Tuesday, December 5, 2017

Honesty, Trust, and Transparency: PA-C and MD




Honesty, Trust, and Transparency

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.”  While most of us cannot grasp the distress caused by not appearing luminous in no-makeup-selfies, this is significantly concerning for Kendall Jenner.  At the tender age of 21, she inaccurately referred to Ms. Kidd as her “life-changing dermatologist.”  Cosmopolitan continues the charade, publishing an article on the Jenner family “dermatologist.” 

It astounds me how some medical professionals can contentedly live in the gray, south of brutal honesty, yet somewhere north of deceit.  Until a few months ago, the Kidd Dermatology website erroneously listed her educational background as having graduated from the USC School of Medicine with honors and made no mention of her supervising physician.  It was later modified to reflect she graduated from the Physician Assistant program at USC. 

There are laws mandating physicians display diplomas and certifications prominently in the interest of transparency.  According to Title 16, California Code of Regulations sections 1399.540 through 1399.546, a PA in “independent” practice is limited to the scope of his/her supervising physician by law.  A board-certified plastic surgeon is supervising “skin specialist” Christie Kidd, PA-C, not a dermatologist.  The website of the plastic surgeon states, “Trust only a Board-Certified Plastic Surgeon;” which in my opinion, seems astonishingly tongue-in-cheek.   He may believe treating bullous pemphigoid disease is just another day in the life of plastic surgeons everywhere, but plastic surgery is a far cry from practicing dermatology and vice versa.  

credit: dailymail.co.uk 
When asked about this, the Public Affairs Manager, Cassandra Hockenson, at the Medical Board of California responded“there is not a huge difference between plastic surgery and dermatology.”  She suggested contacting the Physicians’ Assistant Board for the State of California instead.  She kept repeating that the supervising plastic surgeon had no complaints against him.  I learned two important lessons from contacting the Medical Board of California:  1) Without complaints, a physician can supervise midlevel providers in any specialty they choose, and 2) while required by law to supervise mid-level providers, the safety of patients is not a high priority for the Medical Board of California. 

At a minimum, physicians complete four years of college, four of medical school, and between 3-7 years in residency.  The years of education required for obtaining a PA degree are considerably fewer than that of an MD.  For all intents and purposes, Christie Kidd, PA-C is running an independent dermatology practice directly under the nose of an apathetic California State Medical Board indifferent to regulations.  PA’s can be fined and disciplined by their own board for misrepresentation, however, her “supervising” physician is, in fact, also out of compliance with the law.

While not all celebrities understand the difference in education between an MD or PA, mid-level providers and their supervising physicians should not be immune to the rules and regulations.  Honesty, trust, and transparency are ideals essential to the medical profession.  Physicians are held accountable for the health and safety of the patients we serve.  Google Business modified the Kidd Dermatology listing from “Dermatologist” to “Medical Spa.”  The unsinkable Christie Kidd struck a compromise, settling on the designation as a “skin care clinic.”  Carpe Diem, Ms. Kidd, Carpe Diem. 





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