r/DermatologyPA

Do you allow your patients to pledge abstinence as their primary form of birth control while on Accutane? Or make it a requirement for them to be on a form of birth control regardless if they’re abstinent?

I normally allow my patients to choose abstinence and I make sure to enforce contraception counseling every month. However, today I had a patient’s pregnancy test come back positive. That resulted in a long phone call with iPledge and a difficult conversation with the patient. Safe to say, I would like to never experience that again.

I’m curious to know everyone’s insights on what they normally do. TIA!

I recently saw two different dermatologists for separate full-body skin exams, and I was surprised by how differently they evaluated things.
The first dermatologist wanted to biopsy one small spot on my forearm. The second wasn't concerned about that spot, but instead recommended removing a mole on my chest. He also suggested freezing three spots on my face that I had been told were eczema.
It made me wonder how much variation there is in dermatologists' clinical judgment and decision-making. Is it common for different dermatologists to prioritize different spots or recommend different treatments during skin exams?
I'm not looking for medical advice—just interested in hearing whether others have had similar experiences and how common this kind of variation is.

Offer Review

So I countered at
-120k base - Median 0-1 year salary from 2025 AAPA salary report
- 20% after 75,000 quarterly
- 5 more days of PTO

- I asked what 10% collections look like and I couldn’t get an answer because the practice is newer and the current PA does not earn collections. The current PA was very nice on the phone but said she also felt like when she got the offer 2 years ago that it was low.

- current PA says she sees anywhere between 20-25 patients a day now has been there almost 2 years. Trained for about 6 weeks, felt like the doctor was a good teacher but wishes the didactic learning was more structured and recommends I do Boswell or SDPA fellowship

-I was told that the pay I’ve been offered with the collections is on the high end of the LCOL area and that what I’ve been offered is good for the opportunity. Not willing to go up on base or collections.

- Not willing to go up on PTO - which is so sad given I’m moving pretty far to for this.

- only willing to up my relocation by 2k so a total of 3k

IDK what to do. I’m giving up so much already by moving to the less desirable location - this is pretty upsetting. I think my only ask is that we document exactly when I’m done training for clawback purposes.

I genuinely feel like the are just new and the doctor doesn’t really know what she’s doing just yet but also the PTO thing feels a bit insane

————- see below for original offer:

New Grad PA and received an offer from a private dermatology practice that is willing to train a new grad. I do have another offer the pay and benefits run circles around this one, BUT it is not in dermatology but i do think it could help me get into derm later on.

Offer details:

-Training period (\~3 months): $75,000 salary
-After training/independent schedule: $105,000 salary
-Productivity bonus: 10% of quarterly collections above a specified threshold (<$100,000)
-Schedule: 36-40 hours a week
\-Relocation bonus: $1,000
\-CME: $2,000/year
\-PTO: 15 days total (vacation, sick, personal, and CME all come from the same bank)
\-Malpractice covered
\-State license covered
\-Board exam reimbursement
\-SIMPLE IRA with 3% match
\-Health insurance stipend
\-Contract includes a provision requiring repayment of training-period wages if employment ends before 24 months

Pros:
\-Private practice
\-Physician seems genuinely interested in mentoring a new grad
\-Opportunity to get directly into dermatology without doing another specialty first
\-Productivity bonus structure

Cons/Questions:

\-Training salary seems low
\-Post-training salary seems lower than many of the dermatology PA salaries I’ve seen discussed
\-PTO feels limited when CME & sick is included in the same bank
\-Relocation assistance is minimal and it would be out of state & I don’t love it and housing options seem minimal.
\-Unsure how common the repayment provision is

For dermatology PAs:

Is this fairly standard for a new grad derm offer in 2026?

What would you negotiate first?

Would you focus on salary, PTO/CME, removal of the repayment provision, or something else? I like to travel but also want to go to conferences to network and learn.

Is $105k after training reasonable for a new grad entering dermatology today?

During the process the doctor mentioned their current PA not doing cosmetics but Could I asked to be trained in Botox and Laser to help increase my earnings?

Can I ask for things like a didactic education outside of clinic be paid for? Extra money for conferences or dermatoscope etc?

Appreciate any thoughts from those already practicing in derm.

Does anybody on here actually have luck with actually getting their contracts restructured or do you have to bounce around?

Background of over 16 years practicing derm. Do both medical and cosmetic. Worked at a few different private practices. Current base salary of 150k and 25% collections after reaching 600k net.

Current employer was totally unwilling to negotiate any offers i brought to the table. Ex: lowering threshold to 3x base, a tiered % collections with no salary among other things.

I know my base salary is pretty strong, but with my experience i feel i should be closer to at least 30% collections and also feel my threshold of 4x is too high. The only offer I was given was a tier bonus % structure with no salary that would actually pay me less money based on 800k collections and only 2k more at 1 million collections, so that offer made no financial sense to me to lose my Base salary for basically a pay cut

Am I being unreasonable based off my YOE or are most providers just unwilling to negotiate with us and leaves us no choice to stick it out or bounce around.

