A Physician Assistant (PA) is a healthcare professional that serves as an extension of the Physician to provide accessible, quality healthcare. They are an integral part of the health care team and practice medicine under the direction and supervision of a licensed physician. PAs are nationally certified and state-licensed.

At Village Dermatology, we are fortunate to have 2 amazing PAs available for our patient’s dermatology care. Both Amanda Lanier, PA-C, and Kelly Fordham, PA-C, are licensed Physician Assistants with years of dermatology experience. However, before we discuss our PA\’s, let\’s review some of the most common questions we hear about physician assistants.

Why were physician assistants introduced into healthcare? What do they do? And what kind of training do they receive before they\’re allowed to see patients? Read on to find out.

Physician Assistants: A Brief History

In the mid-1960s, there was a shortage of primary care physicians in the United States. A doctor at the Duke University Medical Center in North Carolina, Eugene A. Stead Jr., MD, recognized the need for additional trained workers to improve and expand healthcare. He enrolled four Navy Hospital Corpsmen who had already received considerable medical training during their military service. These four individuals constituted the first physician assistants\’ class.

Stead based the curriculum of the first PA program on his knowledge of fast-track physician training during World War II. The first batch of PA students graduated from Duke University in 1967. The program was a great success and received federal backing as early as the 1970s, given the continuing physician shortage. Over the ensuing decades, the physician assistant profession has grown into a more formal one with accreditation standards, examinations, and requirements for continuing medical education. Presently, there is a high demand for PAs in the United States. The profession grew 300% from 2011 to 2014 and is estimated to grow by more than 30% between 2018 and 2028.

What do physician assistants do?

PAs work interdependently with Physicians to provide diagnostic and therapeutic patient care in virtually all medical specialties and settings. They take patient histories, perform physical examinations, order laboratory and other diagnostic studies, prescribe medications, and develop patient treatment plans. Their job descriptions are diverse and include clinical practice, patient education, team leadership, medical educations, health administration, and research. For many patients, a PA is their principal healthcare provider. This is very true for our patients at Village Dermatology, as they have experienced the quality care that our PA\’s offer them and prefer the availability of appointment slots offered by our PA team.

A 2014 poll commissioned by the American Academy of Physician Assistants (AAPA) found that the overwhelming majority of patients (more than 90%) think of PAs as trusted healthcare providers who provide excellent service. Also, physician assistants add value to healthcare teams, improve the quality of healthcare, and improve health outcomes for patients. Some of the key advantages of physician assistants, as perceived by patients, include:

• PAs explain things about health and treatment in ways that patients can understand.
• It is easier to get appointments at a medical practice that employs PAs.
• Most patients have great relationships with their PA.
• PAs focus on all of the patient\’s healthcare needs.
• PAs provide high-quality medical care at every appointment.
• Seeing a PA is associated with increased patient satisfaction.
• PAs educate patients about how to stay healthy or prevent illness.

How are physician assistants trained?

PAs are trained at the master\’s degree level. There are currently over 260 PA programs in the country. Admission is highly competitive, requiring a bachelor’s degree and completion of prerequisite courses. On average, incoming PA students bring with them more than 3,000 hours of direct patient contact experience, having worked previously in a medical profession. PA programs are approximately 27 months (three academic years). The PA school curriculum is modeled on the medical school curriculum that involves both didactic and clinical education training. In the didactic phase, students take courses in basic medical sciences, behavioral sciences, and behavioral ethics. In the clinical phase, students complete more than 2,000 hours of clinical rotations in medical and surgical disciplines, including family care, internal medicine, obstetrics and gynecology, pediatrics, general surgery, emergency medicine, psychiatry, and other fields such as dermatology. Upon graduation from an accredited PA program, they must pass a national certification exam and maintain their certification by completing 100 hours of continuing medical education (CME) every two years and a recertification exam every 10 years.

Where do physician assistants work?

Physician assistants can work in practically every healthcare setting, including medical offices, hospitals, nursing homes, community health centers, and many more. As PAs expand in their roles, so do the sub-specialties within this group of practitioners. They are no longer limited to internal medicine or family practice. One can find PAs in CV surgery, radiation oncology, plastic surgery, dermatology, among other areas.

How are PAs part of my dermatology care at Village Dermatology?

At Village Dermatology, we have two physician assistants, Amanda Lanier, PA-C, and Kelly Fordham, PA-C. Our PAs are highly trained and can function as your main dermatology provider no matter the reason that you come in. For example, they can see you for your skin cancer screening, and if you require biopsies or other treatment, they can perform these procedures. They can also diagnose and treat many different medical conditions, including acne, rosacea, psoriasis, eczema, and many others. At Village Dermatology, they are also able to perform numerous cosmetic procedures, including chemical peels, lasers, and microneedling, just to name a few.

