HCDM 43 | Physician Assistant

 

What exactly is a physician assistant and why does it merit recognition as the number one profession in the country? In this conversation between Dr. Richard Marn and Georgia dermatology PA, Savanna Perry, we’re going to see exactly why. Join in as Dr. Marn gets Savanna to explain what the PA title signifies, how it differs from a nurse practitioner, and how different its educational requirements are from most healthcare careers. She also shares about an initiative of hers called The PA Platform, a website that helps students navigate PA school and the PA career. If you’re looking for a healthcare career that entails a lot of clinical work but doesn’t require the amount of schooling that it takes to be a doctor, then you’re going to enjoy listening to this. 

Listen to the podcast here:

The Physician Assistant: Inside The Nation’s Number One Profession With Savanna Perry, PA

I’m glad you’re here. I have a wonderful guest who I’ve gotten to know briefly but has many interesting things going on. I’m happy that she’s on this episode. If you’re someone looking for a profession that has some aspects of being a physician or a doctor, where you see patients, prescribe medications, even doing some procedures, but without the amount of schooling, time, and possibly debt that comes with being a physician, then maybe this career might be for you. We’re going to talk with Savanna Perry. She’s a physician assistant, otherwise known as a PA and she’s based out of Georgia. She has a ton of experience, not only clinically but also experience helping other future PA students or even helping PA graduates.

She has a website called The PA Platform, which we’re going to talk about and learn about how that can help people. She helps the students and graduates learn about how to navigate the PA school and navigate work itself after they graduate. There are a lot of wonderful bits of information here where even I learned a lot about what it takes to be a PA in what you do, but also how it’s different for the nurse practitioner, which has some similarities, as well as how it’s similar and different from the physician. This was very educational for me. I believe it’s going to be very helpful to you as it helps to clarify maybe a career for you as well.

I have an awesome guest. It’s Savanna Perry.  

How are you? Thanks for having me.  

As I told you, it’s a pleasure to have youI’m glad we connected. To get things started, I’d love to get a quick bio of yourself to give people an introduction to your background and what you do.  

I’m Savanna Perry. I work as a Dermatology PA in Georgia. I’ve grown up in Georgia, lived here forever. I went to the University of Georgia. I was a Biology major, graduated in 2012. I went straight into PA school at Augusta University, and I graduated from there in August of 2014. I’ve been working in dermatology for the last years. I also have a website and blog called The PA Platform, where I help people figure out if they want to be PAs, and how to get there and go through the whole PrePA process. I am married to a hospitalist and I have a 2-year-old. Now I work as a part-time Derm PA.  

I want to talk about what services you’re providing on your PA platform. I want to dive into more of the clinical and job aspect of being a PA. What exactly is your job title and what do you do clinically?  

My job title is Dermatology PA. I work in a private practice office, and I see patients from about 8:30 to 4:30 on Mondays and Tuesdays. I usually will see up to about 35 patients. We see anywhere from babies, all the way to elderly patients. I do medicalsurgical and cosmetic dermatology.  

Number two, what are the usual steps you had to take to achieve your professional degree?  

First, I gained a Bachelor’s degree and completing all of the required prerequisites for patient care experience, shadowing, volunteering and the GRE, and then PA school. My program was 27 months. It was a Master’s program. You don’t specialize as a PA or you don’t have to, there are optional programs, but I went straight into getting trained at my job to work in Derm.  

The best part of being a physician assistant is the teamwork aspect, which makes for better patient care. Click To Tweet

What is the best part of your profession in a sentence or two?  

The best part of being a PA is the teamwork aspect. I have an amazing physician, a great office staff and work environment, and I love that. IDermatology, I love getting to see patients improvesee their rashes get bettertheir acne gets better, and how much that makes them happy and affects their confidence. That part is really fun.  

What one misconception do people have about your profession?  

For PAs, it’s a newer career. The biggest misconception probably has to do with our name, Physician Assistant, and people thinking that we are more like an MA or Medical Assistant and stuck to the doctor’s hip, when that’s not usually the case. Most PAs have a lot more autonomy and the ability to practice individually 

Finally, of these quick questions, what other professions do you usually work with closely?  

