by Christina Felizardo, PA-C, Izabela Horzempa, PA-C, and Donna Cahill, PA-C
Affiliations. Ms. Felizardo is with Dermatology Associates of Western Connecticut in Trumbull, Connecticut. Ms. Horzempa is with Integrated Dermatology in Trumbull, Connecticut. Ms. Cahill is with Center for Dermatology, Cosmetic, & Laser Surgery in Mt. Kisco, New York
Introduction
Entering dermatology as a new physician assistant (PA) or nurse practitioner (NP) is an exciting milestone—but also a humbling one. The specialty is visually driven, highly nuanced, and built on pattern recognition that even the strongest graduate education can’t fully prepare you for. The first years in practice often feel like trying to speak a language you’ve heard your whole life, but don’t quite understand yet.
After walking through those early years ourselves, we came to realize something important: confidence in dermatology is not a personality trait or a product of time. It’s the result of specific habits, skills, and mindset shifts that transform uncertainty into capability. These are the lessons we wish someone had pressed into our hands when we started.
Learn Dermoscopy Early, Not Later
If there is one skill that separates a new clinician from an advancing one, it’s dermoscopy. Many of us made the mistake of thinking we needed to “master the basics” before picking up a dermatoscope. In reality, dermoscopy is part of mastering the basics.
The more you use it, the faster your pattern recognition sharpens, and the more your patients trust that you are truly evaluating their skin, not simply glancing at it. Buy a good dermatoscope, not a budget placeholder. Use it on every lesion, not just the ones you plan to biopsy. Fluency comes through repetition, not memorization. Every dermoscopic exam is a rep, and every rep builds confidence that no textbook can.
Treat Clinical Photography as a Clinical Tool, Not a Convenience
One of the most defining changes in our practice came when we stopped taking photos “when needed” and started taking them as part of the visit by default. Photography does more than protect you, it teaches you. It allows you to see how your diagnostic instincts evolve, how conditions progress over time, and how treatment decisions perform in the real world. It also eliminates patient uncertainty, because images replace memory and emotion with evidence.
If you can biopsy it, you can photograph it. If you are monitoring it, you should photograph it. That single habit will save you time, debate, and doubt for the rest of your career.
Confidence Is Built in 15 Minutes per Day, not at Conferences
Dermatology doesn’t reward cramming. It rewards daily friction with unknowns. The most consistently advancing clinicians are not the ones who spend hours at a time studying, but the ones who spend small, intentional moments revisiting cases, looking up uncommon findings, or reviewing dermoscopic patterns. Fifteen minutes per day is more powerful than four hours once per month. Confidence comes in layers, not leaps. The fastest-growing providers aren’t the ones who study the most, they’re the ones who consistently review what confused them yesterday.
Leveraging Industry as a Learning Partner
There is a quiet stigma among new providers that attending industry programs or speaking with medical science liaisons (MSLs) makes you “pharma influenced.” The truth is that therapeutics evolve quickly in dermatology, and industry is often the first place emerging data appears.
The difference between being marketed to and being educated is simple: ask questions. Ask for inclusion and exclusion criteria. Ask how a drug performs compared to standard of care, not just placebo. Ask what limitations weren’t published in the abstract.
Being informed is your responsibility. Who you learn from is your choice, but refusing to learn from a valid source is just another form of knowledge gap.
Build a Network Early: You Will Rely on It More Than You Expect
Some of the most valuable knowledge in dermatology doesn’t come from journals or textbooks, it comes from hallway conversations, text threads, and shared cases between providers who want to help each other succeed. Your network will become your problem-solving board, your ethical sounding space, your “does this look weird to you?” safety net. Build those connections early, not when you’re already overwhelmed. The clinicians who grow the fastest aren’t the ones who work alone, they’re the ones who know who to call when something doesn’t add up.
Stay Curious Even When You’re Sure
Dermatology has a way of humbling all of us eventually. A rash that “should have” responded, a lesion that returns with a surprising pathology result, a case that reminds you that certainty and accuracy are not the same thing.
The safest dermatology providers are not the ones who know the most, they are the ones who keep asking questions even after they feel confident. Curiosity protects patients. Ego endangers them. Humility is not a trait, it’s a clinical safety tool.
Closing Thoughts
The early years in dermatology are not about proving you know everything. They are about proving you are willing to keep learning, refining, and showing up with intention. No one becomes a confident provider overnight, but everyone can become one with the right habits and humility.
The three of us entered dermatology at different times, in different settings, and with different levels of initial confidence. But we all grew the same way: through repetition, curiosity, shared wisdom, and the discipline of building clinical instincts one patient at a time.
If you’re new in this field, take heart: the feelings of uncertainty are temporary. The growth that comes from them is not.