 And guess what, you've come to the right place, our resident Zit guru, Dr. Zit. When it comes to these and you brought more videos. Right. I'm scared. She's draining it, she's draining it, she's draining it. Oh gosh! I'm watching. No, I don't like it. Just really go up. Because it's just like. Oh, oh, oh, oh, oh, oh, oh, oh. It looks like somebody put a wine cork in. Me, some Dr. Pimple Pop, are you guys? I can stay up for hours just watching her videos on YouTube and on Instagram, and I enlist my family to come watch along with me, even though my husband is a little bit squeamish about it. But it seems like everybody thinks that that's all there is to the dermatology field, and it's not. So I just wanted to introduce you guys to what it actually is to be in the field of dermatology. My name is Adana, for those of you who do not know me. Some of you may know me as Adana the PA, where I make weekly videos on YouTube, just chronicling my time so far as a PA student, and just trying to get into the PA profession. I'm interested in the dermatology field, so this documentary comes at the perfect time. I wanna introduce you all to Savannah and Stephanie. They are the two PAs that will be featured in this documentary. They're gonna just be sharing their stories, so enjoy their story and stay till the end where I will give you my final thoughts. Hi, my name is Savannah Perry. I'm a dermatology PA, and I've been practicing for three years in Georgia, and this is my true life. Hello, everyone. My name is Stephanie. I'm a dermatology physician assistant, currently practicing in Southwest Florida. This is my true life. I wanted to be a dermatology PA. I'd like to say before I went to PA school, I had the thought in my mind. I had done a lot of shadowing in dermatology. When I was in college, there was an awesome PA who let me come and shadow her every other week or every week for an afternoon, and so I had a lot of exposure to the field. I think most people, when they think of dermatology, think of it as a boring field or where you're only seeing acne and old people, and that's really not the case. Dermatology is really interesting, and we get to see really cool rashes and different things, so knowing that going into PA school, I still kept an open mind when it came to rotations, so coming towards the end of clinical year, I was thinking maybe either surgery or still dermatology, and luckily a really awesome position opened up. I applied for it, interviewed, got the job, was able to do my last two electives there, and it was kind of just perfect timing, and everything worked out better than I could have ever imagined, and so that's kind of why and how I got into dermatology. I wanted to go into dermatology because I've always had a fascination with skin and treating things like acne. I did suffer from acne during my adolescence and well into adulthood, like many others, so I know how that can affect one's self-esteem. I really loved trying to figure out how to treat my acne and finding things that would work for me, so I really love that aspect of helping people feel comfortable in their own skin and really just helping with self-esteem. I knew that I wanted a job right after PA school. My husband was in medical school, I wasn't going on any big vacations, I was ready to work and pay back my loans, so I started applying to jobs about eight months before graduation, and so I graduated in August, January, February, I was putting out applications, kind of putting out feelers in my community, with my preceptors just seeing what jobs were available, and in about February, March, April, I started getting some calls back. I actually interviewed with a neurosurgeon, a back and spine surgeon, and then with this dermatology position. One piece of advice that I will give you if you're in PA school is do not discuss your job opportunities with your classmates or really your friends if you're going to be working in the same area. This was an issue I ran into where I had found out about a dermatology position, I was really excited about it, told one of my friends who was trying to also be in dermatology in the same town, and she actually had some connections that I didn't have and ended up getting an interview before I did, which I was happy for her getting the interview, but it seemed like it kind of, she kind of went behind my back to do so because she knew it was something I was interested in too. So in hindsight, I wish we had never talked about it, but it was actually my surgery preceptor who I adored, who had gotten the PA before me in this practice, her job. And so when I found out she was leaving, I told him, hey, I'm really interested in dermatology, this job's opening, but my friend's applying to it, I don't know what to do. And he insisted on calling that dermatologist. So he put in a phone call and said, you have to interview Savannah. I went and interviewed and I didn't hear back for about a month. So that was a little nerve wracking. Later on I found out that they actually offered the job to another PA who had graduated in the class before me, but she actually turned it down. They interviewed me, I came in, I shadowed for a day, and then a month later they called me and made me an offer. I can't say that it was without stress with both my friend applying for the same job who she did also land a Derm job, but also just not knowing whether or not I was gonna get it and being so close. So that was a little bit stressful, but ultimately it worked out. I think the biggest thing that you can do if you want to work in dermatology is just tell everyone, tell your faculty members, tell your preceptors, make sure that people know. And it was actually kind of cool because once word got out that I wanted to be in surgery, places started calling me. And at that point I already had a job and dermatology. I had another dermatologist contact me and ask if I was still looking for a job. I had a urology office contact me. So you really have to put yourself out there if you want to