Private group

80k first year no commission. 3ish months training
110k second year commission
130k third year commission
5% on 500k
7.5% on 750k
10% on 1 mil
14 days PTO
2k CME
No tail coverage if you leave within 5 years
30 mile 18 month noncompete from any office in 4 towns

90ish % of PA/NP reach 1 million

Medical/surgical/cosmetic, lots of Mohs closures

I have two years primary care experience and would be taking an almost 50% pay cut that first year 😳

Thoughts?

New Grad PA and received an offer from a private dermatology practice that is willing to train a new grad. I do have another offer the pay and benefits run circles around this one, BUT it is not in dermatology but i do think it could help me get into derm later on.

Offer details:

-Training period (~3 months): $75,000 salary
-After training/independent schedule: $105,000 salary
-Productivity bonus: 10% of quarterly collections above a specified threshold (<$100,000)
-Schedule: 36-40 hours a week
-Relocation bonus: $1,000
-CME: $2,000/year
-PTO: 15 days total (vacation, sick, personal, and CME all come from the same bank)
-Malpractice covered
-State license covered
-Board exam reimbursement
-SIMPLE IRA with 3% match
-Health insurance stipend
-Contract includes a provision requiring repayment of training-period wages if employment ends before 24 months

Pros:

-Private practice
-Physician seems genuinely interested in mentoring a new grad
-Opportunity to get directly into dermatology without doing another specialty first
-Productivity bonus structure

Cons/Questions:

-Training salary seems low
-Post-training salary seems lower than many of the dermatology PA salaries I’ve seen discussed
-PTO feels limited when CME & sick is included in the same bank
-Relocation assistance is minimal and it would be out of state & I don’t love it and housing options seem minimal.
-Unsure how common the repayment provision is

For dermatology PAs:

Is this fairly standard for a new grad derm offer in 2026?

What would you negotiate first?

Would you focus on salary, PTO/CME, removal of the repayment provision, or something else? I like to travel but also want to go to conferences to network and learn.

Is $105k after training reasonable for a new grad entering dermatology today?

During the process the doctor mentioned their current PA not doing cosmetics but Could I asked to be trained in Botox and Laser to help increase my earnings?

Can I ask for things like a didactic education outside of clinic be paid for? Extra money for conferences or dermatoscope etc?

Appreciate any thoughts from those already practicing in derm.

Title says it all. I have an initial phone interview with Epiphany Derm coming up. It’s with one of their recruiters. I have 2 years of medical derm experience in a rural area and am trying to move back to my home state which is the reason for the job hunt. Currently at a very small private practice. Are there any PAs working for Epiphany? Would love to get insight on their interview process and the good/bad/ugly about working for one of their offices. Thanks in advance!

Can we talk about Castle Testing? Who uses it and what is your rationale? The rep came for lunch today and although I've known about this test for years I've never used it and after today I'm still not convinced. How will it change my management of my MM pts? For those with Breslow over 0.8 I'm sending to oncology anyway and they can order the test at that point and speak to them about prognostics. Do you order it for those with less than 0.8 Breslow and if it comes back high risk you send them to oncology if you normally wouldn't?

Curious to see what opinions are out there. I am a new PA in primary care and I’ve seen a lot of different tapering schedules for oral steroids for allergic CD. Most PCPs or ED providers from what I’ve seen recommend a medrol dose pack. My attending suggests medrol dose packs for allergic CD.

I’ve also seen a 9 day taper schedule of prednisone 60mg x3 days etc tapered, this was a derm provider who Rxed this taper schedule.

Open evidence recommends at LEAST 14 days of oral prednisone to prevent rebound dermatitis, this seems like a lot and I have not seen someone do this personally. Im curious to know what the derm providers are doing in regards to this.

I was thinking this when I was talking to a Bimzelx rep today. Every drug rep will testify that their drug is the best, the fastest, the safest, will tell you the winning lottery numbers, and cure world hunger.

She asked me today, “why don’t you use my drug?” And the answer in my head was simply “I already have my preferred biologic, and this drug doesn’t motivate me to learn a new drug thoroughly”. Which is a fine answer, but I always worry that I will turn into that provider that’s still using drugs invented decades ago if I continue that mentality.

All drug rep studies are going to be skewed and biased, so I take their miraculous studies with a grain of salt, so I’m never sure if I’m missing “the next big thing” or not. Normally I wait for annual Derm conferences to see what everyone else is using.

I guess the short question after all that is, how do you all balance using your favorite medications, and introducing innovations as they come out?

Hey, im 23 years old and actively pursuing a Associates of Science degree, then continuing to bachelors, and ultimately want to get into PA school. Im currently looking for a medical assistant job in DERM since thats ultimately what i want to specify in, therefore i want to gain knowledge and build hours for PA school early. I dont have any experience but im a easy and quick learner and highly motivated to pursue this career path. Ive applied to a few clinics around the DFW Texas area but was rejected from all medical assistant opportunities. Ive also reached out to private practices to test my luck but havent gotten any responses just yet. I wanted to ask y'all for any resume advice since all my job experience in the past was all blue collar work. The only medical certification i have is a basic CPR/FIRST AID. If someone has any help to provide me please let me know, i want to get my foot in the door early. Also if someone is around the DFW area and knows any clinics that are hiring medical assistant jobs please let me know. Im willing to drive all around the DFW area for an opportunity. Thank y'all!!!