Correct supply 242 67.0% 119 33.0% 361 31.5% A little less than required 201 55.8% 159 44.2% 360 31.4% Much less than required 85 55.9% 67 44.1% 152 13.3% NR 7 53.8% 6 46.2% 13 1.1% Seeking to Add Dermatologist to Practice? No 526 69.9% 227 30.1% 753 65.7% Yes 183 47.7% 201 52.3% 384 33.5% NR 4 44.4% 5 55.6% 9 0.8% Total 713 62.2% 433 37.8% 1146 100.0%
  • 28. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 26Copyright © 2007 American Academy of Dermatology Table 16 Physician Extender Patient Encounters Type of Physician Extender Patient Encounter Type of Physician Extender PA and/or NP PA Only NP Only Number of practices that currently employ (or recently employed) physician extenders Total 361 220 74 NR 18 7 10 n 343 213 64 Average number of patients seen by one PE per week 86.4 87.0 74.0 When the PE is engaged in patient care, how often is a physician available on-site versus off-site? Percentage of time a physician is on-site (mean %) 92.1% 92.5% 94.6% Percentage of time a physician is off-site (mean %) 7.9% 7.5% 5.4% Practices that report a physician is off-site… ...0% of the time 53.9% 52.1% 65.6% …1-9% of the time 14.6% 16.0% 6.3% …10-19% of the time 15.2% 16.0% 18.8% …20-29% of the time 7.9% 8.0% 4.7% …30-49% of the time 2.6% 2.8% 1.6% …at least 50% of the time 5.5% 4.7% 3.1% Types of patients seen by PE Established patient w/ on-going, stable conditions 98.8% 99.5% 96.9% Established patient w/ worsening conditions 72.3% 74.6% 68.8% Established patient w/ new problems 84.8% 85.4% 76.6% New patients 77.0% 76.5% 71.9% For each type of patient seen by PE, what % are formally presented to physician during patient visit? Established patient w/ on-going, stable conditions 25.4% 27.4% 22.3% Established patient w/ worsening conditions 53.4% 54.4% 55.2% Established patient w/ new problems 37.3% 36.7% 39.3% New patients 46.4% 48.6% 41.7%
  • 29. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 27Copyright © 2007 American Academy of Dermatology Table 17 Physician Extender Patient Care Time per Week Area of Dermatology Mean % of Patient Care Time Physician Extenders who Treat Patients in Each Area (n = 343) n % Medical dermatology 79.2% 328 95.6% Non-cosmetic surgical 8.8% 168 49.0% Cosmetic 12.0% 207 60.3% Total 100.0% Table 18 Physician Extender Training Type of Physician Extender Training Survey Respondents n % On-the-job training in my office 322 93.9% Attendance of CME meeting / courses sponsored by professional societies 280 81.6% Dermatology rotation in PA / NP school 186 54.2% Attendance of external lectures by pharmaceutical / device industry 174 50.7% On-the-job training by previous employer 152 44.3% Formal curriculum of lecture and/or reading defined by dermatology practice 125 36.4% Formal dermatology training program at teaching institution 40 11.7% Other 15 4.4% Total Physicians who Employ PEs 343
  • 30. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 28Copyright © 2007 American Academy of Dermatology Table 19 Subsequent Employer of Physician Extenders Subsequent Employer Survey Respondents n % Dermatologist office 92 55.1% Medical Practice of another specialty 24 14.4% Unknown 19 11.4% Other (specified) 15 9.0% Academic institution 5 3.0% Hospital / hospital facility 4 2.4% Spa or other facility not located in a physician office 3 1.8% Multi-specialty practice 2 1.2% Military 2 1.2% Other non-health related organization 1 0.6% Total Respondents 167
  • 31. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 29Copyright © 2007 American Academy of Dermatology Table 20a To what degree would you support that the AAD… Allow PAs and NPs to attend existing education sessions at the AAD meetings that are currently restricted to dermatologists. Degree of Support Employs or Plans to Hire Physician Extender? Total No Yes n % n % n % 1 = Strongly Oppose 299 41.9% 65 15.0% 364 31.8% 2 101 14.2% 62 14.3% 163 14.2% 3 135 18.9% 71 16.4% 206 18.0% 4 77 10.8% 83 19.2% 160 14.0% 5 = Strongly Support 69 9.7% 138 31.9% 207 18.1% Missing 32 4.5% 14 3.2% 46 4.0% Total 713 62.2% 433 37.8% 1146 100.0% Practices that Do Not Employ Physician Extenders 41.9% 14.2% 18.9% 10.8% 9.7% 0% 10% 20% 30% 40% 50% 1 2 3 4 5 Strongly Oppose Strongly Support Practices that Do Employ Physician Extenders 15.0% 14.3% 16.4% 19.2% 31.9% 0% 10% 20% 30% 40% 50% 1 2 3 4 5 Strongly Oppose Strongly Support
  • 32. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 30Copyright © 2007 American Academy of Dermatology Table 20b To what degree would you support that the AAD… Develop and provide professional education sessions just for physician assistants and nurses practitioners. Degree of Support Employs or Plans to Hire Physician Extender? Total No Yes n % n % n % 1 = Strongly Oppose 156 21.9% 21 4.8% 177 15.4% 2 69 9.7% 8 1.8% 77 6.7% 3 153 21.5% 38 8.8% 191 16.7% 4 167 23.4% 89 20.6% 256 22.3% 5 = Strongly Support 139 19.5% 263 60.7% 402 35.1% Missing 29 4.1% 14 3.2% 43 3.8% Total 713 62.2% 433 37.8% 1146 100.0% Practices that Do Not Employ Physician Extenders 21.9% 9.7% 21.5% 23.4% 19.5% 0% 10% 20% 30% 40% 50% 60% 1 2 3 4 5 Strongly Oppose Strongly Support Practices that Do Employ Physician Extenders 4.8% 1.8% 8.8% 20.6% 0% 10% 20% 30% 40% 50% 60% 1 2 3 4 5 Strongly Oppose Strongly Support
