Dermatology Physician's Assistant - just as good as the doctor?

April 1, 2014 6:50 AM

Is it reasonable to see a PA (Physician's Assistant) for your first dermatology exam for medical (not cosmetic) reasons? Or should I insist on the actual doctor?

Last week, I made an appointment to see a dermatologist for the first time. I'd like to get a baseline review of full body skin (I have a ton of moles/freckles) and I have a few weird things on my skin that I want to ask about. This is totally a medical appointment, not cosmetic and I was clear about that when I made the appointment.

The office just called to confirm the appointment for tomorrow, and they said that I would be seeing the PA (Physician's Assistant) instead of the doctor. Is this reasonable? In general, does a dermatology PA have the right kind of experience to look at weird things on your skin and decide whether it needs to have further examination... and is that further examination just "we better ask the doctor to look at this one", which means I would have to come back for another appointment to see the doctor, when I thought that's what this appointment was for?

Should I cancel this appointment and request one specifically with the doctor, or am I probably OK seeing the PA? I can call the office back and ask them this question, but I wanted to gather some insights if the hive has any.

posted by CathyG to Health & Fitness (11 answers total)

I have always only ever seen the PA at my dermatology office. He's even done the surgery to remove an abnormal mole. They are qualified professionals.
posted by something something at 6:57 AM on April 1, 2014 [4 favorites]

You will probably have to wait months to see an MD dermatologist. You can see the PA tomorrow. If the PA sees something concerning, you'll need additional appointments, maybe with a dermatologist or maybe with other specialists. If the PA isn't concerned, I think you can put your mind at ease.

I've had great experiences with PAs and NPs (not in dermatology) and generally find them to be much more patient-oriented than MDs (plenty of exceptions both ways, I'm sure). They get a ton of clinical training.
posted by mskyle at 6:58 AM on April 1, 2014 [3 favorites]

I can't speak for dermatology specifically, but I used to work in a cardiac surgery ICU with both surgeons and PAs, and found the PAs to be amazingly knowledgable and much, much better at interacting with and teaching patients about their condition.
posted by makonan at 7:00 AM on April 1, 2014

Best answer: Just to add to the pro-PA pile: My husband's dermatology PA is the GREATEST. She is totally qualified, really sweet, and has biopsied him on many occasions. He has dysplastic nevus syndrome, and tons of scary moles. She's done an excellent job keeping an eye on him. She's so great, I've considered leaving my MD dermatologist to be her patient, too.

Every once in a great while, she'll stumble on some issue that she thinks requires the attention of one of the MDs in the practice. When that happens, she just pulls one of them in. It always goes smoothly. In fact, I appreciate that she knows she's not a infalliable dermatology god, and asks her colleagues for their opinions when my husband has something iffy going on.
posted by Coatlicue at 7:08 AM on April 1, 2014 [2 favorites]

I love PAs! 90% of anything you bring to a medical professional can be handled competantly by a PA. PAs generally know when you've got a thing that requires the 10% knowledge of an MD.

Go see the PA, you will be pleased!
posted by Ruthless Bunny at 7:26 AM on April 1, 2014 [1 favorite]

Do not hesitate to see a PA. They're highly skilled and trained clinicians, and they know when to pass the ball.
posted by vitabellosi at 7:41 AM on April 1, 2014

Response by poster: Thanks, everyone. I will definitely see the PA tomorrow with confidence. I think young rope-rider hit the nail on the head regarding why I was upset by this, but everyone's experiences about the quality of care has reassured me that it will all work out. Thanks.
posted by CathyG at 7:56 AM on April 1, 2014

In general, does a dermatology PA have the right kind of experience to look at weird things on your skin and decide whether it needs to have further examination... and is that further examination just "we better ask the doctor to look at this one", which means I would have to come back for another appointment to see the doctor, when I thought that's what this appointment was for?

I agree with the young rope-rider. However, in my experience, if there is something that the PA considers more serious than he/she can handle, the doctor usually gets called in during the same appointment. I haven't had to come back on a different day.
posted by bluefly at 7:58 AM on April 1, 2014 [1 favorite]

This seems to be the way of the future with specialists. Last year, my children and I had the delight of seeing four different kids of specialists; a developmental neurologist, a pediatric gastroenterologist, an otolaryngologist, and a dermatologist. In every case, the provider we actually saw was a PA or ARNP. My kids' issues (neurology and GI) thankfully turned out to be manageable entirely by the ARNPs, my ENT issues needed a CT scan and a followup with the MD, and my dermatology stuff was handled by the PA calling in the MD and saying "Double-check me on this diagnosis and course of treatment, doc" in the same appointment. I think it's great, really; it drastically increases the number of patients they can see while decreasing the costs, and every provider we've seen has been completely competent both to provide care and also to recognize when a case goes outside their scope of practice.
posted by KathrynT at 8:15 AM on April 1, 2014 [1 favorite]

When I went to a dermatologist I started with a PA, but when things turned out to be trickier than we thought she called the doctor in to see what was going on. In my case, the doctor was in the office and so I just had to wait a few minutes -- I didn't have to make a second appointment. (Everything was fine.)
posted by The corpse in the library at 9:37 AM on April 1, 2014 [1 favorite]

My experience is in emergency medicine, but I suspect it's similar in dermatology - the straightforward/routine cases like skin checks and mole biopsies are likely triaged to the midlevel providers, and the more complex cases to the MDs. In emergency medicine at least, if a PA or NP sees a case that is higher level of complexity then they have to run it past the MD and the MD has to also stop in (on the same visit) and do a quick assessment to ensure that the plan is appropriate.
posted by treehorn+bunny at 5:18 PM on April 1, 2014