Today I wanted to write about one of the biggest challenges of being a Physician Assistant owned dermatology based clinic. I know a college student through one of the wards on the BYU-I Campus where I serve in a bishopric. Several weeks ago, he approached me and asked me about a lump on his neck that he had had for several months. I told him it was most likely a sebaceous cyst that had gotten plugged up and could easily be removed but he would need to get a referral from the BYU-I health center before he could see me because he was on the student insurance. About two weeks later, the lump on his neck suddenly became swollen, inflammed, red, and extremely painful. He went to the health center to get the referral but it was closed. On their answering machine they told patients to go to the local urgent care if they needed to be treated. The student went to the urgent care and asked for a referral to see me but was told that they do not refer to me because, and I quote “why would we refer a patient to someone who has less training that we have?”. This particular doctor has said similar things in the past about me. Little does this doctor know that I have been out of school for 16 years, passed by boards 3 times and have 12 years of dermatology experience and attend a dermatology conference every year. Anyway, back to the BYU-I student with the painful lump on his neck. He was told by the urgent care doc that they don’t touch anything on the neck. He was then referred to a local ENT doctor for further evaluation, which was an appropriate thing to do. This part I don’t understand, the ENT changed his antibiotic because the one the urgent care doc gave his was wrong, but then he told the student to wait a few more days! The student then called me, frustrated and in severe pain, asking why it was so difficult to get into see me. I told him to meet me at my office and I would treat him for free!!!. I put him on my exam table, cleaned, anesthetized, and sterilized the 3cm lesion and then, using a sterile #11 scapel, I lanced it. Copious amounts of mucopurulent (pus) discharge was expressed from the lesion, immediately relieving the patient’s pain. The incision site was packed with a small amount of sterile packing strips which were removed 2 days later. Within a few days the patient was completely better. Why did he have to go through so much to see someone that could fix him, but happened to be a PA? I get alot of referrals from many of the great providers in Rexburg, but there are still some anti-PA providers that are only hurting patients and helping contribute to the high cost of healthcare. The student in this story was able to go back to the BYU-I health center after the fact, explain what happened to him and get a referral to me so that I was able to get paid, but it should have been simpler than that.