Two recent studies explored the role of physician assistants (PAs) in dermatologic surgery.1,2 Shortages in the availability of dermatologic services in the United States continue to exist. As a result, PAs have been increasingly utilized in dermatology to increase the number of clinicians providing dermatologic services. Research by Kimball and Resnick concluded that careful workforce planning will be essential to ensure access to high-quality care for patients with skin disease.3,4 Few data detailing the productivity and profitability of PAs in dermatology are available. This information will be valuable to help workforce planners and health care providers plan and improve patient access to dermatologic care.
Methods An Internet-based survey instrument containing 26 questions was sent to 10 dermatology PAs and a dermatologist for validation and feedback. A final revised survey instrument was then created using questionpro.com. E-mail addresses were obtained for 1,195 PAs registered as fellow members or diplomat members of the Society of Dermatology Physician Assistants, and 1,195 addresses were entered into the survey database. Of those e-mail addresses, 743 were reported as active by the e-survey instrument. The survey instrument remained open from November 1, 2011, through January 15, 2012.
Results The survey was successfully e-mailed to 743 fellow members of the Society of Dermatology Physician Assistants, of whom 302 responded (RR=40.6%). Among the respondents, 54 (17.9%) did not complete enough of the survey to give any valuable data, and 42 (13.9%) did not work in dermatology or with a board-certified/ board-eligible dermatologist and thus were excluded. Two hundred and six (68.2%) PAs both completed the survey and were working in dermatology with a board-certified/board-eligible dermatologist.
Gender and age data were compared with the demographic data collected in the 2011 American Academy of Physician Assistants (AAPA) Census and found to be similar. The AAPA reported that 20.6% of dermatology PAs were male and 79.3% were female. The average age of PAs in dermatology was 38.7 years.5 In our survey, 21.1% were male and 78.8% were female, and more than 50% indicated that they were between 31 and 40 years of age.
The average annual income of PAs in our sample was $113,419, with a range of $7,000 to $310,000 (Table 1), and the median income was $100,000. The average annual reported revenue generated by PAs in our sample was $559,597, with a range of $37,000 to $1,500,000 (Table 2). PAs with 5 or more years of experience averaged $621,000 in annual revenue, while PAs with less than 5 years averaged $377,658 in annual revenue (P<.001, Table 3). The amount of production did not vary significantly by gender (P=.07).
Discussion Although experience and training are important factors in determining a PA's delegation of services agreement and/or scope of practice, they are also factors that may influence both the income and productivity of PAs in dermatology. Of the PAs in this study, 73.9% reported their income was at least in part determined by the amount of revenue they generated. With each year of experience, productivity appears to increase. If income is tied to productivity, income will likely increase in response to the increasing revenue generated. Interestingly, when considering an average annual income of $113,419, even PAs with limited clinical experience can generate more than three times their annual salary in practice revenue.
This dataset contains some limitations. Only 85 PAs disclosed the revenue they generated, and 53 PAs did not disclose their salary. Despite the small sample of PAs willing to disclose the revenue they generated, the data appear representative of PAs in dermatology, as several demographic characteristics of our study cohort were similar to those found in the AAPA Census data.
The current data are the first to link dermatology PA incomes to dermatology PA production numbers and may prove useful to PAs, physicians, and administrators in future workforce planning.
To view the references and tables, please see the online version of this article at http://www.jaapa.com.