Putting in the Hours: Optimizing the Role for Dermatology NP/PAs

When it comes to career advancement, putting in hours beyond the clinic day can make the biggest difference, says DEF Advisory Council member Andrea Nguyen, DMSc, MPAS, PA-C. Cooperation and support are also key, she says. And it's also important not to sweat the small stuff. Plus, Lisa Swanson, MD provides an update on oral therapy for acne.

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Transcript

Transcript is provided as a courtesy only and has not been reviewed or edited for accuracy.

Welcome to the Dermalorian Podcast from the Dermatology Education Foundation. The Dermalorian Podcast is made possible with support from Johnson & Johnson. In October, the U.S. observed National Physician Assistant Week. This month marked National Nurse Practitioner Week coinciding with the 40th anniversary of the founding of the American Association of Nurse Practitioners. We caught up with Dermatology Physician Assistant and DEF Advisory Council member Andrea Nguyen, for an update on the ways NPs and PAs are coming together in the Dermatology specialty.

We are here at DERM2025 in the exhibit hall where I am joined by DEF Advisory Council member Andrea Nguyen. Andrea, why don't you tell us a little bit about yourself?

Andrea Nguyen:

Thank you so much, Paul, for the introduction and having me here. It's my absolute honor to be here with you, the DEF team, as well as all of our wonderful colleagues who are attendees and our industry partners here this year in DERM2025.

So a little bit about myself. I practice in Southern California. I've been a Dermatology PA for the past 14 years in clinical practice. And prior to that I did have a prior experience in dermatology as a Biologic Coordinator. And it's been so much fun being on both sides as ancillary staff and now as a clinician, and really seeing a lot of the evolution that we've had in this space and a lot of growth in so many different ways.

Paul:

Well, that's a perfect segue to what I want to talk to you about and that is really how MPs and PAs can grow personally, professionally, and really drive their careers. So you have been involved with the DEF for quite a while. Just tell us a little bit about why you decided to be involved with the DEF and what the DEF does that you think is so important?

Andrea Nguyen:

That's an excellent question. And a really important one is who do we choose to support, to associate with, and to really continue to build our relationships with professionally is something that we should all consider on a deeper level. Looking at the sentiment and the mission statement of the organizations, and from the get-go, from when I first met Joe and the DEF entire team, I had an overwhelming impression that this organization really advocates on the behalf of MPs and PAs. So we have a marriage of the two collective groups. And also the mission statement and the core sentiment of the foundation is really to improve us and elevate us as clinicians, which therefore allows us to deliver better outcomes for our patients. And I think that that sentiment of really champion on behalf of our collective group is so important. And when we look at organizations that is not always the default for every single organization.

And so really looking at the core team, the core mission statement of an association is really important. DEF meets on all marks, and everything that the DEF stands behind and tries to put out as educational initiatives is carefully thought out with that sentiment in mind. How do we best disseminate meaningful educational content to elevate MPs and PAs, whether that is professionally learning how to engage with your patients, having meaningful interactions, optimizing your clinical practice, learning how to do the logistics of clinical practice, but also improving yourself as a clinician. There are so many thoughtful ways that the DEF has really cultivated curriculum in achieving those outcomes for us, and it's a wonderful joy to be a part of it.

Paul:

We know that the number of NPs and PAs in dermatology is only expected to grow. And you touched on something really important for the DEF, which is that it is for dermatology NPs and for dermatology PAs. Why is that important that it's both within this organization?

Andrea Nguyen:

It's really important because at the end of the day, while our training models may differ in the curriculum and licensing and examination and you have different associations, at the conclusion of the day, we're still treating the same diseases, we're still seeing the same patients. And although our licensure and some of our recertification may have some differences, where we're collectively all similar as dermatology healthcare providers. So our educational content in disease state, how to take care of patients, how to deliver excellent outcomes, should be very similar and we should advocate as a collective group. And really that's how we make meaningful progress is there's power in numbers. So we should all join hands and we should work together. I really, really feel very passionate about us working together as NPs as well as PAs.

