Still a Big Need: The Dermatology NP/PA Market in 2026

Demand for dermatology NPs and PAs continues to grow, and compensation remains competitive, says Michelle Sullentrup of myDermRecruiter.com. She gives insights on the current and future job market. Plus, Michelle Hure, MD says it's time to re-think the punch biopsy, and DEF's Joe Gorelick, MSN, FNP-C announces the theme for DERM2026!

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Transcript

Transcript provided as a courtesy. It has not been reviewed or edited for accuracy. 

Welcome to The Dermalorian(TM) Podcast from the Dermatology Education Foundation. There are mixed signals about the health of the U.S. labor market. What, if anything, has changed in terms of employment opportunities for dermatology NPs and PAs? Are there any changes in compensation trends? To find out, we spoke with Michelle Sullentrup, founder and CEO of mydermrecruiter.com. Many of you are probably familiar with Michelle, but Michelle, please tell us a little bit about yourself and about myDermRecruiter.

Yeah. Thank you so much for having me, Paul. I appreciate your time. Yeah. I am the founder and CEO of myDermRecruiter, as you've said. We have spent the last 12 years dedicated specifically to the specialty of dermatology. So we only work in dermatology-placing providers. So that's your dermatology physicians and especially NPs and PAs nationwide.

So this time last year, we chatted a little bit about the job market for NPs and PAs in dermatology. Can you give us an update now what's changed, what hasn't, and how are things looking in terms of opportunities?

There's always still, which is great news, there's always a big need nationally for derm-experienced NPs and PAs. So that's the good news. I did look at some numbers based on our discussion last year. Last year, we had about 120 openings at this time. Right now, we're down to 78 openings at this time. So a little bit of fluctuation down, but that could be due to a lot of things that are going on in the news and in the world right now too.

But we do have our clients still coming to us daily, weekly saying, "Do you have an experienced derm NP or PA for this clinic in this city and state that we got to have somebody tomorrow?" So there's still a big need. We are seeing a little more turnover over the last 12 months as well, just because I think a lot of NPs and PAs are more educated now on what type of compensation they should be seeing in the market, as well as what they should know about their own day-to-day practice. Right?

 Joe Gorelick and I talk a lot about knowing your numbers, and I think a lot of the NPs and PAs have really done a great job of educating themselves and learning what their numbers are, what they're bringing into a practice, and how they should be fairly compensated.

And you touched on the fact that there is some uncertainty. I think a lot of experts are saying that the economy is a little hard to read right now. The job market's a little hard to read right now. Do you think that that's translating into any changes in how people are approaching work in the derm space, maybe not looking to change even if they don't love, love their job? They might just want to stick with it for a little longer?

 Yeah. I think that does happen. We do see that happen. When there is uncertainty, people tend to stand still and not make a lot of moves. But with that being said, there's a lot of information coming down as far as reimbursements go in the world of dermatology and a lot of changes being made all the time that the physicians and physician owners and PE groups have to keep up with.

 So they may stall a little bit as well, because maybe their reimbursement in a certain area went down or they're concerned more. So they may stall a little bit at this time. But I have to say, we still have just a ton of clients that are banging on our door for the great candidates. So maybe they're being a little more picky right now, and then only making a move if they have to. They've got to fill this need.

 But I think, like any human, we do tend to stay a little bit still when there is uncertainty going on in the world. But I have to say, as far as our firm goes, we're in our 12th year, and we look at our data every year, and we've placed more providers this year than we have in the last three years at this time so far. So they come to us because we are specialized, and candidates as well. So I think if they are making moves, maybe they're doing it more thoughtfully with more data, more information, and they come to us for that a lot of the time.

 Does that potentially give folks an opportunity to negotiate a little bit more if they're wanting to stay and want to sweeten the pot for themselves a little bit to remain in a position?

 I think it can for sure. I think every situation obviously is unique and different, but I think if somebody is able to have the data that they need, they can show their current employer and say, "Hey, listen, I'm seeing this over here, and I want to stay here. I'm happy here, but I really need to get my pay up to here to be more competitive."

