The Lahey Dermatology Fellowship Mission‍

The Lahey Dermatology Nurse Practitioner Training Program was started to increase access to quality dermatology care. One of the goals is to educate and train nurse practitioners to provide outstanding dermatologic care. The other aim is to train NPs to pursue lifelong learning in the field of dermatology.

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The Lahey Dermatology Nurse Practitioner Training Program

The Lahey Dermatology Nurse Practitioner Training Program was established in 2003 at Lahey Hospital & Medical Center in Burlington, Massachusetts, making it the first and oldest dermatology nurse practitioner training program in the United States. In 2022, they became the first dermatology nurse practitioner program to receive accreditation from the American Nurses Credentialing Center (ANCC). It was started by Mary Nolen, MS, ANP-BC, DCNP, a nurse practitioner, and Dr. Suzanne Olbricht who is a Mohs micrographic surgeon, past President of the American Academy of Dermatology, former Chair at the Beth Israel Deaconess Medical Center, and an Associate Professor of Dermatology at Harvard Medical School. Nolen is responsible for developing the Competencies for Dermatology Nurse Practitioners. She partnered with Margaret Bobonich, DNP, FNP-C, DCNP, FAANP to develop the competencies. Bobonich, DNP, FNP-C, DCNP, FAANP has been a pioneer in dermatology over the last twenty years and is highly acclaimed for her contributions to dermatology education for NPs.

The Lahey mission is simple, increase the number of dermatology providers to increase access to care. The aim is to prepare NPs to train specifically in medical dermatology. Since it’s induction, 28 nurse practitioners have completed the fellowship which is a comprehensive, two-year program that begins in September and ends in August. Prior to 2010, it was a one-year program that was completely didactic. After receiving feedback from the 2010 cohort, they added the second year to give trainees the chance to have their own schedule, see patients independently, and gain experience billing.  

New cohorts matriculate into the program on even-numbered years. Applications are accepted from December 1 to February 2 of the preceding calendar year, and only two candidates are selected. During the two years, NP Fellows participate in a residency-style training program that includes didactic and clinical curriculum.

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The Trainee Experience

Qualified candidates are NPs from the United States. One to two years of primary care is preferred, but there have been a few NP Fellows in the program who did not have experience, including Garcia-Albea. The program is not currently open to physician assistants (PAs) or international prospects. Trainees receive a stipend of $50,000 the first year and $80,000 for the second year. In comparison, other programs offer more, but they also have a different structure where trainees are seeing their own patients much sooner in the program and are generating revenue for the practice.

VisualDx was the only decision-support tool mentioned, however it’s primarily used for learning, not so much in clinical practice at the point of care. Epic is the electronic medical record (EMR) used in the outpatient hospital clinic. NP Fellows see most of their patients in this outpatient clinic, while a fraction of time is spent conducting inpatient consultations.

NPs in Massachusetts are independent and have their own patient panels. Interestingly, they do have a supervising physician, however NPs are not limited in terms of prescription authority or the types of patients they see. The dermatologists’ notes makes it very easy for NPs to be autonomous.

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The Schedule

The curriculum does not permit time for NP Fellows to work outside of the program. On Mondays, Wednesdays, Thursdays, and half a day on Fridays NP Fellows are in clinic with a preceptor. During the first six weeks of the program, instead of 15-minute visits, the fellows are allotted a preceptor schedule of 30 minutes per patient.

Tuesdays are filled will lectures, Grand Rounds, and they are given time to conduct research to prepare for hour long presentations that take place every other week during lunch. Anyone in the Dermatology Department and the hospital is welcome to attend the presentations and receive a free continuing education (CE) credit. The presentations can be the main cause of stress the first year as fellows are simultaneously learning so many diagnoses for the first time. In the second year, fellows can use first year presentations to build on and present advanced concepts of the disease, treatment, and management, as well as discuss the latest trends in research. As soon as fellows give one presentation, they begin preparing for the next one with the support of an assigned faculty member. The presentations include both an oral and visual component in the form of a PowerPoint. Once a month, they present to the entire hospital as part of Nursing Grand Rounds where a free CE and virtual attendance is offered. Ms. Garcia-Albea is a board member of the National Association of Pediatric Nurse Practitioners’ Dermatology Special Interest Group (SIG) where she posts recordings of the presentations for SIG members interested in learning dermatology to view and earn a CE credit. The presentations cover medical dermatology topics like acne, skin cancer, and psoriasis assigned to them by Ms. Garcia-Albea.

