PracticalDermatology

Many dermatologists work hard to build up a successful practice and patient following and want to grow their business to the next level but find themselves at a crossroads when considering their next hire. Does it make sense to hire a fellow MD or perhaps consider hiring a dermatology PA? Every practice owner is different, has different needs, and different long-term goals, so there is not a black and white answer. But here are six reasons why some dermatologists consider hiring a PA as a vital part of their roadmap to success.

1 More Access for Patient
So many dermatology practices find themselves scheduling patients with more than a four-week wait. Is this really an ideal situation for patient access to care? What if this long wait delays a diagnosis of a skin cancer? Or allows a prior small biopsy site to heal so well that it is difficult to identify for the Mohs surgeon in your group when the patient finally comes in for treatment? Dermatology PAs who are well trained by you or a prior dermatologist can prove to be very valuable when it comes to access to care. Dermatology PAs work as an extension of their supervising physician and their duties are outlined in an agreement when they join the group. You can determine whether you trust the skillset of your dermatology PA to treat all conditions and turn to you for anything that they are unsure of, or, especially if they have less experience, you can agree on a more limited scope of practice. The approach can be customized for each individual situation and practice. Most experienced dermatology PAs have a strong foundation of knowledge and many even have advanced training, but if you prefer to start slow, that’s a discussion that can take place during the early interview phase; if both parties agree you can certainly start slow. Even starting slow with basic procedures or follow up visits still increases access to patient care and over time you may build up trust that will allow access to care for a wider range of treatments.

2 “Dependent Practitioner” Employees
Being a dependent practitioner means that a PA is intended to be an “extension” of her/his supervising physician. Unlike nurse practitioners (or fellow MDs), it is not common for a PA to open his/her own practice. PAs are trained in the medical model and are trained to think in a similar fashion as physicians but without a residency. PAs require on-the-job training within a specialty to refine their skills. Once a dermatology PA is trained, the relationship between the supervising physician (SP) and the PA can be a real win for the dermatologist who likes to work as a team. Once trained, dermatology PAs can treat patients independently and diagnose and treat a myriad of disease processes for more straight forward office visits like acne follow ups or wound checks to more complicated skin cancer evaluations and can even assist Mohs surgeons in the OR. While there are exceptions, most states don’t allow PAs to own 100 percent of their own practice, which reduces competitive risk issues down the road compared to other clinicians.

3 Improve Quality of Life of Dermatologists
Adding a physician extender to the staff could provide the ability to reduce daily patient load from 50 to 40, reduce a five-day work week to a four-day work week, or facilitate a schedule that allows more time for family responsibilities. Furthermore, an additional staff member could free up time for the dermatologist to pursue professional development opportunities like speaking for pharmaceutical companies, participating in clinical research studies, or exploring teaching opportunities. These are some of the more personal factors that some supervising physicians want to focus on as they attempt to acheive work/life balance and confront burnout. For many dermatologists, gaining more time is one of the most appealing things about hiring a physician extender.

4 Management Support
Some but not all dermatology PAs welcome the opportunity to be involved in the management of the practice. These management duties could be in addition to patient care or a split of 50/50 between clinical and non-clinical activities. Some management duties could be related to: staff management or oversight, including schedules, or even interviewing and pre-screening support staff; cinical research coordination; payroll; social media marketing or other marketing activities; product inventory oversight, etc. Some PAs welcome the variety to being solely focused on patient care and are happy to have variability and input into the way the practice operates. In many cases, PAs who become more involved in practice management can be an asset to the practice owner.

5 Satellite or Remote Location Access
It is becoming increasingly common for practice owners to want to duplicate what they built in one location in a whole new location. In some instances, it might make the most sense and be most cost effective to staff the new location with a PA who has remote access to the supervising physician. This can be especially relevant in remote areas where access to medical care is very limited. Many PAs thrive in a new satellite location. Once they are trained, they are qualified to treat common conditions on their own and with technology can easily consult with their supervising physician on treatment plans for more complicated or at-risk patients.

6 The Bottom Line
Dermatology PAs can bill insurance or bill for cash pay procedures. Annual collections for full time Dermatology PAs can vary from $500,000 to over $1,000,000, depending on their skill set and comfort level. This is a substantial amount of increased revenue coming into a Dermatology Practice and can make a tremendous impact on the health and viability of the practice. The supplemental revenue can be beneficial to help support total operating costs like staff and overhead and can increase the practice value when considering an exit or corporate buy out. There is a range of how much revenue one dermatology PA can generate compared to another PA. It depends on prior training, personal skill set, staff support, and personal comfort level with amount of time spent with each patient to provide the highest quality of care. It is important to note that these variables would be similar for other clinicians.

Just What the Doctor Ordered

It is never an easy decision to select the next provider hire. There are pros and cons to hiring a fellow MD vs PA vs NP. Each brings something a little different to the practice. But practice owners who have employed dermatology PAs for decades might say that the value and versatility of the PA profession may be just what the doctor ordered.