  • 33. 2007 Dermatology Practice Profile Survey Dermatologic Practice Characteristics and Activities Page 31Copyright © 2007 American Academy of Dermatology Practices that Do Not Employ Physician Extenders 33.9% 11.2% 20.8% 16.7% 12.8% 0% 10% 20% 30% 40% 50% 60% 1 2 3 4 5 Strongly Oppose Strongly Support Table 20c To what degree would you support that the AAD… Create a new AAD membership category for physician assistants and nurse practitioners. Degree of Support Employs or Plans to Hire Physician Extender? Total No Yes n % n % n % 1 = Strongly Oppose 242 33.9% 56 12.9% 298 26.0% 2 80 11.2% 21 4.8% 101 8.8% 3 148 20.8% 62 14.3% 210 18.3% 4 119 16.7% 88 20.3% 207 18.1% 5 = Strongly Support 91 12.8% 189 43.6% 280 24.4% Missing 33 4.6% 17 3.9% 50 4.4% Total 713 62.2% 433 37.8% 1146 100.0% Practices that Do Employ Physician Extenders 12.9% 4.8% 14.3% 20.3% 43.6% 0% 10% 20% 30% 40% 50% 60% 1 2 3 4 5 Strongly Oppose Strongly Support
  • 34. 2007 Dermatology Practice Profile Survey Office Accreditation and Hospital Privileging Page 32Copyright © 2007 American Academy of Dermatology Table 21 Office Laboratory and Hospital Privileges Office Laboratory / Hospital Privileges Survey Respondents n % Office Laboratory has CLIA Certificate? Yes 911 79.5% No 206 18.0% NR 29 2.5% Laboratory Tests Performed in Office Provider Performed Microscopy 873 76.2% Moderate complexity tests 461 40.2% High complexity tests 505 44.1% Hospital Privileges Medical 1044 91.1% Surgical/Operating Room 199 17.4% Table 22 Office Surgical Procedures and ASC Accreditation Accrediting Organization Surgical Procedures Ambulatory Surgical Center n % n % AAAHC 42 17.6% 15 30.6% JCAHO 135 56.7% 10 20.4% State 92 38.7% 23 46.9% Medicare 75 31.5% 25 51.0% Other 11 4.6% 2 4.1% Total with Accreditation 238 49
  • 35. Page 33Copyright © 2007 American Academy of Dermatology Table 23 Insurance Accepted Insurance Insurance Accepted Accepting New Patients n % n % Self-pay 1019 88.9% 913 89.6% Traditional Medicare 1013 88.4% 885 87.4% Private Fee-for-Service 1000 87.3% 878 87.8% Managed Medicare HMOs 764 66.7% 660 86.4% Tricare 643 56.1% 588 91.4% Medicaid 436 38.0% 352 80.7% Table 24 Medicare Payment Rates Relative to Commercial Insurance Contracts (CICs) Average Payment Rate of Medicare Compared with CICs 2005 Survey 2007 Survey n % n % Average CIC Rates Above Medicare 582 52.0% 459 55.6% Average CIC Rates Below Medicare 325 29.0% 232 28.1% Average CIC Rates Same as Medicare 212 18.9% 135 16.3% Total 1119 100.0% 826 100.0% Mean relative payment rate 105.4 105.4 Job Satisfaction Table 25 Career Satisfaction Aspect of Career Satisfaction Rating Mean Rating n 1 2 3 4 5 Choice of dermatology as specialty 9.2% 0.9% 2.3% 7.7% 79.9% 4.48 1130 Quality of training received 8.4% 2.6% 5.0% 21.4% 62.6% 4.27 1129 Overall career 7.9% 2.5% 5.1% 24.8% 59.7% 4.26 1127 Choice of practice setting / type 7.8% 4.2% 8.7% 21.7% 57.6% 4.17 1128 Choice of geographic location 7.7% 4.3% 9.7% 20.5% 57.7% 4.16 1130 Balance of work & personal life 8.1% 9.0% 16.8% 28.0% 38.1% 3.79 1129 Income 6.9% 9.4% 18.0% 30.4% 35.4% 3.78 1130
  • 36. Page 34Copyright © 2007 American Academy of Dermatology APPENDIX B SURVEY INSTRUMENT
  • 37. Page 35Copyright © 2007 American Academy of Dermatology American Academy of Dermatology Association 2007 Dermatology Practice Profile Survey Thank you for participating in this national survey of dermatologists. Your input will help provide the Academy with the data needed to more effectively serve membership, lobby in Washington for changes in regulation and policy, negotiate with insurance carriers, and represent dermatologists on the state and local level. All responses are confidential and anonymous. 1. Gender: Male Female 2. Age: 3. Year of graduation from dermatology residency:......................................................................... 4. Are you retired? No (If no, please continue with survey question 5.) Yes (If yes, please help us update our records by completing the following informationand return the survey in the postage-paid envelope.) Year of retirement: Member ID: (Retirees Only!) Name: If retired, please stop here and return survey in the postage-paid envelope. 5. Did you complete another residency program in addition to dermatology? No (If no, please skip to question 6.) Yes (If yes, please enter year of completion and whether board certified.) if Board Certified Year Program Completed Family Practice ........................................................................................... Internal Medicine ........................................................................................... Pediatrics....................................................................................................... Other; please specify: _________________________________________ 6. Please select any post-residency fellowships that you have completed: (Check all that apply.) Dermatopathology Mohs Surgery (Mohs- but not ACGME-accredited) Cutaneous Oncology Laser Surgery Pediatric Dermatology Cosmetic Surgery Procedural Dermatology (ACGME accredited) Other Surgical Fellowship Other; please specify: ___________________ years old Background Information