Paul:

You are listening to the Dermalorian podcast from the Dermatology Education Foundation. The Dermalorian podcast is made possible with support from Johnson & Johnson. November also marks World Antibiotic Awareness Day. For this episode's Dermalorian Clinical clip, Pediatric Dermatologist Dr. Lisa Swanson, provides an update on acne treatment and the selection of antibiotic therapies for the disease.

Dr. Lisa Swanson:

Acne is a really big burden for our young patients and we can help with so many things. We've got oodles of topicals and topicals are very, very important, but sometimes they're not enough and we have to reach for a pill. And we have three broad categories of pills for our patients dealing with acne. We have our oral antibiotics, we have our methods that work in a hormonal way and we have Isotretinoin. So when it comes to oral antibiotics, most of us use Minocycline or Doxycycline, and I think each of us have our own personal preference for the one we reach for. I, in fact, I have flip-flopped on this issue. I used to be a Doxy person, but in recent years I switched to being a Mino person, and it's because I was seeing so much sun sensitivity, so much GI upset with Doxy. And it occurred to me that some of the long-term side effects that we worry most about with Mino are when we prescribe it long-term, which we really aren't doing so much anymore.

So in recent years, I've become more of a Mino person. I also really love Sarecycline, and if cost coverage were equal, I would actually exclusively prescribe Sarecycline. Sarecycline, for those in the audience that don't know, is an oral antibiotic in the tetracycline family that's approved to treat acne. It's approved down to the age of nine, and it's very effective, just as effective as Mino or Doxy, but it doesn't bring any of those potential side effects to the table that minnow and doxy do. And so if costs and coverage were equal, I'd be a Sarecycline girl all the way, but sometimes it can be difficult to get insurance to cover the Sarecycline. And then we have our hormonal treatment options. So we have birth control pills and we have Spironolactone, which works in a hormonal way but is not a birth control pill. And these things come in very handy because they can be used long-term.

Of course, the only limitation in kids is they have to be female and they have to have started having a period. But other than that, it's fair game. With the use of birth control pills, I really wish we had another name for them because sometimes when I mention it as an option, I can tell the family is like, eh, about just the title birth control pills. And so I wish we had another name like a hormone regulator or something like that, because I think they'd be far more utilized if we could call them something else. But they help make life so much easier for teenage girls bringing a predictability to their periods and a much more comfortable period experience when you're on a birth control pill that they're really a wonderful tool to have. Spironolactone is nice if patients want to treat in a hormonal way but are worried they're not going to be able to take a pill at the same time every day, which birth control pills require.

Spironolactone is easy. It doesn't require any labs as long as the dose is under 200 milligrams a day. And I find a lot of patients do really great on that. It's also really nice for patients who might have an IUD or something like an Implanon in their arm. Those progesterone-related birth control options often bring more acne to the table and Spironolactone is a very effective way to squash it.

And then of course we have our gem of a treatment Isotretinoin. Don't know what I would do without Isotretinoin. It's such a comfortable security blanket for me with management of acne because I know when the patient isn't getting better or they're really traumatized by their acne, I know I can reach for Isotretinoin and it's such a nice thing to offer. It has a lot of stigma and I address that right off the bat in the patient exam room. I can tell when I say the word Isotretinoin or it's brand name, which is a little bit more familiar to lay people, I can tell they often get this look on their face like, oh no, oh no. And often I'll say, "What have you heard about Isotretinoin? It's often misrepresented." And frequently, they don't even know why they think it's bad. They just heard somewhere it was bad.

And so I go through my safety spiel and I say, "You know, Isotretinoin isn't appropriate for everybody, but I would hate for somebody to be avoiding it for the wrong reasons." And so I encourage them to read up about it, come to me with any questions and help me sort out truth from fiction. Because there is so much fiction out there about Isotretinoin. Most recently, I heard from a patient that they had heard that it can turn your bones green. And I'm like, A; how would you even know that? B; where does this information come from? How does this get spun to such an extreme degree? And so very important to have those solid conversations with patients and their families to determine if Isotretinoin is a good fit for them.

Paul:

Let's get back to Andrea Nguyen as she dives deeper into the opportunities for education and collaboration for dermatology NPs and PAs.

Andrea Nguyen:

The Dermatology Education Foundation really looks to mentor and help elevate eight NPs and PAs at any stage of their career. So whether you are fresh out of school, five years in practice, 10 years in practice, even 20 years in practice, there's a little bit of something for everyone. And the educational content frequently is cultivated and curated for each target group.

