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One dermatologist discusses four tips to help practices foster strong relationships in order to run smoothly and efficiently.
Dr. SteinTeams don’t happen; they’re built. And they don’t work unless they run smoothly.
“I think, as is the case with any line of work, [the team] has to run smoothly or the simplest tasks become difficult,” says Kevin Stein, M.D., of Winston-Salem, N.C. “If things are running smoothly, I can see 40 patients. It’s a fantastic day, I get out on time and the patients are well served and pleased. If we’re not running efficiently and doing our jobs effectively, I think most doctors can agree, we might see 25 patients and have a difficult day. It just makes our lives and our patients’ care more effective if things do run smoothly, and we work as a team.”
David Pariser, M.D., chair of the American Academy of Dermatology’s Dermatology Care Team Implementation Work Group, and Dr. Stein offer these tips for building a better dermatologic team.
Tip 1. Doctors, PAs, and NPs need to see eye to eye.
The PA or NP needs to be, to some degree, a clone of the doctor, in terms of how the doctor manages and treats patients, according to Dr. Pariser.
“There’s no way to learn that except by one-on-one training. And you can’t do that for just a week or a month. It really takes a period of time - six months minimum of training for our PAs and NPs before they put their first hands on a patient,” Dr. Pariser says.
It has to be enough time for the non-physician provider to have encountered common diagnoses; witnessed how the supervising dermatologist manages those patients; and seen how patients who have problems are cared for, according to Dr. Pariser.
The goal is to have developed a good working relationship with the non-physician provider, so that the interactions between doctor and NP or PA are relatively seamless, he says.
Tip 2: Stay connected - even if they’re at another office.
Dr. Stein says his PAs are typically in outlying clinics seeing patients.
“The physician assistants see mostly the ‘bread and butter’ of dermatology: rashes, they do skin cancer checks,” he says. “But I review all the charts. I know that’s not a requirement but it’s something I like to do to oversee the care of the patient.”
Dr. Stein says he corresponds daily with the practice PAs about patient issues, to answer questions they have, and to ask about treatment options they’ve selected.
Tip 3: Each team member should be charged with what he or she does best.
“The goal of the care team should be to allow the dermatologist to do what she or he does best, which is make a diagnosis and establish treatment plans,” Dr. Pariser says. “Then, somebody else can do the minor procedures that might be needed-the biopsy, specimen collection, patch test, etc. Somebody else can give the patient the explanation, do the hand holding and have the face time, which patients appreciate in order to get the best results of their treatment.”
When determining what each team member does best, dermatologists should consider not only what they’re trained to do but also the degree of supervision that they have doing it, Dr. Pariser says.
“You can’t assume that all medical assistants know how to do a biopsy of the skin. Some states don’t allow them to do that. A nurse can’t do surgery, but yet a nurse can be very helpful in taking out stitches and other things that the doctor doesn’t need to do,” Dr. Pariser says.
Dr. Stein adds that it’s important to clearly delineate the dermatologist’s role and the roles of team staff members, based on not only strengths, but also weaknesses.
Tip 4: Don’t underestimate the value of medical assistants.
“We use medical assistants very rigorously. We have trained, what we call ‘dermatology technicians,’ who are above and beyond the average medical assistant. Ours have had two years’ of training in our practice and who we delegate very specific tasks,” Dr. Pariser says.
The procedures that Dr. Pariser’s technicians perform include collection of specimens for KOH examination, cultures, application of patch tests and some therapeutic procedures, such as clipping skin tags, superficial skin biopsies, and more.
“They do not perform any procedures which require medical judgment in the performance of the procedure,” he says. “[The] dermatologist prescribes the specific task and is immediately available if anything unexpected occurs.”