  • 38. Page 36Copyright © 2007 American Academy of Dermatology Current Employee Count (FTE) 7. Please provide the first three digits of the zip code at your primary practice site.................... 8. Do you consider your practice to be primarily serving an: Urban community Suburban community Rural community 9. Please indicate the number of offices (i.e., different locations) in which you practice or have supervisory responsibility ................................................................................................... 10. Which of the following best describes your primary practice location: Solo practice Academic Dermatology group practice Veterans Administration Multispecialty group practice Military Other; please specify: ____________________________ 11. What is the total number of physicians that work in your practice? ..................................... 12. How would you describe the current supply of dermatologists in your community? Much greater than required A little greater than required The correct supply A little less than required Much less than required 13. Are you currently seeking to add more dermatologists to your practice? No (If no, skip to question 14.) Yes (If yes, please continue.) a) How many months have you been looking to add more dermatologists to your practice?......... b) How many dermatologists would you like to add? ...................................................................... 14. In your practice, what is your estimate for the average waiting time in calendar days for a non-emergency appointment? Days for new patients ......................................................................................................................... Days for established patients ............................................................................................................. 15. How many of each of the following staff does your office currently employ? Please specify in terms of full-time equivalents (FTEs). Administrative (Clerical, Billing, Secretarial)..................................................................................... Medical Assistant.............................................................................................................................. Nurse (All types except Nurse Practitioner)...................................................................................... Nurse Practitioner............................................................................................................................. Physician Assistant........................................................................................................................... Aesthetician ...................................................................................................................................... Other; please specify: _________________________________________________________ Dermatologic Practice Characteristics and Activities
  • 39. Page 37Copyright © 2007 American Academy of Dermatology % of each presented to physician (0-100%) 16. Do you currently employ (or have you recently employed) Physician Assistants (PA) or Nurse Practitioners (NP) in your practice? No (If no, skip to question 17 on the next page.) Yes (If yes, please continue.) a) When your PAs and/or NPs are engaged in patient care, how often is a physician available on-site versus off-site? b) Which of the following types of patients are seen by your PA or NP? Check all that apply. Established patients with on-going, stable conditions Established patients with worsening conditions Established patients with new problems New patients c) For each type of patient seen by your PA or NP, what percent are formally presented to a physician during the patient visit? d) On average, how many patients does one physician extender (PA or NP) see in a week? patients per week e) On average, what percent of the PA’s or NP’s patient care time is spent on each of the following? (Three answers should add up to 100 %.) f) What type of dermatology training do the PAs or NPs receive? Check all that apply. On-the-job training in my office On-the-job training by previous employer Dermatology rotation in PA / NP school Formal curriculum of lecture and/or