u/SeesawElectronic8310

Maybe I need to get off Reddit 😂 but genuine question for the derm PAs here:

Why is there SO much hate toward dermatology PAs specifically?

I completely understand—and agree with—concerns about inadequately trained providers practicing outside their competence, especially with how popular derm/aesthetics has become. But some of the opinions I’m seeing go way beyond that.

Apparently PAs shouldn’t do initial skin checks or see new patients, should mostly be limited to stable follow-ups/refills and standardized protocols, and according to one person, PAs who specialize at all are “weird” because our profession was created to address healthcare shortages and therefore we should essentially be working in primary care.

But…why derm?

PAs are literally in EVERY field of medicine. We work in emergency medicine, urgent care, critical care, cardiology, oncology, surgery, neurosurgery, transplant—the list goes on.

So a PA can evaluate an undifferentiated patient in the ER, recognize an MI/stroke/PE/sepsis, manage critically ill patients, assist in major surgery, or literally RUN a code…but prescribing Accutane, evaluating a rash, or deciding whether a lesion warrants biopsy is suddenly where the PA profession becomes inappropriate?

Obviously those examples require completely different training and competencies—and that’s exactly my point. Nobody graduates PA school prepared to independently practice every specialty. We develop specialty-specific knowledge through training, experience, continued education, mentorship, and collaboration with physicians. Why is dermatology treated as though it’s uniquely impossible for a PA to develop that expertise?

And I genuinely wonder how much of the resentment toward derm specifically is about money or the perception that we chose an “easy” or desirable specialty for a “quick buck.”

Because why is a physician choosing a competitive, desirable specialty considered ambition, while a PA choosing that same specialty is framed as greed? And why should our scope somehow be determined by how desirable the specialty is?

Sometimes the argument genuinely starts to sound like: “You may practice medicine as a PA—just not in the specialties people actually want.”

If the concern is competency, then hold us to competency. If the concern is training, require appropriate training. But “this specialty is desirable and well compensated, therefore PAs shouldn’t be practicing in it” isn’t a patient-safety or competency standard.

That part also bothers me personally because I specifically chose the PA profession in part because I knew I wanted dermatology. I didn’t stumble into derm because I heard it paid well. This was the field I wanted. Derm could be one of the lowest-paying specialties and I would still choose it because I genuinely love what I do.

I’ve been in derm for 8 years and I’m still constantly studying, taking courses, attending conferences and trainings, asking questions, and trying to become better at what I do. I don’t expect that learning to ever stop.

Obviously there are bad PAs. There are bad physicians. There are bad clinicians in every profession. And I absolutely think poorly trained people entering derm/aesthetics deserve scrutiny. But that’s a competency and training issue.

Hold us to competency standards. Hold us accountable for practicing within our training and knowing when to involve our supervising/collaborating physicians. Absolutely.

But when did the conversation shift from “practice within your training and competency” to “PAs inherently cannot develop expertise within a specialty”?

Is this something you guys are seeing more of too? And why do you think derm in particular seems to get SO much of it? Because I genuinely don’t remember the anti-PA sentiment being this intense earlier in my career.

EDIT: I think some of the comments helped me clarify what I’m actually asking: why does simply wanting this particular career make people question someone’s motives, character, or worthiness to be a PA? That’s the part I’m trying to understand.

Maybe I need to get off Reddit 😂 but genuine question for the derm PAs here:

Why is there SO much hate toward dermatology PAs specifically?

I completely understand—and agree with—concerns about inadequately trained providers practicing outside their competence, especially with how popular derm/aesthetics has become. But some of the opinions I’m seeing go way beyond that.

Apparently PAs shouldn’t do initial skin checks or see new patients, should mostly be limited to stable follow-ups/refills and standardized protocols, and according to one person, PAs who specialize at all are “weird” because our profession was created to address healthcare shortages and therefore we should essentially be working in primary care.

But…why derm?

PAs are literally in EVERY field of medicine. We work in emergency medicine, urgent care, critical care, cardiology, oncology, surgery, neurosurgery, transplant—the list goes on.

So a PA can evaluate an undifferentiated patient in the ER, recognize an MI/stroke/PE/sepsis, manage critically ill patients, assist in major surgery, or literally RUN a code…but prescribing Accutane, evaluating a rash, or deciding whether a lesion warrants biopsy is suddenly where the PA profession becomes inappropriate?

Obviously those examples require completely different training and competencies—and that’s exactly my point. Nobody graduates PA school prepared to independently practice every specialty. We develop specialty-specific knowledge through training, experience, continued education, mentorship, and collaboration with physicians. Why is dermatology treated as though it’s uniquely impossible for a PA to develop that expertise?

And I genuinely wonder how much of the resentment toward derm specifically is about money or the perception that we chose an “easy” or desirable specialty for a “quick buck.”

Because why is a physician choosing a competitive, desirable specialty considered ambition, while a PA choosing that same specialty is framed as greed? And why should our scope somehow be determined by how desirable the specialty is?

Sometimes the argument genuinely starts to sound like: “You may practice medicine as a PA—just not in the specialties people actually want.”

If the concern is competency, then hold us to competency. If the concern is training, require appropriate training. But “this specialty is desirable and well compensated, therefore PAs shouldn’t be practicing in it” isn’t a patient-safety or competency standard.

That part also bothers me personally because I specifically chose the PA profession in part because I knew I wanted dermatology. I didn’t stumble into derm because I heard it paid well. This was the field I wanted. Derm could be one of the lowest-paying specialties and I would still choose it because I genuinely love what I do.

I’ve been in derm for 8 years and I’m still constantly studying, taking courses, attending conferences and trainings, asking questions, and trying to become better at what I do. I don’t expect that learning to ever stop.

Obviously there are bad PAs. There are bad physicians. There are bad clinicians in every profession. And I absolutely think poorly trained people entering derm/aesthetics deserve scrutiny. But that’s a competency and training issue.

Hold us to competency standards. Hold us accountable for practicing within our training and knowing when to involve our supervising/collaborating physicians. Absolutely.

But when did the conversation shift from “practice within your training and competency” to “PAs inherently cannot develop expertise within a specialty”?

Is this something you guys are seeing more of too? And why do you think derm in particular seems to get SO much of it? Because I genuinely don’t remember the anti-PA sentiment being this intense earlier in my career.