PracticalDermatology

Properly trained physican assistants (PAs) can significantly increase productivity and patient satisfaction in a cosmetic dermatology practice. Jody Comstock, MD, dermatologist at Skin Spectrum in Tucson, AZ, shares her experience with PAs and reveals some of the secrets to her success.

How long have you been working with physician assistants at your practice?

Dr. Comstock: We have been working with PAs for 15 years. They perform procedures including injections with fillers, collagen stimulators, neuromodulators, fat dissolvers, as well as device-based procedures. We have two physician assistants right now, and at any given time, we may have as many as four. Both of my daughters are PAs, and I have enjoyed watching their journeys.

Watch it Now

Get more from Dr. Comstock—watch her Modern Aesthetics Journal Club interview with Rebecca Kazin, MD. Dr. Comstock discusses neuromodulators for medical and aesthetic uses.

Are your patients receptive to PAs?

Dr. Comstock: When we first started using PAs to perform aesthetic procedures, there was some pushback, but we now have such well-trained PAs that our patients are extremely satisfied with the care they receive and the results. They know how rigorously we train anyone who works in our office—including our PAs.

What is the secret to your success with PAs?

Dr. Comstock: It’s all about the training. The biggest mistake that practices make with PAs and other staff is hiring them and then not investing in training. We have a dedicated, formalized one-year training program for PAs that is similar to an internship or fellowship. It includes anatomy, physiology, and technical training, as well as laser certification. They must also complete a specified number of procedures under observation. We also meet with them weekly to review all that they have learned, watch their injection techniques, and mentor them.

This starts with a detailed interview process. We meet with potential hires two or three times before we make a hire, and we have them spend time at the practice to make sure they are a cultural fit and capable of providing the emotional and medical support that we offer all of our patients.

Dr. Jody Comstock (left) with her daughters Jamie Comstock (middle) and Kelly Comstock (right). Both Jamie and Kelly are physician assistants.

How do you retain PAs after you invest in their training?

Dr. Comstock: PAs do move around faster than doctors because they are trained on the job, but most of them stick around longer in cosmetic dermatology than they do in other specialties with higher burnout rates. It takes about a year before PAs start producing revenue for the practice. All of our PAs must sign a contract that they will stay on for two years. If they leave before that time, they must reimburse the practice for some of the costs of training.

What advice would you give to colleagues who are planning to bring in PAs?

Dr. Comstock: Each state has different regulations on device delegation, PA-physician ratio, as well as what procedures PAs can do in supervised or unsupervised fashions. It’s crucial to know the rules in your state. Complications and problems stem from lack of training. It’s a big time commitment and investment.

If a doctor isn’t willing or doesn’t have the time it takes to properly train a non cosmetically exposed PA or mentor a previously cosmetically exposed PA, they might be better off partnering with another cosmetically trained physician to increase the number of procedures that are performed in their practice and boost revenue. The best match is an excellent medical, technical, and cultural fit for your practice.