get those jobs. So once I finished PA school, well actually a couple months before I graduated I began looking for a job. I did look for dermatology jobs at that time. I wanted to stay in Orlando, Florida, which is where my boyfriend lives and my family. So I really just kept my job search and you know, within one city I was open of course to family medicine, things like urgent care because I did kind of really want that general experience before specializing. I got an email from my program about a solo physician family medicine practice that had a UF graduate, which was my school who had to leave. And so that caught my interest. I interviewed there along with a couple other spots but ultimately I decided to go with that practice. The job hunt itself took a few months. Like I said, I began about two months before I graduated. I started working a little bit less than two months after I graduated. A lot of people take time to study for the GRE just to make sure that you pass, that's important. And then you know, you kind of want a little bit of time for yourself. For example, I went on vacation. I went to California with my boyfriend and we kind of just went all over California from the South Coast up to San Francisco. So that's a really good thing to do. And I recommend that everybody takes a little bit of time off just to kind of celebrate the fact that you're done with school and just to enjoy life. I did actually switch jobs after just one year because I didn't like that practice. I didn't, you know, I had, you know, one of those first jobs as a PA that you would just never go back to but you don't regret it because it's all a learning experience. So my second job was in family medicine. I stayed there for two years. I love the practice I had. I can't say anything bad about it. It's actually, I would say it's like the perfect job. It just wasn't my dream specialty. Oh gosh, it's hard to pick a first week on the job for me because I ended up doing both of my elective rotations at my job training. So they hired me in April, June and July. I came back and did my electives there. So I was full on training. I'd already been hired. It was great for them because they got free training but I did my two electives. I took two weeks off to study for boards, took my boards, came back, still training while I'm waiting to get my board results and while I'm waiting for licensing and all of that. And I would say one of the most stressful things was I actually got my pants board results while I was at work. And so I got the email. I said, I've got to go outside for a second. So I went outside and to be honest, my plan was if I didn't pass, I just was gonna leave and not come back because I just think I would have been so embarrassed at that point to already have a job and not be able to pass boards. So that was a little risky on my part but luckily I passed. I went back in and told them we were all happy and then we moved on. I would say for me, I started seeing patients gradually. I trained for about three months and then I would see normal stuff, warts, a little bit of acne follow-ups, just nothing major. I was doing some cosmetic stuff and then slowly my schedule started building and I started being more and more autonomous and working on my own. So my first week on the job was a little bit unusual because of the circumstances, we actually had Hurricane Irma hit Naples, Florida directly which was where I began working. So a lot of my patients had damage or they didn't have power back yet. So we had a pretty slow week. I spent time shadowing the doctor, doing some procedures like shave biopsies, punch biopsies and really just trying to get to know the office, the office staff and familiarizing myself with everything. So a typical day for me is I get to work at around 7.45, 8 and I have a folder of pathology. So any biopsies I've done the past week or so will show up on my desk, my medical assistant puts them there and so I'll spend some time reviewing those, going through labs, seeing if there's anyone I need to call, if we have some skin cancers, deciding what kind of surgery they'll need and just reviewing all of that. And then I usually, my first patient is at 8.15. I see up to 35 patients a day. So that's a lot of patients and it just varies. That's how many can be on my schedule. So I see patients from 8.15 to around 12, get a lunch break from 12 to one. And then we come back at one, see patients till around, my last patient appointment is at 4.15. So sometimes I'm done at 4.30, sometimes it's more like five on a very rare day. It can be around 5.30, just depending on what comes in. And then I go home. So the types of patients I see can vary. I see anywhere from babies all the way to elderly patients, the geriatric population, everything in between. I see all different skin conditions. I mean, it can be something like eczema, acne, psoriasis, rashes, warts, moluscombe, you name it. I do tend to get a lot of the strange rashes just because as the PA, I have a lot more openings for new patients than my supervising physician does. She's seen a lot more follow-ups and her melanoma patients that she's been following for years. So I do see a lot of funny rashes which makes my day interesting. I do a lot of skin checks, a lot of checking moles, checking spots, making sure everything looks good. I do my own procedures and biopsies. So shea biopsies, punch biopsies, freezing warts, freezing precancers, treating moluscombe. I do some cosmetics, botox, filler, chemical peels, some laser. And then I do some excisions occasionally, just cysts or very small skin cancers. It just depends. I feel very comfortable with being able to say I can do this or I don't feel comfortable doing this. And I think my supervising physician trusts that and knows that I'm not going to get myself into anything or any situations that I shouldn't be in. A typical day as a dermatology PA, I do a lot of full skin exams. This is basically when I have a patient get in a gown and it's very systematic. I