Journal of Dermatology for Physician Assistants

The official journal of the Society of Dermatology Physician Assistants

The Evolution Will be Peer-Reviewed

By Peter A. Young, MPAS, PA-C

ABSTRACT
Physician assistants participate in peer-reviewed publications less than other health professionals. The history of osteopathic physicians and podiatrists demonstrate how important journal participation is for successful professional evolution. Various non-dermatologists have contributed novel information to the dermatology literature, including some dermatology physician assistants. The practice of research and authorship positions physician assistants to advocate more effectively for their profession, by cultivating deeper understanding of easily misconstrued scientific literature. A shift is needed in the dermatology physician assistant profession, toward more authorship in peer-reviewed scientific publications.

“Every great movement must experience three stages; ridicule, discussion, and adoption.”– John Stuart Mill

Advocacy campaigns to promote physician assistants (PAs) are ever-present on social media platforms, such as “Your PA Can” and “Your Dermatology PA Can Handle It”.1Williams D. 5 Steps You Can Take to Elevate Your Organization’s Social Media. The American Academy of Physician Associates. https://www.aapa.org/newscentral/2019/10/5-steps-to-use-social-media-to-benefit-the-profession/ Accessed 8/3/2021.2Society of Dermatology Physician Assistants. About Dermatology PAs: Your Dermatology PA Can Handle It! https://www.dermpa.org/page/About_DermPAs Accessed 6/28/2021. These efforts are noble, but there is also need for organized effort on another front: more participation in peer-reviewed journals. Research led by PAs is sparse compared to other health professions,3Miller AA, Dehn R. Physician Assistant research culture: another view. J Physician Assist Educ. 2014;25(3):7-8. and scholarship among PA educators has dropped over the last decade (50.6% report having no publications).4Kayingo G, Kibe L, Venzon A, Gordes KL, Cawley JF. Assessing demand for doctoral-prepared PA Faculty: A five-year longitudinal study. BMC Medical
Education. 22 June 2021, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.3.rs-622609/v1. Accessed 8/3/21.
As the number of dermatology PAs has grown, positive sentiment toward PAs in peer-reviewed dermatology journals has steadily declined.5Laughter MR, Maymone MBC, Presley CL, et al. Advanced practice providers and the dermatology literature. J Dermatol Nurses Assoc. 2021;13(5):258-264. doi: 10.1097/JDN.0000000000000632

It takes decades for new medical professions to fully earn the status quo’s recognition, and these transformations always involve production of science’s only universal currency: peer-reviewed publications. The history of osteopathic physicians (DOs) demonstrates this well; within the past century they evolved from subjects of widespread derision to fully licensed practitioners.

A survey of laypersons in 1936 examined the perceived social status of various health professionals, in which osteopaths ranked 18th overall, below dietitians. In 1937, DOs had privileges equivalent to MDs in only 26 states. The official stance of the American Medical Association (AMA) was that DOs were non-physician “cultists” with whom it was unethical for MDs to associate. But from its inception, the American Osteopathic Association (AOA) actively pursued professional recognition for DOs, including by supporting their publications. By 1902, the AOA had its own Committee on Publication to improve the quality of osteopathic case reports, knowing this was necessary for the Journal of the AOA to become respected. Between 1941 to 1943, Stedman Denslow, DO, published four articles in two prominent non-osteopathic journals. This paved the way for federal support of DO-led research and was of great importance to osteopathic physicians because it showed they could conduct reputable research accepted by the greater scientific community. In the mid-1960s, the AMA dropped the “cultist” label and allowed MD members to associate with DOs. In 2020, approximately 25 percent of United States medical school graduates were DOs.6Norman Gevitz. The DOs: Osteopathic Medicine in America, 3rd ed. Baltimore,
MD: Johns Hopkins University Press;2019.

The history of podiatrists similarly underscores this theme. By 1960 they had earned surgical privileges in 47 states, after decades of legislative efforts. But their success met backlash from the American Academy of Orthopedic Surgeons (AAOS), which asserted podiatrists should be physically supervised by MDs and barred from performing bone surgery (soft tissue only). Podiatrists responded with a “publish or perish” stance, increasing peer-reviewed journal participation to support their claim that legislative changes were appropriate for their level of training. After years of rejection, the Journal of Foot and Ankle Surgery was finally accepted into Index Medicus in 1977. Peer-reviewed articles demonstrating the responsibility, safety, and efficacy of podiatrists became the profession’s ticket to gradually being tolerated by the AMA and AAOS, who slowly toned back opposition.7Durr K, Noll JS. The Evolution of a Profession: The First 75 Years of the American College of Foot and Ankle Surgeons. Chicago, IL: American College of Foot and Ankle Surgeons Inc.;2017. Podiatrists’ abilities to serve patients gradually flourished, and more recognition naturally followed. There is more to the stories of podiatrists and DOs (both were multifactorial, involving marketing campaigns and legislative efforts), but scientific publications were critical for each.

