Dermatologists practicing dermpath

[ucladoc]

Hey everyone,

I'm currently a MS3 and gearing up for residency. I have been interested in derm/dermpath since the beginning of medical school. As of now, I have two basic science publications (not first or second author though; impact factors of journals are 2 and 5.5). By application time, I should have another publication - I will be 2nd author and hope that it will be published in JID. I understand that there have been previous threads in which board members explained the viability of practicing both dermatology and dermpath. However, with the recent release of the 2014 scheduled cuts I was curious to see what the future holds for dermatology trained physicians who entered dermatopathology. The AAD president wrote an open letter recently which caught my attention -

https://www.aad.org/members/practic...sement/payment-101/Dermatology-is-under-siege

In your opinion, is it still feasible for dermatologists to operate private labs? Have you heard of hospital gigs where dermatologists could divide their time between clinic and dermatopathology? Thank you for all your help!

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[asmallchild]

Hey everyone,

I'm currently a MS3 and gearing up for residency. I have been interested in derm/dermpath since the beginning of medical school. As of now, I have two basic science publications (not first or second author though; impact factors of journals are 2 and 5.5). By application time, I should have another publication - I will be 2nd author and hope that it will be published in JID. I understand that there have been previous threads in which board members explained the viability of practicing both dermatology and dermpath. However, with the recent release of the 2014 scheduled cuts I was curious to see what the future holds for dermatology trained physicians who entered dermatopathology. The AAD president wrote an open letter recently which caught my attention -

https://www.aad.org/members/practic...sement/payment-101/Dermatology-is-under-siege

In your opinion, is it still feasible for dermatologists to operate private labs? Have you heard of hospital gigs where dermatologists could divide their time between clinic and dermatopathology? Thank you for all your help!

I'm not well-versed in dermpath so hopefully someone else can chime in. I've heard of positions (declining in availability of course) where dermatologists split time between clinic and reading slides. It is becoming increasingly rare if not unheard of for a solo dermatologist to operate a private lab

 

[ucladoc]

First and foremost - thank you for chiming in! From the limited people that I've spoken with the impression that I got was that most dermatopathologists are derm trained. As such, I've assumed it wouldn't be to unreasonable to expect to find jobs where a physician could divide his or her time between the two fields. However, my assumptions could be wrong. Perhaps more people will share their thoughts....

 

[asmallchild]

First and foremost - thank you for chiming in! From the limited people that I've spoken with the impression that I got was that most dermatopathologists are derm trained. As such, I've assumed it wouldn't be to unreasonable to expect to find jobs where a physician could divide his or her time between the two fields. However, my assumptions could be wrong. Perhaps more people will share their thoughts....

My understanding (or assumption) was that it's pretty much an even split between path trained and derm trained. Finding a job with a general derm component is not difficult. Finding a job with a significant dermpath component tends to be the trickier part since it tends to be more lucrative than general derm.

 

[DermViser]

My understanding (or assumption) was that it's pretty much an even split between path trained and derm trained. Finding a job with a general derm component is not difficult. Finding a job with a significant dermpath component tends to be the trickier part since it tends to be more lucrative than general derm.

I'm surprised Dermpath has become more lucrative, as I thought there have been a significant cut in reimbursement codes.

 

[asmallchild]

I'm surprised Dermpath has become more lucrative, as I thought there have been a significant cut in reimbursement codes.

I think it still remains more lucrative than gen derm particularly if you have a large volume of slides / specimens (again, I'm not in dermpath so who knows how accurate this is)

Friends who have pursued a fellowship in dermpath still tell me it's tough to find a position with significant dermpath time vs clinic time

 

[DermViser]

I think it still remains more lucrative than gen derm particularly if you have a large volume of slides / specimens (again, I'm not in dermpath so who knows how accurate this is)

Friends who have pursued a fellowship in dermpath still tell me it's tough to find a position with significant dermpath time vs clinic time

Yeah, the ones who I know do it, seem to think they can have this magical dermpath + clinical path practice, but I don't see those in high quantity, besides academics. I guess there are those that do full-time dermpath as well in private practice - but that requires a lot of selling on your part to derms to give you their slides vs. a more experienced and trusted one.

 

[MOHS_01]

Full time dermpath only practice -----> BANK. Full time dermpath for a dermatology group ---> Bank. Ha. Full time dermpath is an increasingly difficult gig to find either way -- much as is Mohs. This is a reflection of something that I have argued (at times rather loudly back in my youth) -- we are overtraining sub specialists relative to their mix with general term, their demand, and our overall carrying capacity.

You do not technically need to have fellowship training in any dermatology subspecialty to practice it (even reasonably well); what you need is the capacity to recognize your limitations.... a trait that most jack of all trades, almost by definition, characteristically lack.

Yeah, the ones who I know do it, seem to think they can have this magical dermpath + clinical path practice, but I don't see those in high quantity, besides academics. I guess there are those that do full-time dermpath as well in private practice - but that requires a lot of selling on your part to derms to give you their slides vs. a more experienced and trusted one.

 

[ucladoc]

Full time dermpath only practice -----> BANK. Full time dermpath for a dermatology group ---> Bank. Ha. Full time dermpath is an increasingly difficult gig to find either way -- much as is Mohs. This is a reflection of something that I have argued (at times rather loudly back in my youth) -- we are overtraining sub specialists relative to their mix with general term, their demand, and our overall carrying capacity.

You do not technically need to have fellowship training in any dermatology subspecialty to practice it (even reasonably well); what you need is the capacity to recognize your limitations.... a trait that most jack of all trades, almost by definition, characteristically lack.

Thanks for the reply MOHS 01. Your pragmatic advice is much appreciated!

In my routine research about dermpath I also came upon the following rheum-derm fellowship. http://www.brighamandwomens.org/Departments_and_Services/dermatology/fellowship.aspx I understand that it is not an accredited fellowship. More importantly, it is my understanding that most dermatologists tend to shy away from rheum pts (vasculitis, dermatomyositis, etc) due to practice pressure to see more bread and butter dermatology as this maximizes revenue. However, biologics are becoming standard of care for certain rheumatological diseases and I wonder if more dermatologists will seek these pts as guidelines/compensation for biopsying become more stringent.

 

[MOHS_01]

Thanks for the reply MOHS 01. Your pragmatic advice is much appreciated!

In my routine research about dermpath I also came upon the following rheum-derm fellowship. http://www.brighamandwomens.org/Departments_and_Services/dermatology/fellowship.aspx I understand that it is not an accredited fellowship. More importantly, it is my understanding that most dermatologists tend to shy away from rheum pts (vasculitis, dermatomyositis, etc) due to practice pressure to see more bread and butter dermatology as this maximizes revenue. However, biologics are becoming standard of care for certain rheumatological diseases and I wonder if more dermatologists will seek these pts as guidelines/compensation for biopsying become more stringent.

I went to a program heavy in that **** and I can tell you that you can have all of it your little heart desires; I'd sooner go back to digging ditches than deal with CTDz. Heh.

 

[ucladoc]

Hahaha! That says it all.