Micrographic dermatologic surgery (MDS) diplomates: a demographic evaluation and comparison of Medicare case volume

Micrographic dermatologic surgery (MDS) recently became a board-certified field within dermatology with the first board examination administered in October 2021. To be eligible, dermatologists must have completed a fellowship through the Accreditation Council for Graduate Medical Education (ACGME) or attest to active practice of Mohs micrographic surgery. Attestation of active practice is available from 2021–2025, after which, those sitting for the certifying examination must demonstrate completion of an ACGME-accredited fellowship. This study aimed to compile demographic information on physicians who passed the MDS board certification examination. Medicare Mohs micrographic surgery case volume was compared between fellowship-trained and non-fellowship-trained physicians as well as between members and non-members of Mohs organizations. Names of physicians who passed the examination were accessed on the publicly available American Board of Dermatology website. The Medicare database was used to screen for Mohs surgery case numbers from 2019, and the American College of Mohs Surgery (ACMS) and American Society for Mohs Surgery (ASMS) physician finder tools were used to determine active membership. Physicians not in the Medicare database and those who completed an ACGME-accredited fellowship within the past three years were excluded from case volume analysis. 1673 dermatologists passed the first certifying examination. Medicare Mohs case volumes were compared for 1310 of these physicians. The median number (interquartile range (IQR)) of Mohs surgery cases was significantly higher for physicians who were ACMS/ACGME-fellowship-trained compared to those who were not (370 cases (IQR: 211–560) vs 138 cases (IQR: 37–284), p < 0.001). Members of ACMS and/or ASMS also performed a higher median number of cases compared to non-members (334 cases (IQR: 160–526) vs 95 cases (IQR: 6–246), p < 0.001). Given the 5-year window to take the MDS examination without having completed an ACMS/ACGME-accredited fellowship, more physicians without formal training may choose to become board certified. In addition, less dermatologists may choose to complete an ACMS/ACGME-accredited fellowship since it is not required for board certification. As more dermatologists become board certified in MDS, it may become important to assess for active practice of Mohs surgery and define proficiency metrics.