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- [00:00]
Sarah Vicari
Foreign.
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Cynthia Griffith
Welcome to the JAPA Podcast where we
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Podcast Host
explore how PAs contribute to healthcare and the practice of medicine. Today we are joined by three dermatology PAs and we'll discuss how dermatology PAs not only expand access to dermatologic care, but also contribute to innovations in professional development. Before we get started, don't forget that listeners can earn CME after listening to the podcast. To receive your CME credit and access your certificate, you just listen to the podcast, then complete the post test evaluation in AAPA's Learning Central at cme.aapa.org In 2023, one of our esteemed guests, Cynthia Griffith, published findings from an NCCPA data set that was used to categorize PAS in dermatology. She found that quote although the number of dermatologists is growing slowly, the growth of PAs working in dermatology is rapid and accelerating. End quote. This growth has been accompanied by the expansion of a community of PAs who are working to empower other PAs to provide evidence based and comprehensive dermatologic care. Today we are joined by three dermatology PAs who are on the front lines. Our guests are also nationally recognized PA leaders in dermatology. Welcome Michael Overcash, JAPA Dermatology Department Editor Sarah Vicari, the President of the Society of Dermatology PAS, and Cynthia Griffith, Editor in Chief of the Journal of Dermatology, PAS or jdpa. Before we discuss dermatology, could each of you share a little bit about your background, what first drew you to this field, how long you've been practicing and
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Sarah Vicari
where you currently work?
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Michael Overcash
So hey, this is Michael went on a medical mission trip in 1997 as a photographer short on interpreters. So I worked with a doctor for the first time in my life and I saw how dermatology was something around the world that was greatly needed and patients were suffering and with with conditions they didn't even have a name for. And it was amazing how just having knowledge you could help people so much. So I was truly inspired and one of the guys I was working with inspired me to go to PA school. I thought why would I want to be a public accountant? But that explained was a different thing and it sounded too good to be true. But as you know, it is. It's amazing being a PA and for now, now for 23 years as a PA in Charleston, South Carolina. And then I take PAs every year to Africa, Asia, Latin America and we do medical mission work globally since the 90s now.
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Cynthia Griffith
That's amazing. Thanks for having me. I'm Cynthia Griffith. I've been a practicing PA in dermatology for 15 years now. And when I was a PA student rotating, I liked all my clinical rotations. I liked internal medicine, surgical, oncology. But when the chair of the Department of Dermatology asked if I wanted a job, I said yes because I didn't have one. And that's how I ended up in dermatology. I now split my time practicing one day a week at the VA at UT Southwestern Medical center in Dermatology and working for the NCCPA as a PA Outreach specialist, which means I get to talk to PA students across the country about taking pants. As you said, I've also done research about the profession. And for the last four years, I've had the honor of being the editor of JDPA. One great thing about JDPA, we're celebrating our 20th year of publication this year.
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Sarah Vicari
That's very exciting. SCPA is very proud of our journal. I'm Sarah Vicari. I'm a dermatology PA for 18 years and I work in the south suburbs of Milwaukee, Wisconsin. Woo hoo. I've been. When I was in PA school, I the entire time I was 100% family practice. That's what I wanted to do. I had a family practice PA that I just really looked up to and thought, wow, I could really do that job and I could see myself in family practice. So dermatology was more something that I thought would help me in my family practice group. So my last rotation was in dermatology at the Great Lakes Naval Base in Illinois. And they let me do so much stuff and so hands on. And I just thought, wow, this is really cool. And, and I said, you know, if I, I think I want to do dermatology and if I can get a job in that, I think that's what I'm going to do. And 18 years later, here I am.
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Michael Overcash
Great.
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Podcast Co-host
That's awesome. Thank you guys so much for sharing. And it's so. It's just always a pleasure to hear everybody's story about how they got to where they are today.
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Michael Overcash
Right?
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Podcast Co-host
Right. Michael, I'd like to start with you. So Jeppa has done an excellent job of highlighting practical dermatology content for primary care PAs, especially given how challenging it can be to find timely access to a dermatology provider. From your perspective, how do you approach selecting and shaping content that helps PAs feel more confident managing these conditions on their own?
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Michael Overcash
Yeah, so PAs are primarily patient focused, so I am particularly drawn to articles that are relevant to those on the front lines of practicing medicine. So I really appreciate when I get articles written with practical guidance on diagnosis, treatment guidelines, current emerging therapies. I want high quality tables, I want graphs, flowcharts, graphics that we can use in the room with our patients. And above all, JAPA is the flagship publication for our profession. So content must be accurate.