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Dermoscopy Training and Dermatopathologist Exposure

NP Fellows use a dermatoscope on every patient, they attend the Harvard Dermatology residency lectures on dermoscopy, and they can attend conferences on dermoscopy (which many do), but it’s not a requirement. As often as fellows desire, they can read slides and use a teaching microscope with a dermatopathologist affiliated with Massachusetts General Hospital who volunteers his time.

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Billing, Coding, and Negotiating

A medical coder gives a lecture on billing and coding. Additionally, the department chair also gives a lecture on topics like level of service and modifiers, to name a few. When it comes to contract negotiation, Ms. Garcia-Albea coaches the NP Fellows on important talking points, although this is not a formal process, she’s now considering adding a formal component after our conversation. Lahey NPs are salaried, so productivity is not a huge part of the Lahey practice model, but productivity is discussed with those interested in entering private practice. There is an emphasis on efficiency which the fellows are evaluated on throughout the program.

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Teledermatology & Artificial Intelligence

Teledermatology is utilized in the practice as requested by the patients via Doximity and Epic. It’s primarily used for things that lend itself well to telehealth. On Thursdays, fellows have the ability to get exposure to total body photography which incorporates artificial intelligence. It compares moles and identifies any changes. The full body photography program is primarily run by a nurse practitioner. A dermatologist will be joining the NP based on patient demand.

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Opportunities for Research

In the second year of the program, fellows have to write an article for publication and are given the option to conduct research if they desire. The Journal of the Dermatology Nurses’ Association (JDNA) is the preferred publication. Ms. Garcia-Albea favors case reports, as do many experienced authors, for novice writers. One of the current fellows has her Doctor of Nursing (DNP) degree and according to what I understand, it sounds like she’s planning to implement a quality improvement project as explained by the DNP Essentials.

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Upon Completion

Upon completion, the program aims to have all fellows be qualified to sit for the Dermatology Nurse Practitioner Certification Examination meaning they have the 3,000 direct patient care hours. The past participants have had a 100% pass rate within three months of completing the program. About 25% have stayed to work at Lahey, however it’s not a requirement. With Massachusetts being densely populated with dermatology providers, Lahey really wants to help increase access to care nationwide and thus supports trainees practicing anywhere.

When asked about networking opportunities for fellows following completion of the program, Ms. Garcia-Albea recommended the New England Dermatologic Society, the Society of Dermatology Nurse Practitioners Society (SDNP), and the Dermatology Nurses’ Association (DNA). While the DNA is more nurse centric, it sounds like there are talks to reinvigorate the DNA's Nurse Practitioner Society (which I am a member of; in full disclosure, I’m a member SDNP and DNA). The DNA and SDNP are always welcoming to volunteers to help them increase the momentum of their mission.

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Aspiring Dermatology Nurse Practitioners

Aspiring dermatology NPs don’t need to get dermatology experience prior because they will get plenty of exposure in the program. It is advised that you get primary care and internal medicine experience as dermatology is a medicine heavy specialty.

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Diversity, Equity, and Inclusion

In light of Diversity, Equity and Inclusion (DEI), NP Fellows are encouraged to attend all the Skin of Color Society lectures. Fellows are expected to include visual representations of all skin tones in their bi-weekly presentations and Grand Rounds, regardless of the topic. As aforementioned, the fellows participate in the lectures presented to Harvard residents where there have been an increasing number of talks about DEI. The Dermatology Department provides access to DEI education, including expert speakers who talk about relevant issues like microaggressions. Fellows can participate in the Skin of Color (SOC) clinic which is run by two SOC providers, including a physician and a Hispanic NP who focus on dermatoses prevalent in SOC patients (including melasma, skin checks, and alopecia).