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A nurse practitioner (NP) is a healthcare provider who works independently to manage people’s medical problems and prevent illness. Nurse practitioners often specialize in a specific patient population, for example, children, adults, women, or elderly individuals. Some nurse practitioners may specialize in a medical field such as cardiology, oncology, or dermatology. Currently, Village Dermatology is extremely fortunate to have the expertise of Wendy Cantrell, DNP, CRNP, available to serve our patients. Wendy is a Certified Registered Nurse Practitioner (CRNP) with years of experience in dermatology. However, before we get to that information, let’s examine some of the common questions you might have about nurse practitioners.

What kind of training do nurse practitioners receive? Where do they work? And how do they help improve healthcare in the United States? Read on to learn more.

Nurse Practitioners: A Brief History

The first nurse practitioner program was developed in the mid-1960s in Colorado as a certificate program by Henry Silver, MD, and Loretta Ford, RN, EdD. Ford is widely acknowledged as an international leader in nursing education. She was one of the first people to recognize that nurses with advanced education could improve healthcare, address the critical shortage of health providers, and improve access to healthcare in rural areas.

Silver and Ford jointly developed the nurse practitioner curriculum for pediatric practice. This program has been widely replicated in many fields of medicine, including gerontology, family health, mental health, and dermatology. The program developed by Ford and Silver became a master’s degree program in the 1970s. In 1977, the profession was further standardized with certification exams. The American Academy of Nurse Practitioners was founded in 1985. From an estimated 15,000 nurse practitioners in the US in 1979, the number grew to more than 200,000 NPs in 2015. It is estimated that there will be 244,000 NPs in the US by 2025.

What do nurse practitioners do?

What a specific NP does depends largely on their specialization and the state where they practice. In general, nurse practitioners provide healthcare services to a diverse population of patients in primary care, acute, and specialty settings.

A nurse practitioner is authorized to consult with a patient, obtain a medical history, perform an examination, order diagnostic tests, diagnose an illness, and treat a medical condition. Nurse practitioners also provide evidence-based counseling to patients to prevent illness and optimize health.

When you see a dermatology nurse practitioner, for example, you can expect to receive a thorough medical evaluation, diagnosis, medications (in some states), and individualized treatment plans for your skin, hair, and nail conditions. They will elicit a detailed medical history from you, conduct a physical examination, perform a medication review, and order and interpret laboratory studies if needed. The nurse practitioner may consult a dermatologist or other healthcare providers to provide you with comprehensive healthcare. Once the NP has diagnosed your condition, they will offer the appropriate treatment, follow up on your progress, and maintain detailed medical records.

The important thing to note is that NP’s do not see patients merely as people with a specific medical problem. Rather, they often serve as counselors, mentors, and advisors, and therefore provide a more holistic healthcare experience.

How are nurse practitioners trained?

Becoming a nurse practitioner takes up to 8 years of rigorous education. This includes 4 years to complete a bachelor’s level nursing program to become a registered nurse. Then, there are another 2-3 years to obtain a master’s degree. Plus, there’s additional time, approximately 1 year, to pass the certification examination.

A qualified nurse practitioner or APRN (advanced practice registered nurse) is one who has completed a master’s degree program or a doctor of nursing practice (DNP) degree. In addition to the master’s degree, NPs must have state licensure to practice. Those interested in further specialization must undergo credentialing from various associations such as the American Association of Critical Care Nurses or the Dermatology Nursing Certification Board.

As noted, an NP must complete a specialized nursing program and become certified in the specialty of their choosing. Meaning, when you see a dermatology nurse practitioner, you are seeing a healthcare provider who holds a masters or doctoral degree in nursing sciences, is licensed with the state as an advanced practice nurse, is board certified by the American Association of Nurse Practitioners (AANP) or American Nurses Credentialing Center (ANCC), and has specialization in dermatology medicine (Wendy has 20 years in dermatology). That’s a lot of education and training!

Where do nurse practitioners work?

Nurse practitioners work in a variety of medical settings and specialties. In addition to being a general NP, a nurse practitioner may specialize in a specific population of patients, for example, the elderly, children, or women. Also, nurse practitioners may choose to practice in a specific medical field, for example, family medicine, acute care, pediatrics, gerontology, neonatal care, women’s health, orthopedics, sports medicine, neurology, urology, and dermatology.

The scope of NP practice varies by state. In full practice states, nurse practitioners have complete authority, i.e., they can work without the direct supervision of a physician. In restricted practice states, NPs need to collaborate with a licensed physician who must sign off on certain medical decisions. However, even in these states, NPs still have more authority than registered nurses (RNs), and their responsibilities are similar to doctors.

How do nurse practitioners fit into my dermatology care?

Here at Village Dermatology, we see our nurse practitioners as an integral part of the medical team. There is so much demand for experienced dermatology care that many of our patients prefer to see our nurse practitioners because of their dermatology expertise and availability to see patients in a more timely manner. We are so thankful that we can provide our patients with outstanding nurse practitioners like Wendy Cantrell, DNP, CRNP. If you would like to schedule an appointment with any of our medical providers, please call us or fill out a form, and we will get you in as soon as possible.

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