Why Dermatology PAs and NPs Are More Needed Than Ever After Walmart’s Health Care Fail

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Primary Care: The Backbone of the Health Care System

Primary care is essential for a functioning health care system, offering prevention and comprehensive services to the population. However, primary care faces continued financial and systemic challenges in the US, highlighted by the recent closure of Walmart Health centers. Announced on April 30, Walmart decided to shut down all 51 of its primary care centers across 5 states, including its virtual health services, due to "a lack of profitability." The company cited high operational costs and low reimbursement rates within the fee-for-service (FFS) system.¹ This decision underscores the urgent need for more sustainable and innovative primary care solutions. But what implications does this have for specialty care, such as dermatology? The impact is significant, and dermatology physician assistants(PAs) and nurse practitioners(NPs) are perfectly positioned to offer considerable contributions.

Financial Strains

Walmart's exit from primary care underscores the severe financial strains within the FFS model. In many ways, primary care functions as a loss leader, much like how Costco uses hotdogs and toilet paper to drive membership signups and in-store purchases. Primary care generates significant revenue within the FFS model but struggles to capture or extract value from it.1 Without proper intervention, there could be a shift in patient demand towards specialty care, straining already limited resources, particularly in dermatology.

The Dermatology Demand-Supply Mismatch

Dermatological conditions are among the most common health issues in the US. With robust growth and diverse revenue streams, it is a field marked by significant private equity interest.² However, despite its growth, access to specialized dermatological care remains limited, especially in underserved and rural areas.³ The field also faces a significant demand-supply mismatch, with current national wait times for dermatology around 35 days.⁴ This accessibility gap remains a topic of ongoing debate within the specialty regarding innovative models to better reach patients.

This scenario presents what could be an exciting opportunity to integrate dermatology within the primary care framework, leveraging the expertise of dermatology PAs and NPs. David E. Kent, MD, a board-certified dermatologist and chief medical officer for Derm for Primary Care (DFPC), emphasizes that "60% of patients with skin diseases in our country are managed by dermatology PAs, NPs, and non-dermatology MDs," highlighting the growing role these clinicians play in delivering specialized dermatology services.⁵

The Dermatology PA/NP Workforce

According to the constituent organization of the American Academy of Physician Assistants (AAPA) and the largest specialty group of dermatology PAs, the Society of Dermatology Physician Assistants (SDPA), and the Dermatology Specialty Practice Group (SPG) within the American Academy of Nurse Practitioners (AANP), dermatology PAs and NPs account for about 10,000 trained dermatology clinicians in the US and growing. For context, there are only 11,865 dermatologists, with 44% (5713) of dermatologists over 55 years old and nearing retirement. Dermatology PAs and NPs are highly trained to diagnose and treat a wide range of general dermatologic conditions and are particularly skillful at referral practices and team-based medicine, making them extremely invaluable in a comprehensive primary care setup.

Integration into Primary Care

Integrating dermatology PAs and NPs into primary care could be the spark that primary care needs. These trusted and licensed professionals are adept at managing frontline dermatological conditions and can perform essential procedures within the primary care setting, which private equity-backed dermatology clinics have heavily relied on for scaling. This integration could improve patient outcomes and alleviate the burden on the limited supply of dermatologists, ensuring that patients receive timely and effective treatment. With more dermatology PAs and NPs in primary care settings, the potential for a more sustainable model for primary care starts to make a lot of sense. However, to strengthen this approach, more comprehensive economic analyses need to be conducted to assess the financial sustainability of this integration. Furthermore, exploring the potential applicability of other specialty PAs and NPs within primary care could provide broader insights.

The Role of Telemedicine

The rise of telemedicine also presents an opportunity for dermatology PAs and NPs to expand their reach. Teledermatology can provide patients in remote areas with access to specialized care, reducing the need for travel and improving patient satisfaction. Dermatology PAs and NPs can even leverage telemedicine to offer consultations directly to primary care providers, follow-ups, and even some treatments, further boosting the partnership.

Conclusion

The closure of Walmart Health centers underscores the financial and systemic challenges facing primary care in the US. However, this also presents an opportunity to innovate and integrate specialty care, such as dermatology, into the primary care framework. Dermatology PAs and NPs continue to address the demand-supply mismatch in dermatologic care and can significantly bring their skills within the primary care model. By leveraging their expertise, integrating them into primary care, and utilizing telemedicine, primary care can navigate the sustainability challenges it constantly faces.

Michael Rubio, PA-C, is a dermatology physician assistant at Infinity Dermatology in Brooklyn, NY. He is the vice co-chair of the Society of Dermatology Physician Assistants Communication Committee and a contributor to the National Commission on Certification of Physician Assistants development of the Certificate of Added Qualifications in Dermatology. He is also a co-founder of Well Revolution, a same-day primary care platform that connects patients with primary care providers and specialists, helping to address the primary care shortage crisis in the United States. For more information, visit www.wellrevolution.com.

References

1. Walmart Health is closing. Walmart Corporate News and Information. April 30, 2024. Accessed May 14, 2024. https://corporate.walmart.com/news/2024/04/30/walmart-health-is-closing.
2. Dermatology: looking good. FTI Consulting. May 4, 2023. Accessed May 14, 2024. https://www.fticonsulting.com/insights/articles/dermatology-looking-good.
3. Heath S. Average patient appointment wait time is 26 days in 2022. PatientEngagement HIT. September 14, 2022. Accessed May 14, 2024. https://patientengagementhit.com/news/average-patient-appointment-wait-time-is-26-days-in-2022#:~:text=Patient%20appointment%20wait%20times%20were,wait%20time%20seen%20in%202017.
4. Duniphin DD. Limited access to dermatology specialty care: barriers and teledermatology. Dermatol Pract Concept. 2023;13(1):e2023031. Published 2023 Jan 1. doi:10.5826/dpc.1301a31
5. Kent D. The role of nurse practitioners and physician assistants in dermatology. Derm for Primary Care. December 16, 2022. Accessed May 14, 2024.https://www.dermforprimarycare.com/news/8/role-nurse-practitioners-and-physician-assistants/.