Adding a Derm PA to Your Practice

PAs extend the care that physicians provide and increase access to care.

Being a Good Supervising Physician: It’s more than just chart review

The relationship between a collaborating physician and their physician assistant (PA) is a dynamic relationship built on trust, mutual respect, and inter-dependency. The ideal relationship is one that has developed over years. A long term physician-PA relationship is a huge advantage to you and your practice. It allows you and the PA to know each other’s practice styles and habits. Both of you will be intimately familiar with each other’s style and preferences. Patients will become familiar with the PA and will feel a continuity of care when seeing the same person for years. The PA will build a strong patient following which will only serve to build equity in your practice and maximize productivity.

Retaining a PA long term is quite easy if you make it a priority. Some think that compensation alone is what makes or breaks the relationship. But in reality there are many factors that determine if a PA will stay at your practice for the rest of their career. One of the most important factors is how the PA is treated and what type of collaborating physician you are. The longest, strongest, and most productive dermatologist-PA relationships are those based on the physician doing more then just chart review and signature. Being a good collaborating physician means you will retain a PA for years, if not the rest of their career. The following are qualities of good collaborating physicians based on those physicians who have been able to retain the same PAs in the long run.

Be a Teacher

You are a wealth of medical information that a PA could benefit from regardless of how long they’ve been in dermatology. It is every health care provider’s responsibility to be a life long learner. A PA will appreciate if you get them for interesting or unique cases. Invite the PA to see the neatest case of mango contact allergy you’ve seen this year and they’ll not only learn about the unique cases and atypical presentations, but they’ll appreciate that fact that you thought of them. Be careful not to “pimp” them too hard, especially in front of the patient. You want the PA to be seen as knowledgeable to the patients and staff. Plus, you don’t want the PA to dread this learning experience. If you read an interesting article or study, tag it and share it with your PA. It may stimulate a great discussion between the two of you. Also consider attending some conferences together, you can go to the same seminars and then discuss the learning points over lunch. If you do attend dinner programs given by pharmaceutical companies always ask to bring the PA along. Again, this is a great opportunity to learn and discuss medical information.

Recognize that everyone can contribute

During Grand Rounds or during one of those difficult to pin down cases, encourage your PA to give input. While a PA does not have the breadth of training that a dermatologist has, often there is a wealth of experience that can lead to a suggestion of the right test, treatment option or even a diagnosis that had not been considered. Sometimes it is the simple things that get overlooked in the management of a difficult case, such as, has the KOH been repeated recently. We all learn by doing and this type of participation can be a real boost to the self confidence of a PA.

How many people are in this relationship?

The relationship between a collaborating physician and a PA should be an intimate, unique one built on trust and respect. You should interact with each PA in your office as an individual and not treat them as a group. It is also important not to compare your current PAs with your previously employed ones. In addition, you should be the only person to deal with your PA in terms of contract, duties, staffing, vacation, and benefits – the office manager should not be the go-between. There are many reasons for this. First, your PA is a medical level professional employee. Like other medical level professional employees (such as employee physicians or locum tenens), they should deal directly with you for such important matters. Secondly, if your staff sees that your PA reports to or has to be ‘supervised’ by the office manager they will start treating your PA as their peer rather then effectively assisting your PA to maximize their productivity for the practice. Lastly, and perhaps most importantly, having the office manager be the go-between undermines the relationship between you and your PA. It’s like having a third person in a marriage. It may be easier for you to try and delegate these sometimes difficult tasks to your office manger, but it severely undermines and negatively impacts the physician-PA relationship.

Have an open door policy

Always make it clear to your PA that they can approach you with anything. This certainly means medical questions but also should include personal matters. Subtle, or worse, blatant negative reactions to them approaching you should be avoided at all costs. Subtle signs can include sighing, eye rolling, or skipping over their request for your attention as you go see other patients. More blatant off-putting reactions such as outright negative comments like saying “why are you getting me again?” or “don’t you know this already” or any compliant to staff should be avoided. You always want your PA to feel comfortable coming to you with medical questions about patients. Not doing so undermines your relationship and sets you up for a possible malpractice situation. No matter how great your PA is, they should still know you’re always there for them for medical back up.Your PA should also feel comfortable coming to you about problems with staffing, personal medical problems, or problems outside the office. Not only will this show the PA that you care about them as a person, but in reality it may make you aware of upcoming changes to the PAs schedule or behavior that will impact your practice.

