J Clin Aesthetic Dermatol 2022;15(3 Suppl 1):S11–S13
Douglas DiRuggiero, DMSc, MHS, PA-C, is a certified physician assistant at the Skin Cancer & Cosmetic Dermatology Centers in Rome and Cartersville, Georgia. Douglas graduated with honors from Duke University Physician Assistant Program in Durham, North Carolina, where he also earned his Master of Health Sciences degree. He completed a doctorate degree in 2019 from the University of Lynchburg in Lynchburg, Virginia. Douglas practiced internal medicine for several years but has specialized in dermatology since 2000. Focused on the diagnosis and treatment of all skin, hair and nail diseases, he also enjoys the surgical aspects of dermatology. Douglas has been published in dermatology journals and lectures frequently at medical conferences throughout the United States. He is the Founding President of the Georgia Dermatology Physician Assistant Society and is the Immediate Past President of the New York Dermatology PA Society.
What inspired you to pursue a career in dermatology?
Douglas: I was fortunate in my youth to have never needed the consultation of a dermatologist, so I never had exposure to the specialty until I started clinical rotations in PA school. It was there that I watched ER, pediatric, and family medicine clinicians wrestle with cutaneous presentations. It didn’t take long for me to realize two things: I was going to see a lot of patients with skin problems once I got into practice; and, more importantly, the 4 to 5 hours of didactic lectures during my first year of PA school would not sustain me. My first few years of practice were spent in a busy internal medicine clinic, and I was stuck in the rut of calling everything “maculopapular” and giving everyone lotrisone cream. Frustrated, I decided to pursue dermatology full time in order to learn and truly help others with these problems, so I made the transition, and I have loved every day of it! My inspiration came from a determination to get better at taking care of skin.
What clinical areas in dermatology interest you the most?
Douglas: I am focused on medical dermatology, but I have been working for a great Mohs surgeon for the past 16 to 17 years and enjoy doing complex closures a few days each month. I am a strong advocate and utilizer of biologic medications, and I treat hundreds of patients with immune-mediated skin disorders (psoriasis, atopic derm, hidradenitis suppurativa). Biologic medications give me an opportunity to be a hero every day, as patients routinely reach levels of clearance never before experienced. I see all age groups with all skin, hair, and nail problems. In short, I enjoy complex medical dermatology but love having surgeries sprinkled throughout my schedule.
What emerging treatments are you most excited about?
Douglas: What a fun time to be a dermatology prescriber! When I started years ago, we had prednisone, methotrexate, topicals, and phototherapy for psoriasis, and all of them had more cons than pros. Now, with the development of biologics, the face of dermatology has completely changed. Stay strapped into your seat because the renaissance of atopic dermatitis therapeutics is unfolding and it’s going to be good!
How do you keep patients engaged in and adherent to their treatment plans?
Douglas: Patients are more likely to remain engaged in the diagnostic process (and subsequent treatments) when they know you, as the clinician, are engaged and committed to making them better. When patients come to our clinic, I let them know they are “gaining a new family…and family sticks together and helps each other.” On follow-up appointments, I will often say, “I’m going to ask you about your skin in just a minute, but first tell me about how you are doing?” Like grandma used to say, “People don’t care what you know until they know that you care.”
Creating simple and understandable ways to describe diseases and therapeutics to patients is also important, but we shouldn’t be afraid to admit when we just don’t know something. My patients are willing to accept a gap in knowledge because they know I’m going to do the biopsy, order the test, do some research, or get help from others. However, despite a great patient-provider relationship, many patients still do not adhere to agreed-upon treatment plans. If you have confirmed the diagnosis and developed a good treatment plan, but aren’t seeing improvements in a patient, always consider the possibility of nonadherence. Keeping patients engaged in their treatment plans means addressing issues that make adherence a challenge. Offer solutions. Seek treatment alternatives. Lastly, as clinicians, being positive and offering hope to our patients is a critical part of the holistic treatment process.
As a provider, what gives you the greatest sense of satisfaction in what you do?
