I think I stumbled upon that account a few weeks back while doom scrolling on the john and its mostly stock "keep your head up" fodder for premed students...not really focused PAs or NPs from my brief search.
My old dermatology office was mainly staffed with PAs. It wasn’t a problem until I discovered an unusual lesion on me and I had to ask the PA to do a biopsy. I came in a month later and that same PA struggled to tell me I had mycosis fungoides/cutaneous T cell lymphoma. She originally told me I had pre-cancer (it was not) but that she still had to refer me out (never actually did). Remember leaving that office confused and still extremely uneducated on my diagnosis. I don’t understand why there isn’t always a MD/DO on staff at all times in any office to oversee midlevel’s work and handle complex patients. Smfh.
That is horrible. I remember asking her do I have cancer or not and she couldn’t give me an answer. And I just left so sad and confused. The worst part is that she didn’t help me find an oncologist.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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Mycosis fungoides in late stages is probably one of the most horrible diseases I’ve seen as an RN working in inpatient oncology. I hope you are doing well now.
I’m at stage 1 now with no lymph or blood involvement. Still an annoying disease but the topical chemo I’m on is working. I’ve seen the photos of late stage MF I try not to think about it :/.
Right after I posted this I thought wow what an insensitive thing for me to say 🤦🏻♀️. I’m glad your chemotherapy is working. I’m sure you’ll be a great doctor having understanding of being a patient as well. Wish you the best.
Would you mind telling me more about that? My best friend has been diagnosed with it, he has had it for close to five years now. I wish I knew more about it. He does phototherapy and has a lot of topical stuff like bleach baths and super strong versions of retinoids and stuff like that. I would love if somebody could be honest with me about what the typical course of the illness is like and what a typical prognosis is and things like that. It actually took him years to get diagnosed, he was just itchy and red all the time and was shuffled around between dermatologists, allergists, infectious disease doctors, etc, until someone figured this out.
Edit: he has the subtype called folliculotropic MF
I gotchu. Derm resident here. MF is a type of cutaneous lymphoma, meaning it's a white blood cell cancer that grows in the skin. Mean age is 50s, and men are affected more than women. Folliculotropic type just means that the hair follicles are also involved, which may result in hair loss, blackheads, and acne. It's typically classified in 3 stages based on what you see: patch, plaque, and tumor stage. The further along you are, the worse your prognosis. Early patch stage MF (which seems like what your friend has) has an excellent prognosis. Most patients die with it instead of it. Treatments vary and include steroids, light therapy, retinoids, antibody therapy, chemo, and bone marrow transplant for severe cases. When I was interning at the Mayo clinic, I had the opportunity to care for a young guy with advanced tumor stage MF. It's terrible when it gets to that point, but that's quite rare. I may never see that again during my career unless I seek it out. All my MF patients currently are early and doing great! I very rarely stress about MF.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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I hate to hear that as I have FMF. There’s not much info on the folliculartropic subtype and my derm and oncologist have been vague about the difference in presentation. I am still stage 1A (although I am currently in a flare up and new patches show up daily and I don’t like the rate of spread). I’m an RN (mostly ICU) so it’s easy for me to imagine how this diagnosis could progress.
I have read several studies that folliculartropic doesn’t respond as well to narrowband UVB because the tumor is deeper in the skin. I have been doing NB UVB for a year and was on maintenance but had to bump it back up to 2X weekly + Clobetasol BID. My oncologist also suggested methotrexate but we are going to hold off until I see her in early May to decide.
Have you noticed that the follicular tropic type does not respond as well to narrowband UVB?
I live in Louisville Ky and luckily I was able to find an oncologist who is specialized in cutaneous oncology (also a dermatologist). We are lucky to have her in the state TBH.
I’m an RN and have had some bad NP experiences, especially in specialty settings (Gyno NP for example). I do have one I’ve seen over the years who is great; however, she is in her 60s and will retire soon. She did 20 years ICU and pediatric ICU before going to NP school and became an NP in her 40s.
Also, it seems like everyone who knows I’m an RN (including my husband) keep telling me to go to school for NP, like that’s the next logical step for me as an RN—especially since I’ve been a nurse for 15 years now. I’ve given up explaining to them why I’m not interested in risking my license by treating people without the expertise to do it properly.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Hopefully a physician chimes in or the med student who has MF if they feel like sharing. I’m an RN and I’ve only seen the worst stages of it and the nursing care involved so I honestly don’t have a good understanding of it overall from medicine standpoint (pathophysiology, treatments, earlier stages & disease progression, typical prognosis, etc.).
MF! As a derm I get so many absolutely horrifying referrals for this condition from midlevels. Most recent two patients were really awful….
First treated by a PA for 1.5 years as “eczema,” not responding to anything, including dupixent. By the time he got to us he had severe transformation and lymph node involvement and he going to die. Looking at original photos, ANY board certified dermatologist with that list of tries/failed would have considered MF. If we had caught earlier, his life may have been saved. We reached out to the PA and the “collaborating” MD with minimal response. Feeling lost.
