Almost One-Third of Mohs Surgeons Employ PAs

NEW YORK — Roughly 30% of Moh's surgeons currently employ physician assistants in their practice for presurgical consults, postoperative assessments, intraoperative suturing, and more.

The data, from a small survey presented at the meeting, are among the first to assess the use of physician assistants (PAs) among Mohs surgeons.

"The inherent tie between pathology and surgery in the Mohs specialty makes it very important that the PA act as an appendage of the Mohs surgeon," said Mr. Mark Hyde, a PA-C in the cutaneous oncology department at the Huntsman Cancer Institute at the University of Utah, Salt Lake City.

However, "with the employment of PAs in Mohs surgery, [physicians] can spend more face-to-face time with patients," he said at the annual meeting of the American College of Mohs Surgery.

Mr. Hyde mailed surveys to 576 members of the American College of Mohs Surgery in January 2009, asking whether the physician used a PA and if so, to do what. About a quarter of the physicians replied (143), and of those, 43 (30%) reported using a PA.

Mr. Hyde conceded that the response rate was low, but "because the data are not found anywhere else, we still felt this was important," he said.

Overall, 15 of 43 Moh's surgeons using PAs reported the PA at their practice performed preoperative consults. A total of 25 of the 43 surgeons, meanwhile, responded that their PA conducted postoperative follow-up.

Intraoperatively, 18 of 43 surgeons reported that PAs at their practice were participating in some aspect of repairs. These included primary repair design (8 of 43), dermal sutures on the primary tissue repair (12 of 43), epidermal sutures on the primary repair (18 of 43), dermal and epidermal sutures on the adjacent tissue transfer (8 and 14 of 43, respectively), and suturing of the skin graft (dermal, 10 of 43; epidermal, 16 of 43).

One surgeon reported that the PA at his facility excised Mohs sections, and another reported that their PA inked excised tissue.

No surgeons reported letting their PAs map Mohs sections, nor did any report letting PAs interpret pathology reports.

"There are some tasks that are rarely assigned to PAs in Mohs micrographic surgery--excision of the stages, mapping tissues, inking and grossing tissue, and interpreting pathology," said Mr. Hyde. However, "in our experience, PAs can ink and gross tissue, and increase efficiency by doing so."

He also pointed to an area in which PAs were especially useful to the physicians surveyed--seeing general dermatology patients. A total of 35 out of 43 surgeons, or more than 80%, reported using their PAs in this way.

In fact, he said, in the program at the University of Utah, PAs "act as a source of referrals for the Mohs surgeon."

Despite the use of the PAs in these practices, Mr. Hyde said there was no evidence to suggest that surgeons using PAs remove more tumors per week, or see more patients.

Nevertheless, as the use of PAs increases among Mohs surgeons, the need to identify which tasks PAs routinely perform is crucial to "allow PA programs and PA education providers to focus their training."

The survey was funded by the Society of Dermatology Physician Assistants with an unrestricted research grant. Mr. Hyde is on the board of the society.

NEW YORK — Roughly 30% of Moh's surgeons currently employ physician assistants in their practice for presurgical consults, postoperative assessments, intraoperative suturing, and more.

The data, from a small survey presented at the meeting, are among the first to assess the use of physician assistants (PAs) among Mohs surgeons.

"The inherent tie between pathology and surgery in the Mohs specialty makes it very important that the PA act as an appendage of the Mohs surgeon," said Mr. Mark Hyde, a PA-C in the cutaneous oncology department at the Huntsman Cancer Institute at the University of Utah, Salt Lake City.

However, "with the employment of PAs in Mohs surgery, [physicians] can spend more face-to-face time with patients," he said at the annual meeting of the American College of Mohs Surgery.

Mr. Hyde mailed surveys to 576 members of the American College of Mohs Surgery in January 2009, asking whether the physician used a PA and if so, to do what. About a quarter of the physicians replied (143), and of those, 43 (30%) reported using a PA.

Mr. Hyde conceded that the response rate was low, but "because the data are not found anywhere else, we still felt this was important," he said.

Overall, 15 of 43 Moh's surgeons using PAs reported the PA at their practice performed preoperative consults. A total of 25 of the 43 surgeons, meanwhile, responded that their PA conducted postoperative follow-up.