Douglas: I’ve got the best job in the world. I get to meet with dozens of people each work day and talk with them about their jobs, their families, their hobbies, their concerns, and…oh yeah, their skin problems! My first several years as a derm practitioner were highly focused on confirming the right diagnosis and not missing anything bad, and don’t get me wrong…that is still the primary goal—after all, accurate diagnoses lead to successful treatments, less suffering, and improved quality of life for my patients—but now, my 22 years of experience means the diagnosis comes more quickly through pattern recognition and repetition, leaving more time to engage and minister to the whole person, not just the person’s skin complaint. My greatest sense of achievement isn’t found in the number of patients I see, but rather in the hug I receive from the patient whose psoriasis or atopic dermatitis has disappeared or whose surgical scar has become barely noticeable, or in the immense look of relief on a patient’s face after telling them their groin rash is fungal, not an STD. Simply put, I feel immense satisfaction when I can offer help, hope, and healing to people.
What charitable organizations and professional societies are you involved in?
Douglas: Contributing to and supporting the educational and professional growth of fellow derm PAs and NPs is important to me. I have been the founder or a founding board member of state dermatology societies, a derm foundation, several dermatology conferences, a scientific journal, a free healthcare clinic for the homeless, and a ministry for recovering drug and alcohol addicts. I enjoy professional memberships with teaching societies, medical history societies, and state and national derm PA societies. My wife and I support our local church, US and internationally based missionaries, and underserved children overseas through World Vision.
My wife has labeled me a “chronic initiator.” Simply put: I love initiating or helping to initiate important projects, getting them off the ground and into motion, whether the project is my own or the dream of one of my colleagues. I enjoy finding ways to recognize others for their accomplishments, and I love helping others accomplish their goals.
You mentioned being involved in several conferences. Tell us more about your role(s) in education.
Douglas: I am an educator at the core. I love educating myself, my staff, my patients, and my colleagues. I’ve given over 400 medical lectures and logged more than 12,000 hours of student mentoring during my career. Whether I’m delivering a dinner talk, teaching at a residency or medical school, or lecturing at a conference, I still get nervous before every presentation. I’m not anxious about how I will be perceived, but rather, it’s the responsibility of delivering up-to-date, accurate, and clinically relevant information that others might utilize in their clinics. There’s no room for misinformation when patient care is at stake. In the most recent years, I have lectured on nail diseases, ocular dermatology, pregnancy dermatoses, the gut-skin axis, COVID-19 and vaccine reactions, obesity and the skin, acne, hidradenitis, and many different aspects of psoriasis and atopic dermatitis.
You obviously lead a very busy life professionally. How do you find balance and avoid burnout?
Douglas: I stay so busy, take on so many tasks at the same time, and work so much that I have no time to worry about “burnout” (wink, wink). But seriously, burnout is not just an MD problem: PAs, NPs, and all other healthcare professionals have to find that life-work balance. I may not do it very well, but I do have personal interests and pursuits outside of the clinic that help me find balance between life and work. My Christian faith gives me peace and strength during periods of fatigue or turmoil. Hiking and being outside certainly recharges my battery. With all my kids now out of the house, I recently completed coursework to become a Master Gardener, for which I am now working through a required apprenticeship to become officially certified. Truth be told, I’m more likely to develop green-nail syndrome than I am to have a green thumb, but I enjoy garden, landscape, and conservation projects.
I am also so blessed by my three children. They each have unique talents, passions, and dreams, yet they’re similar by being hardworking, generous, and selfless. My eldest is now out of college and is training for combat special forces. My middle child is a junior in college and is pursuing elementary education (she loves those little kiddos), and my youngest is a sophomore in college and hopes to go on to medical school. My wife has been a high school math teacher and dorm mom at boarding schools for most of our 27 years of marriage. Our dorm residents are mostly international, and we get to act as their “American” parents during some very formative years. This means we have a large second set of kids from all over the world! All of these things help keep me balanced.
What advice would you give NPs and PAs just beginning their dermatology careers?
Douglas: I will refer readers to my Guest Editor’s Message in this issue of NP+PA Perspectives in Dermatology to find recommendations for becoming a great dermatology provider. I’d like to also offer two more nuggets of advice.
First, maintain good exam room etiquette. Establish contact and acknowledge every person upon entering the exam room, make a point of sitting down at some point during the exam (a bent knee lets the patient know you have slowed down enough to focus on them), and always ask the patient if they have any additional concerns. Let the patient end the appointment, not you. You certainly will encounter challenging exam room situations from time to time that will require different approaches, but these pointers have served me and my patients well.
Next, empower your medical assistants. I could not function without my medical assistants. Much more than chaperones, they chart, assist, gather and confirm information, review treatment plans, and offer further education to patients. Train them, praise them, build them up, and let them know they are valued. “Teamwork makes the dream work” is never truer than in medicine!