Respect, trust, & professionalism

Much of this has already been touched on in the previous points but it can’t be under valued. Your PA needs to know you respect them and trust them as a medical professional. Lead by example and exhibit respect and professionalism and expect all of your staff, including your PA, to do the same. Anything less is unacceptable on all accounts.

Support Your PAs’ Education & Professional Involvement

Every PA should have adequate funds and time available for continued medical education (CME). You want your PA to be the most knowledgeable, intelligent, up to date medical provider possible. By paying for your PAs’ CME you’re telling them that you value education and medical knowledge. You’re also saying that you expect them to remain current and abreast of the best dermatology care. PAs also require more CME than many other medical professionals. To remain certified PAs need to obtain 100 hours of CME every two years and we must take a recertifying exam in general medicine every 10 years. Obviously, your PA needs both the funding and the time off to fulfill their CME requirements.

As part of the PAs’ benefit package, the office should pay for the PAs professional dues to at least three PA organizations. PA dues are unbelievably low compared to what physicians have to pay. Your PA should be a member of their professional organizations so they can be alerted to changes in practice regulations, changes in their state scope of practice, educational opportunities, and help for your office if you encounter a problem. Those organizations that are important include the AAPA, SDPA and the state PA organization as well as state dermatological societies if allowed.

If your PA has shown an interest in becoming a leader in these professional organizations you should offer your full support, even if this means some days they’ll be out of the office. It will build both your PAs’ and the practices’ reputation in the medical community. It’ll show that you and your PA care about the healthcare community including patients and practitioners.

Be Generous

When we talk about generosity we’re obviously taking about compensation and benefits, but we can’t overlook the importance of generous gratitude. Everyone likes to be appreciated and thanked. It goes a long way to say to your PA “Great pick up” or “Mrs. X really liked her visit with you. Great job!”

You would be surprised how far a kind word can go.You and your PA can research what the average salary would be other PAs with their similar experience and practice dynamics. Information on this subject is available from the Society of Dermatology PAs and the American Academy of PAs (yet another reason for your office to sponsor the PAs’ membership). If your PA is underpaid, you may think you’re getting a great deal, but it’s just a matter of time before your PA moves on to another practice. In addition, the most productive PAs receive a bonus based on their productivity. Although the issue of productivity based compensation could be an entire article (or book) in itself, the following can serve as a general guideline: your PAs’ bonus should be fair, reasonable, and attainable. If the bonus threshold is too high, or keeps increasing as a multiplier of their base, it will always seem out of reach and actually discourage your PA from maximizing their productivity. A fair bonus threshold would be what the PA directly costs the practice (do not include costs that would not change if the PA was there or not such as rent or utilities). Even after that threshold, the practice keeps the vast majority of the collections. You can easily be very generous with your PA at the same time as making a sustainable practice profit from your PAs’ services. Let’s also not forget that having a PA also provides numerous non-financial benefits such as increased patient access to care, increased patient satisfaction with the practice since they can now be seen sooner and for work-in appointments, building practice equity, and improving physician quality of life.

I hope that you’re already doing many of the good things reviewed here. This would be a great first discussion piece to share with your PA! By sharing this article with them you’ll demonstrate your commitment to the physician-PA team approach to medicine at the same time as telling them you hope they’ll be a part of your practice for many years to come!

Additional Resources

Post a Job
Ready to hire a Derm PA? Post your open position on our SDPA Job Board which is seen by hundreds of Derm PA's. Let us help you find that perfect team member.
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Derm PA Training
Learn some valuable tips on how to integrate a Derm PA into your practice and how to train them so that they can be most effective in helping you and your patients.
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Do I Need a Derm PA?
The demand for dermatological services has never been higher. Learn about the benefits that hiring a dermatology physician assistant can bring to your practice.
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