New research suggests that the prevalence of skin disease burden in the United States generally aligns with the physician assistant (PA) certification exam, with areas for improvement.

According to the new study published in the Journal of Dermatology Physicians Assistants, the National Commission for Certification of PAs introduced a dermatology-specific certification exam in 2023 aimed at ensuring the competence of PAs in the dermatology specialty. Researchers for the current study compared the content of the current exam with data from the American Academy of Dermatology’s 2017 “Burden of Skin Disease Report” (BSDR), which details the prevalence, costs, and mortality associated with different skin diseases. According to the analysis, the dermatology PA workforce doubled between 2013 and 2021. To become certified, dermatology PAs must pass a written exam and complete clinical and continuing medical education. 

"The BSDR consolidated information from 2013 insurance claims pertaining to 24 skin disease categories, and is the definitive text summarizing the prevalence, costs, and mortality of cutaneous ailments in the United States," the authors wrote. "How well the formal training standards of dermatology PAs match the dermatologic needs of the population is not well characterized. To illuminate this, we compared the contents of the certificate of added qualifications blueprint with those of the BSDR."

The researchers assigned numeric values to each diagnosis listed on the certification exam blueprint and compared them to the BSDR's categories for discrepancies between exam content and disease prevalence. The exam blueprint included 133 diagnoses. Overall, there was reasonable concordance between the exam content and the burden of skin disease (average discrepancy of 2.92%). The authors reported where significant differences emerged. Cutaneous infections and viral/fungal diseases were underrepresented in the exam, as were nonmelanoma skin cancers and melanoma, which have substantial mortality rates.

The study also showed that connective tissue diseases, drug eruptions, and bullous diseases were overrepresented in the exam relative to their prevalence, but also that this emphasis was justified by their high cost and potential for fatality. Wounds, burns, and infections were also underrepresented, which the researchers attributed to condition management outside dermatology settings. Ultimately, the authors recommended bolstering exam content covering conditions with higher prevalence and mortality to better align with the actual dermatologic needs of the population. 

"We found reasonable concordance between written examination content and the actual burden of skin disease, with some potential areas for refinement," the researchers wrote. "For example, based on the high prevalence and mortality of skin cancers and their relatively small representation in the CAQ blueprint, increasing emphasis of this topic area could be considered for future iterations of the test."

Practical Dermatology will be providing coverage from the Society of Dermatology Physician Assistants (SDPA) 2024 Summer Conference in San Diego.

Source: Young P, et al. Journal of Dermatology for Physicians Assistants. 2024;18(2):12-14. Doi: 10.1097/jdpa.0000000000000018