PA Specialty Series: Dermatology
In our next specialty series, the ever wonderful @physicianassistantstudents tells us what it’s like to be a derm PA. Do you love cysts and funky skin stuff? Did you suffer with a skin condition and want to help others? Are you a PA-S thinking about derm but not sure what the expect? Discover the lovely land of dermatology and its potential as a fruitful career for a PA-C.
1. Why did you choose to work in your specialty?
As a teenager at about 18 I had really bad acne. I went to the dermatologist got 2 rx creams, and started obsessing over my skin & how to make it look better. It sparked my interest. I then decided to become a medical assistant in a dermatology office to see the other aspects of derm and I fell in love. I then came to realize how you have a good quality of life in derm. For example, no on-call, no real emergencies, etc.
2. What is your scope of practice as a derm PA?
My scope of practice is to diagnose and treat dermatological diseases including hair, nails, full body skin exams, perform biopsies- shave/snip/punch, cyst removals, botox & filler injections, operate lasers, suturing, wound care, biopsy documentation.
3. Describe your first few weeks: what would you change about the experience?
My first few weeks consisted of shadowing my MD and learning the EMR. It was basically learning the basic ropes (how he sets up, what he likes to prescribe and what he doesn't like to prescribe, patient follow up), and how the office operated. Big learning curve.
4. What do you enjoy most about your specialty?
I enjoy clearing patients from diseases such as acne, eczema, and psoriasis. It truly makes a difference in people's lives and gives them more confidence. I also like preventive medicine, so skin checks and performing biopsies are my favorite thing to do as well. Dermoscopy is truly an art that I am learning to master. Learning about all the aesthetic advancements and knowing what works and what doesn't is a bonus, so I can keep myself looking 26 forever :)
5. What are the potential struggles and downsides of your specialty?
There are many struggles working in a private practice: vacation time, working in close corners with people who you do not like, etc. The struggles in dermatology are mostly prescription coverage and non-complaint patients. There is potential for burn out. That all depends on how many patients you are required to see a day, your medical assistants (or lack thereof). Some dermatology practices can be a “mill” so beware.
6. Describe a typical day in your specialty:
Typical day for me is to start at either 9 or 10 AM and finish by 5/6 PM. Right now I see 3 patients an hour (will be bumped up to 4 soon). My schedule now is Tuesday-Friday (I work 9-7 on Tuesday). I typically arrive to work 20-30 minutes before my first patient to make sure my rooms are in order, to fill up my liquid nitrogen mini-tanks in the rooms, and to look at my schedule for the day. The MA’s bring in my patients. I most commonly see patients for full body exams, D&C of skin cancers, warts, acne, rashes, hair loss, psoriasis, molluscum. During my lunch break I am often eating and working at my desk (unless I have a pharm rep come in for lunch). During that time I call patients regarding their biopsy results, return phone calls to any patient’s that called or relay the message to my MA to call, discussing a case with my MD. I also keep up to date with current studies and treatment options. I use uptodate, medscape, dermatology news/cutis, MPR, JDD, and the SDPA website. I read cutis, JAAD, JDD whenever I get a chance. I also have a dermoscopy book on my desk to constantly look at benign and malignant lesions.
7. What advise would you give a PA-S on rotation in your specialty?
My advise would be to ask as many questions as you can on your rotations. Dermatology is an art. It is mostly learned by experience. Reading dermatology textbooks is always beneficial, but it does not teach you how to explain it to a patient, what treatments you actually use in clinical setting, and when they should follow up. Ask to perform biopsies, skin exams, etc. Soak it all in!
8. Any other thoughts?
Go into a field that is your passion. If you don’t know what your passion is yet, go into internal medicine/family/general surgery to find what it is. Surround yourself with positive people who uplift you. Always be curious and never stop learning. This is a career with so many opportunities.