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Podcast Co-host
Perfect. Thank you. You know, and I think that's really important because I think that we probably have a lot of listeners out there wondering about how to get their research published. Right? What, like how do I, how do I actually get published? And it's kind of nice to hear what are. So what are we looking for? Right, so that's, that's a really good intro of maybe some avenues for, for other people, authors, potential authors. So, Sarah, for those who may not be familiar, tell us about the Society of Dermatology PAs and what are some of the current initiatives and opportunities it provides to support PAS and dermatology.
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Sarah Vicari
So the Society of Dermatology PAS is APA, AAPA's largest constituent organization. And that's something that we're really proud of. We are like very proud PAs and we're proud to be working in dermatology. We have many initiatives going on right now. We just completed last week a itch conference in Puerto Rico, which was wonderful. And we focused on all the different causes of itch that, you know, the diagnoses, new treatment options. And so that was something that we, we've started now. This is our second itch conference, but it's more. Our conference focused on one particular thing that we deal with every day. And so that was really wonderful. So we just did that. We have our summer conference coming up in June in Denver, and we also have a conference in Hollywood, Florida in November as well. And we are very excited about Denver. Of course, our registration is now open, so feel free to come on down. And we also just launched a mentorship program called Rise Derm pa, which we've had a great response to. And because dermatology PAs just really love helping the next generation of derm PAs, it's a very big on mentorship, community education, and that's what SCPA really does best.
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Podcast Host
Dermatology PAs are active. We can't underestimate all you guys do. And I think that's a conference name. I've heard itch that's.
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Cynthia Griffith
I mean, I don't know if you have itchy patients, but that is a hard chief complaint. So I think because we needed more CME in that area, there was a hunger for people to learn more about all the different types of itch and the different things you can do to help your patients that have that chief complaint. That's what kind of birthed the conference.
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Podcast Host
Oh, it's brilliant. I was seeing patients yesterday in the hospital and how many confluence or questions did I get about I feel itchy. So yeah, every day.
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Sarah Vicari
Every day, absolutely.
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Podcast Host
Cynthia, I have a question for you. The Journal of the Dermatology APAS or the JDPA covers a variety of topics in clinical, surgical and cosmetic dermatology. How does JDPA present the most innovative and practice proven information forward to pas?
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Cynthia Griffith
Yeah, that's a great question. Well, as Michael knows and many other journal editors, you can only publish what gets submitted to your journal. But I'll say the PA profession is experiencing a renaissance moment currently where we have many PAs who are not only clinicians but also scholars generating knowledge by publishing their case reports, their literature reviews and their primary research. So it makes it a great time to be a journal editor. JDPA also started publishing interdisciplinary evidence based consensus guidelines to inform clinicians across specialties where there are gaps in our current practice and knowledge. The first iteration of this was the expert consensus recommendations on appropriate serologic testing for the chief complaint of hair loss. This was published in the Summer 2025 issue of JDPA.
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Podcast Host
Another practical topic that I'm sure many of us have encountered in clinical practice, not just those of us who practice in dermatology.
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Sarah Vicari
In dermatology we always say hair loss is the hand on the door, you know, question that you get every single day. And it seems like it's worse than ever. Probably some TikTok that I'm not aware of because I'm not on TikTok, but it definitely is the the ultimate hand on door diagnosis and question. So.
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Cynthia Griffith
And as Michael said earlier, we're trying to be very practical for the people that are reading the articles to give them in this. There was great flowcharts and visuals that can guide people that have that chief complaint really through. Is this laboratory testing going to be cost effective and evidence based for. For our patients? So we've really tried to choose topics for these consensus guidelines where there are gaps but where we can function really practically providing tools and kits for our providers as they're treating patients.
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Michael Overcash
Cynthia, that's so relevant right now. If you asked all the dermatologists in the country, what labs do you order for hair loss, you're going to get hundreds of different answers. And so the need for a standard or guide is overwhelming. Likewise, we have biologics that are new every year and we're still ordering tests we don't need, for example, interleukin inhibitors, most of the biologics for psoriasis that we use. There is no need to order a TB test at all. And we can back that up with evidence based medicine. It is a unnecessary test. And now there have been a few deaths from patients given isoniazid because they had a positive TB test. They didn't really need this drug, they didn't need the test to be on this IL inhibitor. But yet we're still ordering these tests. And so just this year we have new publications giving us the confidence to not order unnecessary tests which burden the system and sometimes harm patients. So I really appreciated that article.