will examine starting from the scalp all the way down the body. So I do scalp, then ears, then face, then I will do the upper extremities, then lower extremities, the back, the abdomen and the chest. And we're basically just screening for skin cancer. So if I see a suspicious mole or lesion, we'll do a biopsy then and there on the spot. We do a lot of acute care visits also. This is basically rashes, sometimes cellulitis, which is a skin infection. As far as rashes, a lot of eczema, which is atopic dermatitis, we see a lot of contact dermatitis, shingles, a lot of fungal infections like tinea corporis, which is also known as ringworm. So a lot of very common rashes. And then you always get that kind of textbook rash where you're not really sure, it doesn't respond to the usual treatments like a steroid cream or an antifungal. Those rashes will typically biopsy when they fail treatment. So during these skin exams, something that we do a lot is we use liquid nitrogen for cryotherapy of precancerous lesions. They're called ectinic irritoses. So during the exam, I'm not just looking at the patient, but I'm also using my hands to feel for rough patches. And those rough patches on the skin are signs of previous sun damage. It could be from way back when the patient was a child and had a lot of blistering sunburns and throughout their life, they get these rough areas of ectinic damage. These areas we freeze with the liquid nitrogen to prevent it from becoming a squamous cell skin cancer. Our skin exams usually take up a 15 minute slot, surgical excisions, it's 30 minutes. In a normal day, in a busy day, we'll see up to 30 patients. I do have about an hour of lunch break. I will sometimes take time to do some notes during that time and just catch up on what's coming in the day ahead. I am really interested in doing cosmetics with the practice. My doctor I work with right now, he does do Botox and fillers currently, but it's not something that he really gets excited about. He knows it's something that I am really interested in and something I wanna grow in the practice. And he is really supportive of that. So that's something I definitely look forward to. I have an amazing relationship with my supervising physician. She is awesome. I mean, I would consider her a friend, honestly. I mean, we text each other when Willie Pulitzer's on sale and help each other pick out clothes, you know? So she's awesome. A great teacher, just a great personality. Her patients love her. I think sometimes you have the PA doctor relationship where the patients love the PA more, but in this case, my doctor's patients love her. And so it makes it even harder for me to prove myself and get them to love me as well. But she's super supportive. I work very autonomously. So I see my patients on my own and she's always there if I have a question. Sometimes she's not. So Fridays I work by myself and she's always a phone call away if I needed her. But essentially, if I need something and a patient comes in and has something going on, she's great about just kind of dropping what she's doing, coming and seeing them with me. We get on the same page and then move on. She doesn't mind if I ask her stupid questions. She is just very kind, very compassionate. And that's very important. As a PA, you have to have a great working relationship with your supervising physician. There has to be mutual respect there and you both have to be willing to learn from each other and willing to kind of adjust and understand where each other's coming from. So yeah, so she's awesome. I couldn't ask for a better relationship there. So I work in a solo physician practice. So it's really just me and him and our medical assistant, we have a secretary. It's a very small office. I feel like it's so important that you're comfortable communicating with your supervising physician and that you find somebody or a company, maybe a group of doctors, which I had experience with before this. But the most important thing is communication. I feel like he knows what my real interest is and how I want to contribute to the practice and he's very supportive of that. I feel like when I'm seeing a patient, I can grab him at any time if I have any concerns, any questions. And as a PA especially, as a new graduate, that's so important. Or if you're switching specialties and it's not something that you're super experienced in. So it's really important to feel comfortable asking questions to your supervising physician or physicians and just have a good, open communication. As a third PA, I have a dedicated medical assistant. So my MA is named Taylor and she's also one of my best friends, which is nice. I didn't know that would happen coming in but we're around the same age. We have a lot of the same interests and a lot of the same friend groups. So it's really cool that we're able to work together all day. She's actually trying to go to PA school which makes me sad and excited at the same time. But Taylor is awesome. She can read my mind and that's just from working together so closely over the past three years. I mean, we are together all day long. We share an office. When a patient comes in or checks in, she goes and gets them. She puts them in the room, takes their history, updates their medicines. She takes a review of systems and then she comes and lets me know what's going on. And then when I go in the room, I'm doing the physical exam, I'm talking to the patient and the whole time she's actually scribing and entering that information into the computer. And sending prescriptions, making sure everything's done. When I come out of the room, I go back and fill out my plan, add some details, make sure everything's accurate. But it's extremely helpful having that person with me all day long to make sure that we're on the same page and that I'm doing everything I need to. Everything's getting done. It speeds up the process that I can see everyone in a timely fashion. Because that is important to me to stay on time and make sure my patients aren't