By Victoria Houghton, assistant managing editor, September 01, 2015
Dermatology World: Tell me about your practice how many physicians and non-physician clinicians (NPCs) do you have?
Dr. Pariser: Right now we have 11 dermatologists and seven non-physician clinicians throughout seven locations. Our NPCs include both nurse practitioners (NPs) and physician assistants (PAs). We do not make any distinction between the two in terms of the way we schedule, train, or supervise them even though there are legal distinctions. For purposes of working within the dermatology practice, we supervise them both the same and follow the AAD’s guidelines [The Practice of Dermatology: Protecting and Preserving Patient Safety and Quality Care position statement] on training and supervision of non-physician clinicians.
Dermatology World: Who handles the scheduling of NPCs in your practice?
Dr. Pariser: All of our scheduling is done centrally. We have 13 people who just answer our telephones and schedule appointments. They’re supervised by a manager. We see 120,000 patient visits in a year, so there’s no one person doing it.
Dermatology World: What is your basic guiding principle for scheduling NPCs?
Dr. Pariser: We do not schedule an NPC to be at an office location where a physician is not present. Under exceptional circumstances, there may be some times when it does happen that a physician is not present the doctor is out for some reason or there’s a last-minute change in the schedule. In that case, we have protocols on how these NPCs are supposed to handle cases. If a patient has an acute problem, the patient is referred to one of our other offices or they’re asked to come back the next day to see the doctor. The reason we always want to be on site is so that the NPC can call us in if needed. I train them all myself before they see any patients and make sure they know that I don’t care how busy I am. If you need me, I’m never going to be upset with you for calling me.
Dermatology World: How do you manage the scheduling of NPCs for new patients?
Dr. Pariser: In general, our policy is to have all new patients seen by the doctor. That happens most of the time but I can’t tell you that this happens all of the time. If a patient, for example, has a common and self-diagnosable problem such as acne, they may see the NPC on the first visit. If someone is coming in for rash or if they are referred from another physician for some other problem, then they will see the doctor.
Dermatology World: How do you manage the scheduling of NPCs for existing patients?
Dr. Pariser: If a patient who I have seen is calling to make a follow-up appointment, and I want them to see the PA or NP for the follow up, I will indicate that. Sometimes patients who have seen the NP or PA will make an appointment directly to see that person. That’s okay, as long as that patient is supervised by the physician. For example, suppose we have a male physician and a female PA and the patient is a woman and wants to see a female provider. They might be scheduled with the PA.[pagebreak]
Dermatology World: How is the handoff from physician to NPC handled?
Dr. Pariser: It doesn’t happen the same way all the time. Usually I say, for example, “Here’s the treatment I’m going to start you with. When you come back you will see one of my assistants, and if needed I will be glad to see you.” We also have a policy that every third or fourth visit, no matter what the patient is being seen for, the doctor has to look at them.
Dermatology World: When matching patients to specific NPCs, what criteria do you use?
Dr. Pariser: They’re all created equally, but they do have different experience levels. Some are more interested in procedural and surgical cases. Some are more interested in cosmetic cases and some are more interested in medical cases. We do make some attempt to try match that up but with as many as 1,700 phone calls a day, sometimes it’s not matched up that precisely.
Dermatology World: How does the practice make an appointment with an NPC attractive to patients?
Dr. Pariser: There are surprisingly few patients who get upset by being seen by an NPC. However, anybody who expresses any reservations whatsoever is seen exclusively by the doctor. We are very careful to have truth in labeling the patients who see a non-physician clinician are clearly informed that that’s what they are and that they’re not a physician. They’ve been trained for specific diagnostic abilities and tasks in dermatology and we the doctors stand behind that training.
Dermatology World: The Academy just launched the DermCare Team an initiative that provides professional development resources for dermatology physician assistants, medical assistants, nurse practitioners, and registered nurses. What role do NPCs play in the dermatology practice?
Dr. Pariser: An NPC allows the dermatologist to have much more freedom to do what he or she does best, and that is to treat patients and make diagnoses and not be so much involved in the routine provision of simple procedures. That time can be used to see new patients with new problems, or new problems in old patients. Also, the NPC can spend more time on patient education. One of the major patient complaints these days is that they don’t get enough time with their provider. It’s a way to really extend the reach of the physician. Also, having an NPC really increases the dermatologist’s quality of life and practice. They can provide more care to more patients, and in some cases better care in that the patients will get more face time and education, and will perhaps be more reliable with their treatments if they’re better explained to them.
David Pariser, MD, is in private practice at Pariser Dermatology Specialists in Norfolk, Virginia. He serves as chair of the Dermatology Care Team Implementation Workgroup and the Corporate Relations Task Force.