A well-trained, properly supervised physician extender can serve as an integral member of a thriving medical dermatology practice, an expert says.
"If one wants to practice medical dermatology for fun and profit and not have to do other things like cosmetics," says David M. Pariser, M.D., "having an efficient, well-trained, well-supervised PA is the key."
Dr. Pariser is professor, department of dermatology, Eastern Virginia Medical School and a Norfolk, Va.-based dermatologist in private practice.
Patients enjoy seeing PAs or NPs because they get more face time, education and hand-holding if needed, he adds.
"For me," Dr. Pariser says, "it tremendously improves the dermatologist's quality of life - it's a lot more fun to go to work, there's less burnout and patients love it."
PEs in dermatology
Dermatologists, too, have embraced physician extenders including PAs and NPs, Dr. Pariser says. He has trained four PAs.
According to the American Academy of Dermatology (AAD)'s 2002 practice profile survey (and 2004 Dermatology Business Management Survey), 33 percent of member practices employ extenders. Among such practices, Dr. Pariser says, two-thirds employ PAs; 27 percent employ NPs; and 6 percent employ both (2005 practice profile survey).
"In terms of productivity, the average PA or NP sees about 85 patients a week, versus a doctor, who would see 142," he says. Furthermore, most extenders spend their time doing medical dermatology, Dr. Pariser says.
Regarding supervision, he adds, "Only 18 percent of (PAs) are directly supervised, meaning that every patient is presented and seen by the physician" in these practices.
Conversely, Dr. Pariser says 77 percent of patients are seen in settings where the physician is available on site but does not necessarily see the patient.
"Five percent of patients are seen at a site where the physician isn't even there and is available only by telephone. That goes against the AAD's guidelines on how to use physician extenders," Dr. Pariser says.
In particular, AAD guidelines on the use of nonphysician office personnel state that "Under appropriate circumstances, a physician may designate certain procedures to properly trained nonphysician office personnel. Specifically, the physician must directly supervise" these professionals to best protect patient welfare. This means that save for "exceptional circumstances," the guidelines state, "The supervising physician shall be physically present on-site, immediately available and able to respond promptly to any question or problem."
Additionally, while states define PAs somewhat differently, Dr. Pariser says that regardless of location, "A PA can do whatever their supervising doctor allows them to do. And there's really no definition of what a dermatology PA is. Basically, anybody who wants to can call themselves that."
Working in a dermatologist's office or joining the Society of Dermatologic Physician Assistants can provide qualifications to a degree, he adds, "but there is no uniform definition and certainly no uniform training or certification" for dermatology PAs.
Fine tuning focus
Most PA schools offer little academic or didactic education in dermatology.
"Unless a PA elects to do a clinical rotation in dermatology, the PA would have absolutely no clinical training" Dr. Pariser says.
"There's only one medical school I know of that offers a (one-year) PA residency in dermatology - the University of Texas Southwestern," he adds.