PHYSICIAN ASSISTANTS in DERMATOLOGY
by JOSEPH R. MONROE, PA-C
Whether you're considering expanding your practice or just looking for a helping hand, a physician assistant could be the answer. An expert helps you decide.
IF YOU ARE LIKE MOST DERMATOLOGISTS, THE demands of treating multiple
patients daily, responding to patient prescription calls, making practice
management decisions, and otherwise maintaining a quality personal and
professional life probably leave you harried. Although it may seem that
you have not had a break in weeks and that your office has become your
home, there may be a way to regain your life: hire a [Certified]
1. Where do PAs get their dermatologic training. Will I have to provide it?
PA programs are modeled after primary care medical curricula and include
about the same amount of didactic and clinical dermatology training as
medical school does. All students receive instruction
in suturing, a valuable asset in a dermatology practice. Some PAs going
into dermatology complete a surgical residency, and many come from surgical
backgrounds. All experienced primary care PAs see the routine dermatologic
problems that typically present to such practices. The typical PA student
today has four years of health care experience as RNs, EMTs, [NPs] corpsmen
or paramedics before entering PA school, and most have an undergraduate
degree in science. So even PAs inexperienced in dermatology have had considerable
exposure to it.
To maintain certification, PAs must acquire 100 CME hours every two
years. Dermatology PAs seek this education at dermatology conferences.
The SDPA provides dermatology PAs with many
educational resources: free dermatology magazines, a list of recommended
books and CDs, a home-study course, a website for derm instruction,
and rotations with members.
2. What can a derm PA do, legally; What is his or her function
The short answer: anything the supervising physician wishes to delegate,
is allowed by state law, and the PA is competent to do. In most cases,
PAs simply become another provider in the office.
3. What is the average salary for dermatology physician assistants?
Asking this question is like asking what the average dermatologist earns. It all depends on experience and work performed.
Is the PA doing warts and acne, or lasers and Mohs assisting? Does he or she have a medical assistant or an RN? PA's doing a good amount of surgery and laser procedures, or seeing many patients in high cosmeticcontent jobs are at the high end of a $50K to well over $100K total income that includes production bonuses plus base salary. Survey results show the average PA sees 28 patients daily.
Physician Assistants are licensed medical practitioners making a tremendous impact on the practice of medicine and patent care. Today, an estimated 40,000 PAs work in the United States. The American Academy of Physician Assistants is headquartered in Alexandria, Virginia, which has official liaison status to most national medical oganizations such as the AMA, AAFP, as well as the various other specialty organizations, represents their interests nationally. The profession began in 1967 at Duke University as an effort to impact physician shortages by giving additional training and credentials to former military corpsmen. But in the ensuing 30 years there was a development that almost no one would have predicted.
Experience showed that PAs could perform a surprisingly large percentage of the tasks traditionally reserved for physicians. Along with improvements and standardization of their educational process, the result has been nothing less than the evolution from assistant to cost effective, true practioners of medicine and surgery. Through it all, PAs have steadfastly maintained their dependent, non-competitive relationship with physicians, considering themselves to be team players, always subordinate to the physician as team captain.
The bottom line: According to an ongoing salary survey, a PA with about two to three years derm experience will likely generate a conservatively estimated revenue of three to four times [his/]her salary and would likely be "paying [his/]her own way" within six months, even if she is a new graduate. So by the end of the year, you should easily recover the salary paid to the PA during the training period. Some experienced PAs who see all comers and do multiple procedures generate five to seven times their income, according to the same survey. Obviously, in your own situation, a great deal will depend on the efforts of the PA you hire and on how comfortable you are teaching and delegating.
4. How do I bill for a PAs services?
Depending on the insurance carriers you deal with, your PA will either get a provider number or bill under your name. Either way, you can bill for his/her services using the same codes you use now. The best way to find out about billing in your area is to talk to dermatologists in your state who also have a PA or call the American Academy of Physician Assistants (see below). The SDPA can help you locate such a practice.
5. What about the acceptance of the PA by staff, patients, and referral base?
The key is communication. Discuss your intention to hire a PA with your staff at the outset, giving them an opportunity to offer input, including interviewing the applicant. Carefully explain the applicant's qualifications as a provider to lessen the chance of misunderstanding. If staffers understand that you (and your partners) enthusiastically support the decision to hire a PA, they too will be enthused. If they understand that having a PA will make their lives less hectic, get them home earlier at night, and ensure the financial stability of the practice, the move will likely have their support.
In the same vein, patients will take their cue from physicians and support
staff, and will accept the PA to the extent they see acceptance demonstrated.
To avoid surprising your patients, consider having a brochure printed
up to introduce the new provider and his or her qualifications. Mail
it to selected patients, and leave copies in the waiting room and with
the receptionist. Make sure your patients know that having the PA around
will mean they get their problems taken care sooner. If you do this
right and if you pick the right PA, you may overhear some of your
patients asking to see the PA!
6. What does hiring a dermatology physician assistant do for me, personally?
Let's look at this typical scenario: The PA sees 30 patients (10 of them same-day appointments), does two hours worth of surgery, sees two drug reps, and covers five patient phone calls for refills, generating $1,500 revenue or about four times what you pay him[/her]. During the same day, you see 30 patients, in a timely fashion (down from your usual 50) and get an hour for lunch instead of the usual 15 minutes. You and your staff get home an hour earlier than usual. Your family is pleased, the administrator is happy, your income goes up, your hours go down, and your patients get in quicker. They, your staff, and you are more relaxed.
7. Are there any dermatologists I can talk to who already have PAs in their office?
Yes, upon request by a dermatologist, we provide a list of 25 dermatologists who have volunteered to personally answer your questions.
8. How do I find a qualified physician assistant? Where do I advertise?
SDPA is not a recruiting firm but can help you find a PA through: