Andrew Baker, PA-C, on the Evolution of NP and PA Integration

Over the past decade, dermatology has experienced rapid growth in the advanced practice provider (APP) workforce alongside accelerating patient demand and therapeutic innovation. What was once a model focused primarily on access expansion has evolved into something far more intentional: structured, physician-led integration designed to scale quality, not just volume.

In this Q&A, Andrew Baker, PA-C, president-elect of the Society of Dermatology Physician Associates (SDPA) and recent Ohio Derm APP of the Month, shares his perspective on how dermatology practices are redefining APP integration—from career-stage deployment and competency-based autonomy to subspecialization and strategic workforce planning. Drawing on experience across private practice, academic medicine, clinical trials, and industry collaboration, he outlines how mature organizations are building collaborative models that protect standards while expanding access.

The conversation also looks ahead, exploring what the high-performing dermatology APP will require in terms of specialization, mentorship, and systems-level fluency as the specialty works to scale excellence responsibly.

Q&A

Dermatology Times (DT): Dermatology has seen rapid growth in the APP workforce over the past decade. What do you see as the most significant shifts in how APPs are integrated into dermatology practices today compared with 5 years ago?

Baker: Over the past 5 years, there has been more of a rapid shift from simple utilization to true integration and, in the strongest practices, to intentionally design[ing] this.

Historically, APPs were often viewed primarily as access extenders, managing lower-acuity visits, overflow schedules, and routine follow-ups. That model served an important purpose. But today, more mature organizations are building structured, physician-led care hybrid models that thoughtfully integrate APPs into the broader clinical strategy of the practice.

That includes:

• Defined clinical lanes aligned with training and experience
• Productivity metrics that account for complexity, not just volume
• Structured onboarding programs developed in collaboration with experienced dermatologists
• Longitudinal mentorship models rather than informal supervision
• Improving support staff and other office-based logistics

As someone who has worked closely with physicians across private practice, academic settings, private equity, and the pharmaceutical industry, I have seen how transformative physician engagement is in APP development. The most successful integrations occur when dermatologists are deeply involved in onboarding, protocol creation, case review, and overall professional culture.

There has also been a shift from transactional hiring to strategic workforce planning. APPs are now being incorporated into service line expansion—biologics programs, HS [hidradenitis suppurativa] centers of excellence, surgical support, clinical trials, and cosmetics, with often physician oversight and training anchoring quality and clinical reputation.

The conversation has matured. It’s no longer “How do we increase access?” but “How do we scale excellence responsibly?”

DT: How do you see the balance between autonomy and physician collaboration evolving for dermatology APPs, particularly in high-acuity medical dermatology?

Baker: The evolution isn’t about autonomy vs supervision. It’s about graduated responsibility within physician-directed collaboration.

In high-acuity medical dermatology [ie, complex inflammatory dermatology and cutaneous oncology], the diagnostic and therapeutic landscape is more sophisticated than ever. That complexity elevates the value of dermatologists as diagnostic leaders and treatment strategists but also necessitates the need for highly trained and educated APPs.

APP autonomy in these environments must be competency-based, not time-based. The strongest models include early career:

• Defined escalation pathways
• Regular case review cadence
• Shared protocols for biologics and immunosuppressive therapy
• Joint decision-making for atypical or refractory cases

As disease management becomes more advanced, particularly with emerging systemic therapies and clinical trial options, collaboration actually deepens. APPs may assume increasing ownership of longitudinal disease management: monitoring, patient education, access navigation, [and] adherence optimization. Meanwhile, physicians continue to anchor diagnostic nuance, pivot strategy when needed, and guide complex therapeutic decisions throughout the practice.

That complementary structure protects quality, strengthens outcomes, and is professionally rewarding for both sides.

DT: Are we moving toward true subspecialization among dermatology APPs? What does that mean for training and professional development?

Baker: Yes, and I believe this is one of the defining inflection points for our profession.

We are increasingly seeing focused clinical tracks develop, such as:

• Biologic and systemic therapy specialists
• HS and complex inflammatory disease leads
• Surgical dermatology support roles (Mohs and excisions)
• Cosmetic/aesthetic-focused clinicians
• Contact dermatitis and patch testing specialists
• Increasing number of APP key opinion leaders

This mirrors the evolution of medicine broadly—depth improves outcomes. However, subspecialization raises the bar for structured training. Informal shadowing is no longer sufficient, particularly as therapies become more targeted and risk profiles more nuanced.

Practices should be implementing:

• Competency-based onboarding frameworks codeveloped with physicians
• Advanced didactic curriculum
• Defined case minimums before independent management
• Ongoing [continuing medical education] aligned with focused dermatology tracks
• Research and clinical trial exposure, when available

As a clinical trial investigator and someone involved in national educational initiatives, I see firsthand how rapidly therapeutic innovation is moving. APP education must keep pace.

