Margaret Bobonich, DNP, FNP-C, DCNP, FAANP, is Assistant Professor at Case Western Reserve University’s (CWRU) Schools of Medicine and Nursing where she completed her doctoral degree in nursing practice (DNP), master’s degree as a certified family nurse practitioner (FNP-C), and dermatology NP residency at University Hospitals Cleveland Medical Center (UHCMC). Dr. Bobonich is a Dermatology Certified Nurse Practitioner (DCNP) by the Dermatology Nurse Practitioner Certification Board and was awarded the prestigious designation of Fellow by the American Association of Nurse Practitioners (FAANP). She is dedicated to advancing the NP profession through education and collaboration. Dr. Bobonich has played a pivotal role in developing and overseeing high-level education and training programs for NPs on a national level, including co-founding the Center for Advanced Practice Dermatology, the only interactive DCNP certification review course available. She’s authored numerous journal articles, co-edited textbooks, and has provided seminal research in the field of dermatology NP education. Dr. Bobonich lectures nationally as an advocate for continuing education, advancing professional development, and collaboration among all dermatology providers. Her active clinical practice at UHCMC in Cleveland has a special focus in immunodermatology. Dr. Bobonich’s most recent contribution for dermatology education and practice has been the development of the Florida Atlantic University College of Nursing’s dermatology post-master’s certificate program where she serves as the lead faculty and Adjunct Professor.
What led you to pursue a career as an NP, and, more specifically, to specialize in dermatology?
Margaret: After five years of practice in rural primary care, I realized that skin conditions were probably the most challenging patient complaints. It was difficult to be confident in my diagnosis of skin rashes. Often, providers in the same practice would have different diagnoses and recommendations for management. It made me curious and determined to learn more about dermatology.
My dermatology career began at UHCMC where the Chair of Dermatology agreed to allow me to train side-by-side with the medical dermatology residents. That’s when I realized the vast breadth and depth of dermatology. It was so much more than I ever dreamed.
Tell us more about your clinical practice at UHCMC.
Margaret: As an FNP specializing in dermatology, I treat both pediatric and adult patients with skin conditions. Before completing my master’s program, I spent 15 years as a trauma and aeromedical nurse, with an intense focus on caring for newborns and critically ill children. Therefore, pediatrics has a very special place in my heart and clinical practice. I appreciate the unique characteristics of the child/parent dyad. The best part of my day is when I see kids with acute or chronic skin conditions and know that I can have a positive impact their lives. We all come out smiling!
What inspired your clinical focus in immunodermatology?
Margaret: My post-master’s dermatology NP training at UHCMC/CWRU was a comprehensive program, which included a focus in immunodermatology. Our department is home to expert clinicians who specialize in immune-mediated skin diseases, such as psoriasis, atopic dermatitis, blistering diseases, and cutaneous T-cell lymphoma. UHCMC/CWRU is an important site for ongoing research, including clinical trials, center for translational research, and center for medical mycology. Our center has played a crucial role in many of the scientific advances we are seeing today, and being a part of this environment during my post-master’s training enabled me to stay on top of cutting-edge therapies in the field. The science and technology of immunodermatology is advancing very quickly. We have new treatments—and hope—for our patients with severe skin diseases. My passion for immune-mediated skin disease evolved naturally through my educational journey, and has become a focal point in my practice.
What would you say has the biggest impact among dermatology NPs and PAs on achieving optimal patient outcomes?
Margaret: The foundation and strength of my career in dermatology is based on collaboration. Although we are all educated, experienced clinicians, we are also always learning. Collaborating with professionals in other disciplines and specialties enables us to optimize patient outcomes. Working together also extends beyond clinical practice. Physicians, PAs, and NPs can collaborate on educational initiatives, publications, research, and leadership. I found this be to be especially true when Mary Nolen and I began editing the second edition of Dermatology for Advanced Practice Clinicians. We knew the textbook filled a large educational gap, but we didn’t feel the authorship adequately reflected the important collaboration that can exist among NPs and PAs. Looking forward, we decided to invite our PA colleagues to contribute as authors and co-editors. It has truly been a privledge to work side by side with dermatology PAs.
How do you encourage patients to be engaged in and adhere to their treatment plans
Margaret: Although patients come to us for treatment of dermatologic conditions, they may not always be fully committed to the proposed treatment regimen. Thus, a holistic approach to caring for our patients is essential to achieving optimal outcomes, including patient adherence. Considering the entire well-being of a patient has never been more important than during the ongoing COVID-19 pandemic. Addressing the physical, psychosocial, and economic factors that impact our patients enables us to develop individualized plans of care. It’s important to realize that patient-centered care is not just a euphemism. Recognition of the unique personal goals of each patient must be a priority if we truly wish to improve their health. Patient education can expand a patient’s perception of personal health and available treatment options.
What does it mean to “specialize” in dermatology?
Margaret: The required master’s degree to become a PA or NP does not prepare you to specialize in dermatology. Upon successful completion of an accredited PA program and the Physician Assistant National Certifying Examination (PANCE), PA-Cs are certified in general medicine. Accredited NP programs, on the other hand, require training in a focused area of practice (e.g., pediatrics, women’s/gender-related health, psychiatric/mental health, family health, adult/gerontology health, or neonatal health), followed by certification by a nationally recognized certification board. Traditionally, PAs and NPs entering the specialty of dermatology have had to rely on on-the-job training or self-identified learning through continuing education activities. The result has been an inconsistent and wide range of knowledge and competencies among these dermatology providers. Until recently, there have been no academic programs for the educational preparation of NPs.