You don’t have to be a dermatologist to contribute novel information to the field of dermatology. Captain John Smith had no medical training when he wrote the first account of rhus dermatitis in 1609. The inventor of Mohs micrographic surgery, Frederic Mohs, was not a dermatologist but rather a general surgeon.8Crissey JT, Parish LC, Holubar K. Historical Atlas of Dermatology and Dermatologists, 1st Edition. Boca Raton, FL: CRC Press; 2002. Nurse practitioner Margaret Oliviero routinely co-authors articles with dermatologists in high-impact journals.9DeWane ME, Kelsey A, Oliviero M, Rabinovitz H, Grant-Kels JM. Melanoma on chronically sun-damaged skin: Lentigo maligna and desmoplastic melanoma.
J Am Acad Dermatol. 2019 Sep;81(3):823-833. doi: 10.1016/j.jaad.2019.03.066
Dermatology PA Bethany Grubb has authored work in the Journal of the American Academy of Dermatology,10Grubb B, Henderson DB, Pandya AG. Adult T-cell lymphoma/leukemia presenting as pagetoid reticulosis of the palms and soles. J Am Acad Dermatol. 2011;65(5):1063-1064. doi: 10.1016/j.jaad.2010.02.007. as have several other PAs.

If you fear rejection of your work, rest assured that even experts get turned down. A written description of the first hair transplant in America was rejected by a well-known dermatology journal, the editor’s response being “Can’t be done.” The method is now practiced in offices worldwide.8Crissey JT, Parish LC, Holubar K. Historical Atlas of Dermatology and Dermatologists, 1st Edition. Boca Raton, FL: CRC Press; 2002. My first submission to a peer-reviewed journal was outright rejected, but after revision and resubmission, was accepted.11Young PA, Keller LC, Bae GH. Successful transition to encorafenib following vemurafenib-induced drug rash with eosinophilia and systemic symptoms syndrome. JAAD Case Rep. 2021;9:42-44. Published 2021 Jan 11. doi:10.1016/j. jdcr.2020.12.030 With practice, you may even grow to savor rejections for the lessons they render.

By authoring your own manuscripts, you grow more in touch with existing literature, which better positions you to speak up if your profession is unfairly criticized. For example, a 2018 study concluded that “the diagnostic accuracy of PAs may be lower than that of dermatologists” for melanoma in-situ.12Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK. Accuracy of skin cancer diagnosis by physician assistants compared with dermatologists in a large health care system [published correction appears in JAMA Dermatol. 2018 Jun 1;154(6):739]. JAMA Dermatol. 2018;154(5):569-573. doi:10.1001/jamadermatol.2018.0212 Experts have highlighted issues with the article, most notably its lack of risk factor analysis (including personal history of melanoma, the malignancy’s greatest risk factor).13Marghoob AA, Marchetti MA, Dusza SW. Performance of dermatology physician assistants. JAMA Dermatol. 2018;154(10):1229. doi:10.1001/ jamadermatol.2018.2693 But buried in another article from the same institution and corresponding author are related findings that garnered little public attention. In a study of eight PAs and 12 dermatologists who analyzed 173 skin lesion images, the PAs were 15.9 percent more sensitive than the dermatologists for detection of melanoma (a finding that was statistically significant).14Ferris LK, et al. Computer-aided classification of melanocytic lesions using dermoscopic images. J Am Acad Dermatol. 2015;73(5):769-776. doi: 10.1016/j.jaad.2015.07.028 Comparing these two articles of common origin may help some people to consider possible inattentional blind spots to the positive qualities of dermatology PAs.

Several outstanding articles are available on how to write for peer-reviewed journals.15Elston D. Writing a better research paper: Advice for young authors. J Am Acad Dermatol. 2019;80(2):379. doi: 10.1016/j.jaad.2017.11.01016Livingston EH. 9 tips for getting published in a medical journal. Published online December 3, 2014. The American Medical Association. https://www.ama-assn.org/residents-students/residency/9-top-tips-getting-publishedmedical-journal Accessed August 18, 2021..17Beehler K. Becoming a published author: part 1. Next Steps in Derm. Published online April 23, 2018. https://nextstepsinderm.com/jdd-corner/becoming-apublished-author-part-1-of-a-2-part-series/ Accessed August 18, 2021. There is also now an author group of dermatology professionals offering free mentorship to those interested in writing for peer-reviewed publications, the Collaboratory for Interprofessional Authorship in Dermatology.18The Collaboratory for Interprofessional Authorship in Dermatology. Published online February 1, 2022. CIADerm.org I hope you’ll use these resources to join this great tradition, and in doing so improve PA participation in the greater dermatology community. We each have the power to co-author the future.