I have physicians that I work within the office, other PAs and we have one other PA in my office. The physicians I refer to mainly are plastic surgeons and Mohs dermatology surgeons, occasionally rheumatologists, and patients primary care physicians. We also have medical assistants in my office that I work very closely with. I have a dedicated MA who’s with me 24/7.  

That hopefully gives a nice, complete best picture in a few minutes. Thanks, Savanna. I want to dive deeper into your profession as a PA. You’re a Dermatology PA. What type of patients are you dealing with? Is it just acne all day? How do you work with the team that you mentioned like the MAs, the PAs and the MDs?  

I had this misconception when I was an undergrad at UGA, I had an amazing opportunity to shadow a Dermatology PA. She was awesome. Her name was Hope Cook. She let me come shadow her once a week for a whole afternoon. For about a year, I would go every Thursday afternoon and shadow her. Originally, I had the same thought, “This is just going to be acne and old naked people. This is going to be boring. I don’t want to do Derm. There’s no way this is interesting.” Once I got there, I figured out that Dermatology is interesting because the skin can do some crazy stuff. I’ve seen some wild rashes, and being both the newest provider in my office and having the most availability, I see a lot of new patients, so I get to see all that crazy stuff. If somebody has a triage or a problem, they can usually get in with me the quickest. That’s fun for me because I get to do a lot of problemsolving. I see lots of acne, eczema, psoriasis, moles, funky spots, warts, molluscum, dealing with lots of skin cancer and lots of sun damage. We do cosmetics. We’re doing Botox, filler, chemical peels and lasers as well, cysts, things you’d see on Dr. Pimple Popper. We see those but it’s a nice variety.  

Are you also doing procedures too and prescribing medications?  

As a PA, I do prescribe medications. IDerm, we don’t use pain medicine but there are certain scheduled pain medications that I cannot prescribe, but no one in my office prescribes those based on the nature of our work. That’s not an issue where I’m at, and that’s statedependent. In some states, PAs are able to prescribe more. If a patient comes, they’re on my schedule to see me, usually what happens is my medical assistant will bring them back. She’s going to put them in a room, take a history. We don’t do many vitals in Dermatology. It’s more asking about the very focused history about their skin. She’s going to come out, I’m going to review their chart and look at what they’ve done in the past, what medicines they’re on, and then go in the room.  

My medical assistant goes with me and does documentation while I’m in there. I’m doing physical exam. I’m able to talk to my patient, I’m not staring at a computer while I’m with my patient. It’s awesome. She’s functioning as a scribe, but she’s also getting prescriptions ready, getting samples. If I’m going to do a procedure, if they have a mold that needs to come off, she’s getting that ready. I’d go ahead and do it. If somebody needs a biopsy, we’ll do either a shave or a punch, then we’re freezing with liquid nitrogen. Once she’s done, I’ll finish up my note. We’re on a semi paper and electronic charts, so I dictate my notes. I try to stay on top of that. I never take work home with me. I never take charts home with me. That’s something I decided very early on in my career was that work stays at work. I’ll make sure everything is dictated before I leave. That completes that patient encounter. Imy job now, I do a good bit of excisions, which I enjoy. I love my surgery rotation when I was in PA school. In OR, it’s a little different. It’s nice to be able to do excisions on skin cancers or cysts 

Is a PA supposed to function under a physician’s office or can they work independently?  

The way the PAs were designed was to have a relationship with a collaborating physician. That looks different depending on setting, specialty, experience level, and the relationship between that PA and the physician. That’s one thing that makes PAs unique is that we can have the same title technically, but look completely different. I have Derm PA friends who don’t do any excisions, and I have ones who only do surgery and surgical procedures. A PA who works in cardiothoracic surgery, you’re probably going to be working more closely with your physician. You all will probably talk about every single patient, especially as a new career PA. If you’ve been doing it for 20 years, that might look different. It’s a lot of adjusting as you go. I needed way more hand holding right at the beginning when I was learning, versus now I can treat acne and psoriasis and feel good about those and confident. If I ever have a question, my physician is available. She’s either in the office or I can call her if needed if I need her to help me with a patient. 

Can a PA work independently? In other words, set up shop on their own.  

It’s statedependent on whether PAs can own practices. In Georgia, we cannot. In Florida and California, I know that PAs can own practices, but you still have to have a physician on board. You would technically be their employer. They would still be your collaborating physician.  

There has to be some connection with another physician in some format, and it depends on the state?  