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Cynthia Griffith
Yeah, we, we took a lot of care to develop an interdisciplinary team with physicians and nurse practitioners and PAs that work in general internal medicine, dermatology, and reviewed all the evidence out there to really bring some evidence based guidelines to an area where there wasn't data. So thanks so much. And you know, it's interesting as we look, we, we have so much research, but it's good to be able to focus on these narrow clinical questions where we don't have a lot where we can really try to add and make a difference.
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Podcast Host
You know, one standout thing I think from our conversation already is that each of you is very passionate and active in dermatology care. So why do you guys think that is? We know that the SDPA and the journal and of Journal of Dermatology PAS and even japa, they have, you know, different conferences, educational resources, podcasts. There's a dermcast from the society for derm PAs and advocacy agenda. Why do you think dermatology PAs are so involved in their constituent organization?
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Sarah Vicari
I think that's really because dermatology PAs have always had to have a culture of self driven learning. For decades we've had to build our own educational pathways, share resources with each other and lean on each other to grow. And that has created a community that's incredibly collaborative just by nature. I always say when you go to a dermatology Pennsylvania dinner, everyone is like, what are you using for this? What are you using for this? And what is, what's working? What is it like? And I find that more than any other specialty, at least that I've been at tables at, you know, we're always trying to get better at our jobs. So what you see in the spa today is really the result of that history. Derm pas love to teach, we love to trade pearls and to mentor each other and to really make sure that the next generation is even better prepared than we were. Dermatology is actually a very small specialty, and that closeness means that we genuinely celebrate each other's successes and step in when somebody else needs support. So our journal, our conferences, the dermcast, our advocacy work, which we're really ramping up, all of that exists because our members show up and they say that this is what they need. They're invested in their profession and their patients and basically in each other. And when you put that kind of energy into an organization like ours, it just becomes a place people want to be involved in.
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Podcast Co-host
Yeah, thanks, Sarah. I think you kind of hit on the next thing I wanted to talk about as far as the. The size of the numbers of derm PAs that are out there. Right. And according to the 2025 NCCPA annual report on PAs by specialty, a little over 4% of PAs work in dermatology. Thinking of those PAs who do not practice in dermatology, which is a lot of us, including Kim and myself, and then also just considering the fact that it's been quite a while for some of us since we graduated from PA school, what do you think are some of the biggest developments in clinical, surgical, or cosmetic dermatology that have been maybe in the last 10 years? Like, what do you think are, like, those big moments that you've noticed?
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Cynthia Griffith
Well, I think Michael has already alluded to one. Now is a great time to be a dermatology PA because recently we've had a myriad of new medications that can vastly improve disease for patients suffering from atopic dermatitis, psoriasis, hydranitis supertiva and alopecia areata. These new medications can mean that patients who have suffered with these diseases for decades now can have meaningful relief from their skin disease. So it's an amazing time for me to talk to a patient in my office who has said, I've had this for 50 years. And I'm like, well, we have new medicines that can make you much, much better. So I would say if you're encountering a patient as an internist or in the hospital, and be, you know, be an advocate for your. Pushing your patient along to receive some of those new medicines because they're, they're. They can be really life changing for patients.
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Podcast Co-host
Yeah, I think it's been an exciting several years just with all the developments that have come along. And I, I think conversations like this are so important because of the fact that it's hard for us, for some of us that are not seeing it on a daily basis to keep up with what's going on. Right. Because there's been so many changes in new medications and treatment options for, for patients. So thank you. So many patients also experience significant delays in seeking care from a dermatology provider. Obviously, PAs play a crucial role, a role in bridging that care gap. For those of us who don't practice in dermatology, what are some ways that we can set our patients up for success in this situation?
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Michael Overcash
So, Joe, if I could jump in here, Like Cynthia said, the medicines have been breakthroughs. Like we now have an oral medicine for psoriasis that's much more effective than any oral that ever existed, that has no baseline monitoring and no contraindications and cautions. But if a primary care practice PA doesn't have the awareness of it, they don't know they can prescribe this, but they certainly can. And it's, it's going to keep being a priority for, for all of us to stay educated, stay current and even use, use tools like medical artificial intelligence at times to say, hey, you know, here's this patient, what can I do for them? And then learn these things that you could start before they see dermatology.
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Cynthia Griffith
Along those lines, increasingly at SDPA conferences, I meet non dermatology PAs wanting to learn more about skin disease. I think, just as Michael said, it's necessary because we know the majority of skin complaints are seen by primary care providers due to these difficulties in access across the United States. So I think dermatology PAs, but also all PAs, we never turn that curiosity button off. Right. And so we're always wanting to meet the needs of our patients. And I think that's, that's why these types of conversations can be really, really educational.