The author’s opinions are his own and not representative of any organization.

Acknowledgements: The author would like to thank Gerald Kayingo, PhD, PA-C, for his invaluable contributions to this article.

Peter A. Young, MPAS, PA-C, is a physician assistant and clinical researcher in the Department of Dermatology at Kaiser Permanente in Sacramento, California.

Disclosures: The author has disclosed no potential conflicts of interest, financial or otherwise, relating to the content of this article.

References

  • 1
    Williams D. 5 Steps You Can Take to Elevate Your Organization’s Social Media. The American Academy of Physician Associates. https://www.aapa.org/newscentral/2019/10/5-steps-to-use-social-media-to-benefit-the-profession/ Accessed 8/3/2021.
  • 2
    Society of Dermatology Physician Assistants. About Dermatology PAs: Your Dermatology PA Can Handle It! https://www.dermpa.org/page/About_DermPAs Accessed 6/28/2021.
  • 3
    Miller AA, Dehn R. Physician Assistant research culture: another view. J Physician Assist Educ. 2014;25(3):7-8.
  • 4
    Kayingo G, Kibe L, Venzon A, Gordes KL, Cawley JF. Assessing demand for doctoral-prepared PA Faculty: A five-year longitudinal study. BMC Medical
    Education. 22 June 2021, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.3.rs-622609/v1. Accessed 8/3/21.
  • 5
    Laughter MR, Maymone MBC, Presley CL, et al. Advanced practice providers and the dermatology literature. J Dermatol Nurses Assoc. 2021;13(5):258-264. doi: 10.1097/JDN.0000000000000632
  • 6
    Norman Gevitz. The DOs: Osteopathic Medicine in America, 3rd ed. Baltimore,
    MD: Johns Hopkins University Press;2019.
  • 7
    Durr K, Noll JS. The Evolution of a Profession: The First 75 Years of the American College of Foot and Ankle Surgeons. Chicago, IL: American College of Foot and Ankle Surgeons Inc.;2017.
  • 8
    Crissey JT, Parish LC, Holubar K. Historical Atlas of Dermatology and Dermatologists, 1st Edition. Boca Raton, FL: CRC Press; 2002.
  • 9
    DeWane ME, Kelsey A, Oliviero M, Rabinovitz H, Grant-Kels JM. Melanoma on chronically sun-damaged skin: Lentigo maligna and desmoplastic melanoma.
    J Am Acad Dermatol. 2019 Sep;81(3):823-833. doi: 10.1016/j.jaad.2019.03.066
  • 10
    Grubb B, Henderson DB, Pandya AG. Adult T-cell lymphoma/leukemia presenting as pagetoid reticulosis of the palms and soles. J Am Acad Dermatol. 2011;65(5):1063-1064. doi: 10.1016/j.jaad.2010.02.007.
  • 11
    Young PA, Keller LC, Bae GH. Successful transition to encorafenib following vemurafenib-induced drug rash with eosinophilia and systemic symptoms syndrome. JAAD Case Rep. 2021;9:42-44. Published 2021 Jan 11. doi:10.1016/j. jdcr.2020.12.030
  • 12
    Anderson AM, Matsumoto M, Saul MI, Secrest AM, Ferris LK. Accuracy of skin cancer diagnosis by physician assistants compared with dermatologists in a large health care system [published correction appears in JAMA Dermatol. 2018 Jun 1;154(6):739]. JAMA Dermatol. 2018;154(5):569-573. doi:10.1001/jamadermatol.2018.0212
  • 13
    Marghoob AA, Marchetti MA, Dusza SW. Performance of dermatology physician assistants. JAMA Dermatol. 2018;154(10):1229. doi:10.1001/ jamadermatol.2018.2693
  • 14
    Ferris LK, et al. Computer-aided classification of melanocytic lesions using dermoscopic images. J Am Acad Dermatol. 2015;73(5):769-776. doi: 10.1016/j.jaad.2015.07.028
  • 15
    Elston D. Writing a better research paper: Advice for young authors. J Am Acad Dermatol. 2019;80(2):379. doi: 10.1016/j.jaad.2017.11.010
  • 16
    Livingston EH. 9 tips for getting published in a medical journal. Published online December 3, 2014. The American Medical Association. https://www.ama-assn.org/residents-students/residency/9-top-tips-getting-publishedmedical-journal Accessed August 18, 2021..
  • 17
    Beehler K. Becoming a published author: part 1. Next Steps in Derm. Published online April 23, 2018. https://nextstepsinderm.com/jdd-corner/becoming-apublished-author-part-1-of-a-2-part-series/ Accessed August 18, 2021.
  • 18
    The Collaboratory for Interprofessional Authorship in Dermatology. Published online February 1, 2022. CIADerm.org

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