Home » Blog Articles » dermatology » Dermatology: More Physician Assistants, Burnout & Billing Documentation

In the field of dermatology, physician assistants (PAs) have started entering the medical specialty in greater numbers. This is particularly evident when compared to other medical specialties.

The role of a physician assistant was created many decades ago in order remedy a nationwide shortage of primary care physicians. The first PAs appeared in the U.S. medical system during the 1960s and would grow in popularity across the nation. By the end of 2020, there were 267 accredited physician assistant programs and 148,500 certified physician assistants.

PAs in Dermatology:

The growth of physician assistants is also evident in numerous medical specialties. Presently, nearly every field of medicine in the United States has PAs delivering treatments and procedures. From 2020 to 2030, according to the Bureau of Labor Statistics, the occupation of physician assistant is expected to grow by 31 percent. This is substantially faster than the total for all U.S. occupations, which is 8 percent for the same time period.

This is particularly true for the medical field of dermatology. Research published in JAMA Dermatology states that PAs joined the field of dermatology at a greater rate than the combined rates from all other medical specialties.

Research from national certification data shows that, from 2013 to 2018, dermatology added physician assistants to the profession at a rate of 11.6 percent. In comparison, the mean rate for all other medical specialties combined was 7.8 percent during the same period.

The growth of PAs in dermatology should help to promote greater access to care for the general population. However, as a medical specialty, other trends are changing the profession of dermatology.

For example, some industry observers have stated that dermatology practices are consolidating into larger groups. Solo practices made up about 44 percent of all dermatologists in 2007. However, by 2014, the percentage of solo practitioners had decreased to 35 percent.

Burnout and Dermatology:

In addition, data from 2022 suggest that out of physician medical specialties, dermatologist have lower rates of mental or physical exhaustion (burnout) when compared to other physicians. Incidentally, the highest rates of burnout occur in emergency medicine, critical care and ob/gyn providers.

When looking at the specific factors that contribute to burnout among dermatologists, the top two reason are:

  • Too many bureaucratic tasks.
  • Increasing computerization of practice (EHRs).

Not surprisingly, the COVID-19 pandemic and quarantine created additional stress with 6 out of 10 dermatologists stating they now felt more burned out, then during the period before the pandemic.

The fact that practitioners are required to provide accurate coding and documentation is a reality for modern healthcare. Much, if not all, of this documentation is entered through EHRs or EMRs.

This means that clinicians are required to properly document the delivery of dermatology services, assign ICD diagnosis codes as well as use proper E/M LOS codes.

EHRs and Fatigue:

The use of electronic records has many benefits, however medical practitioners need to carefully monitor what they are entering in the digital interface. The fact that many EHR systems can automatically calculate the level of service and procedure codes based on physician documentation is incredibly helpful.

However, this convenience does carry a risk of a clinician over-relying on the EHRs computing features. If an incorrect code is entered (auto-suggested), the healthcare provider is still responsible for the final documentation.

Improper EHRs and EMRs use can create problems for administrative offices. Carefully logged patient encounter notes are used to generate data for superbills and/or UB-04 forms. Yet, if the clinician is fatigued and entering notes and codes that are not correct or specific enough for that patient encounter, billing and other revenue cycle problems could start to occur.

Mistakes will generate denied claims from insurance payers. If these are not quickly addressed, any medical practice will start to experience cash flow issues.

The constant demand for practitioners to quickly read and enter information into a digital screen can create physical fatigue and stress. Evidence is starting to suggest that EMRs & EHRs which require intensive clicking and scrolling are the worst offenders for creating physician burnout.

Many healthcare workers and medical specialties experience high levels of stress, which if left unchecked can have devastating consequences for one’s general well-being.

Yet, even before COVID-19, doctors, PAs and other support staff stated that they felt undervalued and overburdened at work. Some studies have advocated that the issue of burnout was due to larger problems in the American healthcare system.

There are real health risks for medical providers. In fact, the AMA has stated that 2 out of 5 doctors will screen positive for behavioral health issues such as depression. This kind of behavioral health condition is an early indicator of other health threats such as anxiety and even suicide.

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