A dermatology physician assistant (PA) diagnoses and treats skin conditions, prescribes medications, performs skin biopsies, and in many practices handles cosmetic procedures. They work alongside dermatologists but typically see patients independently for routine and urgent skin concerns. As of 2023, roughly 3,709 PAs in the United States identify dermatology as their primary specialty, making them a significant part of the skin care workforce alongside about 12,120 dermatologists.
Day-to-Day Clinical Work
Most of a dermatology PA’s day looks similar to a dermatologist’s. They examine patients, evaluate rashes and lesions, diagnose conditions ranging from eczema and psoriasis to suspicious moles, and build treatment plans. A typical caseload includes acne, fungal infections, contact dermatitis, warts, precancerous growths, and skin cancer screenings. When a spot looks concerning, the PA can perform a biopsy in the office, send the tissue to a lab, and follow up with results.
Dermatology PAs also prescribe topical and oral medications, including antibiotics, retinoids, immunosuppressants, and biologic therapies for conditions like psoriasis or eczema that haven’t responded to simpler treatments. Prescriptive authority varies by state, but most states grant PAs broad prescribing rights, including controlled substances, under a collaborative agreement with a physician.
Cosmetic and Procedural Roles
In practices that offer cosmetic services, PAs often administer injectable treatments like neurotoxins and dermal fillers, perform chemical peels, and assist with laser treatments. Some dermatology PAs focus almost entirely on the aesthetic side, while others split their time between medical and cosmetic visits. The balance depends on the practice. A PA in a busy medical dermatology clinic might spend the entire day diagnosing rashes and removing precancerous lesions, while one in a cosmetic-focused office may spend more time on anti-aging treatments and consultations.
Minor surgical procedures are also common. Dermatology PAs excise small skin cancers, remove cysts, drain abscesses, and perform cryotherapy (freezing off warts or precancerous spots). More complex surgeries, such as Mohs surgery for skin cancer, are performed by the dermatologist, though a PA may assist or handle the wound closure afterward.
How They Work With Dermatologists
PAs practice under a collaborative or supervisory relationship with a physician, but the details of that arrangement vary widely by state. In some states, the supervising dermatologist must be physically present in the office. In others, the dermatologist can oversee the PA remotely and does not need to review or cosign every chart. Florida law, for example, does not require a supervising physician to cosign charts prepared by a PA working at a satellite office, though the physician must review records from initial consultations for referred patients.
In practical terms, most dermatology PAs see patients on their own schedule, consult the dermatologist when a case is complex or unusual, and manage follow-ups independently. This team structure is one reason dermatology PAs exist in the first place: the demand for skin care far outpaces the supply of board-certified dermatologists.
Impact on Appointment Wait Times
Long waits to see a dermatologist are a well-documented problem. A study of Ohio dermatology offices found the average wait for an appointment with a dermatologist was 56 days, with some patients waiting nearly a year. Offices that also employed a PA or nurse practitioner could often offer an earlier slot. The average wait to see a PA in those offices was 19 days, cutting the delay by more than half.
Interestingly, practices that employed PAs also had somewhat shorter wait times for the dermatologist (48 days versus 60 days in offices without PAs), though the difference wasn’t statistically significant. The takeaway for patients: if you’re offered an appointment with a dermatology PA, you’ll likely be seen weeks sooner, and for most routine concerns, the visit will be very similar to one with a dermatologist.
Education and Training
Becoming a dermatology PA starts with a master’s degree from an accredited PA program, which averages about 26 months. The first year covers foundational medical sciences like anatomy, physiology, pharmacology, and physical examination techniques. That’s followed by 12 to 18 months of supervised clinical rotations across multiple specialties, including internal medicine, surgery, emergency medicine, and pediatrics. These rotations are broad by design, giving PAs a generalist medical foundation before they specialize.
Dermatology-specific training typically happens on the job. After graduating and passing the national certification exam (PANCE), a PA who joins a dermatology practice learns the specialty through hands-on experience, mentorship from a supervising dermatologist, and continuing education. The Society of Dermatology Physician Assistants (SDPA) offers a formal Diplomate Fellowship program for PAs already working in the field. This online program includes 22 modules covering nearly 65 hours of accredited continuing medical education, paired with a core dermatology textbook. Completing it signals advanced competency in the specialty, though it is not required to practice.
Career Outlook and Compensation
The PA profession as a whole is growing fast. The Bureau of Labor Statistics projects 20 percent job growth for physician assistants between 2024 and 2034, which translates to about 33,200 new positions. Dermatology is one of the more competitive PA specialties, partly because the work is largely outpatient, the hours are predictable, and the pay is strong.
The median annual salary for all physician assistants was $133,260 as of May 2024. Dermatology PAs often earn at or above that median, particularly in practices with a cosmetic component, where procedures generate higher revenue. Compensation can vary significantly depending on geographic location, practice type, and experience level.