Yes.  

I’m trying to figure out how if a student’s like, “Why would I be just a PA versus a physician or vice versa? What are the different roles and independence that one has? It sounds like you’re able to prescribe medications, able to do procedures. Depending on the place, location and the environment, if you will, the setting, you could work independently, but with at least a legal connection and clinical connection with a physician or physician group. Is there anything else that someone should consider if they’re like, PA or physician?  

The education is different for the biggest part. Personally, there are some PAs who do want to practice independently. That was never my intention. When I was deciding between PA and med school, I shadowed a team. They were a team of a PA and a doctor. They worked in hospitalist medicine and wound care. I went with them together on rounds and separate to see patients. That process is what showed me that I like that teamwork approach, but I didn’t personally feel like I needed to go through the whole process of medical school to still be able to provide care to patients. Looking at med school and everything that was involved, it seemed very overwhelming. Choosing a residency, I would get very anxious about that. PA presented as this happy medium of you can still take care of patients and be involved and be trained medically and clinically, but you can have that teamwork, which personally, I think makes patient care better when there is a team approach because it’s a checks and balances system. In our officebeing that we do Derm, we try to rotate who does skin exams on patients so that they’re getting multiple sets of eyes. What we found is that helps you to see new things or notice new things that maybe somebody might have missed.  

The school for medical schools, you’ve got to go through college, medical school, internship, residency. For PA school, you have to get an undergraduate degree and a graduate degree? 

They’re all Master’s programs.  

How many years is that?  

Programs range from 24 to 36 months. The majority are straight through. That’s something that I found different because my husband was in medical school while I was in PA school. Our classes for the first half, which was didactic year, it was fifteen months. We didn’t get any time off, maybe 3 or 4 days in between semesters, a couple of weeks at Christmas. Our classes were from 8:00 to 5:00, Monday through Friday. It was intense and it was a lot. I don’t know if probably not all med schools are like this, but my husband’s classes were 8:00 to 12:00, Monday through Friday. He got the summer off to do research, which all of that was important for his path, but it was set up very differently. We still get a ton of classroom time and we’re taught, at least in my program, mainly by doctors. We were part of an academic center and we have the physicians who taught the med school classes coming and teaching us. We took the exact same anatomy and physiology, use the same cadaver lab to do those courses.  

I had a guest several episodes ago, a friend of mine, Alexa Maestrone, she’s a nurse practitioner. She worked with PAs in this neurology group, as well as other NPsShe highlights some of the differences between PAs and NPs. How would you describe the differences between NPs and PAs?  

HCDM 43 | Physician Assistant

Physician Assistant: The biggest misconception about PAs is that they are stuck to the doctor’s hip. In reality, PAs have a lot more autonomy that most people realize.

 

It’s also statedependent because where I’m at in Georgia, we function primarily the same in clinical settings. We have the same rules. NPs cannot own practices here either. In some states, they can and they can practice a little more independently, but in Georgia, it’s all the same. From that standpoint, it’s the training that’s different and how they go to nursing school first and then complete a program to become a nurse practitioner. There’s a big variety in NP programs. There are a bunch that are mostly online, which there’s only one online PA program. The hour requirement is a good bit less than what you have for PA school for clinical experience, which nurses do have usually experienced as nurses before going to NP school.  

When I was looking at nursing versus PA, I wanted that medical training. It’s different. I think doing clinical training where you were involved in the diagnosis and the treatment decisions, versus the taking care of patients, if that makes sense. There are states that are PA friendly and there are states that are more NP friendly. That’s something anyone going into either of those careers should look at before choosing. I’ve spoken to PAs, especially in some Northern or Midwest states that once they got there, they found out that to work as a PA, you had to have an APP postgraduate program if you wanted to do ICU because they preferred NPs who already had ICU training from when they were nurses. If that’s something you want to do, it may be worth exploring that.  

You choose your path even based on where you might want to end up?  

Yes.  

People have misconceptions of your profession that you’re stuck with MDs. What other misconceptions do people have about PAs?  

