I think that I might be overemphasizing my personal, day to day level of disdain for the job; while it is ever present, it really does not creep in while I'm in the room doing the actual work and I have little problem with that function. Where it does rear its ugly head is with the management and oversight of an ever eroding income statement as well as with my discussions with colleagues, placement on various boards and panels, etc. There seems to be primarily two quite distinct populations that I have to cater to within the field: those that have some involvement behind the scenes and are true chicken littles and those employed (regardless of the setting) who are much less predisposed to the woe is me mentality. The problem is with bridging the chasm between the two, lessening the information gap, and doing so in such a way as to not dismiss the general feelings in either camp. It's quite the tight wire to walk, I must say.
What you are really looking at is a supply / demand argument; there are pressures at both ends here that come into play. First, the supply side: we have massively increased our number of trainees in relative terms over the past two decades, accelerating this trend more recently. The reasons behind this are too much to go into right here and now, but, as always, seem to come down to a combination of misguided good intentions and frank self interest. Simultaneously, the rise of the part time doc has occurred, temporarily (so far, at least) mitigating the observed effects of this large percentage change. All of this has happened against a backdrop of rising -- and relatively unrestrained -- demand. An aging population consumes more health services in general and dermatologic services in particular, so we have a demographic push toward more need. There have been few restraints to seeking this care for several years, and when taken together has resulted in a burgeoning demand for skin services. Artificially high demand for services (due to few barriers / restraints / rationing of care) plus artificially low provider resource utilization (large number of docs working part time) leads to an artificial shortage -- and both of these factors are independently moving in the opposite direction as the resurgence of the gatekeeper model, ACO's, etc increase and margins are squeezed.
Fun times when you start digging into the numbers. Fun. Times. Indeed.