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Planning for the Future

As the demand for dermatologic services continues to expand, programs like Lahey are preparing now. One of the ways they are meeting the growing demand is through the Lahey Hospital and Medical Center’s Hair Loss Center of Excellence which Garcia-Albea helps run with another NP. In fact, the NP Fellows get a lot of exposure to hair loss and are trained to competently treat it upon completion of the program. Garcia-Albea anticipates more skin checks in older patients as adults 65 and older become the fastest growing age group. Interestingly, she has noticed a trend in patients being less satisfied with their results and expecting a higher standard of care from providers. With access to more information online and social media, she admits this is an area of great concern (this sentiment has been echoed by many prominent leaders in dermatology as well). She’s been very impressed with the NP Fellows' responses to this concern as they have been quite savvy, patient, empathetic, confident, and open minded when it comes to educating patients and managing expectations.

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Director Victoria Garcia-Albea, NP DCNP

Ms. Garcia-Albea participated in the program from 2006 to 2007. She happened to be one of the few NPs who was accepted into the program without dermatology experience and immediately after graduating NP school. She stayed after completing the program because everyone in the Department of Dermatology is involved in the fellowship and are extremely supportive. She returned in 2019 and is currently the director. At present, she’s presenting evidence to get the annual stipend increased to meet a more suitable living wage for the area. In fact, they’ve altered the structure of the program so fellows are starting to see patients at six months to help offset the overhead. She continues to love the work she is doing and finds it extremely gratifying.

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The Faculty

The faculty is comprised of Ms. Garcia-Albea, NP, the Chair Adam Lipworth, MD, and the Education Chair Julia Benedetti, MD. They all see patients concurrently. Additionally, Dr. Benedetti organizes department organizational meetings and the Lahey Dermatology residency program. Dr. Lipworth handles administrative responsibilities. Ms. Garcia-Albea and Dr. Benedetti are primarily responsible with running the program.

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The Interview

This interview was inspired by a book by Daniel Priestley called Key Person of Influence. In the book, Priestley presents a five-step framework you can follow to become one of the most highly valued and highly paid people in your industry. This is one of the most useful books I’ve read in a long time as it is full of actionable steps you can take immediately. I’ve been following Priestley’s advice and it’s one of the reasons you’re reading this article. One of the five steps is to align yourself with Key Persons of Influence as you work to become one yourself.

In thinking about how I can align myself with Key Persons of Influence, I originally thought about interviewing relatively new NPs in dermatology about their journey. Simultaneously, I’ve been looking for resources to share with a high school freshman I'm mentoring who is interested in being a pediatrician. I came across a video by Dr. Antonio Webb, an orthopedic spine surgeon in San Antonio, Texas. He has been documenting his journey on YouTube and using his platform to educate and inspire aspiring physicians for many years. In the video in reference, he sat down with theAssociate Dean of Admissions at The University of Incarnate Ward School of Osteopathic Medicine. While watching that video I was inspired to not just reach out to practicing Dermatology NPs, but to education and training programs.

I will be writing a full review of the audio version of the book Key Person of Influence soon, so be sure to join the Mahogany Dermatology Community and follow me on Instagram to be notified when that article is published. In the meantime, if you are reading this article and you’re a practicing Dermatology NP or associated with an education and training program open to NPs in dermatology (medical, cosmetic, or surgical) or aesthetics and you would like to be interviewed, please let me know! Additionally, if are interested, I can record our interview and post it on the Mahogany Dermatology YouTube channel similarly to the video seen here. You’ll be given a copy of the file so you can share the video on your social media platform. Lastly, If you know someone who meets the criteria just mentioned, please provide them my contact information, give them a heads up about the opportunity, send me their contact information, and I’ll initiate the conversation.

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Kimberly Madison, DNP, AGPCNP-BC

Kimberly Madison is a nurse practitioner with a passion for writing, entrepreneurship, education, and mentorship. I created this blog to share my journey as source of motivation and as a blueprint as you embark on your journey. Most importantly, I’m looking forward to increasing access to dermatology education and clinical training for aspiring and practicing nurse practitioners. I invite you to view the mission and vision statement on the homepage to see how we can best partner to make our dreams align.

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