Growing your practice with help from mid-level practitioners

Tucson, Ariz. - Recently, more and more dermatologists have added physician's assistants, nurse practitioners, cosmetologists and aestheticians to their practices, for a variety of reasons.

Dermatologist Gerald Goldberg, M.D., knows firsthand what it's like to build a business that includes mid-level professionals.

After 18 years in a two-physician dermatology partnership, his colleague retired, leaving him to decide whether to replace the physician or find an alternative solution. He decided to hire mid-level practitioners, and for him, the decision was the right one.

"Having these professionals on board gives me more time for complex cases and gives the patients quicker access to our services.

"It's also a cost-effective way to manage our business that's positive for the bottom line."

"The main advantage is that it extends our capabilities of getting people into the office promptly," he says. "I couldn't personally see the number of patients we have and get them in so quickly. This way, I can do some of the specialized procedures that I want to do and still be available on an immediate basis for consultation about virtually any patient with significant, complex diagnostic or therapeutic issues or complications."

Patients needing really fast access can be assured they will be seen by someone in the PIMA office within 24 to 48 hours.

Most of the time, however, the physician's assistant and nurse practitioner carry out routine kinds of dermatologic care that take up many practice hours. And, according to their surgical skills, they are trained to do simple excisions and assist in Mohs surgery.

"For example, I might spend 10 to 15 minutes with a patient wanting a filler," Dr. Goldberg says, "and the mid-levels might spend up to 30 to 45 minutes doing that treatment, or 15 minutes with an acne patient and really pamper them ... and our patients appreciate that extra time."

Nevertheless, mid-levels are not as costly as a physician, according to Dr. Goldberg.

Training paramount

Well-trained mid-level practitioners can perform many procedures and services, including initial patient assessments; routine follow-up care; skin cancer and mole checks; acne and wart treatments; Botox (Allergan Medical) and filler injections; removal of hair, some spider veins, tattoos and brown spots; laser skin toning; and light facial peels.

"These kinds of services can be done well by the mid-levels and are usually well-accepted by the patients as we slowly turn selected things over to them," he says, "but it's very important that the mid-levels are extremely well-trained."

For the first six months in the PIMA practice, new physician's assistants and nurse practitioners go through an extensive training program during which they are literally looking over the doctor's shoulder before they see their first patient alone.

New hires then go through a series of training sessions - didactic training, training at grand rounds at the university, and then "mini-rounds" in the office once a week.