The provider who walks into your exam room might not be a dermatologist. Here’s what that means for your skin.
You go in for a skin check. Maybe a spot that’s been bugging you.
The provider comes in, looks you over, and by the end of the appointment, you’ve had five biopsies.
You leave confused. A little shaken.
Wondering why you needed to be cut on that many times, and whether any of it was actually necessary.
Here’s something most patients don’t realize walking in: the person who saw you may not have been a dermatologist at all.
They may have been a nurse practitioner or a physician assistant – a mid-level provider working in a dermatology office.
And while that sounds minor, it has real consequences for your skin.
Why Does It Matter Who Looks at Your Skin?
Most people assume that if they’re at a dermatology office, they’re seeing a dermatologist.
Not always.
And the difference matters. A lot.
Maybe you’ve experienced it yourself.
You left an appointment with five biopsies when all you came in for was acne.
You got a steroid prescription for a rash. It helped, but nobody ever explained why you had the rash in the first place.
Or you had a mole that got glanced over and told it looked fine. Only to find out later it was melanoma.
These aren’t flukes.
They’re what can happen when the person examining your skin doesn’t have the training to know what they’re looking at.
So what does that training actually look like? And how big is the gap?
That’s what we’re going to break down.
What Is a Dermatologist, and What Does Their Training Actually Look Like?
The short version: 8–15 years of training after a bachelor’s degree. 12,000–16,000 hours of supervised clinical experience.
That’s a lot.
After a four-year bachelor’s degree, an aspiring dermatologist spends four years in medical school.
Two years of intense coursework and two years of clinical rotations across all areas of medicine.
Then comes dermatology residency.
Four more years at an academic institution, supervised by at least ten dermatology faculty members who are practicing physicians themselves.
Thousands of hours of looking at skin. Recognizing patterns. Describing what they see.
At the end of residency comes the board certification exam.
It’s notoriously stressful: designed to test whether a physician can immediately recall obscure facts about diseases they may have seen only once in four years of training.
Pass it, and you’re board-certified.
Some dermatologists go even further, completing fellowships in subspecialties like Mohs surgery or dermatopathology.
8–15 years. Thousands of hours. All before seeing a single patient independently.
That’s what “board-certified dermatologist” actually means.
Who Are Mid-Level Providers, and What Is Their Training?
Mid-level providers, nurse practitioners (NPs) and physician assistants (PAs), are increasingly common in dermatology offices.
A quick note on the name: despite the word “assistant,” physician assistants are not doctors or doctors-in-training.
Neither are nurse practitioners. They’re licensed clinicians, but their training looks very different from a physician’s.
Nurse Practitioners (NPs)
The short version: 2–3 years of post-bachelor’s education. 500–720 hours of clinical training. No formal dermatology training.
NP programs after a bachelor’s degree are often heavy on coursework: leadership, administration, theory.
According to the American Medical Association, only 15% of NP programs provide additional hands-on clinical time seeing patients.
Fully online programs are allowed. Which means some NPs complete their entire program without seeing a single patient.
Physician Assistants (PAs)
The short version: 2 years of post-bachelor’s education. Around 2,000 hours of clinical training. No formal dermatology training.
PA school is two years. One year of coursework, one year of clinical rotations.
If a PA student is lucky, they might get a one-month rotation in dermatology.
Shadowing. Learning the lingo. Not seeing patients independently.
That’s it.
What happens after graduation
Once an NP or PA joins a dermatology practice, their training continues on the job.
Shadowing the one dermatologist who oversees them, reading textbooks, sitting in on lectures if they’re lucky.
Their knowledge can be shaped entirely by that one physician.
What that dermatologist knows well, they’ll know well.
What that dermatologist struggles with, they’ll struggle with too.
And in some practices? A senior mid-level provider trains the newer one. No dermatologist involved at all.
How Do Their Approaches to Diagnosis Differ?
This is where the training gap shows up in the exam room.
A board-certified dermatologist has spent thousands of hours looking at skin.
They’ve seen the same patterns countless times.
They often know what something is (or isn’t) in an instant just by looking at it.
For a dermatologist, a biopsy is a confirmatory tool. Something they use to verify what they already suspect.
For a mid-level provider with limited dermatology experience, a biopsy may be something different. A way of finding out what something is in the first place.
That’s a big distinction. And the research backs it up.
What the numbers say
According to a 2018 study in JAMA Dermatology, dermatologists needed to examine 25.4 darker-colored spots to diagnose one melanoma. Mid-level providers needed 39.4 (Anderson et al., 2018).
That gap is biggest at the earliest (and most curable) stage of melanoma.
Dermatologists are significantly better at catching melanoma in situ, when treatment is most effective.
Mid-level providers are more likely to miss it at that stage entirely.
Which matters. A lot.
Melanoma caught early is very treatable.
Melanoma caught late is a very different story.
The same study looked at number needed to biopsy (NNB). The number of biopsies it takes to diagnose one skin cancer. Lower is better.
Dermatologists: 3.3. Physician assistants: 3.9.
That difference might seem small on paper.
But it’s statistically significant.
And it adds up. The unnecessary procedures, higher bills, and a lot of anxiety for patients who didn’t need to be cut on in the first place.
One more thing worth mentioning: the quality of the biopsy matters too. A poorly performed biopsy produces unreliable results.
Junk in, junk out.
When Is Seeing a Dermatologist Especially Important?
The American Academy of Dermatology recommends that mid-level providers in dermatology be used for follow-up care on already-diagnosed conditions. Not for new ones.
So when does it especially matter that you’re seeing a board-certified dermatologist?
- You have a spot, mole, or lesion you’re concerned about
- You have a personal or family history of skin cancer
- You have a crusty, bleeding, or non-healing spot
- You want to make sure nothing gets missed
These are the moments when training depth makes the real difference.
When having a doctor who’s spent years looking at skin, and knows exactly what they’re looking at, matters most.
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Before your next dermatology appointment, it’s worth asking one simple question: will I be seeing a physician?
You can ask when you call to book. Or look up the providers on the practice’s website before you go.
You deserve to know.
At Finger Lakes Dermatology, the answer is always yes. Every visit, you see a board-certified dermatologist — someone who’s spent years training to look at exactly what’s on your skin. Ready to be seen by a doctor who actually knows? Call us at (607) 708-1330 or request an appointment online.
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Drs. Yentzer and Silvers at Finger Lakes Dermatology are board-certified dermatologists serving Ithaca, Cortland, and the surrounding Finger Lakes region. Here, you are a person, not a number. When you see one of our doctors, your concerns are heard. Your input is valued. And you leave feeling seen, validated, and in control of your health. Ready for that experience? Request an appointment.
This content is for informational purposes only and does not constitute medical advice. If you have a skin concern you’d like to discuss, please contact your doctor or a board-certified dermatologist.
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References
Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK. Accuracy of Skin Cancer Diagnosis by Physician Assistants Compared With Dermatologists in a Large Health Care System. JAMA Dermatol. 2018; 154 (5): 569-573.
American Medical Association. Scope of practice: Education matters. https://www.ama-assn.org/practice-management/scope-practice/scope-practice-education-matters
American Medical Association. 3-year study: NPs in ED – worse outcomes, higher costs. https://www.ama-assn.org/practice-management/scope-practice/3-year-study-nps-ed-worse-outcomes-higher-costs
American Medical Association. Physician authors explore what rise of NPs, PAs means for patients. https://www.ama-assn.org/practice-management/scope-practice/physician-authors-explore-what-rise-nps-pas-means-patients