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The Role of Nurse Practitioners and Physician Assistants in Managing Plaque Psoriasis


Alexa Hetzel, MS, PA-C, leads a discussion on the role both physician assistants and nurse practitioners play in diagnosis and management of plaque psoriasis, commenting on the dermatology environment vs the primary care environment.

Alexa Hetzel, MS, PA-C: Hello and welcome to this Dermatology Times Around the Practice titled, “Advanced Practice Provider Perspectives on Advances in the Management of Plaque Psoriasis.” I’m Alexa Hetzel, a physician assistant [PA] at Windsor Dermatology in East Windsor, New Jersey. Joining me today in this discussion are my colleagues, Jennifer Conner, a physician assistant at Dawes Fretzin Dermatology in Indianapolis, Indiana. Terry Faleye, a physician assistant at DermSurgery Associates in Houston, Texas. Laura Bush, a physician assistant at Fayette Area Dermatology in Fayetteville, Georgia. And Lakshi Aldredge, the director for the primary care, nurse practitioner [NP] residency program and an adult nurse practitioner at the VA Portland Healthcare System in Portland, Oregon.

Our discussion today will focus on several topics pertaining to the treatment landscape for the management of plaque psoriasis. We will review available and emerging treatment options through the use of patient cases. Welcome everyone.

Let’s discuss the roles of nurse practitioners and physician assistants in the management of plaque psoriasis. How do you all feel like the role may differ across different APPs [advanced practice providers], whether it’s by region, and who do you feel is mostly diagnosing and managing our plaque psoriasis patients?

Jennifer Conner, MPAS, PA-C: I think it really depends on the level of experience of the APP. In my practice, we have a wide range of experience. I’ve been practicing over 17 years, so I diagnose and manage these patients. If I have a particularly complex case or someone who I’m having trouble managing, I’ll bring in one of the physicians. We have some PAs who are newer to dermatology who may staff those cases with the physicians, but we all work together. We also do a lot of research. One benefit that we have is that we’ve seen a lot of these treatments as they’re emerging and as they’re in the clinical trials before they even hit the market.

Alexa Hetzel, MS, PA-C: It’s such an advantage. We do that too in our office, and I’m so grateful because I know it’s coming, and I know if it works, if it doesn’t work, the side effects. You can really instill confidence in your patients when something is new and you can say it’s not new to me, I’ve seen it before. Which is so exciting. What do you think, Laura?

Laura Bush, DMSc, PA-C: I work in a solo practice with 2 physician assistants and 1 doctor, and the majority of all the medical dermatology is [done] by the physician assistants. Our doctor does 1 day a week in clinic and mostly [does] surgery, so we manage the vast majority of psoriasis patients. I feel like in my area that’s probably the case—the APPs are managing most of the psoriasis cases.

Terry Faleye, MPAS, PA-C: I agree. I’m in Texas, and I feel that for most APPs, especially in that realm, we feel very comfortable managing our patients independently, especially depending on the level of exposure or how long we’ve been in practice. But just like Jennifer said, the landscape is definitely changing. We’re seeing a lot more newer PAs and NPs coming into the space. Definitely if you’re a newer NP or PA, you may not be working independently as much in the beginning, but I believe with the confidence that most of us have, it grows and it gets better.

Alexa Hetzel, MS, PA-C: Lakshi, we’re all in dermatology, so we’re a little bit different from you because you’re in primary care. Does this vary for you compared to what we experience in our office?

Lakshi Aldredge, MSN, ANP-BC: While I run the primary care nurse practitioner residency program, I actually am part time in dermatology as well, where I’ve practiced for 20-plus years. And I agree with what you have all said. The changing dynamic within the dermatology practice landscape is to see more nurse practitioners and physician assistants managing chronic diseases in dermatology, including psoriasis.

I run a complex dermatology biologic clinic, so I see the most complex psoriasis patients. We also have a physician dermatology residency program with our university affiliate, so there is a lot of training and education. The value of that is collaborating with our physician colleagues and taking the opportunity to learn and share complex cases. Working at the VA, we have a lot of patients who have a lot of comorbidities. They may be a complex psoriasis patient who also is undergoing chemotherapy or cancer treatment or has other immunological complications that may make treatment choices challenging. It’s nice to be able to practice in a collaborative environment.

Transcripts edited for clarity

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