PAs in Dermatology Increase Patient Care, Revenue

Today, 70 percent of certified physician assistants (PAs) work in specialties outside of primary care, and 4 percent of the nation's 109,000 certified PAs work in dermatology.

With occurrences of skin cancer on the rise and additional skin cancer screenings needed, this number will only increase. Plus, patients of all ages routinely seek treatment for common skin problems like acne and psoriasis, skin cancer excisions and for cosmetic procedures.

Although in major cities, dermatologists may not be in short supply, there is a maldistribution of providers, including PAs, in rural and remote areas, per the map below from the National Commission on Certification of Physician Assistant (NCCPA).

How can Certified PAs increase access to dermatology services?

• We work autonomously but in collaboration with a physician. The scope of our practice depends on responsibilities delegated by the physician in accordance with state law. My average day includes a schedule of about 35 patients - patients that I can diagnose and treat both medically and surgically.

• Although we are educated and certified in general medicine, PAs learn dermatology through study, by shadowing the physician and through continuing medical education. We free up overloaded physicians because we treat acne and rashes, perform injections and handle follow-ups. I also do annual skin checks for my own patients.

• My expertise lies in skin cancer treatment - doing biopsies for

suspicious growths and performing excisions or curettage procedures for basal, squamous, and melanoma cancers. As patients age, they are more prone to need skin cancer treatment particularly in sunny climates. According to the American Academy of Dermatology, "the incidence of melanoma continues to rise, and people who are 55-75 years of age are most likely to be stricken by this disease. Untreated or late detection of skin cancer in the Medicare population will result in increased mortality and morbidity." So it is important that this population be screened annually and treated when necessary.

• Certified PAs are skilled in cosmetic procedures. I perform sclerotherapy, Botox treatments, and chemical peels. However, PAs are specializing in all areas of cosmetic improvement.

• Around the country tele-dermatology is growing. PAs can use a dermatoscope and EHRs to send photos and communicate with the dermatologist, extending access to remote areas.

• We often handle the referrals from primary care and refer patients to rheumatologists and MOHS surgeons when the diagnosis warrants it.

• We are able to spend a little more time with patients to explain and answer questions about their conditions. In fact, according to the NCCPA, 88 percent of PAs in dermatology counsel and educate patients and their families.

By extending patient access in all these areas, certified PAs are also increasing revenue in dermatology practices while improving healthcare for millions of Americans. They are becoming essential members of dermatology teams, a trend that looks to be growing as people live longer and become more aware of the benefits that dermatology care provides.

Anjana Patel, PA-C, has been a certified PA for 15 years. She has a Masters Degree in Physician Assistant Services from the University of Iowa and is employed by North Atlanta Dermatology, a large practice with four locations, six physicians and five PAs.