waiting too long. So this question, what's the relationship like between the PA and the nurse? I'm gonna answer this from the PA working in outpatient medicine perspective. I don't really work with nurses, never really have because in outpatient offices like family medicine, dermatology, we usually have MAs, medical assistants. It's usually a great working relationship. Something that I encourage you guys to ask when you're interviewing is to find out if you'll have a one-to-one medical assistant, meaning your own medical assistant. That can make your life so much easier because basically any patients who call, any labs that come in, they first get to your medical assistant who then kind of brings it to you and that communication is so important and having that consistency, the same person talking to the same patients, getting to know all of your patients because that same person is bringing them back and bringing them in the room and taking their vital signs. I think it's really, really, really important. Medical assistants do a lot for PAs, especially in dermatology. Often they'll kind of write all of the notes while you're examining the patient, so that's something that's pretty nice about it. When I was in family medicine, I really did all of my notes on the computer without anything previously written by my medical assistant. That's something nice about dermatology. I think one thing that's challenging about being a DermPA that some people may not think about is that it is extremely fast-paced. You have to be able to be efficient and stay on time. Like I said, I see 35 patients. There are DermPAs out there who see 50 to 70 patients. Usually they have two MAs and sometimes they even have a limit on the amount of problems you can have at a visit, but for me, I don't think I realized just how quick it was going to be. And I don't think it's something that everyone could do. If you know that you're someone who just takes more time or is a little bit slower, being a DermPA just may not be the best fit for you. And you also have to be a problem solver because there are a lot of things that come in and you have to be okay with not necessarily having an answer for your patients. So I can't tell someone why at 40 they just developed rosacea or I can't tell them why at 65 they just got eczema. And so there are some unanswered questions in dermatology and that's something you have to be able to explain kind of over and over and be okay doing and know how to do so in a way that reassures your patients. And it is a lot of talking to patients. You have to be willing to touch your patients and you have to be okay with blood obviously if that's an issue for you. I don't know if medicine is the right choice but especially in a Derm position, I mean doing biopsies you just gotta be okay with that. The first time I ever saw a punched biopsy I actually almost passed out. And that's why I was shadowing in college and it's kind of funny now because I do punch biopsies all day long and it's fine, I don't pass out anymore. So it's something you get used to as well. I've only been doing this for six weeks so it's something I'm gonna continue to, I guess, find out in the days coming. But so far I think it's kind of the same as when I was in family medicine. There's always gonna be people who are low-key trying to insult you, throw shade. I had an elderly gentleman, I introduced myself as the physician assistant and he said, oh, how's assistant life? And things like that, he just really tried to educate these people about who PA's are, what we do. I think in his case, I think he already knew what a PA was. So like I said, he was just trying to throw some shade and you can't let those people mess up your day. I had one patient who said, I was examining her and she had something else going on besides just the skin exam, like she had a concern and she said, oh, I don't know if this is in your scope of practice or not, but something like that, well, I'm a dermatology PA. This is, I do skin, I evaluate skin. So it's, again, I think the most challenging thing is just dealing with patients who aren't necessarily sure what your role is and the best way to deal with that kind of thing is just to educate, keep educating patients, general public about who PA's are, what we do and what our scope of practice is. I get paid bi-weekly, my normal salary and then I do get a productivity bonus quarterly. So I kind of get paid in two different ways. Coming out of PA school, I did not really know how to manage money. I had some loans that I wanted to get paid off and so my original plan was to pay the minimum on my loans and then do whatever I wanted and then if there was something left over, I would put that towards my loans. That made for some questionable decisions those first few months and I wasn't actually putting much extra towards my loans. So after those few months, and I think it was more or less, I hadn't ever really had a real salary and then coming out of school where you've just been slammed and studying for so long, you kind of want that freedom to do what you want. So I got myself together and decided that I needed to pay my loans off. They were kind of like a black cloud hanging over my head. I didn't want to be dealing with them for years and years. So I actually started putting everything I could towards my loans and living as frugally as possible and doing so I was able to pay off my loans in about 16 months. So at this point I have no loans, it's awesome. Now I can kind of do what I want but I have learned a lot about saving and just kind of living on a budget and not throwing away money the way I kind of did at first. As far as salary, I do get paid by monthly. I was gonna say by weekly, I get paid by monthly. That's always been the case from my first job, my second job, my current job. So I think that's pretty typical for PAs, at least in outpatient medicine. I do recommend try to make a plan as far as loan repayment if you have student loans. I know I certainly did, well I