Top Career Tips for Early-Career NPs and PAs

Dermatology practices increasingly rely on nurse practitioners and physician assistants (NP/PAs) to deliver high-quality care. Early-career clinicians often focus on mastering diagnoses, treatments, and procedural skills, but long-term success depends just as much on professional judgment, communication, and strategic career growth. Understanding how to build trust, expand scope, and position yourself for advancement can make the difference between merely surviving and truly thriving in your career.

This is especially timely as NP and PA roles continue to gain national recognition. NP has held the No. 1 overall job spot in the United States for 3 consecutive years, and also ranks No. 1 in both health care and STEM, according to US News & World Report. PA is similarly celebrated, ranking No. 2 in health care, No. 4 in STEM, and No. 5 overall.¹ The consistent demand, flexibility, strong job outlook, and competitive compensation for these roles underscore the critical place NP/PAs hold in the health care system—particularly in high-demand specialties like dermatology, where expertise and patient access go hand in hand.

Below, we answer 5 of the most common and critical career-development questions dermatology attendings hear from early-career NP/PAs—questions that, if considered thoughtfully, can guide both clinical and professional growth. Sharing her invaluable insights with Dermatology Times is Shanna Miranti, MPAS, PA-C, a physician assistant at Riverchase Dermatology in Naples, Florida, and a Dermatology Times editorial advisory board member. Miranti has 23+ years of experience as a PA and uses her knowledge and expertise to mentor those early in their careers, offering guidance that extends far beyond the clinic.

What skills do I need to master to be truly valuable—not just productive—in a dermatology practice?

“Adding a PA or NP to a dermatology practice can be an incredibly productive step. It allows a collaborating physician and the practice as a whole to see more patients, perform more procedures, and ultimately care for more people.
That said, success isn’t just about productivity numbers. Long-term career growth depends on developing the right skills. Many new PAs and NPs are paired with a collaborating or supervising physician, and it’s critical to lean into that relationship. Much like the medical training model, shared decision-making builds both knowledge and confidence,” Miranti told Dermatology Times. “In dermatology, there are multiple skill sets to master—strong patient care and communication, procedural expertise such as biopsies, excisions, and Mohs closures, as well as cosmetic procedures like neurotoxins, fillers, and lasers. While the scope can feel overwhelming early on, focusing on mastering these skills opens doors to long-term opportunity.”

Attending physicians echo this perspective, emphasizing that true value develops over time through sound clinical judgment, reliability, and trust. Clinicians become indispensable by recognizing concerning lesions early, biopsying appropriately, prescribing thoughtfully, and knowing when to escalate care. Strong communication and the ability to anticipate next steps matter as much as efficiency—because while speed can be taught, judgment is what earns autonomy.

How do I know whether I’m practicing at the top of my license or being used to fill volume?

The difference often lies in whether a role is truly evolving. NP/PAs practicing at the top of their license experience increasing case complexity, expanded procedural responsibilities, and ongoing mentorship. They receive feedback, are invited into clinical discussions, and are supported in developing areas of expertise.

In contrast, roles limited to repetitive, low-acuity visits without teaching or growth opportunities may prioritize volume over development. While efficiency is part of dermatology practice, sustainable career growth requires intentional investment in training and progression—not just a full schedule.

“It comes back to trust. Once your collaborating physician trusts you with basic and minor procedures, you can start expanding your skill set. That might mean attending advanced suturing workshops, Mohs closure courses, or observing other APPs and physicians with specialized skills, “ Miranti said. “Often, you have to put in the work first—show genuine interest, demonstrate preparation, and educate yourself. Through that effort and a strong relationship with your collaborating physician, you can earn more autonomy and opportunities for advanced procedures. Conferences are also huge. They provide didactic education, hands-on workshops, advisory boards, and access to industry partners. Sometimes industry partners will even bring trainers directly to your office for advanced procedures like lasers or injectables. While some of this training may come out of pocket, it’s often a worthwhile investment in your future.”

What mistakes do early-career NP/PAs make that limit long-term autonomy and trust?

