What kind of education and training does a PA receive and what is the supervising dermatologist's role in training the PA's dermatology training? In Part I of this series (available online at PracticalDermatology.com), we provided information that should help you to determine if a physician assistant is a viable solution to help your practice increase its patient care capacity. Here we outline the basics of an additional consideration: PA education. Understanding the education and training of a physician assistant may help the physician decide whether to hire a new graduate or an experienced dermatology PA.
Requirements for PA education vary from state to state, but in general, physician assistants complete an undergraduate degree and then an additional 24 months of classroom and clinical education modeled after medical school. Typically, there are required clinical rotations in core specialties and additional clinical rotations in elective specialties. Often during clinical rotations, the PA students are trained with the medical students and treated similarly. Following the completion of an accredited PA training program, the individual must pass a national certifying exam, after which they are “certified” and their title changes from PA to PA-C. They must repeat this exam every six years and complete 100 hours of CME every two years to remain certified. Starting in 2014, the recertification exam cycle will extend to every 10 years.
In terms of dermatology, most physician assistants have a relatively small amount of dermatology knowledge and experience at the time they finish training, similar to graduating medical students, and thus they are not capable of seeing dermatology patients immediately after finishing training.
There is no consensus dermatology curriculum for physician assistants or a test, such as the dermatology board exam, to confirm that they have learned enough dermatology to be considered “ready” to start seeing patients on their own. The way they are trained is up to their supervising physician, who makes the determination of when the PA is ready to see patients on his/her own. The American Academy of Dermatology (www.AAD.org) has created a medical student core curriculum that may be a great starting point for the new PA.
In terms of general recommendations, most physician assistants who are new to dermatology will shadow their supervising physician for three to six months. This may include graded increases in responsibility—from a purely observational role initially, to doing histories and exams and presenting the patient to the supervising physician. The PA can also review labs and biopsies before the physician and propose an interpretation to the supervising physician. During this time, the physician should assign readings to the physician assistant and allot some time during the week to review.
Once the supervising physician is comfortable that the physician assistant is capable of seeing their own patients, the PA often starts seeing their own schedule of patients in the same office with their supervising physician while the supervising physician is present. This allows the physician assistant to easily consult with the supervising physician on any patient's diagnosis or treatment approach. After some period of time in this model, the supervising physician may become comfortable to allow the PA to see patients on his/her own, with the supervising physician available for phone consultation, but not present in the office.
Considering Previous Experience
What about a physician assistant who has already been trained in dermatology and has significant dermatology experience? In this setting, it is up to the supervising physician to determine how to bring the PA on board. One approach is to have the PA spend a few days shadowing the supervising physician to learn the physician's practice style, then to spend a few days or weeks seeing patients and presenting their findings and plan to the supervising physician before seeing the patient. This allows the supervising physician a chance to assess the knowledge of the physician assistant and determine when it is appropriate to have the physician assistant start seeing his/her own patients.
Understanding SDPA Fellow and Diplomate Status
All physician assistants working in dermatology practices should be strongly encouraged to join the Society for Dermatology Physician Assistants (SDPA). In order to join and maintain fellow membership status in the SDPA, a PA must be working for a board certified/board eligible dermatologist. The SDPA conducts two large, exceptionally high quality educational meetings each year. These meetings include lectures from both dermatologists who are recognized national experts and from PAs with substantial interest and expertise in particular areas in dermatology. Many practices send their PAs to one or more of these meetings annually. After working for a board certified/board eligible dermatologist for one year, SDPA members are eligible to participate in the SDPA Distance Learning Initiative (DLI). This 70-hour CME curriculum consists of 10 case-based modules with dermatopathology correlations that are consistent across all modules authored by experts in each field. Modules cover the following topics: dermatologic pharmacology (Stephen E. Wolverton, MD), hair disorders (Amy McMichael, MD), nail disorders (Phoebe Rich, MD), pediatric dermatology (Bethany Grubb, MPAS, PA-C), eczematous disorders (Chico Cruz, Jr., MD), vesiculobullous disorders and disorders of pigmentation (Amit G. Pandya, MD), connective tissue disorders (Richard D. Sontheimer, MD), cutaneous manifestations of internal disease (Erik Sorenson, PA, MPAS), and pigmented lesions (Paul Richard Bergstresser, MD). The content is delivered through SDPA, and users have 24/7 access to course content and technical support, as well as biomedical library databases and repositories for any necessary reference documents. The modules include a rich assortment of sharply focused color digital images. After completing the DLI curriculum, a PA is eligible for designation as a Diplomate of the SDPA. All physician assistants working in dermatology offices should be strongly encouraged to pursue Diplomate status. While not equivalent to board certification of a dermatologist, it does ensure that a physician assistant has acquired a substantial level of expertise in dermatology.
Focus on Long-term Collaboration
Mentoring of a PA does not stop after training. Collaborating on unique cases or attending grand rounds and dermatology conferences together also helps strengthen the relationship and training.
The above information should give you a better understanding of the education of a physician assistant and may help you better understand the expectations and contributions of both new and experienced dermatology physician assistants. Future topics include how to compensate, recruit, and integrate a physician assistant into your practice.
Matthew Zirwas, MD, trained and held a faculty position at the University of Pittsburgh, where he worked closely with a number of physician assistants. He is currently Dermatology Residency Program Director at Ohio State University, where he was responsible for hiring the first outpatient physician assistant in the Ohio State University Medical Center.
Vicki Roberts, PA-C, has been practicing as a dermatology physician assistant for over 12 years in West Columbia, SC. She is immediate past president of the South Carolina Society of Dermatology Physician Assistants and is currently Director-at- Large for the Society of Dermatology Physician Assistants.