do, I still have a lot. Really just try to pick a number that seems reasonable, that you can just put towards your loans every month or even every paycheck. It's something that I'm not the best at so I don't have great advice for you. But try to get with somebody who maybe can kind of advise you on that. Maybe even a financial advisor, I don't know. But I think it's important to try to plan as much as you can because once you start getting that paycheck every month, going from being a broke PA student, living off of loans, it can be hard to not splurge and if you're trying to repay your student loans within a few years, it's something that you really just have to try to plan ahead. So part of the reason that I'm on social media is to help advocate for PAs in general, but also for DERM PAs. I want there to be information out there about the profession and about what that looks like and so that people can make educated decisions themselves. So you can know what you might be getting yourself into as a DERM PA before you do so. I think the more information you have, the better. I love to research things probably too much so I can't say that there was much about being a DERM PA out there before I went to school and so it's really nice to have great people to follow and I love learning from other DERM PAs myself and so I think it's a great place to be to help spread the word and help advocate. I get a lot of questions about being a DERM PA and that's what's prompted me to do blog posts and videos about it because I want that information to be available so yeah, I embrace it. Definitely embrace it. I definitely embrace the idea of being a social media influencer for future PAs. I think it's so much fun. I love answering pre-PAs questions or even PA students. I don't feel like it's a burden. I just think it's a lot of fun. I love our Instagram PA community that we have. Everybody is just so supportive. I feel like there's no sense of competition or anything like that and I just think the more you know, the better and what better way than having all of these people on social media that post things and who you can reach out to. PAs on social media who are just like in their profile, oh DM me or PA questions and I love that. I love the support. Feel free to message me and I'd love to answer any of your questions that I can. I think one thing just for a final thought would be if you want to work in DERM, don't give up on it. It may seem like the jobs are hard to get but they're out there and you really just have to keep trying for them and keep pushing and looking and asking. So don't feel like if you don't get a job in DERM right after graduating, you won't be able to do it ever. That's not true. It is a little bit more difficult I would say in big cities to get those jobs. So you may have to work in a smaller town for a little bit, get some experience before moving on but if you want a job in DERM, they're there and you just gotta go look for them. So don't give up. It's a great field. I hope I never have to leave. Advice to pre-physician assistant students and to current PA students is just to really keep an open mind. You might go into PA school with one specialty in mind and just kind of try to. I honestly, I thought I was just gonna get by just kind of make it through so I could work in dermatology and after doing my clinicals in the hospital, just learning so much about diseases and about just everything. I kind of did fall in love with medicine and I wanted to make sure that I had a good foundation and good general knowledge for, you know, when I have kids and they get sick or I have family members or friends who are sick or were diagnosed with something and just kind of want an opinion from somebody close to them. So I love the fact that I did family medicine for three years before specializing. I have no regrets. I grew tremendously from that and but also if you wanna go straight into your specialty, I encourage that 100% too. Honestly, if I was offered my dream job in dermatology in Orlando after I graduated, I would have taken that and I don't think I would have had any regrets at all. So my advice, just keep an open mind, learn as much as you can, make the most out of your clinical rotations, you know, be assertive, make sure you're doing everything that you should be as far as procedures and, you know, that hands-on patient care experience and so important. Build those connections while you're doing your clinicals because that can be a future job. So good luck to all of you. Like I said, if you have any questions, feel free to DM me. I'm the polish PA on Instagram. I just wanna say thank you to Stephanie and Savannah for being a part of this documentary and sharing their story. I hope you guys enjoyed the documentary and you all just got a little bit more information on what it means to actually be a dermatology PA. I know I'm even more interested in the field. I'm super excited and this is just another step in terms of getting more information on the field and the different fields that the PA profession has to offer. So as you guys always know and as I always say, do your research, do your research. The more informed you are, the better decisions you can make and this is an aspect of doing research, finding out that the dermatology field has a lot to offer, finding out that there's so much more in the PA profession than just being in the ER. So hopefully you guys can take that to heart and go ahead and do that research that I always talk to you all about. If you haven't already seen my other True Life series, please be sure to go ahead and check those out. I will leave a link for them. If you haven't already done so, go ahead and subscribe to my channel and follow me on Instagram at Adana, the PA. And guys, I really appreciate all of your input. So if you have any suggestions for a new True Life series that you would like to see, go ahead and leave that in the comment section below. Thank you guys so much for watching and I will talk to you guys later.