This month, columnist Risha Bellomo interviews fellow physician assistant, Jeff Johnson, who shares information about his training and experiences as a surgical PA in a dermatology practice. With skin cancers on the rise in the United States and the general public becoming increasingly aware of the need for annual skin exams, more and more skin cancers are being detected by dermatologists and physician assistants. The majority of these skin cancers warrant a wide excision or Mohs surgery. Many dermatology physician assistants are now involved in more procedure-based medicine under the supervision of their supervising physicians. These procedures may include electrodesiccation and curettage, cryotherapy, shave and punch biopsies, and excisions. I had the chance to interview Jeff Johnson, a physician assistant who has been highly trained in skin surgery and Mohs. I hope the interview below will give physicians and physician assistants a better understanding of PA training and the hard work that goes into becoming a proficient surgeon. Q. What made you decide to become a physician assistant? A. I was trained as a medical laboratory technician by the United States Air Force. After working 3 years and teaching hematology for 2 years at Sheppard Air Force Base in Texas, it was time to advance my medical career. Working throughout the hospital, I had exposure to many different career fields, but I always had great respect for the professionalism and skill level of the physician assistants I worked with. I applied to the Air Force Physician Assistant Program and was selected on my first try. Q. As you know, many PAs have a background in medicine like you did before they even apply for PA school. How did you choose which specialty you would work in? And what led you to dermatology? A. My first love was emergency medicine, so after I completed my training at the Air Force Academy in Colorado Springs in 1995, I was offered placement in a 1-year ER residency program through the military. However, I had a great assignment to a family practice clinic in California and decided to go in that direction. While working in family practice, I worked with Gerald Parker, MD, a physician with a particular love for surgical procedures. Despite working in family medicine, he was an exceptional surgeon and took me under his wing for 3 years. I cannot understate how much I learned from working with Dr. Parker. I was reassigned to Little Rock Air Force Base, where they had in place a PA-run dermatology clinic, which was overseen by physicians. The dermatology clinic was in need of a replacement for the captain who was leaving. I was chosen because of my highly skilled surgical background. Working in the dermatology clinic further expanded my surgical skills, including training with a local Mohs surgeon. As I left the military to continue to work in dermatology, I was fortunate to join a practice owned by Theodore Schiff, MD, a fellowship-trained Mohs surgeon, who has enabled me to continue to grow surgically. Q. How did you continue to grow your surgical skills and what further training have you received? A. I have been working with Dr. Schiff for more than 10 years. I perform more than 90% of the closures associated with Mohs in addition to general dermatology surgery. I have attended and completed Hugh Greenway’s Superficial Anatomy and Cutaneous Surgery Program in San Diego on three separate occasions. I refer to it as a 6-day-long bootcamp of surgical information. It is definitely not for those only modestly interested in surgical procedures. The course is designed for physicians, so very few PAs have attended, much less three times. Q. How are you utilized in your practice and what type of supervision do you have? A. When performing complex closures associated with Mohs, I am always closely monitored by Dr. Schiff. He sees every patient throughout the procedure, and the patient is ultimately moved to the closing team for completion. Our protocol is Dr. Schiff introduces me to the patients at the beginning when we explain the Mohs process; after working together for so long, we have it down to a science. This type of confidence makes the patients feel reassured. Having been at Water’s Edge Dermatology for 10 years, I already know almost every patient who comes in for Mohs. However, there are some who feel most comfortable with Dr. Schiff performing the closure, which is completely understandable. This situation is rare since the majority of the patients feel very comfortable with me. Q. How would you describe a typical day in your practice? A. I have three different clinical days. General dermatology days start at 8:30 a.m. and end at 5 p.m., and we generally see close to 50 patients. General surgery days are the same hours, and I do approximately 15 to 20 surgeries. These days I do not have direct supervision, but the physicians are only 15 minutes away in one of our other offices. Finally, Mohs days start at 8 a.m. and generally we do 10 to 12 Mohs cases. Q. What are the most common surgical procedures besides Mohs that you do? A. The most common surgical procedures are excisions of cutaneous malignancies and epidermal inclusions cysts, as well as dysplastic nevi and lipomas. I would say that most are linear closures, but with Mohs, advancement and rotational flaps as well as full and split thickness grafts are done routinely. Q. Have you ever thought of pursuing any other surgical specialties? A. I absolutely love what I do and would never consider working in another specialty. Dermatology is the perfect blend of general dermatology patients and surgical procedures. I think if I did just one thing every