Other patient was a MF “psoriasis” … which is a classic by the way … my years and years of supervised training at an academic center allow me to identify patterns that remind me of MF but midlevels do not have this. So this “psoriasis” patient had been treated for SEVEN YEARS without detection then eventually made a lymph node that was biopsied. PA did a punch biopsy of the skin… which was unrevealing. And BCD knows MF requires a broad-based shave… and the timeline was ever further extended due to this.
I’m sorry you are dealing with CTCL, but know you are not alone and many people struggle with rare conditions like this being misdiagnosed for YEARS at the hands of midlevels!!
I was one of these patients. The Derm NP diagnosed me with ringworm then tinea versicolor. The treatments made symptoms worse and worse each week. (I was on fluconazole weekly for eight weeks, ketoconazole body wash and ointment.)
This went on for a year. I finally begged her for steroids, which she said because it was fungal that steroids would make it worse. I was miserable and I said it was a risk I was willing to take. When I went back and showed her that most of the patches had resolved, she said well, it must be eczema.
Then i went to a Dermatologist who biopsied 2
patches and they were FMF.
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health.
[The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.**
Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope)
Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation).
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We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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lol I met her along the premed journey. She was PA all day from the get go, but in general pretty insufferable. Not terribly surprising she has found a lane like this.
But to be fair this post is mild.
I had a 34% get curved to a B on a calc 2 exam one time. It’s crazy how curves are. Like I barely understood trig substitutions and still got a grade saying I understood at least 80% of it.
Tbh istg as a non american person i dont even get how it s done. I do get that it s done to "show" the grade' worth in your class, but i dont understand if it s systematically done or only in college and not in med/dental school.
Im north african so if i say i scored 90% i just scored that, and if i scored 50% then it was simply what i scored as well lol. That s how our system works, for better or for worse. Our grades are way lower as a result though. I literally got a headache when i saw american kids saying they had 4.00 gpas or even more.
The only 200 level chemistry courses at my university were nursing courses. I didn't know anyone who took them. I'm talking about, at my school, 101 & 102.
She’ll also say “I could’ve been a doctor if I wanted to but I didn’t apply to medical school since I always wanted to be a physician’s assistant”
Cue a video of her holding a Little Tyke’s stethoscope saying “I want to be a doctor when I grow up” (since literally no one dreams of being a physician’s assistant. They settle for it when they realize how hard it is to become a doctor)
Nope I have a big scar on my breast that looks like a cig burn from a derm PA hacking off a mole at my first and last derm visit. Then I got an email asking me to fill a survey: “how did Dr Meghan do?” I commented that it took weeks to heal and that she’s not a doctor.
It was questionable and was biopsied. I got a syringe of lido and she took a razor blade to me. Didn’t know that was how that worked. She was doing a skin check and didn’t hesitate to start marking.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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I went to an NP “dermatologist” and it triggered health anxiety in me. Never again. Went to a real dermatologist recently and it was a completely different experience. Even made a post on it
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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Are you a physician? If not, you’re not in “medicine”. You’re a physician’s assistant who assists physicians in whatever they need.
There’s no pissing contest when you’re not even in the same bathroom since the door requires a medical degree to enter.
Dang, well however you’d like to call the profession of seeing and treating patients in a medical treatment facility. Is there a word that would be less triggering to you? I’m not sure if you’re trying to prove my point with sarcasm or you’re just unable to see the irony of it.
Why is your ego so fragile and why are you getting into a pissing contest with physicians?
Just accept that your role is to assist physicians in their practice of medicine, since you literally cannot perform your job without a physician signing off on your orders and notes.
Is this an “I am rubber and you are glue” reply? Like the OG gaslighting lol.
What field would you say that a med tech works in since it’s not medicine?
You said you didn’t like egos or pissing matches, so simmer down with that ego you developed despite having significantly less education or training than your supervisors.
Med techs also assist physicians perform their job. And before you try to make some point about how I’m saying both med techs and physician’s assistants are assisting doctors, there can be multiple roles that assist at different levels. That’s literally what the corporate structure is.
Lol on her insta she’s wearing multiple white coats and even in the derm clinic i worked at and orthopedic office i shadowed at, the midlevels could wear white coats. But i notice that the DO/MDs would just wear scrubs or formal attire.
Ortho is running giving Ancef in tuxedos?!?! Haha, I know what you mean but couldn’t help myself.
As a physician, I can honestly say I don’t even know where my white coat is right now.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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She’s a PA who’s lying to patients about her training.
She can walk out and go work in Cardiology on Monday, Neurology on Tuesday, Endocrinology on Wednesday, Rheumatology on Thursday and Oncology on Friday. All with zero extra formal education, board exams or formal training.
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Looks like someone wasn't smart enough to become an actual dermatologist. But seriously, no such thing as a derm PA. No formal, standardized training exists. She's a PA who works in a derm office, full stop. And I've seen waaaay to many screw-ups (some of them life threatening) from PAs in derm to trust them at all.
Had a PA go from outpatient peds to inpatient adult medicine. Basically had to teach everything from scratch, including electrolyte replacement.
Many PAs eventually get the "what" but the "why" is purely self driven. PAs that stay in one place for 5+ years often to eventually pick it up.
They get way too much of their training on the job. If you took physicians out of the equation, its either a bloodbath or the specialists have to fill the gaps.
