You ask me about derm constantly, so here's the whole picture.

I've been a dermatology PA for over five years. I work part-time now and see about 25 patients a day. My days are a mix of medical derm, skin checks, biopsies, and cosmetic procedures - and yes, I do most of it independently.

The part I underestimated going in was the learning curve. Dermatology is pattern recognition, and patterns take reps. My first year I looked things up constantly. That's normal, and any specialty you pick will feel that way at first.

If derm interests you, shadow it. Then shadow something else. Clinic flow differs enormously between specialties and you want to know what kind of day suits you.

What I cover:

• My current schedule and patient volume
• Procedures I do regularly, including biopsies
• Medical versus cosmetic dermatology
• The diagnostic learning curve as a new derm PA
• Moving from a packed schedule to a saner one
• Why shadowing multiple specialties matters

Resources:

Free application timeline: https://www.thepaplatform.com/services/free-application-timeline

PA Program Map: https://www.thepaplatform.com/pa-platform-map

Pre-PA counseling: https://www.thepaplatform.com/services/pre-pa-counseling

Free resume download: https://www.thepaplatform.com/services/free-resume-download

Mentioned in this episode:

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Alright, y', all, Today is a solo episode where I am diving into answering some questions I got on Instagram about my job as a dermatology PA and the questions I get all the time.

Welcome to the Pre PA Club podcast.

If you want to learn how to become a physician assistant, you're in the right place.

I'm your host, Savannah Perry.

Let's get to it.

Hey, y'.

All, Like I said at the beginning, I am a dermatology PA and that's what we're talking about today.

My name is Savannah and I am have been practicing for about five and a half years now.

I've only ever done dermatology as a PA, but I am in my second practice now.

I also [email protected] and do this podcast and help run the Pre PA Club Facebook group.

So thank you for listening.

I hope that you enjoy this episode.

I haven't done.

I can't remember the last time I did a solo episode where it was kind of just me talking.

Which to be perfectly honest, always feels kind of weird as I sit in my basement.

But it's a nice time where I get to kind of deep dive into some stuff.

Before we jump into answering questions and we'll get right to it, I do want to mention the two sponsors of our podcast, MyPA Resource and PA School Prep.

So to start with, MyPA Resource is a personal statement editing service specifically for PA School and PA School Prep is an online course that helps you get ready for specifically the anatomy, physiology and med terms portions of PA School with a nice refresher and you can use the code futurepa on either of those websites.

You can also use it@the PA platform.com.

All right.

I'm actually really excited about this because number one, I love my job.

I wouldn't have stayed in it if I didn't.

I mentioned in a previous episode that I just turned 30 and I've kind of been reflecting on some of the things I've learned and even though that's still, I think, fairly young, but one thing I've learned is it's just not worth your time to stay somewhere where you aren't happy.

And.

And so if I didn't enjoy what I did, I would find something else.

But a little bit of first, how I got into dermatology.

When I was in college, I, you know, was looking for shadowing hours because I knew I wanted to be a PA and the only place that I could find in Athens, Georgia when I was at school at uga, that Would call me back was a dermatology office, and there was an amazing PA There who let me come shadow her.

I feel like I went maybe weekly or at least a couple times a month for a whole afternoon, and it was great.

And so at first, you know, my mindset going into those shadowing times was that it was going to be very boring.

I was under the assumption that dermatology was all acne and old naked people.

And there is a lot of that.

But dermatology is also very interesting.

And one thing that I didn't realize until I did start shadowing and working in medicine and even on rotations a little bit more, is one thing that makes derm unique is that you get to see visibly a lot of what's happening, so you get to see the pathology.

We're not guessing the way you are looking at numbers.

Like, if you're dealing with hypertension or high cholesterol, or even if you listen to the interview I did last week with Julia, we talked about how.

Or maybe we talked about it after, I don't remember.

But basically, endocrinology to me is like a lab medicine, where you're going off of numbers more so than what you see with the patient.

But dermatology is different, and there's a little bit of an instant gratification of seeing someone get better.

And also, skin can just do some really crazy stuff.

And so it was actually very, very interesting.

When I shadowed, I will say, at first I was kind of scared, squeamish.

And I've gotten a few questions about this recently, about people saying, you know, I got into PA school or I really want to apply, but I'm not sure if I can stomach the procedures or blood or whatever.

So for me, the very first time I saw a punch biopsy, I was shadowing at the derm office, and it was on the knee, like, right on top of the knee that she was doing a punch.

And I just.

I guess I didn't realize or expect the skin to be as deep as it was.