day, I would become bored very quickly. Q. Do you teach other PAs or NPs how to do surgery? A. Yes, I routinely have PA and NP students rotating through our practice. In fact, it’s rare that I don’t have someone around. We have many different offices and providers willing to work with students, so in the end, the student is exposed to as many different styles and patient populations as possible. However, when it comes to surgery, they work primarily with me because of the volume of surgeries I am involved with. I am very particular when it comes to performing surgery. Anyone can just pull together a wound; I try to teach the students to develop a critical eye both in their own work and in others. The only way to truly improve is by doing an honest assessment of each surgery you perform and how that can be improved upon in the future. I also have the students take out the sutures of each surgery. I also am on faculty for Practical Medical Solutions, in which I teach an intermediate and advanced surgical workshop along with Randy Banks, MPAS, PA-C, who teaches the basic section of the course. This keeps me sharp and up to date on new techniques. Q. Is there any type of surgical procedure or technique you would be interested in learning or pursuing that you don’t already do? A. There is not anything out there that we aren’t currently doing that I wish we did. I am in a comfortable place right now in terms of skill and opportunity within my surgical team. And with continuing to teach, it keeps things interesting. Q. What advice would you give other PAs interested in pursuing a career in dermatology, with a specialty in surgery? A. I guess my best recommendation is to never give up. I speak with students who say they want to work in dermatology, yet they never go the extra mile to learn and improve their surgical skill. This also includes PAs already in dermatology. There is a difference between someone who can just pull together a wound and one who can do it skillfully. My suggestion is to attend as many surgical conferences and workshops that you can and then continue to market yourself. Don’t underestimate the value that you as a skilled physician assistant with demonstrable surgical skills can offer a practice. If you truly have a love for surgery and it is what you want to do, then work to set yourself apart from your peers. When I started, I followed a Mohs surgeon on my days off from the military just to gain experience. If you never give up, one day a door will open. In my world, there are few things as rewarding as seeing a patient back after Mohs and have them remark what an incredible job we did closing their wound. No one is a harsher critic of my work than I am. To walk out of the room impressed with one’s own work is a remarkable feeling and a result of years of learning and striving to improve. I want to personally thank Jeff Johnson for participating in this interview and sharing his life as a surgical physician assistant. I hope all who read this article find insight into the PA profession and find the motivation to go that extra mile to be an adept surgeon with the supervision of your physician. If you are a physician assistant looking to expand your surgical skills or a physician in need of a dermatology PA with surgical skills please visit www.practicalmedicalsolutions.com or www.fsdpa.org learn more. Risha Bellomo, MPAS, PA-C, has practiced dermatology for more than 9 years. She currently works at Advanced Dermatology and Cosmetic Surgery in Orlando, FL, and has been their Director of PA/NP Cosmetic Training for the last 4 years. Risha is also Owner and President of Practical Medical Solutions, LLC. Disclosure: The author has no conflict of interest with any material discussed in this article.
The Life Of A Surgical Physician Assistant
This month, columnist Risha Bellomo interviews fellow physician assistant, Jeff Johnson, who shares information about his training and experiences as a surgical PA in a dermatology practice. With skin cancers on the rise in the United States and the general public becoming increasingly aware of the need for annual skin exams, more and more skin cancers are being detected by dermatologists and physician assistants. The majority of these skin cancers warrant a wide excision or Mohs surgery. Many dermatology physician assistants are now involved in more procedure-based medicine under the supervision of their supervising physicians. These procedures may include electrodesiccation and curettage, cryotherapy, shave and punch biopsies, and excisions. I had the chance to interview Jeff Johnson, a physician assistant who has been highly trained in skin surgery and Mohs. I hope the interview below will give physicians and physician assistants a better understanding of PA training and the hard work that goes into becoming a proficient surgeon. Q. What made you decide to become a physician assistant? A. I was trained as a medical laboratory technician by the United States Air Force. After working 3 years and teaching hematology for 2 years at Sheppard Air Force Base in Texas, it was time to advance my medical career. Working throughout the hospital, I had exposure to many different career fields, but I always had great respect for the professionalism and skill level of the physician assistants I worked with. I applied to the Air Force Physician Assistant Program and was selected on my first try. Q. As you know, many PAs have a background in medicine like you did before they even apply for PA school. How did you choose which specialty you would work in? And what led you to dermatology? A. My first love was emergency medicine, so after I completed my