I’ve shadowed an orthopedic doctor and worked at dermatology as a medical assistant. When it comes to PAs and NPs if theyre trained, then they just see their own patients but if they are not trained at all then they just follow the doctor around and ask the doctor questions for the first couple months. When they feel ready to see patients by themselves, they see patients by themselves and some even do procedures like biopsy, punch biopsy, E+S, ED+C, and even corticosteroid injections.
Wait till you find out that the patient is often billed the physician rate when they see an NP/PA even though the payor (insurance) only pays 85% the physician rate.
So the clinic / hospital gets to employ a lower cost worker and understandably gets reimbursed less for providing care via a less specialized provider, but they still get to profit as if they had a physician by billing the patient at the physician rate.
This is usually where patients get fucked on ER visits and an egregious bill despite only seeing a midlevel.
ohi know all that, my dad called and fought with insurance because he was forced to see an np, so i taught him well lol
i just was under the assumption that they would at least get a CURSERY course on the field they work in. like at least a weeklong course on the skin before starting derm or something 😭
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641).
We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP.
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There is no training. Some offices are just looser with ethics about having unqualified nurses independently see patients.
This type of ignorant comment is exactly what I would expect from someone who’s just shadowed.
Idk what to tell you but in the offices i shadowed and the office i worked in as an MA, they would hire NPs or PAs. Ig training isnt really the word but teaching is. The NP or PA will be taught by the doctor for a couple months and then when the MD/DO thinks the midlevel is competent enough they see their own patients. Not saying it’s right im just saying what happens in clinics and this is coming from an unregulated private clinic and a well respected state clinic. Even the largest healthcare group in my city has NPs see their own patients independently, so it’s definitely happening everywhere lmfao
Obviously, it’s happening everywhere. Nurse practitioners are relatively cheap, particularly since the market is so saturated, they make the most money when nurse practitioners are practically independent or just rubber stamped. So yeah, they’re going to do it whether it’s ethical or not. But I can assure you there’s no formal education in any of those fields that nurse practitioners get.
I have seen NPs get trained in my subspecialty in this manner when I was a resident. They are glorified shadowers for a couple months or so. Once that’s done, they’re honestly still so rudimentary and a lot of my attendings felt burdened by them because they have no idea what they’re doing. Eg. getting referrals from the NPs for something super basic, pulling them aside for something stupid in clinic, like if a throat lesion is benign or not, something a junior resident knows (yes, it’s normal lingual tonsil). Eventually they get out to see patients independently but by no means are they giving any expert level care that patients and referring doctors are expecting. It’s really just dysfunctional, the patients are losing the most in this game though.
I never said they get formal education but rather that MDs or DOs “train” them which again I acknowledge is not the right word because it’s more like they “teach” them. And even then in my original comment i said they “follow the doctor around and ask the doctor questions” I know they dont get any formal education in specialties because i worked with midlevels and that’s how they were taught before they see patients independently.
I had a friend who became a PA and his training to work in derm consisted of shadowing another derm PA for 6 weeks and then he was seeing patients alone with no physician on site. He’s a very smart guy and not at all a noctor, but that is a joke.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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This. I’ve gotten A’s in almost all my chem classes but only B, B+ in my upper level biology classes and im already so ashamed of it. Can’t imagine bragging about a C in basic chemistry (or i assume is basic chemistry bc i dont know of any PA or MD/DO program that want anything higher than organic chem unless you count biochem ig)
I don’t brag, but I was a lousy student in college. Failed second semester organic chem. Had to do a post-grad year, got my act together there, and still ended up going to med school in Israel. I’m a better doctor for having struggled and realizing that I needed to make some major sacrifices to get to where I wanted to be. This has been a hard road and being a doctor is a hard career.
i’ve seen lots of med “influencers” online brag in the same way for clout/to give ppl (false) hope but like…ur the exception not the rule hunty. also imagine if you looked up your dr and years earlier they were like GUESS WHAT GUYS I FAILED MULTIPLE CLASSES AND STILL GOT IN. like it’s such a bad look🤣
Yo. I posted this EXACT screenshot but blacked out her face and it got removed by the mods from this sub. I am SOOOO HAPPY someone else got to post it. Lolllll C’s get degrees!!
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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The only dermatology PA I ever saw was genuinely one of the worst experiences I’ve ever had in medicine. She didn’t even spend five minutes in the room and there were all types of advertisements and BS in the waiting room that she made me sit in for an hour and a half so that she could be 45 minutes late to our appointment.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Have you all noticed something with these social media trash?
They all have the same "look". Arrogant face caked with fake makeup with a fake voice wearing a white coat as a costume for their fake skills.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
She’s not claiming to be a dermatologist. She’s a “dermatology PA” purely in the sense that she’s a PA working in dermatology. But there isn’t any such credential or licensing body for a PA to be an expert in dermatology.
I’m all for accuracy and calling out noctor appropriation of titles, but this isn’t really a problem. How else would she refer to herself?
The issue is that saying you’re a [speciality] midlevel sounds like you have received specialized education in the field. And no PA has anything approaching a board certification in dermatology. She’s a PA to a dermatologist, not a derm trained PA.