reading defined by dermatology practice Attendance of external lectures by pharmaceutical / device industry Attendance of CME meeting / courses sponsored by professional societies (AAD, SDPA, etc.) Formal dermatology training program at teaching institution Other; please specify:____________________________ g) If you have had PAs leave your practice, where did they go? Check all that apply. Dermatologist office Academic institution Medical practice of another specialty please specify:_____________________________ Military Multi-specialty practice Unknown Hospital / hospital facility Other non-health related organization Spa or other facility not located in a physician office Other; please specify:______________ Percentage of the time a physician is on-site (in same office)........................................... % Percentage of the time a physician is off-site (available by electronic means).................. % Total................................................................................................................................... 100 % Established patients with on-going, stable conditions ..................................................... % Established patients with worsening conditions .............................................................. % Established patients with new problems.......................................................................... % New patients .................................................................................................................... % Medical dermatology...................................................................................................... % Cosmetic dermatology................................................................................................... % Non-cosmetic surgical dermatology ............................................................................. % TOTAL........................................................................................................................... 100 % Dermatologic Practice Characteristics and Activities (continued)
  • 40. Page 38Copyright © 2007 American Academy of Dermatology 17. Are you currently seeking or planning to hire (within the next 3 years) a Physician Assistant (PA) and/or Nurse Practitioner (NP) to your practice? No (If no, skip to question 18.) Yes (If yes, please continue.) PA Count NP Count a) How many physician extenders are you currently seeking to hire? .......................... b) Excluding those listed above, how many more physician extenders do you intend to hire in the next 3 years? ................................................................. 18. To what degree would you support that the AAD offer the following services/benefits for Dermatology Physician Assistants and Nurse Practitioners? Strongly Oppose (1) (2) (3) (4) Strongly Support (5) • Allow Physician Assistants and Nurse Practitioners to attend existing education sessions at the AAD meetings that are currently restricted to dermatologists....................................................... • Develop and provide professional education sessions just for Physician Assistants and Nurse Practitioners.......................................... • Create a new AAD membership category for Physician Assistants and Nurse Practitioners.......................................................... 19. On the average, how many patients do you see in a week? ....................................................... 20. On average, how many days per week do you see patients? Select one. 21. How many weeks per year do you see patients?................................................................................ 22. How many hours per week do you individually see patients in the following areas? Medical dermatology ............................................................................................................................ Non-cosmetic surgical dermatology ..................................................................................................... Cosmetic dermatology.......................................................................................................................... TOTAL.................................................................................................................................................. 23. How many hours per week on average do you spend on the following activities NOT included in regular patient care hours above? (Please enter a zero for those activities you don’t perform.) 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 More than 6 Administration/Paperwork/Correspondence ................................................................................... Dermatopathology........................................................................................................................... Hospital consults............................................................................................................................. Lecturing/Teaching ......................................................................................................................... Research (include writing grants/manuscripts)............................................................................... TOTAL ............................................................................................................................................ Dermatologic Practice Characteristics and Activities (continued)
