The Practice Brief: Burnout, APP Growth, and Individualized Care

Help your practice thrive—one week at a time.

Welcome to The Practice Brief, your weekly roundup of the news, trends, and ideas shaping the future of dermatology. Each edition highlights the biggest developments in practice management, reimbursement, policy, AI, business, and professional growth, while connecting them to existing Dermatology Times and NP/PA Connect coverage. The goal isn't just to keep you informed—it's to help you discover what's next, identify opportunities, and keep your practice performing at its best.

PA Burnout Is Becoming a Long-Term Workforce Problem

Burnout remains a significant concern among PAs, with workload, compensation, and administrative responsibilities continuing to contribute to professional strain.

According to findings from Medscape's 2026 PA Burnout and Depression Report, 35% of surveyed PAs reported burnout, while another 15% reported experiencing both burnout and depression. Among PAs experiencing burnout, 44% said their symptoms had persisted for more than 2 years.

Administrative burden emerged as the most commonly reported contributor to burnout, cited by 57% of respondents, followed by inadequate compensation at 49% and excessive working hours at 39%.

Importantly, respondents largely pointed toward organizational rather than individual solutions. Increased compensation, more manageable schedules and patient loads, and additional support staff were among the changes PAs said could help address burnout.

For dermatology practices that increasingly rely on APPs to expand patient access and support growing clinical demands, the findings suggest that workforce sustainability may depend on addressing the structural factors contributing to burnout.

▶ Why it matters: Burnout is not solely an individual wellness issue. Workload, administrative support, scheduling, and compensation can affect clinician retention and, ultimately, a practice's ability to maintain patient access and continuity of care.

The Expanding APP Role Goes Beyond Increasing Patient Capacity

As practices confront workforce pressures, APPs are also taking on increasingly broad roles across dermatologic care.

During National APP Week, Donna Lam Cahill, PA-C, reflected on her path into dermatology and the evolution of the PA profession. Her experience highlights responsibilities that extend well beyond increasing patient capacity, including evaluating and diagnosing patients, developing treatment plans, maintaining longitudinal patient relationships, educating colleagues, and advocating for patients navigating insurance and access barriers.

Cahill also emphasized the importance of persistence, mentorship, and continued professional development for PAs entering dermatology.

Her perspective comes as APPs play an increasingly visible role in dermatology practices, particularly as patient demand and therapeutic complexity continue to grow.

▶ Why it matters: Integrating APPs effectively requires more than adding clinical capacity. Mentorship, professional development, administrative support, and recognition of APPs as integral members of the care team can help practices build a more sustainable workforce.

Alopecia Areata Care Is Moving Toward Earlier, More Comprehensive Management

Alopecia Areata Awareness Month highlighted how rapidly the treatment landscape for AA has changed.

The availability of targeted systemic therapies, particularly Janus kinase (JAK) inhibitors, has expanded options for patients with severe disease and changed expectations surrounding treatment. Recent discussions have increasingly focused on earlier intervention, appropriate patient selection, long-term disease management, and the psychosocial burden associated with AA.

These advances are also creating new questions for clinicians. As effective systemic therapies become available to broader patient populations, treatment decisions may increasingly require consideration of disease duration, severity, patient age, comorbidities, previous treatment response, and individual treatment goals.

The evolving landscape also reinforces the importance of recognizing AA as more than a cosmetic condition. Hair loss can have substantial psychological and quality-of-life consequences, making shared decision-making an important component of management.

▶ Why it matters: The clinical conversation around AA is shifting from whether meaningful regrowth can be achieved to which patients should receive systemic therapy, when treatment should begin, and how clinicians can balance long-term disease control with patient-specific needs.

Tolerability Shapes Hedgehog Inhibitor Selection in Advanced BCC

For patients with advanced BCC who are candidates for hedgehog pathway inhibition, treatment selection may require clinicians to look beyond efficacy alone.

During a recent Dermatology Times Case-Based Roundtable, Shannon Trotter, DO, and participating clinicians discussed practical considerations surrounding sonidegib and vismodegib, including dosing, pharmacokinetics, drug interactions, adverse-event profiles, and differences in clinical trial response criteria.

Tolerability emerged as an important component of treatment selection and long-term management. Clinicians discussed strategies including treatment interruptions and supportive measures to help patients manage adverse events and remain on therapy.

The discussion also emphasized the value of setting expectations before treatment begins. When asked which changes they planned to incorporate into practice, attendees most frequently selected counseling patients about adverse events before the first dose.

▶ Why it matters: In advanced BCC, treatment success may depend not only on selecting an effective therapy but also on choosing one a patient can realistically remain on. Upfront counseling, individualized treatment selection, and proactive adverse-event management can therefore become part of the therapeutic strategy.

Pediatric Dermatology Is Increasingly About Treating Beyond the Skin

Lessons from the Society for Pediatric Dermatology (SPD) 2026 Annual Meeting underscored the breadth of factors clinicians may need to consider when caring for children and adolescents with dermatologic disease.

Sessions addressed textured hair care, vitiligo, atopic dermatitis, vascular anomalies, genetics, dermatopathology, and mental health, pairing advances in disease management with broader discussions about communication and culturally informed care.

The meeting also highlighted the importance of recognizing psychological and social factors that may accompany dermatologic concerns. Discussions surrounding body dysmorphic disorder, for example, reinforced the need for clinicians to recognize when a patient's distress may extend beyond the objective severity of a skin finding.

Other sessions emphasized communication between dermatologists and dermatopathologists, consideration of comorbidities, and culturally competent counseling for patients with different hair types and backgrounds.

▶ Why it matters: Whole-patient pediatric dermatology requires clinicians to consider more than the visible manifestations of disease. Psychological health, cultural context, comorbidities, family dynamics, and communication across specialties can all influence diagnosis, treatment, and long-term outcomes.

The Bigger Picture

This week's developments point toward a broader shift in what it means to deliver effective dermatologic care. Therapeutic innovation remains central to the field, but treatment decisions increasingly depend on factors beyond efficacy alone, including tolerability, patient preferences, psychosocial health, cultural considerations, access, and clinician capacity.

At the same time, the expanding role of APPs highlights the importance of ensuring that the clinicians delivering increasingly complex care have the resources and support to sustain it. Persistent burnout, administrative burden, and workload pressures are not separate from patient care; they can influence workforce stability, access, and the ability of practices to provide longitudinal care.

Across AA, advanced BCC, pediatric dermatology, and practice management, the common thread is individualization: building treatment strategies and practice models around the needs of both patients and the clinicians caring for them.

References

1. Dermatology Times. PA burnout persists as workload, pay, and administrative burdens take a toll. Accessed October 22, 2026.
2. Dermatology Times. National APP Week: Donna Lam Cahill, PA-C, on persistence, patient advocacy, and finding a career in dermatology. Accessed October 22, 2026.
3. Dermatology Times. Alopecia Areata Awareness Month 2026 in review. Accessed October 22, 2026.
4. Dermatology Times. Tolerability and response criteria guide hedgehog inhibitor choice in advanced BCC. Accessed October 22, 2026.
5. Dermatology Times. Whole-patient care in pediatric dermatology: Lessons from SPD 2026. Accessed October 22, 2026.