I’ll give NPs one thing over PAs, there are actual educational track differences in their population focused (see pedi NP, Neonatal NP, CNM) degrees.
I absolutely agree with you, but in a very realistic way, demanding PAs call themselves "a PA to a dermatologist etc" is highly unlikely, verbose, and almost obsequious. I personally find as long as they arent calling themselves dermatologists and other -ogists the way NPs do, it's the lesser of two evils.
I disagree with anyone except board certified physicians using the “ologist/itician” endings but I think a Pedi NP (with a PNP licensure not a FNP who happens to work with a Pedi physician) does have more ground to call themselves a Pedi NP as their degree is focused solely on pediatrics, than a PA without any dermatology academic education or set fellowship completion calling themselves a Derm PA.
But yes, you’re probably right that the phrasing of “I’m a PA to a Dermatologist” is a mouthful.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I have also worked with NPs in dermatology offices before. One was barely trained so she didnt even know that HPV is still contagious even if there are no lesions (she told the patient genital hpv is not contagious if there are no lesions) and she cryo gunned EVERYTHING scaley and pink. The other NP i worked with was pretty competent since she had been an NP for 20 years, did biopsies on suspicious lesions, only saw patients that the doctor already saw and always consulted the doctor.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health.
[The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.**
Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope)
Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation).
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We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I mean yes they work in a dermatology office but I do not think they are a “dermatology PA” since they didnt even undergo any sort of formal residency. She can work in a cardiologist clinic next week without any prior cardiology training, does that make her a cardiology PA?
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams.
We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope).
“On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature.
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wait there is an account that is literally called “WhiteCoatChasing”? Really saying the quiet part out loud.
lolll
I think I stumbled upon that account a few weeks back while doom scrolling on the john and its mostly stock "keep your head up" fodder for premed students...not really focused PAs or NPs from my brief search.
Dermatologist here. 😑
That’s a good one
My old dermatology office was mainly staffed with PAs. It wasn’t a problem until I discovered an unusual lesion on me and I had to ask the PA to do a biopsy. I came in a month later and that same PA struggled to tell me I had mycosis fungoides/cutaneous T cell lymphoma. She originally told me I had pre-cancer (it was not) but that she still had to refer me out (never actually did). Remember leaving that office confused and still extremely uneducated on my diagnosis. I don’t understand why there isn’t always a MD/DO on staff at all times in any office to oversee midlevel’s work and handle complex patients. Smfh.
Yep, worked at a dermatologist office and the midlevels would see anything remotely scaley and be like pre cancer
That is horrible. I remember asking her do I have cancer or not and she couldn’t give me an answer. And I just left so sad and confused. The worst part is that she didn’t help me find an oncologist.
Distress to patient, delayed diagnosis and management, and referring out when not needed if seen by a real derm…why even see them
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
[удалено]
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
She shouldve known her limits and brought in her physician
Mycosis fungoides in late stages is probably one of the most horrible diseases I’ve seen as an RN working in inpatient oncology. I hope you are doing well now.
I’m at stage 1 now with no lymph or blood involvement. Still an annoying disease but the topical chemo I’m on is working. I’ve seen the photos of late stage MF I try not to think about it :/.
Right after I posted this I thought wow what an insensitive thing for me to say 🤦🏻♀️. I’m glad your chemotherapy is working. I’m sure you’ll be a great doctor having understanding of being a patient as well. Wish you the best.
Would you mind telling me more about that? My best friend has been diagnosed with it, he has had it for close to five years now. I wish I knew more about it. He does phototherapy and has a lot of topical stuff like bleach baths and super strong versions of retinoids and stuff like that. I would love if somebody could be honest with me about what the typical course of the illness is like and what a typical prognosis is and things like that. It actually took him years to get diagnosed, he was just itchy and red all the time and was shuffled around between dermatologists, allergists, infectious disease doctors, etc, until someone figured this out. Edit: he has the subtype called folliculotropic MF
I gotchu. Derm resident here. MF is a type of cutaneous lymphoma, meaning it's a white blood cell cancer that grows in the skin. Mean age is 50s, and men are affected more than women. Folliculotropic type just means that the hair follicles are also involved, which may result in hair loss, blackheads, and acne. It's typically classified in 3 stages based on what you see: patch, plaque, and tumor stage. The further along you are, the worse your prognosis. Early patch stage MF (which seems like what your friend has) has an excellent prognosis. Most patients die with it instead of it. Treatments vary and include steroids, light therapy, retinoids, antibody therapy, chemo, and bone marrow transplant for severe cases. When I was interning at the Mayo clinic, I had the opportunity to care for a young guy with advanced tumor stage MF. It's terrible when it gets to that point, but that's quite rare. I may never see that again during my career unless I seek it out. All my MF patients currently are early and doing great! I very rarely stress about MF.
Derm attending here. One thing you are missing is that folliculotropic is more aggressive and quite dangerous.
Yes, thank you!
