Here’s How to Become a Dermatology PA. Is It the Right Specialty for You?
If you regularly proclaim the benefits of petroleum jelly as a skin moisturizer and think it is superior to antibiotic ointment for wounds, dermatology may be the right PA specialty for you. My interest in dermatology stems from a curiosity about the weird red bumps on the back of my arms (keratosis pilaris), my dry skin in the winter (xerosis cutis), and family members with poison ivy allergy (allergic contact dermatitis) and severe childhood eczema (atopic dermatitis).
Before PA school
Before you’re consumed with starting didactic year, studying for rotation exams, and wondering when to dive into PANCE review, medical experience is a must. Prior to applying to a PA program, I applied to positions as a scribe or medical assistant and was hired in a private dermatology practice. This experience cemented my interest in dermatology. As a medical assistant, I scribed for the PA and physician, set up biopsy trays, processed specimens to send for pathology, sterilized instruments, and called patients with pathology results. The experience was invaluable in preparing me for an elective rotation in dermatology because of the first-hand knowledge I received:
- Insight into all of the positions necessary to keep a dermatology practice running smoothly.
- Practice setting up for procedures quickly and without waste. I learned how many gauze pads are needed for a tangential shave biopsy (just 1), when to have extra aluminum chloride hexahydrate or electrocautery ready (for deep biopsies or patients who are on antiplatelet therapies), and to always have a permanent marker ready to label specimen bottles for multiple biopsies.
- Necessary knowledge to anticipate the tools needed for a visit (Wood’s lamp for possible vitiligo, intralesional triamcinolone for a keloid, liquid nitrogen for warts) and tasks to complete during downtime (sterilizing instruments, preparing lidocaine, ensuring rooms have consent forms).
During my PA program elective rotation in dermatology, I told my preceptor and residents about my interest in dermatology and my hope to work in the specialty after graduating. If you know or have narrowed down which specialty you want to work in, make this clear during your rotation!
- It demonstrates your commitment to the specialty and your desire to actively participate during the clerkship.
- It gives you the potential to learn procedures and possibly perform simple procedures with the guidance of the preceptor (skin tag removal, cryotherapy for warts, local anesthesia, suturing).
- It gives the preceptor time to contact colleagues and dermatologists in the area who may be hiring.
- It can prompt the preceptor or residents to recommend textbooks for further study and reference.
Researching your master’s thesis
As part of the graduation requirement for my PA program, each student needed to complete a master’s thesis on either a pharmacologic treatment for a disease, a community-based intervention, or a literature review of a translational research question. Fortunately for me, dupilumab was FDA approved months before I began considering my thesis. I have a family member with moderate to severe atopic dermatitis, so I was interested in researching the only indicated treatment for patients ages 18 years old or older. (Note: the FDA has recently approved dupilumab for patients ages 12 years old or older.) If your program requires you to do a similar type of thesis, choose a topic in your specialty so you can gain even more knowledge before certification.
I asked my dermatology preceptor to be my research advisor for my thesis. Again, any opportunity to discuss dermatology or research dermatology diseases and treatments will provide invaluable clinical knowledge for the future. It’s also a handy tool in interviews to show your passion for the specialty and demonstrate your commitment.
It sounds cliché, but the day-to-day “work” of being a dermatology PA doesn’t feel like work to me. I loved working in a private practice before PA school and my rotation in a hospital-based outpatient dermatology practice. Now I love working in a hospital-based outpatient dermatology practice. I see a variety of patients and presentations, and the passion of the dermatologists, residents, nurse practitioners, medical assistants, staff, and administrators in my department is inspiring.
If you think dermatology might be the right specialty for you, here are the day-to-day activities you can expect. (This is based on my job, others may vary):
- Working hours from 7:45 am to 4–5 pm depending on the last patient appointment. Patient appointments begin at 8 am every 15 minutes with the last appointment at 4 pm.
- Seeing patients for everything from acne, warts, acute rashes, and spot checks to follow-ups with patients who have atopic dermatitis.
- Performing procedures such as simple excision of cysts, medication injections, wart cryotherapy, or biopsies for suspicious lesions.
- Calling patients with pathology or lab results, answering questions, or providing medication refills.
- Collaborating with the prior authorization coordinator for medications requiring prior authorization or medication appeals.
- Routing patients to the appropriate provider for specialized continuation of care such as skin cancer treatments (including Mohs micrographic surgery), inclusion in clinical trials, and follow-up with providers specializing in conditions (such as hidradenitis suppurativa, psoriasis, or cancer).
- Reading journals, attending continuing medical education courses, and discussing evidence-based treatment modalities with colleagues.
I know dermatology is the right specialty for me because I love what I do even with a 2- to 3-hour daily commute and time outside of clinic hours calling patients and completing charts. I’ve had to navigate encounters with patients who “only want to see the doctor,” and I’ve successfully ended these with an explanation of the history of the PA profession.
It’s important for patients to know that PAs are capable medical providers trained in general medicine similar to the training doctors experienced prior to entering World War II. I explain that PAs are medical professionals who diagnose illness, order and interpret diagnostic tests, develop and manage treatment plans, and prescribe medication. After this conversation, patients typically want to schedule with me for future appointments!
So, if you aspire to look at skin, hair, and nails up close, want to perfect a fungal scraping and potassium hydroxide (KOH) preparation, or vouch for the benefits of lukewarm showers with gentle soap and no washcloth, dermatology may be the specialty for you. It is dynamic, personal, challenging, and ultimately rewarding. I’m continually excited to learn new ways to manage common dermatologic conditions and feel privileged to practice in this specialty every day.
Find out more information about Rosh Review’s PA Qbanks.
Is this the right PA specialty for you? is a series that provides practical advice from PA-Cs for students and individuals looking for their right fit.