Dermatology diagnoses among rural and urban physician assistants

Document Type

Journal Article

Publication Date



JAAPA : official journal of the American Academy of Physician Assistants








OBJECTIVES: Dermatology is not heavily covered in the curricula of physician assistant (PA) programs or on the certification examination, even though patient visits to PAs for skin complaints are very common. If significant on-the-job training is thus required for dermatology care, then practice setting differences likely impact the quality of that informal training. This study sought to identify differences in the ability of rural and urban PAs to diagnose skin disorders.METHODS: An Internet-based survey of rural and urban primary care PAs (n = 295) was conducted. The survey collected demographic information and provided case scenarios with questions related to diagnosis of a skin disease or complication.RESULTS: Average quiz score was higher for rural PAs than for urban PAs (61.6% versus 55.4%, P = .024). Rural PAs more commonly treated the majority of their patients seen for skin complaints. Rural PAs reported a greater comfort level in diagnosing and treating skin disease than did urban PAs (91% versus 80%, P < .05). Both groups referred a comparable percentage of patients to skin specialists. Regression analysis identified several factors that accounted for the ability to predict success scores for both the rural (P < .05) and urban (P < .05) groups.CONCLUSIONS: The stronger overall ability of rural PAs to diagnose a variety of skin diseases is likely impacted by the higher number of dermatologic cases they see. PA educators should re-evaluate the curricula devoted to skin conditions and consider elective opportunities for students with an interest in a dermatology career.

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