 I think a lot of the physician owners are listening to that, because they've seen the changes over the last few years. Also, with that being said, I have a lot of PAs and NPs that I meet face-to-face at DEF and just in the market usually that will come to me and ask for advice, "Hey, I got this contract. I'm looking at making a move quietly, confidentially. I've got this contract from this big PE group. I know you work with them. Can you tell me if this is a fair contract, if this is competitive, if this is everything I should have in this contract?"

  And my first thing to them is always like, "Come to us first. We'll get you in the door with the higher expectation or the expectation of what's very fair and we know that they're willing to pay." But we always still give free advice. Right? So I do that on a weekly basis as the CEO. I give a lot of free advice out to say, "Yeah. This looks really competitive," or "Hey, this looks above market. This is a good deal," or I had this week a very specific example, somebody who got a contract from PE, and it was sort of a mess. It didn't make sense, and we realized they sent her the wrong offer letter altogether. Right?

 So it's like, you need an expert to bounce these things off of, because you don't know what you don't know, and she wasn't able to see it. I was able to see it in two seconds, just because I've been doing this for a really long time. But I think having that advocate for yourself, if you are looking to make a move, but you feel like the market's a little scary right now, or you're not sure if you really should move right now. When you have an advocate like us on your side as far as having the data you need to move forward and feeling comfortable of what's fair and what's a good thing versus a bad thing in an offer or in a contract, that puts a lot of people's minds at ease.

You are listening to The Dermalorian Podcast from the Dermatology Education Foundation. Coming up, Michelle Sullentrup addresses the question on everyone's mind. What are the latest trends in compensation for dermatology NPs and PAs? But first, we pause for this episode's Dermalorian Clinical Clip. Dermatologist and dermatopathologist Dr. Michelle Hure says it's time to rethink the punch biopsy. Here's why.

Punch biopsies are not always necessary. In fact, they're not what we want for pigmented lesions. I think this has always been a dogma that we have dealt with for so long. And unfortunately, it's just not going to lead to a good diagnosis. So punch biopsies are not the way to go for most pigmented lesions or even just a lot of lesions, except for inflammatory skin disease. And even then, we should actually be looking at different methods, because sometimes the punch is still not right for that either.

   Okay. And then number two for me is going to be having clinicians understand what the timeline is for getting their path reports back and that it's not a quick turnaround time for getting a decent, good diagnosis back. This is not a test that's a simple lab test that the computer spits out the answer. It takes time to actually produce a good diagnosis.

  The tissue has to be processed, and maybe testing has to be done. So the turnaround time is really nonnegotiable. And so, sometimes it takes a while, and I think that's something that unless you have some knowledge of how the tissue is actually processed, which is I go over that in one of my talks, you don't understand the process that the tissue goes through in order to get onto a slide under the microscope for us to look at and make that diagnosis. I think that's a really big myth, is that it's not a quick answer for derm path.

And the third, sometimes the biopsy is not going to be helpful. So there's that myth that the biopsy is going to tell you the answer. Unfortunately, especially when we're talking about an inflammatory skin disease, it's not going to tell you the answer, the cause. It's going to give us a pattern, an inflammatory pattern. Right? So it's not going to tell us what caused it. And so, no amount of repeat biopsy or second opinion or stains or special stains is going to help us with that answer, because that's just not what that biopsy is meant to tell us.

 We can't tell you what is causing your atopic dermatitis or allergic contact dermatitis. All we can tell you is that you have it. So I think that we have to understand what the limitations are of biopsy and what we actually are going to be getting as an answer and what is not actually appropriate to be asking from the biopsy.

 Let's get back to our conversation about dermatology NP and PA employment opportunities. And so, you mentioned that the NP or PA should kind of know their own data. We'll get to that in a second. But at myDermRecruiter, you guys, you have a wealth of data and really are the industry standard. So what's the latest in terms of compensation trends and where are things headed?

 Yeah. So we've seen that most NPs and PAs that have five years plus of experience are in that 28% to 33% of their overall collection. So what that means is, they're taking home that percentage of what they're bringing in. So if they're bringing in $1 million and they're bringing in 30%, $300,000. Right? So we're seeing that inch up, which is good.

