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As any busy dermatologist will tell you, good medical assistants (MAs) are worth their weight in gold. Wait, make that platinum - good medical assistants are really valuable. Who else has the power to make your day run flawlessly, calm restless patients when you're an hour behind schedule, and take care of the myriad details that would bog you down in a hurry if you had to tend to them all?

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Practice Management

Making the Most of Medical Assistants: MAs Can Deliver for Dermatologists and Their Patients

Karen Childress

Tuesday, December 05, 2006

As any busy dermatologist will tell you, good medical assistants (MAs) are worth their weight in gold. Wait, make that platinum - good medical assistants are really valuable. Who else has the power to make your day run flawlessly, calm restless patients when you're an hour behind schedule, and take care of the myriad details that would bog you down in a hurry if you had to tend to them all? Not to mention provide patient education…

Making the most of your MA involves hiring the right person to begin with, giving that individual proper training and mentoring, maintaining a good working relationship, and attending to their professional development. Here's how.

Hire Based on Practice Needs

Kimberle Kennedy is executive administrator for Ironwood Dermatology in Tucson, Arizona, and the current president of the Association of Dermatology Administrators/Managers (ADA/M). When she is in hiring mode, finding the right personality is as important as good skills and experience. "They have to be able to handle a fast-paced environment. It can be a three-ring circus - phones ringing constantly, each physician seeing 40 to 50 patients a day, dealing with refill requests, continuously balancing priorities," says Kennedy. "If someone is looking for a calm office, this isn't the place."

No two dermatology practices are exactly alike, so it's important to look for MAs who have skills specific to your unique needs. Because Ironwood performs a lot of procedures, Kennedy makes it a point to hire MAs who know sterile technique and how to clean, organize, and care for surgical instruments. Kennedy also looks for someone with an aptitude for the computer. "I want an MA who is not only clinically good, but who is not afraid of technology," she says.

It's a tall order to find an MA who has the right personality to ensure patient satisfaction, can function in a fast-paced and sometimes stressful environment, has top-notch clinical skills, and who has administrative talents as well. But they are out there. Once you've found the perfect person, the next step is first-class orientation and training.

Train the Team for Patient Flow

Even an MA with prior dermatology experience will require training on how things are done in your office. Kennedy puts each new MA through a series of trainings on the practice's EMR system, laboratory procedures, and safety. They are also observed on technique. "We check them out to make sure they know what goes into what pack and how to care for instruments, and we observe their injection techniques to make sure they meet our standards," says Kennedy.

When it comes to having a skilled MA, dermatologists get back what they put in. Lawrence Anderson, MD, of Dermatology Associates of Tyler, in Texas, says it takes six to eight weeks for a new MA to be comfortable with about half of what goes on in his practice. By the four- to six-month mark, they have seen enough variety to be comfortable with 90 percent. "The key is that everyone learns differently," says Anderson, "so you have to figure out with each individual how they best learn - verbal, visual, show it to me in a book - then you can tailor your training." Ironwood Dermatology physicians each use three exam rooms and two MAs at all times. Kennedy doesn't view this as a luxury, but rather as a sound use of resources. Adequate staffing allows the MAs to stay a step ahead of the dermatologists all day; as Kennedy puts it, "They play leapfrog."

When a dermatologist enters the exam room, an MA has already completed an assessment, prepared the patient, and readied any supplies or instruments the physician is likely to need. "When the physician walks into the room," says Kennedy, "the patient is ready to go." Then, when the dermatologist shifts his attention to the patient in the next room, the MA stays behind to finish wound care, answer questions, or make sure the patient knows what to do in terms of follow up.

Anderson says a well-trained MA using symptom-specific protocols can take a good history and even do a review of systems on a patient. This saves him time, allowing him to focus more fully on the patient in front of him. "Before I go in a room, they give me a 15- to 20-second synopsis of why the patient is there and give me a snapshot. They get very good at tipping me off that there is something of concern that I need to take more time with. This enables me to better direct my questions… and spend more time on what's pertinent," says Anderson.

Sherry Walls, CMA at Modern Dermatology in Dallas, says one of the most important roles the MA plays is that of translator. "Sometimes the doctor leaves the room and the patient will look at the MA and say, 'What did he say?' Because we understand what the doctor has said and what the patient didn't understand, we can interpret," says Walls, "Sometimes you have to explain it all over again." This extra step, according to Walls, cuts down on follow-up phone calls and makes for happy patients because they leave the office with all the information they need.

Retain the Best

The demands on MAs are high in a busy dermatology practice. Once you've hired and trained the right staff to make your office flow well, how do you keep them? What can you do to prevent burnout and departures for more relaxed environments? How should dermatology practices let their MAs know how much they're valued? Paying a competitive salary and offering a good benefits package is important, but MAs, like the rest of us, also need to feel appreciated for their ideas and opinions. And they need to be treated with respect.

Anderson says that to retain the best MAs, dermatologists should keep abreast of wage levels in the area and be competitive. "You have to pay them fairly," he says. "Money is an issue, but it's not primary." What is  primary? In Anderson's book, it's having a good relationship and showing an interest in the staff. "Ask them how they're doing, about their children, be sincere," he says. "Not to the point that you're crossing the line and being too personal, but they need to know that you care about their well-being. Money isn't the end all, be all," says Anderson. "You can pay three times as much as anyone else, but if you're a jerk, it won't matter."

Kennedy says listening to staff is key to retention. Ironwood Dermatology holds weekly meetings, during which Kennedy pays close attention when staff members come up with good ideas. Recently, for example, staff complained that the office's tiny shredders were tedious and inefficient. She quickly arranged for a large shredder and a recycle pickup service. "If they have a good suggestion, we jump on it," says Kennedy.

Professional Development

The more an MA understands about dermatology, the more he'll be able to anticipate the needs of both patients and doctors. Kennedy provides all new MAs with a list of the most commonly prescribed dermatology medications and their indications, along with the most frequent diagnoses seen at Ironwood Dermatology. This is one way the practice demonstrates right from the start that it's interested in educating staff beyond the basics, and proves that it wants staff to grow and develop professionally.

Anderson believes in challenging his MAs to keep them engaged and motivated. "MAs in general are younger and get bored more easily if they do the same things over and over. If they show promise, you can teach them new things," he says. Anderson cites training an MA to assist with surgical procedures as an example.

Consider offering your MAs a paid membership in the Dermatology Nurses' Association (DNA; or other professional society such as ADA/M. DNA president Melodie Young strongly encourages both membership in the organization and continuing education for MAs. "The best MAs are the ones who see themselves as professionals, who want to learn more and participate," says Young. Kennedy says sending her clinical staff to the association's annual meeting is "both a reward and a benefit for the staff, and their professional development benefits the practice"- and its patients.

MAs: Dermatology Patient's Best Friend

Practice management publications, including this one, often list the benefits of strategically using nonphysician clinical staff to optimize the care delivered to patients. Medical assistants can perform a variety of tasks that will allow dermatologists to devote maximum focus to each patient's concerns. The scope of practice allowed for MAs varies by location. Check with your state licensing board to find out which of these tasks might be delegated to MAs in your dermatology practice:

  • Distribute over-the-counter samples and explain how they are used
  • Provide prescription samples at the request of the dermatologist
  • Give injections
  • Input clinical findings into the electronic medical record
  • Anticipate when a biopsy is likely, based on protocols set by the physician, and set up instruments and supplies in advance
  • Assist with minor surgical procedures
  • Provide routine patient education

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Physicians Practice

Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.