As the medicare reimbursement for primary care physicians (GP) get smaller, a lot of GP are forced to work longer hours with smaller paychecks. This trend will eventually lead to a bigger shortage of GP in U.S. I hear that there are a increasing number of GP who learn to practice lucrative derm and cosmetic procedures and do extremely well financially. Many of them are learning these cosmetics (botox, laser, collagen) and derm procedures (like skin bx) from conferences and courses. Can IM residencies train IM residents more in dermatology? Are there any IM residencies doing that?

Skin biopsies are simple, and many IM training programs include training in how to do them. Hopefully, you will do them to help diagnose serious illnesses in your patients, not simply to increase your billing. Freezing AK's also increases a PCP's reimbursements, and is easy.

All that other stuff is unlikely to be in an IM or FP residency, since it's outside the scope of practice of IM/FP.

And there's where the problem is. You can certainly take a course to teach you how to botox, and then open up shop and start injecting. However, when you get sued, I believe you will be held to the standard of a practicing dermatologist. Unclear if your IM/FP malpractice insurance will cover you.