How can NPs and PAs become more standardized in their approach to education and training?
Margaret: Educational curriculum is designed to assist the student in developing requisite competencies for professional practice. For dermatology NPs, the article “Competencies for Dermatology Nurse Practitioners,” which was published in 2018,1 identifies entry-level knowledge, skills, and abilities for NP specialization. The Dermatology Nurses’ Association’s “DNA Scopes and Standards,” (revised in November 2020)2 provides guidelines for our professional performance as NPs. Together, these authoritative documents provide the foundation for dermatology NP educational curriculum and practice.
The Society for Dermatology Physician Assistants (SDPA) has developed a standardized training program for PAs working in the field of dermatology. The SDPA Diplomate Fellowship program offers 22 detailed modules that span the knowledge, skills, and tools needed to specialize in dermatology.
You mentioned that there is a recently developed academic program for specialization in dermatology. Tell us more.
Margaret: There are very limited opportunities in regard to formal post-master’s programs specilizing in dermatology for NPs and PAs. Currently, there are three interprofessional post-masters training programs for NPs. The Lahey Clinic program in Boston, Massachusetts, and the UHCMC program in Cleveland, Ohio, were established more than 15 years ago, but can only accommodate 1 to 2 NP trainees a year. More recently, the Florida Atlantic University (FAU) Christine E. Lynn College of Nursing Dermatology Nurse Practitioner Specialty Post-graduate Certificate Program in Boca Raton, Florida, was established. The FAU program is the first interactive dermatology post-graduate training program for NPs. NPs who have successfully completed their master’s and primary certification may complete three additional semesters for specialization in dermatology at FAU. The program curriculum was developed to provide NPs with the requisite professional competencies within the scope and standards of dermatology practice via online didactic classes (Figure 1), on-campus skills training, and clinical practicum with board-certified dermatologists and/or DCNPs. The first class of students entered the program in January 2021, and the next class is scheduled for January 2022.
What expert credentials do NPs and PAs have in dermatology?
For NPs practicing in dermatology, they may be eligible to sit the Dermatology Certified Nurse Practitioner (DCNP) examination if they have documented a minimum of 3,000 clinical hours. The Dermatology Nurse Practitioner Certification Board created the exam in 2008 and is currently undergoing accreditation.
For PAs, the SDPA offers a high-quality didactic program specializing in dermatology. Successful completion of this program and ensuing examination earns PAs the designation of Diplomate Fellow in Dermatology. This distinguished title represents a PA’s exceptional education and dedication to dermatology.
What is the best way to prepare for the DCNP certification examination?
Margaret: Dermatology NPs who wish to sit for certification can go to DNPCB.org website for more information. Content for the exam is detailed so the candidate can prepare according to the test blueprint. However, an acknowledged challenge to taking the exam has been the lack of DCNP review courses. In 2019, the Center for Advanced Practice Dermatology (CAPD) developed an interactive DCNP review course that goes beyond an online didactic class. Study modules are sent months in advance to enhance an NP candidate’s exam preparation, which is followed by a two and a half day webinar presented by expert faculty who review dermatology knowledge and allow participants to practice test-taking skills. After the inaugural 2019 course, the number of DCNPs increased by 37 percent. This year, in addition to the DCNP review course, the CAPD is offering the Practice to Pass program in which candidates can utilize practice exams online over several months.
Why do you think it is important to become certified in dermatology?
Margaret: Validating knowledge through certification or fellowship is an important professional measure of competency. Credentialing and certification demonstrates to colleagues, employers, patients, and the public that we have achieved the highest education and training for our specialty. This can have a significant impact on one’s career. Certification can provide a competitive advantage when seeking employment and career advancement, with a higher salary scale. In the future, we may see third-party insurance providers limit reimbursement of services to those professionals who do not have documented certification in their specialty. Lastly, achieving certification/fellowship credentials should be a personal milestone for each one of us as we take pride in our professional accomplishments.
What are you most proud of in your dermatology profession?
Margaret: The impact of COVID-19 on dermatology NPs and PAs has been significant, impacting all of us personally and professionally. Last year brought unprecedented challenges to our dermatology practices. Patients, staff, and clinicians were all confronted with threats to our physical, psychological, and financial well-being. While some providers were able to maintain their practice, it required major alterations in the delivery of care to ensure the safety of their patients and office staff.
The harsh reality of the COVID-19 pandemic included a tremendous economic impact on dermatology NPs and PAs. The threat of job loss during this time placed additional burden on providers. In a survey by CAPD in December of 2020, 60 percent of NPs reported being terminated, furloughed, or facing a reduction in work hours for an unknown period of time due to the COVID-19 pandemic. One of the ways I saw NPs respond was by utilizing their layoff time to prepare for certification. Now, more than ever, demonstrating professional expertise through credentialing has become vitally important. Supporting our colleagues was so important that CAPD provided 78 scholarships for the DCNP review courses to NPs who had been terminated, furloughed, or experienced a reduction in shift hours. With crisis comes opportunity, and many colleagues have taken the opportunity to bring greater meaning to their personal and professional lives through education and self-improvement.
1. Bobonich M, Nolen M. Competencies for dermatology nurse practitioners J Am Assoc Nurse Pract: 2018;30(11):606–613.
2. Dermatology Nurses’ Association. DNA scopes and standards. J Dermatol Nurse Assoc. 2020;12(35):4.