Job market still great?

[derminterview]

Hey guys, congrats to everyone who matched and hope it worked out for everyone else.

I matched at a program I liked a lot but is probably just a middle of the road program. Don't know if this matters, but I have no interest in practicing in this region of the country. What are some things that are done to network in places I might want to live?

Not interested in huge markets like NYC, LA, San Fran, Chicago, etc. Just want a nice middle sized city near a coast. Is it still relatively easy to find a job like this?

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[PatsyStone]

Bump.

Does anyone have any thoughts?

Now that I matched, I have nothing to worry and stress over, and honestly, it feels odd. Thinking about the job market may be a good substitute.

 

[luxaeterna]

I agree. Finishing up internship here and I've been replacing match anxiety with employment anxiety. Should probably worry about what derm residency is going to be like.

 

[asmallchild]

Hey guys, congrats to everyone who matched and hope it worked out for everyone else.

I matched at a program I liked a lot but is probably just a middle of the road program. Don't know if this matters, but I have no interest in practicing in this region of the country. What are some things that are done to network in places I might want to live?

Not interested in huge markets like NYC, LA, San Fran, Chicago, etc. Just want a nice middle sized city near a coast. Is it still relatively easy to find a job like this?

I wouldn't worry. For starters, hard for anyone to predict with 100% accuracy given how quickly healthcare changes. As of today, if you are flexible and doing general derm, it isn't difficult to find a position in most markets. The best jobs, as with most fields, are typically found via word of mouth (although I used a recruiter to find my current position and am fairly happy with the results)

 

[Hoser]

Having been in the job market this year, it was totally fine. I got many job offers, both from places I cold-called and from places that were advertised. I really do not think that where you did your residency will be a big deal at all. I love my program, though it isn't considered top tier, had a great 3 years, and had the luxury of picking through various job offers. Can't predict the future, but if you are a general dermatologist I suspect your outlook will be rosy.

 

[Medicine123abc]

Merrit Hawkins (recruiting firm) is just one small metric, but if you look at advertised Derm jobs compared to other specialities...we are doing OK.

http://www.merritthawkins.com/job-s...logy&subspecialty=&regionId=-1#jobGridResults

Pathology had 0 postings. Radiology had 1. So...I think Dermatology is in demand across vast swathes of the United States.

I'll also weigh in from a health economics standpoint. In my opinion, there are a limited number of medical specialties where the thereotical demand is essential infinite. General dermatology is one of them. Dermatologists can induce demand by promoting further services (surgical, medical, cosmetic etc). One can argue that any human being in the United States would benefit from being seen by a Dermatologist from age 0 on. This is not the case for fields like Radiation Oncology. I believe that as residency spot increase, Dermatology is a specialty that has a bigger buffer.

 

[RB93]

How about major metro markets like LA/SF? Is it also easy to find a job in general derm in those markets? I have anecdotally heard of stories of people who did not do their residency in the area being unable to find jobs there, but not sure how true that is in general...

 

[PatsyStone]

How about major metro markets like LA/SF? Is it also easy to find a job in general derm in those markets? I have anecdotally heard of stories of people who did not do their residency in the area being unable to find jobs there, but not sure how true that is in general...

I've met several residents from programs in the Midwest of South who were able to find jobs in LA and SD. From talking to them, it didn't seem that difficult, but I have no idea how good the jobs are

 

[exeunt]

from what i hear SF is rough but i think LA/SD are fine (i'm from ca)

 

[Hoser]

There were certainly jobs to be had in LA/SD area for people finishing their residencies from different states. I don't know about SF.

 

[doctalaughs]

The job market for general dermatology is good compared to other specialties although its not as good as 10 years ago. For midsized and unpopular locations you'll probably have no trouble. For large desirable cities you will still likely find a job although it may not be a good one (ie your chances at partner may be unlikely or misrepresented by groups).

Mohs and dermpath is another story- very tight market.

 

[MOHS_01]

^^^ ditto this - spot on.

 

[sawtella]

I'm starting to interview for jobs and I would really appreciate the advice of some the attendings who have gone through it before. What would you say the major advantages/disadvantages are about joining a small derm only practice vs multi-speciality group? Also, what about joining an all Mohs practice but being the only gen derm there? I do enjoy medical derm but I would also like to do some excisions, lasers and a small amount of cosmetics (primarily injectables). Thanks for your help!

