Advanced practice providers (APPs) are playing an increasingly prominent role in dermatology. NPs and PAs delivered 27.4% of dermatology office visits in 2020, up from 15.5% in 2013 (P<.001), according to a recent review published in The Journal of Clinical and Aesthetic Dermatology.1
Their role is even greater in areas with fewer dermatologists. APPs account for 55.6% of dermatology providers in micropolitan areas and 87.8% in rural settings.1
Yet specialty certification is not required to practice dermatology, and many APPs still enter the field through on-the-job training rather than a standardized postgraduate pathway. Authors Lynn Smith, DNP, DCNP, and Izabela Horzempa, PA-C, reviewed the 2 major dermatology specialty credentials available to APPs, the Dermatology Certified Nurse Practitioner (DCNP) certification for NPs and the Certificate of Added Qualifications in Dermatology (CAQ-Derm) for PAs—and the gaps that remain in standardizing dermatology training.1
For NPs: What Does It Take to Become a DCNP?
The DCNP examination, launched in 2008 and administered by the Dermatology Nurse Practitioner Certification Board (DNPCB), is the only specialty board examination for dermatology NPs in the United States.1
To qualify, an NP must have:
- A master's or doctoral degree in nursing
- Current APRN state licensure
- National APRN certification
- At least 3,000 hours of dermatology NP practice within the previous 3 years
- Current practice in dermatology1
Clinical hours completed through a formal dermatology NP fellowship can count toward the 3,000-hour requirement.
The examination includes 175 multiple-choice questions completed over 4 hours. Assessment and diagnosis account for 35% of the exam, followed by prescribing and procedural interventions at 33%, patient and professional education at 24%, professional activities at 5%, and research analysis at 3%.1
Candidates must correctly answer 74% of questions to achieve the passing standard score of 95. Certification costs $400 and is valid for 3 years.1
By the Numbers: DCNP Certification
Despite the growing dermatology NP workforce, relatively few NPs hold the credential.
As of July 2025, 588 NPs nationwide were DCNP certified, with Florida having the largest number at 63. A 2024 American Association of Nurse Practitioners workforce survey of 10,275 NPs found that only 0.3% reported a dermatology specialty certification.
Just 60 candidates took the DCNP examination in 2024 and 61 in 2025. Passing-rate data were not available.1
Connect FAQ: Dermatology Specialty Certification
What is DCNP certification?
The Dermatology Certified Nurse Practitioner credential is a specialty board certification for NPs practicing dermatology. Eligibility includes at least 3,000 hours of dermatology NP practice during the preceding 3 years, along with graduate nursing education, APRN licensure, and national certification.1
How does CAQ-Derm differ from DCNP?
DCNP is specifically for NPs, whereas CAQ-Derm is offered to PAs. CAQ-Derm requires at least 4,000 hours of dermatology experience within 6 years as well as 75 Category 1 dermatology CME credits and verification of dermatologic skills.1
Do I need specialty certification to work in dermatology?
No. Specialty certification is not currently required for NPs or PAs to practice in dermatology.1
Do I need to complete a dermatology fellowship before taking the DCNP exam?
No. Fellowship training is one way to accumulate qualifying clinical experience, but graduation from a dermatology fellowship is not required to sit for the DCNP examination.1
Does dermatology certification improve patient outcomes?
That remains unknown. Outcomes-based evidence connecting APP dermatology certification with improved diagnostic accuracy, procedural competency, or patient outcomes is currently limited.1
What may certification offer right now?
Certification provides formal recognition of advanced specialty knowledge and experience. For PAs, CAQ-Derm recipients have also reported benefits including promotions, increased compensation, expanded responsibilities, and greater patient recognition.1
For PAs: How Does CAQ-Derm Work?
PAs have a newer specialty certification pathway.
The National Commission on Certification of Physician Assistants (NCCPA) introduced CAQ-Derm in 2023 as the first accredited certification recognizing advanced dermatology knowledge and experience among PAs.1
Eligibility requires:
- Active NCCPA certification
- A current state license
- At least 4,000 hours of dermatology experience within the previous 6 years
- At least 75 Category 1 dermatology CME credits within the previous 6 years
- At least 25 of those CME credits completed within the previous 2 years
- At least 5 Category 1 CME credits in dermoscopy
- A Physician Attestation Form verifying dermatologic knowledge and procedural skills1
The CAQ-Derm examination contains 120 multiple-choice questions. History and physical examination represents 25% of the task-based blueprint, followed by diagnosis, nonsurgical interventions, and pharmacology at 15% each.1
Scores range from 200 to 800, with 350 required to pass.
