The Art of Adding a PA to Your Practice

The goal of the physician assistant (PA) role is to give patients greater access to care. Dr Richard A. Smith, a founder of the profession, had the objective of “multiplying hands” as a “physician extender.” Could you use an extension of the physicians within your practice? Keep the following tips in mind, based on my experience successfully working as a PA in the same dermatology practice for 15 years, as you contemplate hiring a PA.

1. Train the PAs you employ to practice how you want them to practice.

I frequently encourage my PA students to seek employment in a practice/hospital system where they will be mentored and supported in a positive work culture. Before working in the same dermatology practice for 15 years, I worked for a year in general dermatology and blindly mailed my resume to as many practices as I could find. I was fortunate to find a few practices that were interested in meeting me.

The practice I ended up working in was immediately the right fit. I began by shadowing the 2 physicians with whom I worked. I noted how well the patients were cared for and how much the medical assistants, personal care coordinators, and nurses enjoyed working there. At the time, most of the employees had been there for several years and seemed genuinely happy while working. Each day, I followed the physicians through their skin examinations, biopsy evaluations, and preoperative and postoperative visits, along with their surgeries. This allowed me to learn a great deal about the disease processes we were seeing, as well as practice my surgical skills. I also learned the nursing role of making preoperative calls so I could better understand the practice’s care plans for patients coming in for Mohs surgery.

In addition to the training I received, I read as much as I could about everything that I saw daily. I was tasked with writing educational articles for the newsletters we sent out to patients; through this, I was able to do more research into topics such as UV clothing and sunscreen ingredients. I also attended continuing medical education (CME) meetings through the American College of Mohs Surgery, the Society of Dermatology Physician Assistants (SDPA), and the Mayo Clinic. PAs are required to receive 100 hours of CME training every 2 years to maintain certification. Investing in your PAs helps ensure that they are up to date in patient care and have supplemental training beyond what the physicians in your practice can provide. All new dermatology PAs should consider expanding their skills and knowledge through the SDPA’s Diplomate Fellowship program, which offers 64.5 hours of category 1 CME credits across 22 online modules.

When I joined the practice, they did not have a PA. There was no office assistant or designated medical assistant to work with me. This was a time when I still had to regularly explain to patients that PA stood for physician assistant and detail the training of PAs. Because the practice did not have the role built in, we were all able to shape the position. After a few months of intense training, I began seeing my own patients on my own schedule. Many of these patients were introduced to me through the physicians in the practice during postoperative appointments. The patients then saw me at subsequent appointments for their skin examinations. In the beginning, I would present my findings to the physicians after the examination, similar to how a resident presents to attending physicians, and we would review my assessment and plan. I would have 1 of the physicians come in to see patients with me if I had a question about a lesion or how to biopsy a lesion, or if I thought the patient would be more comfortable having the physician in the room.

Within a year, I was busy enough to see a full day of patients. I still brought in the physicians from time to time, and continued to do so as needed even 15 years later. Additionally, I had the opportunity to share an office with the physicians, which allowed me to listen to conversations on how they managed their patients, peek at anything interesting under the microscope, and ask questions I might have about incoming pathology reports. This experience was invaluable for me, and I learned so much during this time. Ensuring that the PA who is joining your practice is trained appropriately, and ideally the way in which the physician practices, ensures an appropriate continuum of care.

2. Support your PAs as the practice grows.

Adding my position to the practice allowed for much needed additional access to care for the patients in our community. I could accommodate patients sooner and triage those who needed to be seen more urgently for surgery. I earned the trust of the physicians in the practice and had the autonomy to add a patient into their schedule if I was concerned about an aggressive squamous cell cancer or a suspicious melanocytic lesion.

In the early days of my practice, I saw patients without any assistance. This quickly changed as the number of patients I was seeing increased, and the physicians hired a medical assistant who was dedicated to working with me. This gave me the ability to safely see more patients because I was able to offload some of the administrative burden to my staff . I subsequently became more involved in customizing my scheduling template, allowing for improved efficiency throughout the day. As the physicians noticed the value I was bringing to their practice, they incorporated a productivity bonus into my compensation package in response to my ability to significantly increase the practice’s revenue. Feeling supported and appreciated as an important member of the team made it easy for me to put down roots.

3. Know when you need to find more space.

After my first 2 years, I altered my schedule to see patients when the physicians were not in the office. Our offices were open Monday through Thursday, leaving an empty space on Fridays. I opened my schedule in 1 location on Fridays to create more access for patients. Before that, I saw most of my patients in a satellite clinic 30 minutes away due to limited space at our primary location. Although patients were sometimes willing to travel across the bridge to see me, some of our older patients did not want to make the trip, so I needed a solution for these patients. Although I was alone most Fridays, 1 of the physicians would come into the office if needed, and both physicians were always available by phone or email.

As I neared my third year of practicing, I became pregnant with my first child. I had so many patients that it was time to hire another PA to join the practice. Shortly after my maternity leave, the practice was so busy that management made the decision to build an additional office down the hall so the PAs could see patients while the physicians performed Mohs surgeries. The modifications made to expand the space available to see patients quickly paid off , with the increase in access directly proportional to theincrease in revenue.

Greater access to care

The other day, I saw a post on social media about someone in my community having to wait 6 months to see a dermatology provider. In fact, there is a national shortage of access to dermatology providers. As we move into the future of health care, consider the value of employing, training, and supporting PAs within your practice and expanding as you grow.