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Physician Assistants in Medical Aesthetics

PAs have entered a new era. We're no longer bound to working in general medicine and have been integrated into every practice specialty including, more recently, aesthetic medicine. Physicians in dermatology and plastic surgery (especially facial plastic surgery and oculoplastic surgery) are finding the physician-PA (or physician-NP) team to be a prerequisite for maintaining a successful aesthetic practice. While "successful" here conveys the idea of monetary advantages, it also includes improved patient care and increased patient loyalty.

Adding a PA to an established aesthetic practice requires a PA-physician relationship that embodies trust, respect and the ambition to work as a team. A PA entering an established practice should be aware of the advantages and disadvantages he or she has. Here are a number of tips to help an aesthetic medicine practice successfully integrate you as a PA.

Define the PA's Role

The process most important to integrating a PA is defining what role you'll play in the practice. The supervising physician and you should clearly discuss ambitions and expectations of one another before beginning to work together. The PA's role then should be explained to the staff, so that there's no confusion with them or with patients that could disrupt the flow of the office.

The role of any PA in aesthetic medicine depends on the experience of both the supervising physician and the PA. The PA should never perform procedures that he or she is uncomfortable with or that the supervising physician prohibits. In addition, the supervising physician should never expect the PA to perform procedures in which he or she is not adequately trained. The laws governing PA scope of practice vary significantly from state to state and should be well understood by all parties.

When the clinical responsibilities have been defined, the PA is ready to begin expanding the practice.

Begin Team-Building

Once you have begun to see patients, the most difficult task may be building rapport with patients and the office staff. Three factors contribute to this: your confidence in yourself, the physician's confidence in you and the staff's confidence in you.

A number of factors can determine patients' perception of you before they meet you. A patient will speak with the receptionist on the phone and at the check-in counter and likely will see the medical assistant and the physician before your first interaction. If any of those people hesitate in the slightest manner, your chances of patient conversion drop dramatically.

Treat every patient encounter like an interview, because that is exactly what it is. Cosmetic procedures are a luxury, and that luxury is readily available in a vast number of settings. You must prove to patients that not only do they want to treat themselves to the Botox or dermal filler in this office, but also they want you to perform the treatment. When introducing yourself, it's best to shake hands and sit in front of patients. Engage them with eye contact, and chat with them for a few minutes to make them feel as if they're part of the "practice family."

If the patient is an established patient, ask the supervising physician to make the introduction. Once a client sees that the doctor stands behind the PA, the patient is more likely to have faith in you and your abilities.

Get Organized

Before providing a service, a protocol of procedures must be established. This fosters a sense of organization and establishes order. For any aesthetic practice, these should include consent forms, photography protocols, post-care instructions, next-day nurture calls and a 12-day follow-up visit. Before any procedure, the receptionist or medical assistant should always ensure that the patient has signed all consent forms, at least annually if not at every visit. In my practice, I go the extra mile by verbally explaining the immediate and long-term side effects that could occur from the treatment.

There are several reasons to include photography as part of the pretreatment protocol. One is that photographs give a baseline from which one can measure progress objectively. And, these photos are useful for self-marketing, because they are your personal treatment accomplishments-not those before-and-after shots from aesthetic device companies. A number of companies provide photography equipment specifically for use in aesthetic medicine. Before investing, check with colleagues to determine which company provides the equipment and service best matched to your practice.

When developing post-care instructions, it's essential to remember that they are tools to help field common post-care questions. It should not take the place of the next-day nurture call, which is the optimum way to head off any arising problems, establish strong ties with patients and set you apart from other providers. Before the patient leaves the office, a 12-day follow-up visit should be scheduled. At 12 days, the patient has had time to evaluate his or her treatment, and swelling and bruising have subsided; therefore, additional touchups may be administered if needed.

Start Low, Go Slow

At the first treatment encounter, you have one chance to develop either a long-term patient or a patient who'll never allow anyone other than a physician to treat him or her again. In order to establish a strong degree of trust with my patients, I always explain to them that I "start low and go slow." In other words, I treat them with the appropriate amount of material needed for a significant improvement with their primary concern, but I never treat excessively. It's always easy to add more Botox, dermal filler or laser treatments, but you cannot take away what you have done.

This tactic works very well, especially coupled with the 12-day follow-up appointment. Patients will respect you for not trying to force everything upon them in one visit. They also appreciate the time taken on the 12-day follow-up visit to ensure their level of satisfaction is high and their outcome is exceptional.

One of the primary benefits to being a PA in aesthetic medicine is the luxury of time. Take an extra five minutes with patients to make the experience unique from those clinicians who "turn and burn" their patients.

Perception Is 98% of Reality

As an aesthetic practice consultant, I am amazed when I enter an office and the clinician is sloppily groomed. His disheveled appearance is mirrored by each of his employees, as well as by the appearance of the office. In order for patients to perceive the PA and the practice as unflawed and trustworthy, each facet of the experience must be refined.

Employees should be in uniform, with minimal makeup and jewelry. The counters should be clean and clutter-free. All equipment should be free of fingerprints, makeup and other residues. Remember that the overall image youroffice portrays is the reality your patients perceive.

Educate the Extender

PAs and NPs represent a distinctive niche in medicine. They have the autonomy and education that registered nurses lack, but frequently they don't get the respect they deserve as clinicians. It's the duty of PAs to constantly perform in a superior manner and to wow physicians and patients alike.

You must keep abreast of cutting-edge technologies and procedures through continuing education. With the plethora of available Web sites, journals, workshops and conferences, it can be at times baffling as to which source to rely on for the best information. It's best to concentrate on the resources that illustrate views from clinicians on the forefront, including reading journals and books and attending meetings and symposia.

Thank Patients and Staff

We clinicians often forget to thank those who make the practice of medicine possible. At the end of an office visit, thank patients for coming in to the practice. They are able to go to many other providers for treatment, so it's important to make them aware that you appreciate their loyalty.

Make sure to say good night and thank you to the entire staff before leaving every evening. The morale of the staff reflects directly into their work ethic.

PAs practicing aesthetic medicine have become invaluable to dermatologists and plastic surgeons. Through the integration of PAs in the aesthetic medicine specialty, patient care and loyalty, as well as monetary revenue, can increase dramatically. Expanding an established aesthetic practice to include a PA can be accomplished with the foundation of a strong PA-physician team as the base and these tips the building blocks.

Krystie P. Lennox is an aesthetic consultant, a clinical trainer for aesthetic practices and a dermatology physician assistant in West Palm Beach, Fla. She is co-founder of the Aesthetic Extender Symposium and of Lennox and Associates Consulting, LLC. She is on the ADVANCE for Physician Assistants editorial advisory board.


I found this information both insightful and encouraging. I began working in a salon/spa as a skin therapist with my esthetics license, and now I am working towards becoming a physician assistant in medical aesthetics to take my training to the next level. It is great to know that PA's are utilized in this specialty field.

John Cummings,  EMT/StudentFebruary 22, 2014


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