And so as you.

Kind of the way a punch biopsy works is you numb it, and then you take this kind of little cookie cutter and kind of push it and spin it into the skin with a little bit of pressure.

And then you pull it out, and the skin kind of pops out, and you can see all the layers.

You can see the epidermis, the dermis, and then the subcutaneous fat.

And to be honest, that freaked me out.

And I think I remember the PA looked over at me and she goes, do you need to sit down?

Which I definitely did.

And I did take that moment to sit down and excuse myself, actually, from the room, because I know that I have somewhat of a. I wouldn't throw up, but I pass out kind of easily, or I used to.

And so, yeah, that was eye opening to me.

And the same thing happened when I was shadowing in orthopedics when they did a joint injection.

And even, you know, I got used to the blood.

I got used to suturing.

Like, I did fine during my surgery rotations.

No issues there.

But broken bones, when I encountered those again in emergency medicine, those still made me feel kind of faint.

So if I was still exposed to them more, I would probably get used to it.

But all that to say, I do punch biopsies all the time now, and they don't bother me.

And so that is something you can get over.

But I loved the procedure aspect of it.

And so I went into PA school with an open mind.

Of course, you know, I hadn't experienced that many different areas.

And I'd shadowed in derm, neurosurgery, orthopedics, and hospitalist medicine.

And so I'd seen kind of different areas.

But I was keeping my options open, knowing that I did enjoy dermatology.

And I had heard great things about working in dermatology.

But so I went through PA school during rotations.

I still really enjoyed just procedural medicine.

I loved my general surgery rotation.

And then when it came time to get jobs, it kind of worked out that this job was available.

And I may.

I know it's a little jump in the gun for anyone who's pre pa, but I may do another episode on exactly how I got my job, just because that's another thing that I get questions about a lot because it can be difficult.

But, yeah, so I ended up in Durham, which I'm very happy, like I said.

All right, so I'm gonna go through.

I posted on my stories a while ago on Instagram a question box of talking about, you know, what questions do you have about my day to day?

And I got so many questions, which is awesome.

And you can actually still submit questions.

It's in my highlights on Instagram.

And I've been kind of just trying to respond to those every day a little bit when I look presentable, which is not a great reason, but it's true.

Okay, so the number one question, what does the work schedule look like and what are your office hours?

So in what I do as a derm pa, I have kind of Just a normal schedule.

And I am part time now.

So as of right now, I'm only working about two days a week.

But I, you know, go in at around 8 and I'm usually home by 5.

Honestly, it hasn't.

I switched practices in September to go part time because I wanted to be home more with my little baby who is awesome.

But it's been a little bit of an adjustment.

Just kind of going from a place where I had a very.

I'd been there for five years and I had a very strong practice.

I was seeing 35 patients a day.

I'd seen a lot of those patients for years and years since I started.

And then going to a new practice where I'm essentially building my practice again.

A lot of my patients right now are new patients.

Now that I've been there since September, I am seeing more follow ups and my schedule's getting fuller.

So I'd say now I see about 25 patients a day.

But eventually I would expect that to get back up to around that 35 patient mark.

It just takes a while to get there.

And that little change of pace or slowing of pace has been very, very nice.

But I get there at 8 and then I always have a lunch break unless I'm running behind.

I try to plan surgeries for right before lunch to kind of build in a buffer or procedures like cosmetic procedures that may take a little bit longer because I don't mind running into lunch if I have to.

Sometimes we have lunch in the office, sometimes we go out.

I actually live fairly close to my office.

So if I do have a break or we don't have anything going on, a lot of times I'll just go home and eat something there and maybe try to clean up a little bit or just relax at home or see my baby for lunch if I can.

So yeah, that's kind of my schedule as far as who I see.

We see babies and kids all the way up to elderly people.

The other day I had a patient who was a hundred and three, which was amazing.

She was so sweet and so that was cool.

That was probably the oldest patient I've ever seen.

But all different ages, all different issues.

It's a nice mix of kind of medical, derm, cosmetic surgical.

At this new practice I am getting to do more surgeries and more procedures, which I.

Which I do.

I've always done all my own biopsies, but now I am doing more excisions, which I enjoy.

Still doing a lot of cosmetics, fillers, Botox peels.

Yeah.

So all the fun stuff.

Okay, so one question I got was, how do you keep up with charting when you see so many patients in a day?

So the way that I operate, and if you ever shadow just pas in general, just what you'll find is that everyone kind of operates a little bit differently and has a different procedure, and every office is different or every setting.

And that's why it is important to shadow in different areas.