Intraoperatively, 18 of 43 surgeons reported that PAs at their practice were participating in some aspect of repairs. These included primary repair design (8 of 43), dermal sutures on the primary tissue repair (12 of 43), epidermal sutures on the primary repair (18 of 43), dermal and epidermal sutures on the adjacent tissue transfer (8 and 14 of 43, respectively), and suturing of the skin graft (dermal, 10 of 43; epidermal, 16 of 43).

One surgeon reported that the PA at his facility excised Mohs sections, and another reported that their PA inked excised tissue.

No surgeons reported letting their PAs map Mohs sections, nor did any report letting PAs interpret pathology reports.

"There are some tasks that are rarely assigned to PAs in Mohs micrographic surgery--excision of the stages, mapping tissues, inking and grossing tissue, and interpreting pathology," said Mr. Hyde. However, "in our experience, PAs can ink and gross tissue, and increase efficiency by doing so."

He also pointed to an area in which PAs were especially useful to the physicians surveyed--seeing general dermatology patients. A total of 35 out of 43 surgeons, or more than 80%, reported using their PAs in this way.

In fact, he said, in the program at the University of Utah, PAs "act as a source of referrals for the Mohs surgeon."

Despite the use of the PAs in these practices, Mr. Hyde said there was no evidence to suggest that surgeons using PAs remove more tumors per week, or see more patients.

Nevertheless, as the use of PAs increases among Mohs surgeons, the need to identify which tasks PAs routinely perform is crucial to "allow PA programs and PA education providers to focus their training."

The survey was funded by the Society of Dermatology Physician Assistants with an unrestricted research grant. Mr. Hyde is on the board of the society.

NEW YORK — Roughly 30% of Moh's surgeons currently employ physician assistants in their practice for presurgical consults, postoperative assessments, intraoperative suturing, and more.

The data, from a small survey presented at the meeting, are among the first to assess the use of physician assistants (PAs) among Mohs surgeons.

"The inherent tie between pathology and surgery in the Mohs specialty makes it very important that the PA act as an appendage of the Mohs surgeon," said Mr. Mark Hyde, a PA-C in the cutaneous oncology department at the Huntsman Cancer Institute at the University of Utah, Salt Lake City.

However, "with the employment of PAs in Mohs surgery, [physicians] can spend more face-to-face time with patients," he said at the annual meeting of the American College of Mohs Surgery.

Mr. Hyde mailed surveys to 576 members of the American College of Mohs Surgery in January 2009, asking whether the physician used a PA and if so, to do what. About a quarter of the physicians replied (143), and of those, 43 (30%) reported using a PA.

Mr. Hyde conceded that the response rate was low, but "because the data are not found anywhere else, we still felt this was important," he said.

Overall, 15 of 43 Moh's surgeons using PAs reported the PA at their practice performed preoperative consults. A total of 25 of the 43 surgeons, meanwhile, responded that their PA conducted postoperative follow-up.

Intraoperatively, 18 of 43 surgeons reported that PAs at their practice were participating in some aspect of repairs. These included primary repair design (8 of 43), dermal sutures on the primary tissue repair (12 of 43), epidermal sutures on the primary repair (18 of 43), dermal and epidermal sutures on the adjacent tissue transfer (8 and 14 of 43, respectively), and suturing of the skin graft (dermal, 10 of 43; epidermal, 16 of 43).

One surgeon reported that the PA at his facility excised Mohs sections, and another reported that their PA inked excised tissue.

No surgeons reported letting their PAs map Mohs sections, nor did any report letting PAs interpret pathology reports.

"There are some tasks that are rarely assigned to PAs in Mohs micrographic surgery--excision of the stages, mapping tissues, inking and grossing tissue, and interpreting pathology," said Mr. Hyde. However, "in our experience, PAs can ink and gross tissue, and increase efficiency by doing so."

He also pointed to an area in which PAs were especially useful to the physicians surveyed--seeing general dermatology patients. A total of 35 out of 43 surgeons, or more than 80%, reported using their PAs in this way.

In fact, he said, in the program at the University of Utah, PAs "act as a source of referrals for the Mohs surgeon."

Despite the use of the PAs in these practices, Mr. Hyde said there was no evidence to suggest that surgeons using PAs remove more tumors per week, or see more patients.

Nevertheless, as the use of PAs increases among Mohs surgeons, the need to identify which tasks PAs routinely perform is crucial to "allow PA programs and PA education providers to focus their training."

The survey was funded by the Society of Dermatology Physician Assistants with an unrestricted research grant. Mr. Hyde is on the board of the society.