Paul:

And so obviously education, it's in the name, it's a key part of what the DEF does, but we also know that mentorship and sharing pearls and learning from people who have kind of been down this road already can be so important. So could you talk a little bit about some of the mentorship opportunities that you think are important for NPs and PAs in dermatology and maybe share some of your favorite perils that you like to give people who are looking for mentorship advice?

Andrea Nguyen:

Absolutely. Now, more than ever in this current climate with a vast number of growing dermatology, healthcare professionals, many of which are PAs and MPs, finding mentorship opportunities or career growth opportunities is more important than ever because we have seen a shift in the traditional way that newer graduates essentially come to private practice or an institutional practice, where you have a single supervising physician working hand-in-hand with a dermatology healthcare professional. So a lot of these nurse practitioners and PAs are looking for educational curriculum outside of just a singular relationship with a collaborating physician.

So mentorship opportunities, whether that's through relationships you cultivate at the live events, whether that's reaching out to us as far as the Advisory Council, getting connected, Joe has always been very supportive of our collective group and very open to helping facilitate educational opportunities, especially for the newer graduates, and even programs such as the Biologic Small Molecule Boot Camps.

That's very so, so important for newer to graduate APPs or APPs who are not as comfortable using some of these advanced therapeutic options. And it's even open to our staff. So our medical assistants who are interested, our biologic coordinators, many of us have struggled with staff changing and staff turnover. And really the training to get some of our ancillary staff up to speed, it takes time and you only have so many hours in a working day in clinic. It's really nice to unload some of that burden on the primary healthcare professional and to bring them to a meeting like the Biologic Small Molecule Boot Camp.

Paul:

And you hit on something else that I think is really important. We so often think of disease state education and helping people be better diagnosticians and better at choosing the best treatment for their patient, but there's so much just in a clinic day of working with staff and leading a staff that is so critical to what you guys do day` in and day out. And it's those sorts of topics that I think are so important to cover as well.

Andrea Nguyen:

Yeah, absolutely. And I agree with you wholeheartedly, Paul. So in our profession, first and foremost, we're going to go over disease states, therapeutic medications, all the logistics as far as how do you take care of your patient from a medical standpoint, diagnosing, workup, laboratory evaluations, how to get your patient to where they need to be. That's a majority of it, but there's a portion of that that is sort of the logistics workings of the visit. What do you do on the back end? How do you take care of your patient after you write your prescription, after you close the interview, how do you approach a patient engagement and interview to really set yourself up for success?

So there's so many things that happen in a working day, and really again, the content is cultivated to cover and encompass everything we do inclusively. So yesterday we had a really outstanding lecture on MIPS and discussing some of those nuances of what this means for us in clinical practice. And that has nothing to do with diagnosing a patient but is very important to us in our day-to-day working workflow. And additionally, just like prior authorizations, having well-trained staff that facilitate our patient encounters that help us get patients the right therapeutic agents for them, in a hopefully streamlined fashion, can really help patients. Because if they're sick and they need treatment now, isn't treatment sooner better than treatment many weeks or months later? And so these are kind of the additional logistical details that we might not think about, but definitely impact our clinical care.

Paul:

To bring it all together, I'm going to kind of throw you on the hot seat and just ask you, what is the most important career advice you would give your younger self if you could right now?

Andrea Nguyen:

Oh gosh. So that's a great question. I would say if it was to myself specifically, I would say don't sweat the small stuff, but you still have to put in the hours. It's not the hours during the workday from 9:00 to 5:00, it's what you do after 5:00 PM that really helps cultivate your growth. Right? And we're always learning. We're always evolving, always be curious. Always continue to seek the education that you need. But also don't forget to have fun. Don't sweat the small stuff. That's why I would tell my younger self.

Paul:

That is excellent advice. So with that, thank you very much, Andrea for joining us for the Dermalorian Podcast from the Dermatology Education Foundation.

Thanks for joining us. The Dermalorian Podcast is produced for the Dermatology Education Foundation by physician resources. Catch up on episodes you've missed wherever you stream podcasts, and spread the word to colleagues. We'll see you next time.