So if you shadow me and you shadow an emergency medicine pa, our jobs and how we do things is probably going to look so, so different.

The office I'm in right now is actually very unique.

They have found a way to kind of have a hybrid paper chart and EMR type thing because they weren't quite willing to completely give up the paper charts just because they make it really easy to kind of find what you're looking for.

And so going from an EMR system where I, at my old office would literally sit in front of a computer all day, every day, to not even looking or touching at a computer, that it makes sense.

Looking at or touching a computer, my practice now, that's a huge change, but it's actually kind of nice and I don't really mind it.

So the way it works now is a patient checks in and they bring us the chart.

The medical assistant will take the patient back, get their history, kind of update anything in the chart that's needed, and then they will let me know that the patient's ready, put the chart outside the door, and then I will go in, talk to the patient, do my physical exam, decide what I want to do, and then they're taking notes in the chart.

During that time, I come out and I try to, in an ideal world, dictate right away.

So with a dictation, I do it in my phone and I just kind of say I read my note, essentially.

And the nice thing about dermatology is a lot of stuff is pretty repetitive.

And so I can kind of speed through it, add any details I need to add.

There are a few kind of template things that, that I can use, but I dictate, I send it off, and then a few days later, I get the paper chart where I can kind of sign off on my note and make sure everything's correct.

So it's kind of an interesting system.

But, yeah, I never take charts home with me.

I never chart from home.

I never leave anything until tomorrow.

And that's just something I've always done.

There are a few things as a PA that are really important to me.

One of those is just kind of respecting my patient's time and trying to make them not wait as long as possible and trying to be as efficient as I can.

And the other one is just that I really want to leave work at work as much as possible.

And that doesn't mean that I don't think about my patients or things that happened at work, but I'm not actually working at home, and I don't have to take call or anything like that.

If there's ever an issue out of the office, one of the medical assistants can call me or text me and let me know, and then I can either come in if I need to, or we can handle it over the phone.

Okay, so what would you change about the derm PA specialty, if anything?

So that's an interesting question, and this is something that I don't think I realized even until I took the job.

So when you're looking at jobs or specialties, one thing to keep in mind is just the type of lifestyle you want to have.

So there's two different types of work, or there may be more, but for kind of our purposes, there's kind of this clinic scheduled work, and then there's shift work.

So in what I do as a derm pa, when I'm fully booked, I could be booked out three to six months with patients.

And so that makes it difficult to plan things.

And you have to think about, you know, if you're working in a clinic setting Monday through Friday, you're going to have a limited amount, probably of vacation days that you have to to plan.

And you have to think about scheduling and do things really far in advance.

So if I ever wanted to schedule a vacation or time off, it had to be done at least six months ahead of time for me to respect my patients and the office staff.

I mean, things come up and that's fine.

But having to try to find new spots for 35 patients is very difficult.

And if anyone has worked, you know, reception or as a medical assistant, you probably are like, yes, please don't do that to me.

So I really tried not to do that.

I have, and this is may or may not be a good thing, but I've actually never taken a sick day.

I've never called in sick to work.

I tend to work through illness, for better or worse.

I worked up until my due date when I was pregnant.

I literally worked until Friday and then went in and had my baby on Monday.

And so then I did take 11 weeks off, which I highly recommend.

But, you know, it's just to Me, it's very important that I try to be on top of scheduling as much as possible.

But the alternative to that is something like working as a hospitalist or in shift work.

So my husband is a hospitalist, and his schedule is seven days on, seven days off off.

So that's nice, because he pretty much always has these big breaks if he wants to do something.

So that's another part of why I changed my schedule, because it made it a little bit difficult with me working Monday through Friday to see him when our schedules didn't line up that well.

So now we actually have a few days off together every other week, so I can see him a little bit more.

But, you know, it is.

It is something to think about.

If you are someone who likes to vacation or likes to be able to kind of up and go or may need time off or something, being in a job like a hospitalist or an emergency room or an urgent care, where you have shifts and not necessarily a schedule of patients expecting to see you specifically may be a better fit for you.

So that not necessarily something I change about dermatology, but I guess something to think about if you are interested in dermatology, Something I would change.

Oh, gosh, maybe I would change that.

I wish patients understood their insurance more.

One of the things that happens a lot of times in Durham is people come in thinking that we can just cut off all their moles or I just want this spot off because I hate it.

But that's not what insurance is for.

So health insurance is for if something is potentially harmful or malignant, not just because you hate it.

And so sometimes it gets a little old, having to continually explain that to patients over and over and over.

