‍Women’s Dermatologic Society (WDS)

I recently had the pleasure of watching in a virtual panel discussion on Diversity in Recruitment in the Dermatology Workforce hosted by The WDS Diversity, Equity, and inclusion Committee of The Women’s Dermatologic Society: Physician | Leaders | Mentors.The WDS dates back to 1973 with the core mission of empowering and connecting women in dermatology through personal and professional development, mentorship, service, and leadership. They recruit members from private practice, academia, managed care, and industry. From what I can tell based on the description of the different memberships, they do not offer membership for nurse practitioners (NPs).

 Diversity in recruitment in the dermatology workforce

The panel was led by some highly regarded and successful Board-Certified Dermatologists. Seemal Desai, MD, FAAD the incoming President-elect of the American Association of Dermatology (AAD) at the time of recording. Mara Weinstein Velez, MD, FAAD, a Fellowship Trained Cosmetic and Laser Surgeon who is also an Assistant Professor of Dermatology at the University of Rochester in New York. Valencia Thomas, MD MHCM, a professor in the Department of Dermatology at the University of Texas MD Anderson Cancer center, Section of Mohs and Dermasurgery in Houston, Texas. The conversation, moderated by Olabola Awosika, MD of the Pinnacale Dermatology clinic in Michigan, centered around the steps to recruit and retain individuals underrepresented in medicine (UIM) into dermatology. From what I could tell, I was the only non-physician in attendance. It was a great discussion and a lot of points were brought up that parallel nursing when it comes to Diversity, Equity, and Inclusion (DEI) and dermatology.

 Exposing aspiring nurse practitioners sooner to explore dermatology

I couldn’t agree more with the panelists on the topic of early exposure for students. Nursing curriculum does not include dermatology, instead we learn about the integumentary system which covers pressure ulcers, skin cancer prevention (ABCDE skin assessment), and infections of the skin, hair, and nails. NP curriculum expands to briefly cover topics like how to document skin abnormalities, how to recognize sexually transmitted infections, and how to treat brown recluse spider bites. It’s no surprise why most NPs don’t consider dermatology or know what steps to take if they want to make the transition from primary care.

One reason I started this blog was to share the resources I use to transition into dermatology. Like most NPs, I started my search on YouTube. I found a lot of nurses and NPs posting videos on aesthetics and cosmetic treatments. But it was challenging finding NPs in dermatology talking about what steps they took to make that transition. I have to thank NurseAggz or Aggie, a former L&D nurse turned Dermatology NP and content creator who happens to look like me. From what I can tell, she is the only NP specializing in medical dermatology that produces content on social media that talks about recommended NP dermatology organizations, networking opportunities, programs, costs, and the realities of being a new healthcare provider. More importantly, she's accessible via social media to answer questions in real-time.

‍Mentorship

To expose young minds sooner, I started a mentorship program for kids K-college to expose them to career experts, including healthcare professionals, to motivate them to start thinking about their future. Additionally, I’ve recently collaborated with a mentorship program based in Maryland to host a nurse career fair. Mentorship and speaking engagements are powerful tools to increase exposure and representation in nursing. In nursing school, we are told repeatedly about the importance of mentorship, but often don’t know the steps to take. I’m in the process of creating a toolkit for mentors and mentees that I will elaborate on in more detail in future posts. Join the Mahogany Dermatology community here to find out when that article is released.

‍Nursing curriculum and clinical rotations

It’s natural to look to nursing curriculum as the solution to all our problems. However, after being the DNP student representative for the George Washington University Curriculum Committee, I learned that while new change is welcomed with open arms, nursing schools have to wait to implement change that will not negatively impact graduation requirements for the current cohorts; and that may take more than a year to introduce.  The best place to expose NPs to dermatology would be the clinical setting, however the preceptor shortage is a barrier to students having this opportunity.

The preceptor shortage problem

During my DNP program I took a course called Entrepreneurship and Innovation for Nurse Leaders. I fell in love with that course and soon joined the Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders (SONSIEL). During the course we were tasked with identifying a problem and creating an innovation solution. I addressed the preceptor shortage; another topic that deserves a separate post. In short, NPs want to mentor and train NP students by offering a preceptorship. However, they are not always compensated fairly or supported sufficiently for the time they invest while being expected to maintain a full patient load and the productivity requirements of their practice. Many schools of nursing require students to find their own preceptor, but end up bearing that responsibility when a proportion of students are unable to find an available preceptor in a market where they compete with medical and physician assistant students. The answer is in the latest evidence which reveals that NPs value more than just financial compensation, they would also appreciate low-cost, high value privileges that universities already possess. It’s just a matter of sitting down and looking at the numbers, creating a system of automation, and a dedicated team that can create an ecosystem of support. By taking these steps we can increase the number of NP students who have the opportunity to experience a dermatology clinical rotation and subsequently increase their chances to obtain employment requiring experience. If you didn't know, the majority of dermatology employers require an average of 2-5 years of experience, which is why Physician Associates outpace NPs in obtaining these coveted positions as a new or experienced provider.

Optimizing the dermatology clinical rotation

I’m going to conclude Part 1 of this series by addressing how to optimize dermatology clinical rotations. While I empathize with the preceptor shortage, I did not struggle finding a preceptor in NP school because I had experience cold calling medical offices and my professor asked for a favor from a former student. Below are my clinical rotation specialties and the credentials of my preceptors:

·     Primary care rotation: with a physician specializing in Internal Medicine

·     Primary care rotation: with a physician specializing in Functional Medicine

·     Older adult rotation: with a nurse practitioner specializing in hospice care in a long-term care setting

·     Older and frail adults rotation: with a nurse practitioner in a long-term care setting

·     Older and frail adults rotation: with a physician working in a long-term care setting

·     Sports medicine rotation: with a DNP prepared nurse practitioner specializing in sports medicine

In my first two rotations, I called the medical office stating I was a NP student looking for a preceptor in the stated specialty. I was grateful when the physicians agreed to precept me, but also surprised to find out there were NPs working at the practice site. I always found it interesting that I wasn’t paired with the NP, which would have enhanced my clinical experience. I want to be clear, NP students can benefit from the mentorship and preceptorship opportunity from a physician, NP, or PA. However, there are some challenges that only NPs face that only other NPs can relate to and coach you through. I don’t know why NPs are not always promoted on medical practice websites or given the same opportunities to precept. But that is one area where clinical rotations can be optimized.

The second area clinical rotations can be optimized, is to provide a blueprint and training for both the preceptor and student that addresses expectations, desired objectives, and clearly delineates the differences between a nurse and nurse practitioner. A checklist of tasks would be nice too, including having the opportunity to 2) chart, 2) write and send a prescription, 3) complete an entire focused visit, 4) meet with a pharmaceutical rep, 5) perform a simple medical and/or cosmetic procedure with supervision, and 6) explain test results with a patient, to name a few things. There are some tasks on the business side of things they should be exposed to also, but I'll save that for another post.

In Part 2 of this series, I will discuss why it is imperative that everyone be well versed in the needs of communities of color so they can competently and confidently establish trust and improve health equities. Join the Mahogany Dermatology Community here to be notified when Part 2 is released.

‍

Kimberly Madison, DNP, AGPCNP-BC

Kimberly Madison is a nurse practitioner with a passion for writing, entrepreneurship, financial literacy, and mentorship. I created this blog to share my journey as I become a dermatology nurse practitioner and entrepreneur. Most importantly, I’m looking forward to helping nurse practitioners and aspiring students to better understand the business of dermatology and their role to improving access to care, providing culturally competent care, and advancing education.

‍

‍