MAY-JUN 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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© GETTY IMAGES Dr. Gilbert works with his daughter, Melissa, who is a physician assistant. She has been with the practice for seven years and removes moles and cysts and performs Botox injections. "It's like having another dermatologist in the offi ce," says Dr. Gilbert. Melissa sees patients on her own, and she and Dr. Gilbert seek out each other's opinions on challenging cases. Jennifer Winter, PA-C of Dermatology and Allergy Spe- cialists of Olympia in Washington encourages physicians to be generous in their training of new PAs and NPs and look at it as an apprenticeship similar to the training a physician receives in residency. "Each will progress at a different pace," she notes. "And take into account that additional reading and study outside the clinic can impact progress." Dr. Reichel agrees. In addition to in-offi ce training, she requires her new PEs to pursue additional education by taking part in journal or book reviews. Informed Consent and Liability In addition to reviewing the recommended procedure, including risks and benefi ts, informed consent for patients being treated by a PE should include that the patient is aware of and comfortable with the fact that the provider of the service is an NP or PA and not a physician. Any patient who is uncomfortable being treated by a PA or NP should be referred to the physician, says Winter. "If they are only comfortable with a physician treating them, they should only have appointments with the physician," she says. "However, if they are content with a PA/NP at scheduling, then they are most likely comfortable with them per- forming the procedure as well. But this should be noted because any adverse outcome can impact your licensing." Some practice owners worry that the addition of PEs may expose them to increased liability risks, but in fact they may help prevent malpractice incidents. PEs typically spend more time with patients than physicians do, which not only improves patient satisfaction but makes them more likely to uncover dissatisfaction. Between 1991 and 2007, the majority of payouts for medical malpractice and negligence were made on behalf of physicians (37 percent), as opposed to physician as- sistants (3.1 percent) or nurse practitioners (1.5 percent), according to a March 2015 article in Medical Economics. But if a patient is harmed as a result of a PE's care, the practice and the supervising physician can be held liable. This is because the practice owner hired the provider and the physician determined that the PE was competent enough to perform the treatment. Therefore, proper training and protocols are crucial. Keep a written list or description of procedures that PEs may perform. These guidelines should be enforced by the supervising physician. Physicians should also periodically review patient charts for quality assurance, in addition to routine cosigning of notes. Also, make sure you adhere to all state requirements and that your PEs have access to the supervising physician during treatments, whether in-person, by phone or by computer, in case questions or complications arise. Dr. Reichel encourages physicians to spend time with their PEs before they see patients on their own to ensure that they are well-trained. "Continue to teach at every opportunity," she says. "But don't provide too much over- sight. Once you know the PE is capable, they should be free to do their jobs." Tina O'Reilly is a freelance writer based in Rhode Island. 36 MAY/JUNE 2018 | Med Esthetics EXTENDING CARE Some worry that the addition of PEs may expose the practice to increased liability risks, but in fact they may help prevent malpractice incidents.

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