“One of the biggest mistakes is overconfidence. Confidence is important—for both patients and colleagues—but it’s okay to say, ‘I don’t know.’ It’s okay to say, ‘I’m not sure what this rash is, so we’re going to biopsy it and learn more.’ What’s scary for a practice is when someone doesn’t know what they don’t know. Early on, you’ll likely need to do more biopsies and spend more time learning. Seek out dermoscopy courses, workshops, and online training to sharpen your diagnostic skills,” Miranti told Dermatology Times. “Very few people can pick up an instrument and master it instantly. Developing expertise takes time, repetition, and humility. Every experienced provider has been in that early-career stage. Ask questions. Shadow procedures. Attend workshops. Put in the extra effort—it pays off.”

Equally problematic is under-communication, particularly when supervising physicians are not kept informed of evolving or atypical presentations. Poor documentation and defensive clinical habits can also erode trust. Attendings emphasize that autonomy is earned through consistency, openness to feedback, and clinical humility. NP/PAs who ask thoughtful questions, acknowledge limits, and show steady improvement are far more likely to gain independence over time.

How long should I stay in my first dermatology job, and when’s too soon to leave?

Most dermatology leaders agree that it typically takes at least 1 to 2 years to build a solid clinical foundation, learn practice workflows, and establish professional credibility. Leaving earlier than that, without compelling reasons such as inadequate supervision, unsafe expectations, or ethical concerns, can raise concerns for future employers.

“I don’t believe there’s an expiration date on a first job. You shouldn’t go into it thinking, ‘I’ll only be here for a year.’ You never know where that job could take you if you apply yourself. That said, if you’re extremely limited—no collaboration, no growth opportunities, no education—and you’re essentially practicing in isolation, that’s not a healthy learning environment. None of us grow in a vacuum. Shared decision-making and mentorship are essential, especially in the first few years,” Miranti stated. “With many practices now part of larger PE-backed organizations, there can actually be tremendous growth opportunities. You may be able to work with Mohs surgeons, cosmetic specialists, or pediatric dermatologists within the same organization, allowing you to explore different paths and find where your passion truly lies.”

That said, remaining in a role with no mentorship, no opportunity for growth, and rising burnout can also hinder long-term success. Early-career clinicians should periodically assess whether they are still learning and progressing; if growth has stalled despite good-faith efforts, it may be appropriate to explore other opportunities.

What metrics should I actually care about when evaluating my performance and compensation?

Although visit volume and productivity metrics are commonly tracked, they represent only one dimension of performance. Attendings and practice leaders place significant value on diagnostic accuracy, appropriate biopsy use, safe prescribing habits, quality documentation, and the ability to manage patients independently over time.

“Productivity matters—patient volume, procedures per day or week—but it’s not the whole picture. APPs bring tremendous value beyond numbers,” Miranti said. “You may cover for physicians, handle walk-ins or urgent visits, improve access to care, and boost patient satisfaction. Patients often appreciate the time APPs spend with them, which can significantly improve patient experience and outcomes. When negotiating contracts or raises, bring both your hard data and your intangibles to the table. Understand your numbers, but also recognize your broader impact. Give yourself credit for where you shine.”

Procedural competence and low complication rates are also key indicators of readiness for expanded scope. When considering compensation, clinicians should also weigh access to training, staffing support, realistic expectations, and long-term growth potential. A role that balances productivity with quality and development is more likely to be sustainable and professionally rewarding.

Conclusion

Early-career clinicians who invest in their professional growth beyond daily patient volume set themselves up for long-term success. By focusing on judgment, communication, mentorship, and measurable quality metrics, NP/PAs can earn trust, expand their scope, and build a durable career in dermatology and beyond. Asking the right career questions and revisiting them regularly can make the difference between simply keeping pace and thriving in a dynamic specialty.

References

1. NP, PA are top healthcare jobs in the US. News release. DEF. Published January 13, 2026. Accessed January 26, 2026. https://dermnppa.org/np-pa-are-top-healthcare-jobs-in-the-us/