"The Dermatology Medical Assistant"
Ahh..the dermatologist. A soothing calm atmosphere where you are greeted by a zen massage therapist perhaps and offered a fresh beverage. Maybe you can get a facial and while you are there you can ask about that pesky mole right? WRONG! wrong, wrong wrong!
Who am I?
If you are reading this...you are probably a medical assistant, either currently or thinking about working for a dermatology practice. Or maybe you are a provider, or manager (good for you!) trying to understand the perspective of your support staff. Maybe you're a patient, trying to get a more clear understanding of what you were experiencing at the not-so-calm dermatology practice earlier. "Where was the massage therapist offering fruit?" you might have asked yourself. Well, I am going to go ahead and clear a few things up. Let me just get out of the way first who I am to be able to give you such a perspective, because I already know that's siting in the very front of your mind. I am a medical assistant of eighteen years. My initial training began with basic health occupation training at a vocational high school which continued on when I joined the U.S. Navy to train to become a Hospital Corpsman. After serving for five years I continued into my medical assisting career encountering and learning various different specialties. The last six years and seven months were spent with a rapidly growing and ever changing dermatology practice, for which I developed a training protocol for as well as clinic protocol guidelines. Starting with two primary and one satellite office, it now has ten and growing. This job, has been the most interesting, to say the very least.The Perception of Dermatology
Dermatology is sneaky in every little way. Things are never what they seem. It seems so innocent doesn't it? Acne and warts right? Moles? Do they do facials there? They really didn't go over that chapter much in school did they? "Not necessary, really, was it.. I mean, how complicated can a skin condition really even get?" (that was my favorite question I have been asked by a student). "Well, why don't you go grab the Fitzpatrick and look up Stevens-Johnson Syndrome and we'll talk" I would respond. "How much could there possibly be to know?" would be another one of my favorites. When you can tell me how a TNF inhibitor functions without pause...well then you would reach a point of wisdom where you wouldn't ask that question again.
This specialty receives an ever popular and inaccurate reading of being "laid back and quiet" Quite the opposite is actually true. As a medical assistant in particular, especially a driven one who cares about the patients, our minimum standards alone put the "above and beyond" in any standard clinic to shame. Be ready for action, and for the love of action and the learning experience. If you are thinking extra expectations means extra dollars, it generally doesn't in most cases, but it depends on where you are The experience you acquire, however, as well as the knowledge base you gather does pay off. We are the patient educators, the giver of results, the damage control specialists, the results tracking specialists, the expert attention to detail tasking team, patient care coordinators, customer service specialists, guidance givers, student teachers, training crews, multitasking masters and research experts. The list even continues, but I could put a person to sleep going on.
The Providers
At great risk of boring you with the details, but hopefully bringing delightful entertainment with the mental image, allow me to briefly go over a rough translation of our daily expectations. I am basing this on my own experiences, however, I have worked with twenty three providers (not all at once naturally) I have adapted to each and every one of their particular styles and methods of practice and patient approach. This is a characteristic that is essential especially in a larger practice. (You will love this part of your job when you get a new management team that comes in to counsel you on change and adapting to it. oblivious to your expertise on the matter) Dermatologists are known as the most particular types of physicians when it comes to their needs and requirements (next to surgeons) They're needy, to put it bluntly. I worked with a Dermatologist who admitted it openly. "We are the most needy doctors that exist." Really? He admitted that? I will say, In my entire career dermatologists, although the most particular when it comes to style and needs, have been the most delightful to work with. They are always gracious and appreciative of their support team. I cannot say I have ever left a day without hearing "Thank you for everything today!" from whatever provider I was working for, every one of them. I can probably say the same thing about a handful of the other providers I have worked for in the years previous in my career.