What I usually see the most are actually on social media more than in the clinic. Where I’m at, patients have a good understanding of what PAs are. I don’t get asked about my profession or told that people want to see the doctor in my actual day job. One thing I see sometimes is that people assume that PAs want independent practice, and that we want to be independent and want to be doctors or couldn’t go to med school. That’s not the case. I would say the majority of people who became PAs chose that and chose it for a reason, whether it was their own personal plan and goals. It was designed as a secondary career and a lot of PAs still use it. We have a lot of people who were teachers who decide at 30, 35, 40, they want to go into medicine, and signing up for 8 to 12 years of med school. PA is a great option for them to pivot and transition into a clinical role. I would say the majority of us do not want to be fake doctors. We don’t want to be independent. We are happy with our roles.  

You mentioned that the rewarding part of your job is working with some great team and having some of those people to bounce ideas off of. Is there a least favorite part of your job?  

I have to separate into being a PA and working in Dermatology because they’re separate. Being a PA I’m very happy with my decision. When I first started, I was very overwhelmed because we only got two weeks of Dermatology in PA school. It was not a lot. I did a lot to figure out. I have had great teachers, every physician I’ve worked with has been an amazing teacher. I originally did my two elective rotations in PA school, which was 8 weeks in my job. I was already hired. I was able to use that as a great training time. Once I graduated, I had to take a couple of weeks off to study for boards. It took another month or so to get my board scores back and get licensed with the state and get all of my insurance stuff set up.  

I was training for a good four months where I was with the doctor, learning EMR, learning billing and coding, learning Dermatology, studying every night, and then we slowly started opening my schedule to regular routine follow-ups to things I’d already seen with her. Then acnes and warts, and then build from there and kept checking in to see what she was comfortable with, what I was comfortable with, where I was struggling. There was a lot of support at first, but that was a huge learning curve. I was exhausted for the first six months. 

It’s like an apprenticeship or a residency on steroids the first few months after.  

I honestly thought of myself as a resident for the first few yearsOne thing I realize, there was something else I wasn’t comfortable with. As soon as I had acne figured out, I figured out that I was struggling with psoriasis, and I focused on that for a while to make sure that I comprehended everything. Then moved on to PIDs, even though I don’t see a ton of PIDs that makes it a little harder but focusing on that a little bit more, but I thought of myself as a resident. I had times a couple where I thought, I wish I had residency because I would see something weird.  

I remember one time a patient came in, she was young, a child and she had this rash. It was weird. It was only on one leg. It was one of those cases that I walked into the room, I looked at her and instantly knew I’ve got to get to the doctor, This is weird. I don’t know what’s happening. In those cases, usually I know what I need to do. I know we’re going to have to do a biopsy or start here or whatever. I have an idea, but I want to make sure that we’re on the same page. I grabbed her, she came in and I was like, I’ve seen this once. I saw it 12 years ago in residency. At that moment I’m like, I wish I had residency.” Even if I did a residency, I may not have seen that. Those times made me want that, but then going back to what you said, I was like, “This isn’t residency. I’m two years out of practice. Here it is, I get to see it.”  

For typical PAs, especially from graduate school and going into a specialty and they do a deep dive into that specific specialty. Is that typically what happens?  

Most PAs go straight into their jobs. I would say most physicians like to train PAs primarily on their own starting outThey would prefer to get a fresh PA versus someone who maybe hasn’t been trained the way they would prefer. Most PAs go straight in, but some people will do a program. There are one-year post-grad training programs like emergency medicine, surgery, psych, ICU. There are a few unofficial Derm ones, but not anything.  

You could do a one-year fellowship type thing. What are all the different subspecialties that PAs can go into? Anything that you think of medicine or is it maybe only the top 5 or 7 that typically go into?  

It’s anything. The only ones I’d say they can’t typically because they are more specialized programs would be anesthesia. There’s an anesthesiology assistant who is the equivalent to a PA. I don’t think every state uses those.  

I am trying to get one of the anesthesiology assistants on this program eventually.  

PA has recently been recognized as the number one profession by US News. It’s a good sign to increase awareness around the profession. Click To Tweet

They have a very niched thing. There’s also a pathology assistant program, and that’s different. The only other specialty that’s a little hit or miss is OBGYN because midwives are used so much. Most states are not very PA-friendly when it comes to the OB portion of working as a PA. I know a PA here, she works in Derm. She went to school here to be a PA, went out to California to do an OBGYN post-grad program. She did it for a yeardelivered over 300 babies out there, came back and Georgia still would not approve her to deliver. She ended up in Derm because she couldn’t do her dream of doing the OB part of working in that specialty. That’s one thing I tell people, sometimes people are like, “I want to do OBGYN.” If you want to do the GYN side, there are lots of opportunities there. Probably it’s going to be tough depending on where you’re at.  