training at the Air Force Academy in Colorado Springs in 1995, I was offered placement in a 1-year ER residency program through the military. However, I had a great assignment to a family practice clinic in California and decided to go in that direction. While working in family practice, I worked with Gerald Parker, MD, a physician with a particular love for surgical procedures. Despite working in family medicine, he was an exceptional surgeon and took me under his wing for 3 years. I cannot understate how much I learned from working with Dr. Parker. I was reassigned to Little Rock Air Force Base, where they had in place a PA-run dermatology clinic, which was overseen by physicians. The dermatology clinic was in need of a replacement for the captain who was leaving. I was chosen because of my highly skilled surgical background. Working in the dermatology clinic further expanded my surgical skills, including training with a local Mohs surgeon. As I left the military to continue to work in dermatology, I was fortunate to join a practice owned by Theodore Schiff, MD, a fellowship-trained Mohs surgeon, who has enabled me to continue to grow surgically. Q. How did you continue to grow your surgical skills and what further training have you received? A. I have been working with Dr. Schiff for more than 10 years. I perform more than 90% of the closures associated with Mohs in addition to general dermatology surgery. I have attended and completed Hugh Greenway’s Superficial Anatomy and Cutaneous Surgery Program in San Diego on three separate occasions. I refer to it as a 6-day-long bootcamp of surgical information. It is definitely not for those only modestly interested in surgical procedures. The course is designed for physicians, so very few PAs have attended, much less three times. Q. How are you utilized in your practice and what type of supervision do you have? A. When performing complex closures associated with Mohs, I am always closely monitored by Dr. Schiff. He sees every patient throughout the procedure, and the patient is ultimately moved to the closing team for completion. Our protocol is Dr. Schiff introduces me to the patients at the beginning when we explain the Mohs process; after working together for so long, we have it down to a science. This type of confidence makes the patients feel reassured. Having been at Water’s Edge Dermatology for 10 years, I already know almost every patient who comes in for Mohs. However, there are some who feel most comfortable with Dr. Schiff performing the closure, which is completely understandable. This situation is rare since the majority of the patients feel very comfortable with me. Q. How would you describe a typical day in your practice? A. I have three different clinical days. General dermatology days start at 8:30 a.m. and end at 5 p.m., and we generally see close to 50 patients. General surgery days are the same hours, and I do approximately 15 to 20 surgeries. These days I do not have direct supervision, but the physicians are only 15 minutes away in one of our other offices. Finally, Mohs days start at 8 a.m. and generally we do 10 to 12 Mohs cases. Q. What are the most common surgical procedures besides Mohs that you do? A. The most common surgical procedures are excisions of cutaneous malignancies and epidermal inclusions cysts, as well as dysplastic nevi and lipomas. I would say that most are linear closures, but with Mohs, advancement and rotational flaps as well as full and split thickness grafts are done routinely. Q. Have you ever thought of pursuing any other surgical specialties? A. I absolutely love what I do and would never consider working in another specialty. Dermatology is the perfect blend of general dermatology patients and surgical procedures. I think if I did just one thing every day, I would become bored very quickly. Q. Do you teach other PAs or NPs how to do surgery? A. Yes, I routinely have PA and NP students rotating through our practice. In fact, it’s rare that I don’t have someone around. We have many different offices and providers willing to work with students, so in the end, the student is exposed to as many different styles and patient populations as possible. However, when it comes to surgery, they work primarily with me because of the volume of surgeries I am involved with. I am very particular when it comes to performing surgery. Anyone can just pull together a wound; I try to teach the students to develop a critical eye both in their own work and in others. The only way to truly improve is by doing an honest assessment of each surgery you perform and how that can be improved upon in the future. I also have the students take out the sutures of each surgery. I also am on faculty for Practical Medical Solutions, in which I teach an intermediate and advanced surgical workshop along with Randy Banks, MPAS, PA-C, who teaches the basic section of the course. This keeps me sharp and up to date on new techniques. Q. Is there any type of surgical procedure or technique you would be interested in learning or pursuing that you don’t already do? A. There is not anything out there that we aren’t currently doing that I wish we did. I am in a comfortable place right now in terms of skill and opportunity within my surgical team. And with continuing to teach, it keeps things interesting. Q. What advice would you give other PAs interested in pursuing a career in dermatology, with a specialty in surgery? A. I guess my best recommendation is to never give up. I speak with students who say they want to work in dermatology, yet they never go the extra mile to learn and improve their surgical skill. This also includes PAs