  We have seen a lot of practices come to us lately and asking for advice, because their NPs or PAs are asking for a cost-of-living raise, and we haven't seen that before in dermatology. It's a different question, because most of these NPs and PAs sign contracts that are terms of two years, three years, but we have a lot of practices coming to us and going, "Hey, our NPs and PAs are asking for cost-of-living raises mid-contract. What do we do?"

   Well, technically, you're mid-contract. So there's no change, but I've encouraged them to say, "Well, let's find out why they're asking for this. What's the issues? What's the problem?" So we help practices to manage that as well, to keep those good employees that you're talking about that want to stay where they're at, but they see maybe what somebody else is making. We help them dig in and find out, like, "Well, why are they asking this question? Let's dig in and have that conversation."

So I am hired as a consultant a lot of times for private practices that will come to us and say, "Hey, I just want to keep them happy. Can you talk to them, see what they need, and then help us negotiate a better contract for them or a better term for them?" And so, yeah, I always want to get to the root of it, but that is something new that we've seen this year, cost-of-living raises, which doesn't apply to physicians ever, but these NPs and PAs are asking about it, and I don't think it's necessarily a bad thing. I think it's just, the key is to be smart in how you're approaching it as a candidate and also how you're advocating for yourself, but also sticking with your contract terms too. Right?

Makes sense. And so, you just mentioned obviously compensation being a percentage of collections, and I know this is something we discuss a lot, but it bears repeating. Could you talk a little bit about collections, billings versus collections? And that's really where the NP or PA needs to know their data, right?

Yeah. Absolutely. So we talk about, you'll hear those words, like you stated, billings, collections. There's a big difference. Right? So what you bill for the practice is not always what's collected. So I always tell people, forget billings, because billings honestly don't matter as much as what they're collecting for you. And your contract, 98% of the time, you're getting paid off of what they're collecting.

 So we use the word collections because of that. Right? So that means you might bill $1 million for the practice, but they collect 500,000 for you, and that $500,000 in collections is what your contract applies to of how you're getting paid. Okay? So if you're getting 30% of $1 million or 30% of $500,000, big difference. Right? So 98%, like I said, of contracts for all the employers nationally that we work with are going to pay you on that collections.

 And if you remember, collections is cash. How much cash came in the door to the practice that they actually received, and then what cut of that are you getting as an NP or PA? So I think that's really important, because if somebody is telling you, "Well, we bill $1.2 million in collections as an NP and PA here." Okay, but what do you collect on that? Because insurance companies don't always pay what they bill. Medicare has different rates of reimbursement. It's complicated.

     So you need to know what's your average collections for providers in that practice, because collection is cash. It's king. So that's how I always tell people to remember it and remember that verbiage, because I think sometimes NPs and PAs get confused by that when they're looking at offers or looking at opportunities, or even if a colleague is telling them about, "Well, I get paid 50% of collections over here," something crazy. Right? And it's like, "Is it 50% of collections, or is it 50% of billings?" because that could be very, very different.

So we find that groups, that 2%, because, like I said, 98% of our practices that we work in nationally, they're paying you on that collections, that cash is king, but there are 2% out there, maybe like a big hospital system or an academic institution of some kind, they sometimes will pay on billings. And it may seem like a higher percentage, but it's because they're not collecting dollars in the door as much. So it's a rarity, but that does happen out there too. But yeah, collections is cash. Cash is what matters to your practice owners and your practice administrators of what comes in the door and how you get paid. So that's how I always like to wrap that up for people.

 If you are employed at the practice and/or applying to a practice, you should be able to see what their average collections are, so you know what you're agreeing to. Right?

Yeah. Absolutely. And you can see in your EMR, if you have the proper access, which most providers do, that you are able to say, "This is how much I billed this much, and this is how much I was paid, our collections came in and what I was paid on," because they're comparing the EMR of what they billed to their commission report. Right?

   So they get a commission report saying, "Okay. This is what you're getting paid this month, that's above and beyond your draw or your percentage of collections that has been agreed to in that contract." So yeah, they'll be able to quickly do a math calculation and show, like, "Oh, this is about 35% or 40%." And it does fluctuate a little bit in the beginning of the year, especially right now, January, February, March.

  Medicare is really slow to reimburse in the beginning of the year, and then we've had a couple government shutdowns. So that hasn't been very helpful either. So there are some willy-nilly things going on right now with collections specifically because of that. So they'll get to it, but there may be a delay.

