Bringing in Physician Extenders

Last year's column on recruiting an associate continues to generate a lot of feedback. (If you missed that column, go to www.skinandallergynews.com

The most common question goes something like this: “If, after going through your checklist, I conclude I can't afford an associate—or the right associate simply isn't available—what about a physician assistant or nurse practitioner?”

Speaking at a recent dermatology conference, Dr. Roger Ceilly of the University of Iowa in Iowa City, past president of the American Academy of Dermatology, outlined the basics of incorporating physician extenders into a practice.

Dr. Ceilly began to explore that option when he had difficulty recruiting physicians. “Young doctors are reluctant to settle in a non-sun belt, medium-sized metro area, even though Cedar Rapids is a wonderful place to live,” he told me.

To those who are hesitant to go the extender route, Dr. Ceilly says, “Every non-MD in your office is a physician extender to some degree. Your receptionists do triage.”

There are many advantages to incorporating PAs or NPs, he says. “My PAs handle a lot of the medical dermatology, allowing me to devote more time to surgery. PAs do a more thorough total cutaneous examination than most physicians do.”

There are other advantages as well. “Patients have better access to my care. They get more face time with caregivers, and they like that. They also benefit from a team approach. And I benefit from a decreased workload and less burnout. It's an efficient and cost-effective solution to an expanding office.”

Recruiting good extenders requires careful planning. “Take the time to write a detailed job description,” Dr. Ceilly advised. “An office procedure training manual, detailing all practice protocols, is a must. Make sure adequate reference materials, for dermatology and general medicine as well as coding and documentation, are available. And put mechanisms in place to allow extenders to learn from existing clinical staff.”

As with any employee, careful hiring is essential. “Hire the best PA. Take your time; don't settle for less.” Dr. Ceilly recommends a tiered interview process, as do I: an immediate superior, followed by management, and then a physician. He also suggests having the best candidates spend some time in the office shadowing physicians before a final decision is made.

Dr. Ceilly says he prefers to recruit extenders who have had experience in a general medical office. “They will be better equipped to recognize underlying medical problems. Besides, when they have worked with sick people, they appreciate what a good deal dermatology is.

“Prior experience in a dermatology practice is not important,” he added. “You're going to have to retrain them anyway.”

Dr. Ceilly personally trains his extenders. Each procedure in the training manual must be covered, and signed off three times: the first time after the procedure is observed, the second after assisting with it, and third after performing it.

“The most important thing is to make them your clones,” he said. Train them to know your practice style inside and out, so that your patients will be comfortable with them. “My PAs function much the way a resident would, except they can charge for their services.”

Compensation will depend on the going rate in your area, plus other factors. Dr. Ceilly factors in how well each extender interacts with staff, and with patients, and how much more productive they make the office's physicians.

All of his extenders sign a 2-year commitment to stay with the practice; if they leave early, they must repay all salary received during their training period.

He discourages the use of an incentive system. “You don't want them cherry picking the lucrative procedures, because then you're right back where you started,” he said.

Exactly what duties you delegate to your extenders, and how closely you supervise them, should be discussed carefully and decided upon in advance. To a certain extent, it will depend on the laws in your particular state. However, the policy of the AAD is that at least one physician should be physically present in the office where extenders are working; that physicians see all new patients; and that physicians see all new problems in established patients.

Last year's column on recruiting an associate continues to generate a lot of feedback. (If you missed that column, go to www.skinandallergynews.com

The most common question goes something like this: “If, after going through your checklist, I conclude I can't afford an associate—or the right associate simply isn't available—what about a physician assistant or nurse practitioner?”

Speaking at a recent dermatology conference, Dr. Roger Ceilly of the University of Iowa in Iowa City, past president of the American Academy of Dermatology, outlined the basics of incorporating physician extenders into a practice.

Dr. Ceilly began to explore that option when he had difficulty recruiting physicians. “Young doctors are reluctant to settle in a non-sun belt, medium-sized metro area, even though Cedar Rapids is a wonderful place to live,” he told me.

To those who are hesitant to go the extender route, Dr. Ceilly says, “Every non-MD in your office is a physician extender to some degree. Your receptionists do triage.”

There are many advantages to incorporating PAs or NPs, he says. “My PAs handle a lot of the medical dermatology, allowing me to devote more time to surgery. PAs do a more thorough total cutaneous examination than most physicians do.”

There are other advantages as well. “Patients have better access to my care. They get more face time with caregivers, and they like that. They also benefit from a team approach. And I benefit from a decreased workload and less burnout. It's an efficient and cost-effective solution to an expanding office.”

Recruiting good extenders requires careful planning. “Take the time to write a detailed job description,” Dr. Ceilly advised. “An office procedure training manual, detailing all practice protocols, is a must. Make sure adequate reference materials, for dermatology and general medicine as well as coding and documentation, are available. And put mechanisms in place to allow extenders to learn from existing clinical staff.”

