Core competencies for dermatology physician assistants: knowledge recommendations from a national survey of dermatologists and physician assistants

Abstract The specialty of dermatology has no formal competency guidelines for its physician assistant (PA) workforce, which doubled in the past decade and is the 5th-largest of any specialty. We set out to delineate potential core competencies for dermatology PAs by surveying dermatologists and PAs. A survey was sent to 97 PAs and 142 dermatologists, consisting of 149 dermatologic diagnoses and systemic medications. Participants were asked to rate items on a sliding scale of proficiency, according to the knowledge they expect of PAs after 2 years of dermatology employment. Participants were solicited via email, phone, and in-person at professional functions. Contact information was obtained from clinic websites, corresponding authors of relevant articles, and the American Medical Association’s directory of dermatology residencies. Clinicians without 2 years of relevant experience were excluded. Clinicians recorded their license type, years practicing dermatology, state of licensure, and optional comments. Data were collected between 01/10/2022-02/28/2023. Diagnoses and medications eliciting strong recommendations for comprehensive understanding from both dermatologists and PAs, discrepancies between each cohorts’ responses, and variability of individual answers. The response rate was 72%. At least 50% of the 79 dermatologists and 79 PAs who met inclusion criteria answered “start treatment” or “manage most” for 67 and 91 of 102 diagnoses, respectively. At least 50% of each expected proficiency for most common infections, eruptions, benign lesions, and non-melanoma skin cancers. At least 50% of dermatologists and PAs recommended strong knowledge for 32 and 39 of 47 medications, respectively. Free-typed comments were submitted by 22 dermatologists and 23 PAs; these mutually endorsed the dermatologist-led care team model and highlighted the heterogeneous nature of the current workforce’s aptitudes, citing variation of individuals and settings. This information could serve interprofessional efforts toward establishing nationally-recognized clinical competencies, thereby facilitating more uniformly excellent patient care from PAs on dermatologist-led teams. Educational needs for early-career PAs will vary by institution; thoughtfully-planned standards might formally enable competence demonstration in specific areas of dermatology.