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Sarah Vicari
And everyone's always invited to STPA conferences. So come on by, number one. But also just I think that getting people to the right, you know, people to treat them for these diseases, but you doing any workup ahead of time is always great. But just, you know, making sure that you have a network in your community of dermatology PAs that you have access to, because we're always, you know, willing to fit people in, especially if somebody's miserable. Like we, we have such great drugs now and, you know, to everyone else's point, it's just so wonderful to be able to have a very clear, you know, understanding that we can get people better. And I always say that the diseases I like the best are the ones I can know I can get people better at. And that just keeps expanding and that's wonderful. So diagnoses I used to hate to give, you know, to patients like alopecia areata vitiligo that really are just life changing for people in what used to be the worst ways. It's so much, so much better to be able to have a drug that you can give them and give them some confidence that we should be able to get them better.
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Podcast Co-host
Yeah, what a. And what a great point about the fact that you don't have to be a derm PA to go to a derm conference. Right. And I think that's so important for all, for all of us in all, all of our specialties, knowing that, hey, look, you know, like, for me in emergency medicine, it's common for me to go to an emergency medicine conference, right. Where I get a nice broad array of CME and I get to, you know, know a little bit about a lot of things, whereas maybe I'm lacking in something specific like dermatology. So maybe it would be better for me to go to a CME conference that actually is all about what I need to be learning about. So I think you make a great point there. That's really good. Thank you.
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Sarah Vicari
And we often have tracks as well for, like, beginners, you know, intermediate, and people later in career. And so it's not like it's going to be over your head or you're going to feel overwhelmed. So we, you know, we're prepared for that as well. And just there's something for everybody.
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Podcast Co-host
Yeah. Thank you. So recently on one of our podcasts, we explored psychodermatology with JAPA author Allison Trask. In the episode, she shared the that patients with dermatologic conditions experience stigma and bias. What are some ways that we can reduce the stigma our patients experience?
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Sarah Vicari
I think, number one, I would say just making sure that you're not afraid to touch people. I've never caught anything from anybody. And that goes from scabies to warts and everything. And so I think just making that people really feel a lot of. I've had people tell me before that other providers seemed like they were afraid to touch them, never got close to them. So I think when you're treating somebody with a dermatology condition, just to make sure that you're not treating them and making them feel even more isolated and excluded. And then hearing their stories, you know, you hear stories about people with psoriasis that say that they weren't allowed to go into a hot tub at the gym and other different really sad tales and just making them feel heard because that's most of the time what they want to do and just then again, pointing them and getting them in the right, into the right people to help them.
- [19:12]
Cynthia Griffith
I mean, I agree with what Sarah said. I've had people be very moved by the fact that I touched them and comment on the fact that they have not had care providers in the past that have touched them. And just as I am doing my exam, I'm touching their, their skin. And they feel, they feel that instant rapport because, because I made that physical connection. In dermatology, we have conditions that we treat that are visible, so it can cause shame and embarrassment or low confidence for patients. I try to ask questions to try to take that into account because a skin condition that I might document as mild by medical criteria may be really horrible to the patient. So I try to understand how it's affecting their sleep, their self esteem, their relationships, or their ability to work. And we try to work on them being at their goal, if, if that makes sense.
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Michael Overcash
Cynthia, I love what you said there. And it's so hard sometimes to assess, are you at treatment goal? Because for some people, they might have plaques of psoriasis, but they say, well, I don't care. Mom's vacuum works fine. She'll just vacuum up the scales. And I had a lady the other day that had some tiny little gutate lesions on her legs. And she said, it's ruining my life. I only wear capris. I don't wear pants. I have to wear capris. And so my mentor shared with me a single question that I use all the time as. And I believe you can ask this one question and know if your treatment goal or not. Not by examining or calculating body surface area. But he said to me, he said, ask people this. If your skin were better, would your life be any different? And if they say no, it would. They say, no, wouldn't be any different. Then you're there. Okay. Even if they have some little bit left. But if they say, well, if I were clearer, I would go to the pool party, I wouldn't lie about having something else and skip the party. I would go. Or I used to wear black and navy, but I can't now. So, yeah, if they can think of something they're not doing, then we gotta work harder.
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Cynthia Griffith
I love that. If your skin were better, would your life be any different?
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Michael Overcash
Exactly. Yeah. That's it.
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Podcast Host
I was thinking, man, I could adapt that to my own practice, but for like, different scenarios. It's a great way to figure out what a patient's goals are. Yeah. Okay. Before we wrap up, I'd like to do a rapid round in one sentence each. Please respond to the following. So first question. Most misunderstood fact about a dermatologic condition.