As with any employee, careful hiring is essential. “Hire the best PA. Take your time; don't settle for less.” Dr. Ceilly recommends a tiered interview process, as do I: an immediate superior, followed by management, and then a physician. He also suggests having the best candidates spend some time in the office shadowing physicians before a final decision is made.

Dr. Ceilly says he prefers to recruit extenders who have had experience in a general medical office. “They will be better equipped to recognize underlying medical problems. Besides, when they have worked with sick people, they appreciate what a good deal dermatology is.

“Prior experience in a dermatology practice is not important,” he added. “You're going to have to retrain them anyway.”

Dr. Ceilly personally trains his extenders. Each procedure in the training manual must be covered, and signed off three times: the first time after the procedure is observed, the second after assisting with it, and third after performing it.

“The most important thing is to make them your clones,” he said. Train them to know your practice style inside and out, so that your patients will be comfortable with them. “My PAs function much the way a resident would, except they can charge for their services.”

Compensation will depend on the going rate in your area, plus other factors. Dr. Ceilly factors in how well each extender interacts with staff, and with patients, and how much more productive they make the office's physicians.

All of his extenders sign a 2-year commitment to stay with the practice; if they leave early, they must repay all salary received during their training period.

He discourages the use of an incentive system. “You don't want them cherry picking the lucrative procedures, because then you're right back where you started,” he said.

Exactly what duties you delegate to your extenders, and how closely you supervise them, should be discussed carefully and decided upon in advance. To a certain extent, it will depend on the laws in your particular state. However, the policy of the AAD is that at least one physician should be physically present in the office where extenders are working; that physicians see all new patients; and that physicians see all new problems in established patients.

Last year's column on recruiting an associate continues to generate a lot of feedback. (If you missed that column, go to www.skinandallergynews.com

The most common question goes something like this: “If, after going through your checklist, I conclude I can't afford an associate—or the right associate simply isn't available—what about a physician assistant or nurse practitioner?”

Speaking at a recent dermatology conference, Dr. Roger Ceilly of the University of Iowa in Iowa City, past president of the American Academy of Dermatology, outlined the basics of incorporating physician extenders into a practice.

Dr. Ceilly began to explore that option when he had difficulty recruiting physicians. “Young doctors are reluctant to settle in a non-sun belt, medium-sized metro area, even though Cedar Rapids is a wonderful place to live,” he told me.

To those who are hesitant to go the extender route, Dr. Ceilly says, “Every non-MD in your office is a physician extender to some degree. Your receptionists do triage.”

There are many advantages to incorporating PAs or NPs, he says. “My PAs handle a lot of the medical dermatology, allowing me to devote more time to surgery. PAs do a more thorough total cutaneous examination than most physicians do.”

There are other advantages as well. “Patients have better access to my care. They get more face time with caregivers, and they like that. They also benefit from a team approach. And I benefit from a decreased workload and less burnout. It's an efficient and cost-effective solution to an expanding office.”

Recruiting good extenders requires careful planning. “Take the time to write a detailed job description,” Dr. Ceilly advised. “An office procedure training manual, detailing all practice protocols, is a must. Make sure adequate reference materials, for dermatology and general medicine as well as coding and documentation, are available. And put mechanisms in place to allow extenders to learn from existing clinical staff.”

As with any employee, careful hiring is essential. “Hire the best PA. Take your time; don't settle for less.” Dr. Ceilly recommends a tiered interview process, as do I: an immediate superior, followed by management, and then a physician. He also suggests having the best candidates spend some time in the office shadowing physicians before a final decision is made.

Dr. Ceilly says he prefers to recruit extenders who have had experience in a general medical office. “They will be better equipped to recognize underlying medical problems. Besides, when they have worked with sick people, they appreciate what a good deal dermatology is.

“Prior experience in a dermatology practice is not important,” he added. “You're going to have to retrain them anyway.”

Dr. Ceilly personally trains his extenders. Each procedure in the training manual must be covered, and signed off three times: the first time after the procedure is observed, the second after assisting with it, and third after performing it.

“The most important thing is to make them your clones,” he said. Train them to know your practice style inside and out, so that your patients will be comfortable with them. “My PAs function much the way a resident would, except they can charge for their services.”

Compensation will depend on the going rate in your area, plus other factors. Dr. Ceilly factors in how well each extender interacts with staff, and with patients, and how much more productive they make the office's physicians.

All of his extenders sign a 2-year commitment to stay with the practice; if they leave early, they must repay all salary received during their training period.

He discourages the use of an incentive system. “You don't want them cherry picking the lucrative procedures, because then you're right back where you started,” he said.

Exactly what duties you delegate to your extenders, and how closely you supervise them, should be discussed carefully and decided upon in advance. To a certain extent, it will depend on the laws in your particular state. However, the policy of the AAD is that at least one physician should be physically present in the office where extenders are working; that physicians see all new patients; and that physicians see all new problems in established patients.