   Okay. Excellent. So another trend that we're seeing is that NPs and PAs in dermatology are getting increasingly interested in opportunities beyond patient care. So in some practices, they're working on running research. Some of them are doing other things within the practice. Are these things that you're beginning to see reflected in the job searches, that it's not just necessarily searching for someone who will see patients, but might do other things within the practice?

At myDermRecruiter, we're not seeing a ton of that. We are getting still about 98% of patient-facing opportunities that we're representing, but there are about 2%, again, in that academic or hospital-based settings that are asking for some research, but it's a very small percentage of what we're seeing.

 Okay. Makes sense. So we do know that NP and PA positions are popular. We've seen U.S. News has had... I think NP has been first place at least for two years. NP and PA has been in the top five for several years.

We've definitely seen growth within dermatology. Any predictions? I know I'm putting you on the spot a little bit, but do you think there's going to be continued opportunity for growth for more NPs and PAs in this space?

 I do, because as long as they're not making more and more derms every year, which they aren't, there's only a limited number of dermatologists we're getting every year, and the patient demand is huge. In the last 12 years, and really beyond that, and, not to age myself, in the last 25-plus years, I've never seen a downturn in the need for dermatology providers. It just simply isn't there, because there aren't enough providers that specialize in dermatology nationally.

  So hopefully, we see more and more NPs and PAs come into the specialty, because the doctors need the support. And doctors that we deal with, they love their NPs and PAs in their practice. They like to mentor them, help them, do great things with them as far as patient education, and so really support them. So we try to only work with practices that are going to treat our NPs and PAs really well. We love helping them find the right opportunities.

   There's been plenty of people that we've placed elsewhere, help them get out of a job and get into a better job that really changes their life financially, as well as their schedule. We had a lot of people still working five days a week, 8:00 to 5:00, on a flat salary with no commission or bonus system of any kind. There's still those people out there in rural markets, and they may think, "Oh, this is all that our area has available." It's not. We can tell you there's opportunities available out there that have great pay, great work-life balance options.

 So definitely get on our website or download our app. It's free. It's myDermJobs, our app is, and then, of course, our website is mydermrecruiter.com, and there's jobs popping up on those places every single day that we get direct from employers. There's no fake jobs on our sites. So everything we have out there is real. We have real relationships long-term with these clients, and we can get you a better opportunity for sure.

Awesome. And just to clarify for folks who may not be familiar with the process, when you're working with someone to get placed, there's no fee to them. Correct?

No. No. Our services are 100% free to you as an NP, a PA, or even a physician in dermatology, because our job is to go out and find top talent for the clients that pay us and trust us to represent their brands and their practices. And I'll tell you what, we're picky about who we will represent as well, because we only work in derm. So we have to keep our reputation stellar.

 So if I place you with a client that treats you poorly, doesn't do a good job of keeping you happy there, that's bad on me. So we don't do that. So we work with the best in the industry nationally. They pay us to go out and find top talent. We are organically aligned to work with you as a candidate, you as a job seeker, because we're not going to talk you into a job.

   We're going to show you, "Hey, here's three options that are available to you that fit all your criteria that look really great to us. They're competitive. We know this area. We know the contract they provided the last guy, and this is the same or better." So all of those nuances, they don't have to look for on their own. And yeah, it's absolutely free.

Excellent. And I think our audience would agree. Folks recognize myDermRecruiter as a leader in this space dedicated to dermatology and, like you said, really being a partner and an advocate for dermatologists, but especially NPs and PAs that are looking for positions. You can get more from Michelle Sullentrup on the DEF website at dermnppa.org, and plan to attend the career symposium at the DEF Essential Resource Meeting NP/PA CME Conference or DERM2026 this summer. In case you missed it, DEF has announced that the theme for DERM2026 is The Wizard of Oz. DEF president, nurse practitioner Joe Gorelick revealed the theme on social media this week.

   There's no place like DERM. Follow the yellow brick road to DERM2026 NP/PA CME Conference.

Get more information and register to attend at dermnppa.org. We hope to see you there. Thanks for joining us for The Dermalorian Podcast, which is produced for the DEF by Physician Resources.