The Front Lines
Medical assistants in dermatology are very utilized for every and any skill they possess and are then trained for more. We are usually only limited by what state we work in and the laws which mandate what we can and cannot do under the supervision of a physician or nurse. For any patients out there reading this, take comfort in knowing that medical assistants trained in dermatology are trained extensively and well! There are details involved that cannot be trivialized. Medical assistants are either trained well or not at all. for those who don't have the drive for it, they do not last long. For one provider in a clinic there should be three of us assigned, at least. It depends (usually) on the weight of the schedule. When we room a patient it isn't simply performing vital signs. We are expected to develop such a strong knowledge base as to nearly "pre-assess" the patient. We must research the chart, look for clues and be sure to ask the right particular questions according to their complaint to ensure that the patient is appropriately "groomed up" for their five minute visit with the provider, and anticipate any procedures setting up for them in advance. Yes, a patient visit is typically a ten to fifteen minute scheduled visit for a new patient, and a five minute scheduled visit for follow up visits. "How do they do it?" you ask. That is the provider time. The rest is medical assistant or nurse time. The provider should be able to look at our note, go in, assess appropriately, write a prescription, or perform a biopsy, and jet to the next patient. When they leave then we are then there to finish up with educating the patient on specifics and tying up their visit. If I only had a nickel for every time I heard a patient say "YOU should be the doctor". To which I reply, "No way, this is way more fun! Besides, who do you think taught me everything?" But it's not just all of that with the patient that we do. That is just the beginning. There is then the room to clean, the specimen to handle, the forms to scan, our EMR note to finish, the phone is ringing off the hook, there is a biopsy needed in room one, a blood draw and PPD in two, and the Dr. comes out of room 3 to say "I need 3 shaves in here" , the next two patients are here and ready to go back, we need more instruments to be scrubbed and autoclaved, "Do we have any Botox?!" someone shouts, there's a melanoma that needs to be signed off right now, let's make sure it get's logged right away and the patient contacted ASAP, D'oh! the computer locked up, the courier is here for the blood that is still in the centrifuge spinning, the receptionist comes back to top off the madness by saying, "The four 'o' clock wants to know how much longer it's going to be." (phone still ringing and fax machine screeching in the background).....
Do we lose it? Nnnope. . It takes a serious need for action and strong ability to multitask and work as a team to be able to handle it. The down side is, the more multitasking one takes on, the less optimal they become with efficiency. It is tempting when you have the ability and drive to multi task well to do more and more, thinking it is a good thing and that this will show that you are showing initiative. Instead it just shows that you have your hand on too many pots, not good actually,(but, while your at it anyway...no one will complain about letting you go to it). There is a reason for this, though. Even someone with excellent multitasking capabilities, although necessary in dermatology, must be careful not to overdo it or something vital can easily be overlooked or under-prioritized and eventually forgotten. There are many tasks to take on in a day and it is vital to work as a team!
I can say confidently, that it takes a good SIX MONTHS for a medical assistant new to dermatology to be totally comfortable working the clinic and being comfortable with their general dermatology training and knowledge strength. A solid introductory training program is THREE weeks. I have learned that by experience and from talking to others at the DNA conferences. It takes a good NINE weeks to get the flow going steady with clinic skills overall. The rest of the six months total is obtaining dermatology knowledge to a functional level. I have been working in the atmosphere for nearly seven years, have worked with 23 providers, been to two DNA conferences and multiple dinner conferences and I am still learning something new every now and then. (Listening to the drug reps helps too!)
Is every dermatology practice like this? Well most of the doctors and providers who I have assisted all do pretty much the same thing in practice, fundamentally, with variable differences in style and preference. They all have talked about where they have been and how they do things. One of the things our practice had "assigned" me to do for a while was transitioning new providers into the practice. I would follow them wherever they would go, learning their particular preferences and helping them to learn who to contact for what and teaching them our computer systems and billing sheets, and familiarizing them with our policies and procedures etc. I became known as a "go to". In so doing, I have talked with all of them and listened to them talk about other dermatology programs. The difference that I have learned primarily, although I am still learning, is that private practices have a little less access to the more expensive equipment than larger hospital facilities or government funded programs. This, however, does not really change the level of expectations set forth for the M.A.
The Team
There are aspects of dermatology that must be solid to
help the clinic run smoothly. Key members of the team including
management, front office, billing, providers and medical assistants all
must be able to communicate effectively as a team and dynamically as a
group to allow patient care and satisfaction to be optimal. That is really hard to come by most of the time in a large group but sometimes you get really lucky. Teamwork as a whole is best, having the support of your superiors (and knowledgeable ones) not only stimulates morale but increases patient confidence. If a patient calls to speak to a manager and he or she has no knowledge base to be constructively helpful with, the patient will lose confidence in the company as a whole. As I have heard patient's put it a million times, "the left hand should know what the right hand is doing." For a busy, non stop and highly specialized focus, in my experience, the more communication and knowledge there is within the team, the more it feels like a "well oiled machine" to everyone from provider to patient. In clinic you must be able to function as a unit. Communicate openly with one another and stay on task, prioritizing appropriately and knowing by communicating what your status is and what you are doing. It should flow smoothly, like a well choreographed dance, perfectly timed and consistent.
To wrap it up
. Dermatology is character and knowledge building. It is for the medical assistant that wants hands on experience and a lot of patient contact. It is not what one would expect. I have had the privilege of working alongside providers who were outstanding teachers. I have provided some of the most empathy to patients and their families than I ever had in urgent care.
Hope you enjoyed my little rant. :)