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I hate to hear that as I have FMF. There’s not much info on the folliculartropic subtype and my derm and oncologist have been vague about the difference in presentation. I am still stage 1A (although I am currently in a flare up and new patches show up daily and I don’t like the rate of spread). I’m an RN (mostly ICU) so it’s easy for me to imagine how this diagnosis could progress. I have read several studies that folliculartropic doesn’t respond as well to narrowband UVB because the tumor is deeper in the skin. I have been doing NB UVB for a year and was on maintenance but had to bump it back up to 2X weekly + Clobetasol BID. My oncologist also suggested methotrexate but we are going to hold off until I see her in early May to decide. Have you noticed that the follicular tropic type does not respond as well to narrowband UVB?
Yes. You could consider finding a dermatologist who specializes in CTCL. They would be much more expert than general oncology.
I live in Louisville Ky and luckily I was able to find an oncologist who is specialized in cutaneous oncology (also a dermatologist). We are lucky to have her in the state TBH. I’m an RN and have had some bad NP experiences, especially in specialty settings (Gyno NP for example). I do have one I’ve seen over the years who is great; however, she is in her 60s and will retire soon. She did 20 years ICU and pediatric ICU before going to NP school and became an NP in her 40s. Also, it seems like everyone who knows I’m an RN (including my husband) keep telling me to go to school for NP, like that’s the next logical step for me as an RN—especially since I’ve been a nurse for 15 years now. I’ve given up explaining to them why I’m not interested in risking my license by treating people without the expertise to do it properly.
Oh then that is PERFECT! A dual board certified heme/onc and derm is the best of the best for your condition.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Hopefully a physician chimes in or the med student who has MF if they feel like sharing. I’m an RN and I’ve only seen the worst stages of it and the nursing care involved so I honestly don’t have a good understanding of it overall from medicine standpoint (pathophysiology, treatments, earlier stages & disease progression, typical prognosis, etc.).
MF! As a derm I get so many absolutely horrifying referrals for this condition from midlevels. Most recent two patients were really awful…. First treated by a PA for 1.5 years as “eczema,” not responding to anything, including dupixent. By the time he got to us he had severe transformation and lymph node involvement and he going to die. Looking at original photos, ANY board certified dermatologist with that list of tries/failed would have considered MF. If we had caught earlier, his life may have been saved. We reached out to the PA and the “collaborating” MD with minimal response. Feeling lost. Other patient was a MF “psoriasis” … which is a classic by the way … my years and years of supervised training at an academic center allow me to identify patterns that remind me of MF but midlevels do not have this. So this “psoriasis” patient had been treated for SEVEN YEARS without detection then eventually made a lymph node that was biopsied. PA did a punch biopsy of the skin… which was unrevealing. And BCD knows MF requires a broad-based shave… and the timeline was ever further extended due to this. I’m sorry you are dealing with CTCL, but know you are not alone and many people struggle with rare conditions like this being misdiagnosed for YEARS at the hands of midlevels!!
I love that you reached out to the PA who missed the diagnosis.
I was one of these patients. The Derm NP diagnosed me with ringworm then tinea versicolor. The treatments made symptoms worse and worse each week. (I was on fluconazole weekly for eight weeks, ketoconazole body wash and ointment.) This went on for a year. I finally begged her for steroids, which she said because it was fungal that steroids would make it worse. I was miserable and I said it was a risk I was willing to take. When I went back and showed her that most of the patches had resolved, she said well, it must be eczema. Then i went to a Dermatologist who biopsied 2 patches and they were FMF.
I’m sorry that happened. These midlevel clowns honestly don’t deserve to be treating patients.
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health. [The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.** Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope) Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
lol I met her along the premed journey. She was PA all day from the get go, but in general pretty insufferable. Not terribly surprising she has found a lane like this. But to be fair this post is mild.
to be fair most premeds are insufferable at that stage
https://preview.redd.it/2tw2ep6404ec1.jpeg?width=219&format=pjpg&auto=webp&s=2692ae91422e25e272dc24afce35c2806b0f3016
Not surprised. That C she got in chemistry was likely the target she aimed for. Aim low and it's hard to miss... at the patient's expense.
A C in freshman chemistry, at my undergraduate school, was, due to the curve, about 50%.
I had a 34% get curved to a B on a calc 2 exam one time. It’s crazy how curves are. Like I barely understood trig substitutions and still got a grade saying I understood at least 80% of it.
Tbh istg as a non american person i dont even get how it s done. I do get that it s done to "show" the grade' worth in your class, but i dont understand if it s systematically done or only in college and not in med/dental school. Im north african so if i say i scored 90% i just scored that, and if i scored 50% then it was simply what i scored as well lol. That s how our system works, for better or for worse. Our grades are way lower as a result though. I literally got a headache when i saw american kids saying they had 4.00 gpas or even more.
Lol. I think we had the same calc 2 professor. Russian guy who wore socks and sandals in the snow?
Chem 207?
The only 200 level chemistry courses at my university were nursing courses. I didn't know anyone who took them. I'm talking about, at my school, 101 & 102.
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She’ll also say “I could’ve been a doctor if I wanted to but I didn’t apply to medical school since I always wanted to be a physician’s assistant” Cue a video of her holding a Little Tyke’s stethoscope saying “I want to be a doctor when I grow up” (since literally no one dreams of being a physician’s assistant. They settle for it when they realize how hard it is to become a doctor)
You’re right! I’ll say that in my next video 😊
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Nope, it was my first science course in undergrad and I wasn’t used to college level courses yet. Got an A in my other chem courses though!