  • 41. Page 39Copyright © 2007 American Academy of Dermatology 24. Please check which of the following procedures you perform: Select all that apply. Chemical Peels Liposuction Cosmetic Botox Injections Sclerotherapy Cosmetic Laser Surgery Dermabrasion Hair Transplants Photodynamic Therapy (PDT) Mohs Micrographic Surgery UV Light Therapy Collagen/Filler Injections If you perform UV Light Therapy, do you offer it onsite? Yes No 25. Do you currently use AAD clinical guidelines? Yes No 26. Does your office laboratory have a current CLIA certificate? Yes No 27. Which of the following laboratory tests are performed in your office? Provider Performed Microscopy (KOH, Fungal) Moderate complexity tests (DTM, Tzanck Smear) High complexity tests (Histopathology, Mohs) 28. Is your office accredited for surgical procedures? No If no, are you thinking of pursuing accreditation within the next 18 months? Yes No Yes If yes, who accredited your surgical procedures? Check all that apply. AAAHC JCAHO State Medicare Other; please specify: 29. Do you own, or are you part owner of an Ambulatory Surgical Center? No (If no, skip to question 30.) Yes If yes, by what agency is the ASC accredited? AAAHC JCAHO State Medicare Other; please specify: 30. Which of the following hospital privileges do you hold? Check all that apply. Medical Surgical/Operating Room Dermatologic Practice Characteristics and Activities (continued) Office Accreditation and Hospital Privileging
  • 42. Page 40Copyright © 2007 American Academy of Dermatology if Ins. Accepted if Ins. Accepted 31. Do you accept assignment for Medicare Part B in your primary practice? Yes No 32. For each of the following insurance types, indicate whether you accept that insurance and whether you are accepting new patients with that insurance. Traditional Medical........................................................................................... Managed Medicare HMOs............................................................................... Medicaid ......................................................................................................... Private Fee-for-Service Insurance .................................................................. Tricare.............................................................................................................. Self-Pay Patients ............................................................................................. 33. If you have current commercial insurance contracts (CICs), how does the average payment rate compare with the Medicare fee schedule? Please respond as a percentage of the Medicare rate: (For example, if the average CIC payment is the same as Medicare, enter 100%; if 10% below Medicare, enter 90%; if 10% above Medicare, enter 110%.) On average, the commercial insurance contracts are ____________ % of the Medicare rates. 34. In the past two years, have you been audited by Medicare or a private insurer? Select any that apply. Medicare A private insurer 35. How satisfied are you with each of the following aspects of your career? Very Unsatisfied (1) (2) (3) (4) Very Satisfied (5) Choice of dermatology as specialty.......................................................... Choice of geographic location .................................................................. Choice of practice setting / type ............................................................... Balance of work & personal life ................................................................ Income ...................................................................................................... Quality of training received ....................................................................... Overall career ........................................................................................... 36. At what age might you expect to stop providing patient care? I expect to stop when I am ______ (age). I do not currently have plans to stop providing patient care. We greatly appreciate your time in completing this survey. Please return this survey using the self-addressed, stamped envelope included in your packet. Thank you. Reimbursement Sources and Commercial Insurance Job Satisfaction if Accepting New Patients

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