Perceptions of expertise in cutaneous surgery and cosmetic procedures: what primary care physicians think.

Background: Primary care physician (PCP) perceptions regarding expertise in cutaneous surgery and cosmetic procedures are unknown.

Methods: An internet-based survey was administered to physicians in primary care medicine residency programs in the United States. Respondents were asked to select the specialist most qualified to perform different cutaneous cosmetic and surgical procedures.

Results: Five hundred sixty-one PCPs undertook the survey. Dermatologists were identified as the most qualified specialist to evaluate and biopsy worrisome lesions on the face (95%), perform skin cancer surgery (56%), inject botulinum toxin (61%), inject fillers (55%), and perform laser procedures (75%). Seventy percent of respondents correctly defined Mohs micrographic surgery (MMS), and 60% of respondents selected a fellowship-trained dermatologist as the best physician to perform MMS. U.S. medical school graduates were more likely than foreign medical school graduates to select a Mohs fellowship-trained dermatologist as the most qualified physician to perform MMS (adjusted odds ratio (AOR) = 1.52, 95% confidence interval (CI) = 1.05-2.21). PCPs without exposure to dermatology in medical school were about half as likely those with exposure to correctly define MMS (AOR = 0.51, 95% CI = 0.30-0.89).

Conclusions: Dermatologists are recognized as the most qualified specialist to perform a variety of cutaneous cosmetic and surgical procedures, including skin cancer surgery, botulinum toxin injections, filler injections, and laser procedures. Mohs fellowship-trained dermatologists were viewed as more qualified to perform MMS than other dermatologists, plastic surgeons, otolaryngologists, or ophthalmologists.