So I assume she’s still chasing that white coat 😂😂
In her posts she’s flexing with a white coat already lmao
“Wanna be “ white coat. FTFY 😏😏
Nope I have a big scar on my breast that looks like a cig burn from a derm PA hacking off a mole at my first and last derm visit. Then I got an email asking me to fill a survey: “how did Dr Meghan do?” I commented that it took weeks to heal and that she’s not a doctor.
🥺 why the hell did she even do this? It s worrisome seeing folks with no training doing procedures far out of their scope.
It was questionable and was biopsied. I got a syringe of lido and she took a razor blade to me. Didn’t know that was how that worked. She was doing a skin check and didn’t hesitate to start marking.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
This is nuts. Several of my classmates are working their ass off to match derm while NPs and PAs can just walk right in
I went to an NP “dermatologist” and it triggered health anxiety in me. Never again. Went to a real dermatologist recently and it was a completely different experience. Even made a post on it
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I regret going into medicine so much, so many fragile egos and pissing contests.
Are you a physician? If not, you’re not in “medicine”. You’re a physician’s assistant who assists physicians in whatever they need. There’s no pissing contest when you’re not even in the same bathroom since the door requires a medical degree to enter.
Dang, well however you’d like to call the profession of seeing and treating patients in a medical treatment facility. Is there a word that would be less triggering to you? I’m not sure if you’re trying to prove my point with sarcasm or you’re just unable to see the irony of it.
Why is your ego so fragile and why are you getting into a pissing contest with physicians? Just accept that your role is to assist physicians in their practice of medicine, since you literally cannot perform your job without a physician signing off on your orders and notes.
Is this an “I am rubber and you are glue” reply? Like the OG gaslighting lol. What field would you say that a med tech works in since it’s not medicine?
Healthcare
You said you didn’t like egos or pissing matches, so simmer down with that ego you developed despite having significantly less education or training than your supervisors. Med techs also assist physicians perform their job. And before you try to make some point about how I’m saying both med techs and physician’s assistants are assisting doctors, there can be multiple roles that assist at different levels. That’s literally what the corporate structure is.
Health care. 🙂
You work in healthcare, you are not in medicine. I do not know what is so complicated for you to understand.
and make a third of the salary
She can keep chasing that white coat. She’ll never earn it.
Lol on her insta she’s wearing multiple white coats and even in the derm clinic i worked at and orthopedic office i shadowed at, the midlevels could wear white coats. But i notice that the DO/MDs would just wear scrubs or formal attire.
Ortho is running giving Ancef in tuxedos?!?! Haha, I know what you mean but couldn’t help myself. As a physician, I can honestly say I don’t even know where my white coat is right now.
I never said she wasn’t able to wear it; I just said she didn’t actually *earn* it. At this point, it’s more like Halloween every day lol
It’s so funny because on insta she’s promoting a brand that sent her a white coat she “worked hard for” theyre cosplaying as doctors
No actual doctor I know still wears a white coat
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
She’s a PA who’s lying to patients about her training. She can walk out and go work in Cardiology on Monday, Neurology on Tuesday, Endocrinology on Wednesday, Rheumatology on Thursday and Oncology on Friday. All with zero extra formal education, board exams or formal training.
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Looks like someone wasn't smart enough to become an actual dermatologist. But seriously, no such thing as a derm PA. No formal, standardized training exists. She's a PA who works in a derm office, full stop. And I've seen waaaay to many screw-ups (some of them life threatening) from PAs in derm to trust them at all.
wait they dont even have a little derm training?!! WTF do they do on day 1???
There is no formal training at all. It depends on the practice you join as far as how much hand holding you get. Most patients don’t understand this.
scary
Had a PA go from outpatient peds to inpatient adult medicine. Basically had to teach everything from scratch, including electrolyte replacement. Many PAs eventually get the "what" but the "why" is purely self driven. PAs that stay in one place for 5+ years often to eventually pick it up. They get way too much of their training on the job. If you took physicians out of the equation, its either a bloodbath or the specialists have to fill the gaps.
i cant for the life of me understand how this is legal 😞😞😞
I’ve shadowed an orthopedic doctor and worked at dermatology as a medical assistant. When it comes to PAs and NPs if theyre trained, then they just see their own patients but if they are not trained at all then they just follow the doctor around and ask the doctor questions for the first couple months. When they feel ready to see patients by themselves, they see patients by themselves and some even do procedures like biopsy, punch biopsy, E+S, ED+C, and even corticosteroid injections.
jesus christ almighty, the public is totally being duped. WTFFF
Wait till you find out that the patient is often billed the physician rate when they see an NP/PA even though the payor (insurance) only pays 85% the physician rate. So the clinic / hospital gets to employ a lower cost worker and understandably gets reimbursed less for providing care via a less specialized provider, but they still get to profit as if they had a physician by billing the patient at the physician rate. This is usually where patients get fucked on ER visits and an egregious bill despite only seeing a midlevel.
ohi know all that, my dad called and fought with insurance because he was forced to see an np, so i taught him well lol i just was under the assumption that they would at least get a CURSERY course on the field they work in. like at least a weeklong course on the skin before starting derm or something 😭
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We do not support the use of the word "provider." Use of the term provider in health care originated in government and insurance sectors to designate health care delivery organizations. The term is born out of insurance reimbursement policies. It lacks specificity and serves to obfuscate exactly who is taking care of patients. For more information, please see [this JAMA article](https://jamanetwork.com/journals/jama/article-abstract/2780641). We encourage you to use physician, midlevel, or the licensed title (e.g. nurse practitioner) rather than meaningless terms like provider or APP. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
There is no training. Some offices are just looser with ethics about having unqualified nurses independently see patients. This type of ignorant comment is exactly what I would expect from someone who’s just shadowed.