The examination blueprint has not been without debate. Young and colleagues questioned whether its content fully reflects the conditions PAs encounter in practice, noting that some high-prevalence diseases are relatively underrepresented while less common conditions receive greater emphasis.3
Is CAQ-Derm Worth It for PAs?
The review highlighted several reported professional benefits among PAs who obtained a CAQ-Derm.
More than 40% successfully pursued a promotion, approximately half received or anticipated a pay increase, and more than one-third received a cash bonus. Additionally, 60% reported or anticipated increased job responsibilities, while approximately 66% reported greater respect and acceptance from patients.1
Those findings suggest specialty certification may offer professional benefits—but whether certification translates into better clinical outcomes is a different question.
The Bigger Issue: How Should APPs Be Trained in Dermatology?
For many NPs and PAs, certification is only one piece of a much larger training question.
Formal dermatology fellowship opportunities remain limited, and most APPs continue to acquire specialty skills through varying forms of on-the-job training. Although competency frameworks have been developed for dermatology NPs, Smith and Horzempa noted that no formally published, peer-reviewed dermatology specialty competency framework specific to PAs had been established at the time of publication.1,2
Some structured programs are available. NP fellowships include programs at Lahey Clinic and the University of Rochester Medical Center, while programs available to both NPs and PAs include those at Penn State Health Milton S. Hershey Medical Center and Oregon Health & Science University. The University of Utah also offers a 12-month Dermatology Fellowship for Advanced Practice Clinicians.1
Access, however, can be highly competitive, with some programs accepting only 1 or 2 trainees per cycle.
The American Academy of Dermatology addressed this broader issue in a March 2025 position statement, noting that advanced practice residency and fellowship programs for nonphysician clinicians "are not formally recognized nor standardized in their training."2
Does Specialty Certification Improve Patient Care?
We don't know yet.
That's one of the most important distinctions for practicing NPs and PAs considering certification.
There is currently limited outcomes-based evidence showing whether dermatology specialty certification improves diagnostic accuracy, procedural competency, patient outcomes, or health care utilization.1
Smith and Horzempa called for additional research examining those outcomes, as well as greater collaboration between physician-led dermatology organizations and NP and PA professional organizations to establish more standardized training expectations.
They pointed to cardiology as a potential model. In 2020, the American College of Cardiology published formal clinical competencies for cardiovascular NPs and PAs developed collaboratively by APPs and physician experts and endorsed by multiple professional organizations.1,2
A similar approach in dermatology could help establish clearer expectations as APP involvement in the specialty continues to expand.
The Connect Takeaway
APPs are already a major part of the dermatology workforce, particularly in communities where access to dermatologists is limited. Specialty credentials such as DCNP and CAQ-Derm offer NPs and PAs a way to formally demonstrate dermatology-specific experience and knowledge, but they exist within a training landscape that remains far from standardized.
For clinicians considering certification, the decision may currently be as much about professional development and validating specialty expertise as demonstrating a proven effect on patient outcomes. As the APP dermatology workforce continues to grow, determining whether certification translates into measurable clinical benefits, and establishing clearer training standards across the profession, will be important next steps.
References
- Smith L, Horzempa I. Advancing standards: the role of specialty certification in advanced practice practitioners in dermatology practice. J Clin Aesthet Dermatol. 2026;19(7-8 Suppl 1). https://jcadonline.com/advancing-standards-the-role-of-specialty-certification-in-advanced-practice-practitioners-in-dermatology-practice/
- Young PA, Prajapati S, Bae GH, Feldman SR. A comparison of national skin disease burden with standardized examination content for dermatology physician assistants. J Dermatol Physician Assist. 2024;18(2):12-14. https://www.researchgate.net/publication/371446862_A_comparison_of_national_skin_disease_burden_with_standardized_exam_content_for_dermatology_physician_assistants