But it's.

It's just part of the job.

And I think insurance stuff comes up in every specialty and every area, not just the one I work in.

All right, maybe that was a tangent.

I don't know.

Okay, so I like this question.

Did you have a difficult time diagnosing when you first began?

Yes and no.

So in PA school, I had two weeks of dorm, and then I got hired at my job in April, and I graduated in August.

So I was able to set up my last two elective rotations in Durham at my job in June and July.

And I'll be honest, like, those first six months, I was exhausted.

I would come home, I would sit on the couch and I would not get up because just my brain was tired from learning.

And there was a lot to take in with both learning the medicine part of it and the EMR and just how things worked.

And so, yeah, it was difficult at the beginning, and there were things that I just didn't feel comfortable with, so.

And that has changed as I've practiced more.

The first thing was psoriasis.

It just.

It can be overwhelming.

There's a lot of medicines.

It can look different with different patients.

And so that kind of took me a little while to feel comfortable with.

Then it was probably pediatrics.

And even now, you know, pediatrics is something that I would say I kind of can struggle with or need more help with, just because, you know, it's kids and it's babies, and we don't see that all the time.

And their skin can just be a little bit different.

But, yeah, and I think what you'll find on rotations and in your job is, you know, you're not gonna know everything at the beginning, and it'll take a little while to get used to it and figure out what you need to know and how you need to know it and all this stuff.

But eventually you'll feel comfortable.

And I think after about six months is when I really started feeling pretty confident and pretty comfortable.

And I think now, at this point, five and a half years in, I know what I don't know.

And if there's any ever a question, even if it's something that seems straightforward, but just I have that little bit of doubt.

I ask for help and I ask for another opinion.

So in my practice, one of the other questions I got was, how much autonomy do you get?

And so I would say I get as much as I want, if that makes sense.

So in my practice, there is the physician, and then another page.

And the physician is usually there when I'm there.

On Monday morning, she goes to the prison, which is pretty cool, and does clinic there.

And then the other time, she's there, and she's always reachable by phone if needed.

And then the other PA is there, too.

And, you know, we all consult each other, but, you know, I have no shame in if I see something weird or that I'm unsure of just asking her to come in and take a look.

And she is more than happy to.

She is funny because she'll be like, I love the weird stuff, and I don't get to see it.

All I do is skin checks.

And you guys get to see the weird stuff, which is so true, because I'm seeing all the new patients, I'm seeing all the triages.

So she really likes just being involved with anything weird.

And so even if A lot of times I'm pretty sure of what I want to do as far as a plan or diagnosing.

I just like to have that confirmation.

And I would say, I mean, I'm only working two days a week now, but I only bring her in maybe a couple times a month or, you know, I'll just ask her about something.

And so, yeah, I think as a pa, it's important to just kind of know, be confident in what you know, but also know what you don't know and be willing to ask for help.

And I think that's true of doctors and really anyone working in medicine, you know, you've got to be willing to kind of get out of your comfort zone and ask for help when you need it.

And then.

Oh, gosh.

Okay, let me see.

I'll do one more here.

I don't want to make the episode too long, but I will try to.

Ooh, okay, this is a good one.

What is your favorite type of patients or conditions to see and treat?

So I like to.

I mean, real.

Probably depends on the day, but, you know, and it changes.

So I really like treating teenagers and acne.

It's really rewarding to see them improve and to see them get better and kind of gain confidence just because of how their skin looks.

And acne is fairly straightforward.

I mean, there's only so many options and kind of, it's like a puzzle to put them together and figure out what's going to work best for the patient and kind of come up with their.

Their perfect regimen.

But.

But yeah, I actually really enjoy that.

And so sometimes teenagers, you know, can be a little reluctant to talk to their provider and give details, but there are just some really cool kids out there, and I like getting to kind of help them with their skin.

And I guess part of that is with my own skin.

And I mean, I still break out even as a derm pa.

But thinking back, like in high school, like, I wish that someone had kind of validated the fact that it makes you self conscious when you break out.

Whereas I feel like sometimes that can be written off by parents or whoever.

So, yeah, that's probably one of my favorite things to treat.

All right, well, I'll stop this episode here and I think I am going to do another one on exactly, like how I got my job, how to get a job, how to get into a specialty, and if there's anything else you want to know about my job, let me know and I'm happy to talk about it.

Obviously, I can talk about it.

For a very long time, but I won't bore you guys any longer.

Thanks for hanging in there with me.

And stay tuned for more Pre PA Club episodes coming at you.

Bye, guys.