The APP of 2026 cannot be trained like the APP of 2016, and physician mentorship remains central to that evolution. Having said that, the [National Commission on Certification of Physician Assistants] Dermatology [Certificate of Added Qualifications] is available, but its true value for dermatology PAs [physician assistants] is unclear at this time. The SDPA Diplomate Fellowship has long been viewed as the gold standard of dermatology PA education. 

DT: With rising patient demand and persistent dermatologist shortages, how should practices strategically deploy APPs to maintain quality while expanding access?

Baker: Access without structure creates risk. Access with intentional design creates sustainability.

Strategic deployment must recognize a fundamental truth: Not all dermatology APPs function at the same level, nor should they be expected to. Career stage, training, and cumulative clinical hours matter significantly.

A thoughtful model differentiates between early-career, midcareer, and highly experienced APPs.

1. Right patient, right provider, right setting—based on career stage

Early-Career APPs (0-5 years)

This is a formative phase focused on skill acquisition, diagnostic pattern recognition, and structured mentorship. Clear triage pathways are essential.

Patients often best suited for early-career APPs include, particularly in the first 1 to 2 years, [those with]:

• Acne
• Rosacea
• Straightforward dermatitis
• Stable biologic follow-ups
• Protocol-driven chronic disease management

New suspicious lesions, undifferentiated rashes, complex autoimmune presentations, aggressive skin cancers, or systemic disease concerns often warrant dermatologist evaluation first, with collaborative follow-up as appropriate.

Expectations at this stage should prioritize competency development over productivity.

Midcareer APPs (6-10 years)

At this stage, diagnostic confidence and efficiency improve significantly. These clinicians often manage broader medical dermatology panels and more complex longitudinal disease.

They may:

• Initiate and manage biologics within defined protocols
• Manage moderate to complex inflammatory disease
• Triage surgical consults effectively
• Participate more actively in mentoring junior APPs

Collaboration remains structured, but the cadence may shift from directive oversight to strategic discussion.

Experienced APPs (10+ years/~10,000+ clinical hours)

Highly experienced dermatology APPs function differently and should be deployed differently.

With substantial case volume and pattern recognition depth, these clinicians may:

• Manage complex inflammatory disease within collaborative frameworks
• Lead biologic programs operationally
• Participate in clinical trials
• Contribute to protocol development
• Assist in onboarding and internal education
• Serve as strategic partners in service line expansion
• Complex surgery

Their role often extends beyond clinic throughput into quality improvement, workflow optimization, and leadership initiatives.

Expecting an early-career APP to function like a 10,000-hour clinician is inappropriate. Conversely, underutilizing a highly experienced APP is inefficient and professionally limiting.

2. Structured collaboration models

Regardless of career stage, physician engagement remains foundational.

High-quality systems include:

• Case review
• Shared inbox governance standards
• Standardized documentation templates
• Clearly defined consult and escalation triggers

In early career stages, collaboration is more frequent and directive. In midcareer stages, it becomes consultative. At advanced levels, it becomes strategic and bidirectional.

3. Metrics beyond productivity

Practices expanding access must measure more than visit volume. Quality indicators should include:

• Biologic monitoring adherence
• Escalation appropriateness
• Diagnostic concordance
• Revisit patterns
• Patient satisfaction

When career-stage deployment aligns with structured oversight and meaningful metrics, access can expand without compromising standards. APP integration should be treated as a clinical architecture decision, not merely a staffing decision.

In my advisory and nonclinical work, I’ve become increasingly selective about where I invest time because integration quality varies widely. The organizations positioned for long-term success are those that:

• Differentiate expectations by experience level
• [Maintain] physician-led mentorship
• Invest in structured onboarding
• Design collaboration intentionally

Scaling dermatology responsibly requires nuance, and career stage awareness is central to that strategy.

DT: Looking toward 2035, what does the role of a high-performing dermatology APP look like, and what should clinicians be doing now?

Baker: By 2035, the high-performing dermatology APP will be:

• Clinically specialized
• Deeply collaborative with dermatologists
• Data-literate and outcomes-focused
• Comfortable with [artificial intelligence]–augmented diagnostics
• Skilled in value-based care models
• Potentially leading defined service lines under a physician partnership

Technology will enhance diagnostic support and workflow efficiency, but it will not replace clinical judgment, therapeutic nuance, or the physician-led model that anchors dermatology excellence.

APPs will likely assume greater responsibility in longitudinal disease management, patient education, adherence strategy, and population health initiatives—always within collaborative physician relationships.

To prepare now, clinicians should:

• Invest in structured advanced dermatology training
• Develop depth in systemic and complex inflammatory disease
• Engage in research and clinical trials when possible
• Build leadership and operational fluency
• Understand reimbursement, policy, and value-based models
• Seek meaningful physician mentorship

The APP who thrives in 2035 will not simply be clinically capable; they will understand systems, strategy, and collaboration at a national level.

And as our profession continues to evolve, it’s essential that we move forward unified, dermatologists and APPs aligned, protecting standards, advancing education, and designing care models that elevate dermatology as a whole.