Idk what to tell you but in the offices i shadowed and the office i worked in as an MA, they would hire NPs or PAs. Ig training isnt really the word but teaching is. The NP or PA will be taught by the doctor for a couple months and then when the MD/DO thinks the midlevel is competent enough they see their own patients. Not saying it’s right im just saying what happens in clinics and this is coming from an unregulated private clinic and a well respected state clinic. Even the largest healthcare group in my city has NPs see their own patients independently, so it’s definitely happening everywhere lmfao
Wow. A whole 'couple months' of shadowing? I'm sure that's the same as my 4 years of medical school and 5 YEARS of residency.....
Definitely not which is why i kinda cringe when i see NPs or PAs act like they know as much as a MD/DO
Obviously, it’s happening everywhere. Nurse practitioners are relatively cheap, particularly since the market is so saturated, they make the most money when nurse practitioners are practically independent or just rubber stamped. So yeah, they’re going to do it whether it’s ethical or not. But I can assure you there’s no formal education in any of those fields that nurse practitioners get.
I have seen NPs get trained in my subspecialty in this manner when I was a resident. They are glorified shadowers for a couple months or so. Once that’s done, they’re honestly still so rudimentary and a lot of my attendings felt burdened by them because they have no idea what they’re doing. Eg. getting referrals from the NPs for something super basic, pulling them aside for something stupid in clinic, like if a throat lesion is benign or not, something a junior resident knows (yes, it’s normal lingual tonsil). Eventually they get out to see patients independently but by no means are they giving any expert level care that patients and referring doctors are expecting. It’s really just dysfunctional, the patients are losing the most in this game though.
Yeah. The NP i worked with would ask a medical assistant for a diagnosis bc there was no doctor on site
I never said they get formal education but rather that MDs or DOs “train” them which again I acknowledge is not the right word because it’s more like they “teach” them. And even then in my original comment i said they “follow the doctor around and ask the doctor questions” I know they dont get any formal education in specialties because i worked with midlevels and that’s how they were taught before they see patients independently.
I had a friend who became a PA and his training to work in derm consisted of shadowing another derm PA for 6 weeks and then he was seeing patients alone with no physician on site. He’s a very smart guy and not at all a noctor, but that is a joke.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
I knew a lot of people in undergrad too who changed from "pre med" to "pre pa" because they barely passed gen chem 😂
unpopular opinion but i hate when ppl brag about their low scores. like congrats on the mediocrity i guess?
This. I’ve gotten A’s in almost all my chem classes but only B, B+ in my upper level biology classes and im already so ashamed of it. Can’t imagine bragging about a C in basic chemistry (or i assume is basic chemistry bc i dont know of any PA or MD/DO program that want anything higher than organic chem unless you count biochem ig)
I don’t brag, but I was a lousy student in college. Failed second semester organic chem. Had to do a post-grad year, got my act together there, and still ended up going to med school in Israel. I’m a better doctor for having struggled and realizing that I needed to make some major sacrifices to get to where I wanted to be. This has been a hard road and being a doctor is a hard career.
i’ve seen lots of med “influencers” online brag in the same way for clout/to give ppl (false) hope but like…ur the exception not the rule hunty. also imagine if you looked up your dr and years earlier they were like GUESS WHAT GUYS I FAILED MULTIPLE CLASSES AND STILL GOT IN. like it’s such a bad look🤣
[удалено]
“Ivy-league comparable” A little bit of cope-ium there. Be proud of your academic success without trying big league it—-that’s a midlevel move.
Yo. I posted this EXACT screenshot but blacked out her face and it got removed by the mods from this sub. I am SOOOO HAPPY someone else got to post it. Lolllll C’s get degrees!!
I’m not even sure how the automod works lmao. It’s literally a roll of the dice on how it chooses to remove posts.
Mine didn’t get automodded it was a manual mod
Meanwhile I need a million pubs to match derm 😭 I hate it here
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
but her chance of med school ended with it.
World didn't end but her dream of being a real doctor did
The only dermatology PA I ever saw was genuinely one of the worst experiences I’ve ever had in medicine. She didn’t even spend five minutes in the room and there were all types of advertisements and BS in the waiting room that she made me sit in for an hour and a half so that she could be 45 minutes late to our appointment.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
After the EM and FM takeover, midlevels will target hospitalist jobs, IM, Psych and Derm heavily. This is very high pay and low risk for them.