already in dermatology. There is a difference between someone who can just pull together a wound and one who can do it skillfully. My suggestion is to attend as many surgical conferences and workshops that you can and then continue to market yourself. Don’t underestimate the value that you as a skilled physician assistant with demonstrable surgical skills can offer a practice. If you truly have a love for surgery and it is what you want to do, then work to set yourself apart from your peers. When I started, I followed a Mohs surgeon on my days off from the military just to gain experience. If you never give up, one day a door will open. In my world, there are few things as rewarding as seeing a patient back after Mohs and have them remark what an incredible job we did closing their wound. No one is a harsher critic of my work than I am. To walk out of the room impressed with one’s own work is a remarkable feeling and a result of years of learning and striving to improve. I want to personally thank Jeff Johnson for participating in this interview and sharing his life as a surgical physician assistant. I hope all who read this article find insight into the PA profession and find the motivation to go that extra mile to be an adept surgeon with the supervision of your physician. If you are a physician assistant looking to expand your surgical skills or a physician in need of a dermatology PA with surgical skills please visit www.practicalmedicalsolutions.com or www.fsdpa.org learn more. Risha Bellomo, MPAS, PA-C, has practiced dermatology for more than 9 years. She currently works at Advanced Dermatology and Cosmetic Surgery in Orlando, FL, and has been their Director of PA/NP Cosmetic Training for the last 4 years. Risha is also Owner and President of Practical Medical Solutions, LLC. Disclosure: The author has no conflict of interest with any material discussed in this article.
This month, columnist Risha Bellomo interviews fellow physician assistant, Jeff Johnson, who shares information about his training and experiences as a surgical PA in a dermatology practice. With skin cancers on the rise in the United States and the general public becoming increasingly aware of the need for annual skin exams, more and more skin cancers are being detected by dermatologists and physician assistants. The majority of these skin cancers warrant a wide excision or Mohs surgery. Many dermatology physician assistants are now involved in more procedure-based medicine under the supervision of their supervising physicians. These procedures may include electrodesiccation and curettage, cryotherapy, shave and punch biopsies, and excisions. I had the chance to interview Jeff Johnson, a physician assistant who has been highly trained in skin surgery and Mohs. I hope the interview below will give physicians and physician assistants a better understanding of PA training and the hard work that goes into becoming a proficient surgeon. Q. What made you decide to become a physician assistant? A. I was trained as a medical laboratory technician by the United States Air Force. After working 3 years and teaching hematology for 2 years at Sheppard Air Force Base in Texas, it was time to advance my medical career. Working throughout the hospital, I had exposure to many different career fields, but I always had great respect for the professionalism and skill level of the physician assistants I worked with. I applied to the Air Force Physician Assistant Program and was selected on my first try. Q. As you know, many PAs have a background in medicine like you did before they even apply for PA school. How did you choose which specialty you would work in? And what led you to dermatology? A. My first love was emergency medicine, so after I completed my training at the Air Force Academy in Colorado Springs in 1995, I was offered placement in a 1-year ER residency program through the military. However, I had a great assignment to a family practice clinic in California and decided to go in that direction. While working in family practice, I worked with Gerald Parker, MD, a physician with a particular love for surgical procedures. Despite working in family medicine, he was an exceptional surgeon and took me under his wing for 3 years. I cannot understate how much I learned from working with Dr. Parker. I was reassigned to Little Rock Air Force Base, where they had in place a PA-run dermatology clinic, which was overseen by physicians. The dermatology clinic was in need of a replacement for the captain who was leaving. I was chosen because of my highly skilled surgical background. Working in the dermatology clinic further expanded my surgical skills, including training with a local Mohs surgeon. As I left the military to continue to work in dermatology, I was fortunate to join a practice owned by Theodore Schiff, MD, a fellowship-trained Mohs surgeon, who has enabled me to continue to grow surgically. Q. How did you continue to grow your surgical skills and what further training have you received? A. I have been working with Dr. Schiff for more than 10 years. I perform more than 90% of the closures associated with Mohs in addition to general dermatology surgery. I have attended and completed Hugh Greenway’s Superficial Anatomy and Cutaneous Surgery Program in San Diego on three separate occasions. I refer to it as a 6-day-long bootcamp of surgical information. It is definitely not for those only modestly interested in surgical procedures. The course is designed for physicians, so very few PAs have attended, much less three times. Q. How are you utilized in your practice and what type of supervision do you have? A. When performing