It has become more and more common to see non-physicians for skin problems. I see patients all the time whom have never seen a physician for their skin care. Is this advisable?
Let’s first look at the difference between these practioners.
- Education
- A physician must complete four years of medical school and at least three years of residency training specific to Dermatology, supervised by a Dermatologist. This training is thorough and must include Pediatric Dermatology, General/Medical Dermatology, Skin Pathology, and Skin Surgery. After such training, the physician is eligible to take a board examination in Dermatology, certifying that he/she has met the requirements to become board-certified in Dermatology.
- A Nurse Practitioner (NP) must first complete a degree in Nursing. Most will have some experience as a nurse and then go on to complete training to become a Nurse Practitioner. There is no additional clinical training (i.e. Residency) after they receive their degree. There is no formal training in Dermatology, except some elective time shadowing a Dermatologist that some may take.
- A Physician’s assistant (PA) completes three years of medical education. There is no additional clinical training required after they receive their degree. There is no formal Dermatology training.
- Experience
- A Dermatologist has at least three years of supervised training in an accredited training program in Dermatology. After successful completion of this training, the physician can then go and see patients as a “Dermatologist”.
- The experience that a Nurse Practitioner has that is specific to Dermatology varies greatly. Nearly all have no formal training (i.e. accredited training program) in Dermatology. Most will have no supervisory training. Some will have “shadowed” Dermatologists during a rotation or two, that are usually 4 weeks long. Some Dermatologists will have a new Nurse Practitioner shadow them for some short amount of time before allowing them to see patients. Mohs Nurse Practitioners have little or no hands on surgical experience when they receive their degree. Very few will have formal Dermatology training that amounts to about 12 weeks of training, with many hours being online.
- The experience that a Physician’s assistant has that is specific to Dermatology varies greatly. Nearly all have no formal training (i.e. accredited training program) in Dermatology. Most will have no supervisory training. Some will have “shadowed” Dermatologists during a rotation or two, that are usually 4 weeks long. Some Dermatologists will have a new Physician’s assistant shadow them for some short amount of time before allowing them to see patients. Most Physician’s Assistants will have surgical experience during their education, although usually not as primary surgeon, but as a first or second assistant. Such cases are usually related to General Surgery or other Surgical fields. Very few will have some short formal Dermatology training.
Do you think that seeing a PA or NP is the same as seeing a Dermatologist?
Absolutely not! Aside from the differences above, a recent study in Dermatologic Surgery April 2025 showed that NPs and PAs are far more likely to perform a biopsy than a Dermatologist. I believe that the reason is lack of knowledge and/or experience. If one looks and knows what something is, a biopsy may not be necessary. If one does not know what something is, it is more likely that a biopsy is taken.
Summary
Given the option to see a board-certified Dermatologist or a NP or PA, it is always best to see a board-certified Dermatologist for skin, hair, and nail diseases. Period!
If one has a new problem it is highly advisable to see a board-certified Dermatologist as you are more likely to be properly diagnosed, have less chance of getting a biopsy taken, and more likely to be treated appropriately. For follow-up visits, when a diagnosis is established and a treatment plan has been initiated by a Dermatologist, it “may” be appropriate to see a NP or PA for follow-up visits to access how you are responding to treatment. It would still be best to see a Dermatologist.
Let’s look at this in simple terms. If you were to watch Rembrandt paint for 4 weeks, 8 weeks, or even 12 weeks, will you be an artist at the level of Rembrandt? Of course not! If one shadows a Dermatologist for 4, 8, or 12 weeks, can they make accurate diagnosis as a Dermatologist does, perform biopsies as a Dermatologist does, or discuss treatment options as a Dermatologist. In nearly all cases, of course not! Many of you have seen Youtube videos of surgeries, but can you perform one? Of course not. If you need to see a skin specialist, then see a skin specialist–one that has three years of specific training in an accredited program and is board-certified. That is what you are paying for.