What do you think the future looks like?  

I will tell you that US News Week, or whatever their title is, just named PAs as the number one profession in the US.  

I did read that before 

We‘ve always been in the top three, which they look at that from the time it takes to become a PA, financial investment versus salary thing, and the variety of the profession. That’s a good sign for increasing awareness around PAs. In general, in our country, there’s a need for medical care. You’re probably aware that they haven’t increased residency spots in many years. That makes the physician shortage more, though there’s more of a need. That’s where PAs fill in some of those gaps, especially for rural medicine. It’s a great career. It’s going to continue to grow. I will say, during COVID, which happened across the board in medicine, there were a lot of furloughs and layoffs, especially in specialties. I was very fortunate to keep my job. We were shut down for about six weeks, where I wasn’t getting paid, I wasn’t seeing patients. There are crazy things that could happen that could affect it. Overall, it’s still a good profession to go into. 

This is my rapid-fire question. I love to ask guests to see what’s on the other side. Beaches or snow? 

Beaches. 

What is your favorite holiday? 

Christmas. 

What is your favorite vegetable? 

Asparagus. I’ve got a really good asparagus I’ve been making a lot. 

Grilled? 

In a pan with some garlic and a little bit of soy sauce.  

Ship that to New York for me. What do you admire most about your spouse? 

He is a really fun dad. 

What do you do when you don’t feel motivated? 

I watch reality TV. 

HCDM 43 | Physician Assistant

Physician Assistant: The majority of PAs don’t want to run an independent practice. They are really happy with their roles.

 

What’s something you can eat for a week straight? 

Can I say iced coffee? Is that a food? 

Sure, why not? What kind of musical instruments have you learned to play? 

Piano. 

What is one skill that you think that’s giving you an advantage in work? 

They think that I’m really good at finding deals and finding from the internet. One of our office chairs broke, and I was able to find the part.  

Would you rather burp every time you lean in for a kiss, or drool every time you talk? 

Burp every time I lean in for a kiss.  

Savanna, tell us about your website and your thing that you’re doing for PAs and PA students outside of your clinical work.  

HCDM 43 | Physician Assistant

Physician Assistant School Interview Guide: Tips, Tricks, and Techniques to Impress Your Interviewers

I started The PA Platform as an outlet while my husband was in med school. He was really busy and I was used to being a student and having assignments and tests. After PA school, I didn’t have that anymore. I created The PA Platform as a blog, and it’s developed into a cool community where we have podcast episodes on The Pre-PA Club every Friday that we’ve been doing for a few years. Blog posts go up once or twice a week, a really strong Instagram community, a Facebook group called The Pre-PA Club. My blog, The PA Platform, has been nice for connecting students, and we do mock interviews and help make the process easier since it isn’t standardized the way that med school and some other types of grad programs are.  

It’s a bunch of services there. You help set up mock interviews, help with the application, essays, whole bunch of different things. Anybody interested in PA school, check it out. What’s the name of the website? 

ThePAPlatform.com 

Is that the best way people can reach you is through that website?  

Yes. There’s a contact form on there. My email’s on there. I’m also responsive on Instagram and that’s@ThePAPlatform. If you send me a message or a comment, I’ll try to get back to you there too.  

You also have a number of other coaches that also work with you that are through that website. There are a lot of different people to choose from if they’re not available or a preference as well. 

We only use PAs, practicing PAs, but we have a lot of PAs who help with coaching, which is nice to get different opinions and different inputs into how you’re doing, if you need an unbiased opinion.  

I think that’s a great resourceYou found a need and a niche for that. That’s fantastic. Savanna, thank you so much for coming on. It has been a pleasure and educational for me to learn about you and your specialty and your career 

Thank you so much for having me.  

 

Thanks for tuning in. To learn more about our guest or other past guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.comIf you like what you heard on this show, then please go to my website and add your name and email to my email list, that way you can get the latest announcements and news as they arise. You can also find me on Instagram, @DrRichardMarn. Thank you so much for reading. I’ll catch you on the next episode.  

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