Dermatology NP Practice is Evolving as Demand Increases

Skin is the largest organ on our bodies, but the growing demand for dermatological care makes it more difficult for patients to be seen quickly. Nurse practitioners can help close this care gap, but dermatology is still in the minority among other NP specialties.

There are more than 355,000 nurse practitioners (NP) licensed in the United States in a variety of practice areas.¹ Although primary care is the specialty that attracts the bulk of NPs, general and adult primary care could encompass a degree of dermatological care. When it comes to NPs certified specifically in dermatology, the total is about 0.5%, according to a 2020 workforce survey by the American Association of Nurse Practitioners (AANP).²

Data collection on nurse practitioner specialties stalled somewhat during the COVID-19 pandemic, says AANP, but studies from the pre-COVID area showed that there has been an increasing demand for NPs working in dermatology.

Dermatology treatments encompass a roughly $75 billion per year industry, and estimates from a 2017 report showed that employment of NPs and physician assistants specialized in dermatology practice increased from about 28% in 2005 to 46% in 2014.³ The report didn’t specify if each of these NPs and Pas working in dermatology had been certified in their specialty, but it did reveal there were about 3,700 NPs specializing in dermatology at the time of the report.³

Most NPs are trained with master’s degrees, but the dermatology specialty requires additional post-master’s specialty education and training. Recertification takes place every three years with additional continuing education coursework.³

The standards and competencies that are used as a basis for dermatology certification in NPs are relatively new, having only first been established in 2015 by a volunteer task force. Competencies continue to be developed, but specific requirements and scope of practice rules for this specialty vary by state.³

Each state nursing board sets rules and regulations for nurse practitioners practicing in that individual state. Some state boards of nursing require that nurse practitioners work in partnership with a physician, but there is a push to expand the practice of authority of all types of nurse practitioners across all 50 states.

Currently, the 26 states and the District of Columbia allow nurse practitioners full practice authority, meaning that nurse practitioners can practice independently in their area of practice. These states include:⁴

• Alaska
• Arizona
• Colorado
• Connecticut
• Delaware
• Hawaii
• Idaho
• Iowa
• Kansas
• Maine
• Maryland
• Massachusetts
• Minnesota
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Mexico
• New York
• North Dakota
• Oregon
• Rhode Island
• South Dakota
• Vermont
• Washington
• Wyoming

Other states have reduced or restricted practice authority for NPs, meaning there is less they can do independently under their license. In many of these cases, a partnership with a licensed physician is required for different areas of practice.⁵

According to AANP, about 75% of all NPs work with other NPs, while the remaining works in physician practices. Additionally, about 74% of NPs reported in a 2020 AANP survey that they were able to write patient prescriptions without a physician’s co-signature.²

Additional states are working toward increasing the scope of practice and privileges for NPs, with Florida, Pennsylvania, and California being among those to most recently expand NP authority.⁴

The American Academy of Dermatology Association offers an interactive map to review the most recent scope of practice laws for NPs and Pas in your state at https://www.aad.org/member/practice/compliance.

References

1. American Academy of Nurse Practitioners. NP fact sheet. Available at https://www.aanp.org/about/all-about-nps/np-fact-sheet. Updated November 2022. Accessed Jan. 15, 2023.
2. American Academy of Nurse Practitioners. 2020 AANP National Nurse Practitioner Sample Survey Results. Available at https://storage.aanp.org/www/documents/no-index/research/2020-NP-Sample-Survey-Report.pdf. Accessed Jan. 15, 2023.
3. Bobonich M, Nolen M. Competencies for dermatology ​nurse practitioners. JAANP. Available at https://journals.lww.com/jaanpresourcecenter/pages/competencies.aspx . Updated 2018. Accessed Jan. 18, 2023.
4. NurseJournal.org. Nurse practitioner practice authority: State-by-state guide. Available at https://nursejournal.org/nurse-practitioner/np-practice-authority-by-state/. Updated November 2022. Accessed Jan. 18, 2023.
5. American Academy of Nurse Practitioners. State practice environment. Available at https://www.aanp.org/advocacy/state/state-practice-environment. Updated October 2022. Accessed Jan. 18, 2023.