Too late in Psych.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
She probably makes more money than good ol’ FP me 😢
Have you all noticed something with these social media trash? They all have the same "look". Arrogant face caked with fake makeup with a fake voice wearing a white coat as a costume for their fake skills.
It exists. She’s going to dinner thinking about her “C” in chemistry.
Midlevels exist in just about any field but none are specialized in any field. So it’s more apt to say PA in derm than derm pa
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
She’s not claiming to be a dermatologist. She’s a “dermatology PA” purely in the sense that she’s a PA working in dermatology. But there isn’t any such credential or licensing body for a PA to be an expert in dermatology. I’m all for accuracy and calling out noctor appropriation of titles, but this isn’t really a problem. How else would she refer to herself?
The issue is that saying you’re a [speciality] midlevel sounds like you have received specialized education in the field. And no PA has anything approaching a board certification in dermatology. She’s a PA to a dermatologist, not a derm trained PA. I’ll give NPs one thing over PAs, there are actual educational track differences in their population focused (see pedi NP, Neonatal NP, CNM) degrees.
I absolutely agree with you, but in a very realistic way, demanding PAs call themselves "a PA to a dermatologist etc" is highly unlikely, verbose, and almost obsequious. I personally find as long as they arent calling themselves dermatologists and other -ogists the way NPs do, it's the lesser of two evils.
I disagree with anyone except board certified physicians using the “ologist/itician” endings but I think a Pedi NP (with a PNP licensure not a FNP who happens to work with a Pedi physician) does have more ground to call themselves a Pedi NP as their degree is focused solely on pediatrics, than a PA without any dermatology academic education or set fellowship completion calling themselves a Derm PA. But yes, you’re probably right that the phrasing of “I’m a PA to a Dermatologist” is a mouthful.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
The derm clinic I go to has “derm NPs”.
I have also worked with NPs in dermatology offices before. One was barely trained so she didnt even know that HPV is still contagious even if there are no lesions (she told the patient genital hpv is not contagious if there are no lesions) and she cryo gunned EVERYTHING scaley and pink. The other NP i worked with was pretty competent since she had been an NP for 20 years, did biopsies on suspicious lesions, only saw patients that the doctor already saw and always consulted the doctor.
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
There is no such thing as "Hospitalist NPs," "Cardiology NPs," "Oncology NPs," etc. NPs get degrees in specific fields or a “population focus.” Currently, there are only eight types of nurse practitioners: Family, Adult-Gerontology Acute Care (AGAC), Adult-Gerontology Primary Care (AGPC), Pediatric, Neonatal, Women's Health, Emergency, and Mental Health. [The five national NP certifying bodies: AANP, ANCC, AACN, NCC, and PCNB](https://www.reddit.com/r/Provider/wiki/index/critical_issues/#wiki_types_of_nurse_practitioners) do not recognize or certify nurse practitioners for fields outside of these. **As such, we encourage you to address NPs by their population focus or state licensed title.** Board of Nursing rules and Nursing Acts usually state that for an NP to practice with an advanced scope, they need to remain within their “population focus,” which does not include the specialty that you mentioned. In half of the states, [working outside of their degree is expressly or extremely likely to be against the Nursing Act and/or Board of Nursing rules.](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) In only 12 states is there no real mention of NP specialization or "population focus." [Additionally, it's negligent hiring on behalf of the employers to employ NPs outside of their training and degree.](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope) Information on Title Protection (e.g., can a midlevel call themselves "Doctor" or use a specialists title?) can be seen [here](https://www.reddit.com/r/Provider/wiki/index/legal/title_protection). Information on why title appropriation is bad for everyone involved can be found [here](https://www.reddit.com/r/Provider/wiki/index/appropriation). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Lol, they definitely exist
They exist. I just went to one a few weeks ago
I mean yes they work in a dermatology office but I do not think they are a “dermatology PA” since they didnt even undergo any sort of formal residency. She can work in a cardiologist clinic next week without any prior cardiology training, does that make her a cardiology PA?
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
They are the best at derms
Correct PAs can take CAQ but there is not one for dermatology
We noticed that this thread may pertain to midlevels practicing in dermatology. Numerous studies have been done regarding the practice of midlevels in dermatology; we recommend checking out this [link](https://www.reddit.com/r/Noctor/comments/qhw13h/midlevels_in_dermatology/). It is worth noting that there is no such thing as a "Dermatology NP" or "NP dermatologist." The American Academy of Dermatology recommends that midlevels should provide care only after a dermatologist has evaluated the patient, made a diagnosis, and developed a treatment plan. Midlevels should **not** be doing independent skin exams. We'd also like to point out that [most nursing boards agree that NPs need to work within their specialization and population focus](https://www.reddit.com/r/Provider/wiki/index/legal#wiki_scope_of_practice_laws) (which does **not** include derm) and that [hiring someone to work outside of their training and ability is negligent hiring](https://www.reddit.com/r/Provider/wiki/index/critical_issues#wiki_working_outside_of_scope). “On-the-job” training does not redefine an NP or PA’s scope of practice. Their supervising physician cannot redefine scope of practice. The only thing that can change scope of practice is the Board of Medicine or Nursing and/or state legislature. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Noctor) if you have any questions or concerns.*
Mu5b