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What’s That Spot?

August 20, 2014

Oh, those pesky Nurse Practitioners.  Held up as a savior of primary care in underserved areas, they are nevertheless under constant siege from uncomfortable doctors with one-hundred-thousand-dollar educations.   The latest salvo comes from Dr. Brett Coldiron (I swear that’s his name), who published in the Journal of the American Medical Association a study that suggests nurse practitioners and PAs are billing for “surgical procedures” that they are not trained to perform.

These are not major surgical procedures.  Nurses are not doing low anterior resections or heart transplants.  50% of these procedures are dermatological.  Oh, by the way, Dr. Coldiron is a dermatologist.

The definition of what constitutes a surgical procedure is pretty consistent: a medical procedure involving an incision with instruments; performed to repair damage or arrest disease in a living body (The Free Dictionary);  Medical treatment in which a doctor cuts into someone’s body in order to repair or remove damaged or diseased parts (Merriam Webster);  A procedure is considered surgical when it involves cutting of a patient’s tissues or closure of a previously sustained wound (Wikipedia). By those definitions, taking off a mole or a spot suspected of being cancerous on someone’s back does constitute surgery.  Someone’s body is getting cut into.  Merriam Webster says a doctor is the one that cuts into people.  OK.  I’m a doctor.  I have no special training in dermatology, but if took a mole off someone, even though I have no idea how to do it, Dr. Coldiron would presumably be fine with it.  But if I’m a nurse, with specific training in skin cancers and how to detect them and remove suspicious spots, and I took a mole off someone, I’m not properly trained.  It doesn’t make any sense.

Coldiron said while the mid-level providers may have received extra training within a relevant specialty, many likely lack the expertise of doctors who have done a residency within the field. “If nurses are going to practice surgery, that’s not [nursing] – that’s medicine,” he said.  You know what’s involved in taking off a skin tag?  A pair of scissors and a bandaid.  Removing a mole is more involved.  Now you need a little novocaine and a knife, and a bandaid.  Such a procedure demands some instruction, sure, but not a dermatology residency.

The issue at hand here is money.  The authors of the study do not care about whether or not NPs can take moles off safely.  In fact, the study says nothing at all about safety.  They care about billing.  If a nurse takes off skin tags, that’s money out of their pockets.  This nurse vs. doctor thing has got to stop.  Turf wars do our patients no good.


From → Healthcare

  1. Seriously

    You are a hero to all APRNs out there.

    Thank you for actually stating the obvious in public and I hope you dont get discouraged by the attacks which will surely come from those only interested in the money but quick to pretend there is a safety issue.

  2. Amen Mike and Sheri. Certainly we do not need to have a RN First Assist to remove moles and skin tags? Deb

  3. You are quite right. It doesn’t do any one any good. On top of that, nurses can help doctors and they can in turn help others. Lets consider what we can all accomplish together.

    Preferably without the backside of health care: aka the admin.

  4. Thank you Dr. Leng for this article. You are indeed correct. Too many times, specialists start turf wars in the name of “patient safety,” but in reality it is about money.
    Appreciate your honesty.

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