Derm Dispatch: One NP's Mission to Expand Rural Dermatology Access

Welcome back to Derm Dispatch!

Obehi Oriaifo, DNP, FNP-BC, DCNP, a dermatology nurse practitioner with the US Department of Veterans Affairs (VA) in Iowa and founder of DermaNP Solutions, recently joined Derm Dispatch host Renata Block, DMSc, MMS, PA-C, to discuss the access barriers driving her decision to launch a teledermatology platform for rural and underserved patients. Oriaifo also detailed her clinical experience treating veterans through the VA system and the practical realities of building an independent telehealth practice.

Long Wait Times Push Patients Hundreds of Miles for Care

Oriaifo practices in Des Moines, Iowa, but also sees patients from rural areas who travel nearly 3 hours for an appointment. She said most patients wait around 6 months to be seen, even within the VA system, before an appointment lasting only 10 to 15 minutes.

"I've had patients tell me, I've driven 3 hours to be here," Oriaifo said.

Block noted similar access problems in Chicago, where patients often see a nurse practitioner or physician assistant sooner than a dermatologist. Oriaifo said the wait time delays basic care such as clearing an acne flare before a wedding, and she described hidradenitis suppurativa patients who cycled through repeated 5-day courses of Bactrim at urgent care for years before reaching a dermatology provider.

Rural and Underserved Communities Face the Widest Gaps

Oriaifo chose to license DermaNP Solutions in Iowa and Alaska after reviewing workforce data. She cited Dermatology Nurse Practitioner Certification Board figures showing Alaska has about 33 dermatologists for a population of 741,000 and only 1 board-certified dermatology nurse practitioner in the state, while Iowa has about 188 dermatologists and 15 dermatology nurse practitioners for 3.2 million residents.

"It's about representation, it's about accessibility, redefining the quality of skin care," Oriaifo said.

She added closing the gap also means building trust in communities with skin of color and other populations historically overlooked in dermatology.

Weekend Scheduling and Self-Pay Model Target Working Families

DermaNP Solutions operates as a weekend, self-pay telederm practice designed for families and professionals who cannot easily take time off during the week. Oriaifo said she built the model around 30-minute visits, longer than the standard 10- to 15-minute in-person slot, to give patients time to fully discuss their concerns. The platform accepts HSA payments and can generate a superbill for patients seeking insurance reimbursement.

"I want my patients to feel like they're not going to feel rushed," Oriaifo said.

Regulatory Hurdles Outweigh Clinical Ones for New Practice Owners

Oriaifo said the steepest learning curve in launching DermaNP Solutions has been navigating business licensing and regulatory requirements state by state rather than clinical care itself. She practices in Iowa and Alaska as an independent nurse practitioner and does not require a medical director in either state, a requirement she noted still applies to some practices led by physician assistants.

"Just seeing patients like reaching out organically is like, yes, this is actually a huge need," Oriaifo said of the platform's early response.

Oriaifo closed the conversation by encouraging colleagues considering a similar path to seek mentors early and stay grounded in their reason for entering dermatology.

"Know your why," she concluded.