complex closures associated with Mohs, I am always closely monitored by Dr. Schiff. He sees every patient throughout the procedure, and the patient is ultimately moved to the closing team for completion. Our protocol is Dr. Schiff introduces me to the patients at the beginning when we explain the Mohs process; after working together for so long, we have it down to a science. This type of confidence makes the patients feel reassured. Having been at Water’s Edge Dermatology for 10 years, I already know almost every patient who comes in for Mohs. However, there are some who feel most comfortable with Dr. Schiff performing the closure, which is completely understandable. This situation is rare since the majority of the patients feel very comfortable with me. Q. How would you describe a typical day in your practice? A. I have three different clinical days. General dermatology days start at 8:30 a.m. and end at 5 p.m., and we generally see close to 50 patients. General surgery days are the same hours, and I do approximately 15 to 20 surgeries. These days I do not have direct supervision, but the physicians are only 15 minutes away in one of our other offices. Finally, Mohs days start at 8 a.m. and generally we do 10 to 12 Mohs cases. Q. What are the most common surgical procedures besides Mohs that you do? A. The most common surgical procedures are excisions of cutaneous malignancies and epidermal inclusions cysts, as well as dysplastic nevi and lipomas. I would say that most are linear closures, but with Mohs, advancement and rotational flaps as well as full and split thickness grafts are done routinely. Q. Have you ever thought of pursuing any other surgical specialties? A. I absolutely love what I do and would never consider working in another specialty. Dermatology is the perfect blend of general dermatology patients and surgical procedures. I think if I did just one thing every day, I would become bored very quickly. Q. Do you teach other PAs or NPs how to do surgery? A. Yes, I routinely have PA and NP students rotating through our practice. In fact, it’s rare that I don’t have someone around. We have many different offices and providers willing to work with students, so in the end, the student is exposed to as many different styles and patient populations as possible. However, when it comes to surgery, they work primarily with me because of the volume of surgeries I am involved with. I am very particular when it comes to performing surgery. Anyone can just pull together a wound; I try to teach the students to develop a critical eye both in their own work and in others. The only way to truly improve is by doing an honest assessment of each surgery you perform and how that can be improved upon in the future. I also have the students take out the sutures of each surgery. I also am on faculty for Practical Medical Solutions, in which I teach an intermediate and advanced surgical workshop along with Randy Banks, MPAS, PA-C, who teaches the basic section of the course. This keeps me sharp and up to date on new techniques. Q. Is there any type of surgical procedure or technique you would be interested in learning or pursuing that you don’t already do? A. There is not anything out there that we aren’t currently doing that I wish we did. I am in a comfortable place right now in terms of skill and opportunity within my surgical team. And with continuing to teach, it keeps things interesting. Q. What advice would you give other PAs interested in pursuing a career in dermatology, with a specialty in surgery? A. I guess my best recommendation is to never give up. I speak with students who say they want to work in dermatology, yet they never go the extra mile to learn and improve their surgical skill. This also includes PAs already in dermatology. There is a difference between someone who can just pull together a wound and one who can do it skillfully. My suggestion is to attend as many surgical conferences and workshops that you can and then continue to market yourself. Don’t underestimate the value that you as a skilled physician assistant with demonstrable surgical skills can offer a practice. If you truly have a love for surgery and it is what you want to do, then work to set yourself apart from your peers. When I started, I followed a Mohs surgeon on my days off from the military just to gain experience. If you never give up, one day a door will open. In my world, there are few things as rewarding as seeing a patient back after Mohs and have them remark what an incredible job we did closing their wound. No one is a harsher critic of my work than I am. To walk out of the room impressed with one’s own work is a remarkable feeling and a result of years of learning and striving to improve. I want to personally thank Jeff Johnson for participating in this interview and sharing his life as a surgical physician assistant. I hope all who read this article find insight into the PA profession and find the motivation to go that extra mile to be an adept surgeon with the supervision of your physician. If you are a physician assistant looking to expand your surgical skills or a physician in need of a dermatology PA with surgical skills please visit www.practicalmedicalsolutions.com or www.fsdpa.org learn more. Risha Bellomo, MPAS, PA-C, has practiced dermatology for more than 9 years. She currently works at Advanced Dermatology and Cosmetic Surgery in Orlando, FL, and has been their Director of PA/NP Cosmetic Training for the last 4 years. Risha is also Owner and President of Practical Medical Solutions, LLC. Disclosure: The author has no conflict of interest with any material discussed in this article.