 

[DermMatch]

@MOHS_01 and @doctalaughs , why do you think the market is tight for Mohs and dermpath? I've never been able to figure this out and where I'm at, seems like there's no shortage of patients or slides.

 

[DermMatch]

Also from what I have seen, there are jobs to be had everywhere, but the pay is not always the greatest. SF sucks.

 

[PatsyStone]

Also from what I have seen, there are jobs to be had everywhere, but the pay is not always the greatest. SF sucks.

Just curious, how bad is it? If you don't feel comfortable posting, I understand

 

[MOHS_01]

@MOHS_01 and @doctalaughs , why do you think the market is tight for Mohs and dermpath? I've never been able to figure this out and where I'm at, seems like there's no shortage of patients or slides.

The simplest explanation is that we have trained too many subspecialists : general dermatologists. Throw in the bill client kickback issue for path and the proliferation of the Society guys for Mohs and you have compounded a structural allocation problem with financial conflicts....

It's really much more nuanced than that but real life does not allow for the time necessary to write a book on the matter at this time.

 

[Slack3r]

The simplest explanation is that we have trained too many subspecialists : general dermatologists. Throw in the bill client kickback issue for path and the proliferation of the Society guys for Mohs and you have compounded a structural allocation problem with financial conflicts....

It's really much more nuanced than that but real life does not allow for the time necessary to write a book on the matter at this time.

By Society do you mean not trained through the ACMS?

 

[asmallchild]

By Society do you mean not trained through the ACMS?

Yes, society members have not completed an ACMS or ACGME approved fellowship

 

[Slack3r]

Yes, society members have not completed an ACMS or ACGME approved fellowship

Seems pretty shady. And insurance still reimburses these people?

 

[doctalaughs]

The simplest explanation is that we have trained too many subspecialists : general dermatologists. Throw in the bill client kickback issue for path and the proliferation of the Society guys for Mohs and you have compounded a structural allocation problem with financial conflicts....

It's really much more nuanced than that but real life does not allow for the time necessary to write a book on the matter at this time.

Agree with above. How many dermatologists are needed to support 1 mohs specialist? Probably between 8-10 depending on how aggressive they are with their own excisions. How many dermatologists for 1 dermpath? Probably between 12 and 15 if not more. Now if you graduated in the last 15 years think about how many of your co-residents went into mohs or dermpath? There's your answer.

Dermpath is even worse because another chunk is coming from path programs.

 

[DermatoFIGHT]

What about when reimbursements are cut and the "semi-retired" dermatologists come back out to get their paychecks up. The market is suddenly flooded with a 20% increase in dermatologists. Think about it.

 

[bronx43]

What about when reimbursements are cut and the "semi-retired" dermatologists come back out to get their paychecks up. The market is suddenly flooded with a 20% increase in dermatologists. Think about it.

What's scarier is when there is a big correction in asset prices, and semi-retired physicians of ALL specialties flood back into the market or just never retire.

 

[DermatoFIGHT]

What's scarier is when there is a big correction in asset prices, and semi-retired physicians of ALL specialties flood back into the market or just never retire.

Then we just run off the cliff like a bunch of lemmings

 

[Slack3r]

What about when reimbursements are cut and the "semi-retired" dermatologists come back out to get their paychecks up. The market is suddenly flooded with a 20% increase in dermatologists. Think about it.

What I've always been curious about is what's to stop the new glut of NPs from setting up as derms, especially when they get independent practice rights?

Half the derm offices I know of already have NPs basically seeing their own patients anyway, and it's not like a good majority of private practice derm is all that complex. What's stopping them?

 

[DermatoFIGHT]

What I've always been curious about is what's to stop the new glut of NPs from setting up as derms, especially when they get independent practice rights?

Half the derm offices I know of already have NPs basically seeing their own patients anyway, and it's not like a good majority of private practice derm is all that complex. What's stopping them?

The startup capital

 

[Tamahawk]

@MOHS_01 and @doctalaughs , why do you think the market is tight for Mohs and dermpath? I've never been able to figure this out and where I'm at, seems like there's no shortage of patients or slides.

The Dermpath job market sucks a$$. Anyone on this thread considering Dermpath should cut bait right now, or accept the idea of only reading your own slides (and maybe you group's if u r lucky).

The Mohs market is not nearly as bad if: 1) u r willing to relocate to small-medium sized non-coastal cities OR 2) if u r willing to do MOHs only a few days a week OR 3) if you are willing to accept much lower pay. You will certainly not be getting offered a cush MOHs-only job in a big city on one of the coasts fresh outta fellowship.