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Cynthia Griffith
I'd say less is more when it comes to skincare routines.
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Sarah Vicari
I agree completely with that with Cynthia, less is absolutely more. And I would add that not every rash that is annular is tinea.
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Michael Overcash
I would say that detergents, water, diet, and most of the things people worry about are not actually causing their acne or their eczema or their psoriasis.
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Podcast Host
Interesting. All right, how about the single biggest misconception or myth that people hold about dermatologic conditions?
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Cynthia Griffith
The myth would be, I don't need sunscreen if I'm not going outside. I'm like, how'd you get here?
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Sarah Vicari
It's really bad in Wisconsin. People will be like, I don't need it in the winter. I'm like, oh my God, you need it even more in the winter. So I completely also agree with that. I think also people who don't think that they need an annual skin check, everyone should really have one. Especially I would say past 30. Sometimes, you know, 20 to 30 is a little borderline, but past 30, I think everybody needs one.
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Michael Overcash
The vitamin D thing is killing me. You do not need to get sunlight to get vitamin D. That is a bad way to get vitamin D because you could get 1% or ten or a hundred percent. What type of skin do you have? How much is exposed? What time of year? Where is your latitude? What's the weather like? What's the UV index? There's too many variables. And so you cannot reliably get vitamin D. Go buy a supplement, go buy a pill at Walmart and then put your sunscreen on. Don't get vitamin D from sunlight.
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Podcast Host
But one policy change that would improve
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Cynthia Griffith
patient outcome tomorrow I'm going to say removing the license tie between experienced PAs and physicians state by state. Even more important now, as the physician population ages into retirement, I would change
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Sarah Vicari
the policy about step therapies because they're all outdated, like requirements for some dermatology drugs. And the fail first policies also just delay care. They worsen disease severity in a lot of people and create unnecessary suffering for patients who often need more timely targeted medications that are now available readily.
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Michael Overcash
I would say get rid of the in state requirement for telehealth.
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Podcast Host
Just nodding my head for all of you. What gives you the most hope and optimism regarding the future for PAs in dermatology?
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Cynthia Griffith
It's a great time to be a PA. Any specialty because there's so much variety in additional opportunities once you have that bedside patient care experience that informs anything you do.
- [24:00]
Sarah Vicari
Next, I would say what gives me the most optimism is just this next generation of dermatology PAs that are coming up. They're incredibly engaged. They want mentorship, they care about the equity and access more than I think any of us ever did at that stage in our career. And they're stepping into leadership earlier than ever. When you see that kind of energy and the intention that's coming up behind you, it's just impossible not to feel really hopeful about where our profession is headed.
- [24:27]
Michael Overcash
Dermatology is vast, it's challenging. But PAs are quick to adapt and we adapted technology and change. We're okay with incorporating AI into image analysis and medical decision making, and PAs are well positioned for the future of medical practice.
- [24:44]
Sarah Vicari
Wow.
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Podcast Host
Michael, Sarah, Cynthia, thank you guys. This has been a really inspiring and eye opening talk. Before we wrap up, any final thoughts?
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Cynthia Griffith
Well, I'm excited that this podcast has brought us together because I have seen Michael's name on JAPA for a long, long time, read a ton of of the column, and I'm so excited that this podcast was an excuse for me to get to have a conversation with you.
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Michael Overcash
You, Cynthia, you are kidding. Listen, you, Sarah's like the president and you're the JDPA editor. I'm just barely doing anything like once a month editing an article.
- [25:18]
Sarah Vicari
So now, Michael, you gave such a great talk about medical missions and climate change and all those kind of things. I. I love listening to your lectures as well. So I'm fangirling over here as well. And I just think that the final reminder is to even all the providers of not just dermatology care, but, you know, PAs who sometimes wear our own worst patients. Make sure you go get your skin checked. Befriended Derm pa. Happy to do it. It's not weird. It's never weird. It's just, you know, looking at one piece of skin to the next. So I always say I've done my best friend's skin check, so come on in, guys.
- [25:49]
Podcast Host
Well, now I feel better for texting some pictures of my skin and thank you all. You know, you have really contributed to our greater understanding of dermatology, not just in this podcast, but in the work you do as editors and as, you know, constituent organization presidents. So kudos to everyone and to our listeners. Don't forget, you can earn CME by listening to the podcast. To receive your CME credit and access your certificate, you just listen to the podcast and complete the post Test and evaluation in AAPA's Learning Central at cme.aapa.org until next time.