Right now, general Derm offers you the greatest likelihood of practicing in a big city for decent pay. And Gen Derm is probably the most protected from specific CPT code cuts in reimbursement.

 

[MOHS_01]

The Dermpath job market sucks a$$. Anyone on this thread considering Dermpath should cut bait right now, or accept the idea of only reading your own slides (and maybe you group's if u r lucky).

The Mohs market is not nearly as bad if: 1) u r willing to relocate to small-medium sized non-coastal cities OR 2) if u r willing to do MOHs only a few days a week OR 3) if you are willing to accept much lower pay. You will certainly not be getting offered a cush MOHs-only job in a big city on one of the coasts fresh outta fellowship.

Right now, general Derm offers you the greatest likelihood of practicing in a big city for decent pay. And Gen Derm is probably the most protected from specific CPT code cuts in reimbursement.

Right... although that's kinda like saying the CT surgery market is okay as long as you are willing to move to a small town with no surgical presence, make half the professed median, and do gall bladders most of the week.

Sound ah-mazing.

 

[Tamahawk]

Right... although that's kinda like saying the CT surgery market is okay as long as you are willing to move to a small town with no surgical presence, make half the professed median, and do gall bladders most of the week.

Sound ah-mazing.

Lol! True

 

[DermatoFIGHT]

Right... although that's kinda like saying the CT surgery market is okay as long as you are willing to move to a small town with no surgical presence, make half the professed median, and do gall bladders most of the week.

Sound ah-mazing.

I like posts that are real like this and don't paint a false picture :-D

 

[Tamahawk]

I like posts that are real like this and don't paint a false picture :-D

The honest answer is that it is not as bad as some people on here say it is, but it is certainly not phenomenal like it used to be. However, if you compare it to other specialties, like Pathology for example, we have been less severely castrated than many others. We WILL be hit hard in the next few years (biopsy codes, MOHs codes, closure codes), but that is talking about the future, not present.

 

[dermie1985]

The honest answer is that it is not as bad as some people on here say it is, but it is certainly not phenomenal like it used to be. However, if you compare it to other specialties, like Pathology for example, we have been less severely castrated than many others. We WILL be hit hard in the next few years (biopsy codes, MOHs codes, closure codes), but that is talking about the future, not present.

Does reimbursement affect job availability? I was more thinking this would affect salary/pay, but not the # and availability of jobs. I still feel like the number of derm residency training spots relative to the need for dermatological services is still imbalanced in the U.S. and the job market is a lot easier than a lot of other specialties.

Also, in terms of job availability in bigger markets. Yes, you may take a pay cut or work more than 4 days/week. But, it's still rosier than a lot of other specialties. I know a few internal medicine residents at my home program (which is in a desirable area and definitely a Top 10 program) who aren't doing fellowship who've even had a lot of trouble finding hospitalist jobs in the area (one is starting off as the night float attending...i.e. nights ONLY....for his first year out). Compared to this, working outpatient 5 days/week with minimal call isn't exactly the worst thing to happen to you.

 

[MOHS_01]

Does reimbursement affect job availability? I was more thinking this would affect salary/pay, but not the # and availability of jobs. I still feel like the number of derm residency training spots relative to the need for dermatological services is still imbalanced in the U.S. and the job market is a lot easier than a lot of other specialties.

Also, in terms of job availability in bigger markets. Yes, you may take a pay cut or work more than 4 days/week. But, it's still rosier than a lot of other specialties. I know a few internal medicine residents at my home program (which is in a desirable area and definitely a Top 10 program) who aren't doing fellowship who've even had a lot of trouble finding hospitalist jobs in the area (one is starting off as the night float attending...i.e. nights ONLY....for his first year out). Compared to this, working outpatient 5 days/week with minimal call isn't exactly the worst thing to happen to you.

Yes, most certainly. As reimbursements and income get cut, groups are less likely to have the desire to divide the pie ever further.... and physician productivity will increase in an effort to offset these losses, further eroding demand for new hires.

If path and Mohs codes are cut further, they may not remain the revenue drivers for derm practices as they have traditionally been. If you understand derm group dynamics, it has been these two referral driven subspecialties that have pushed for general derm expansion. Lessening that reward will lessen the incentive to recruit new hires.

It is always more beneficial to the groups' bottom line to secure additional productivity from existing providers (versus the addition of new faces).

Look at what has happened to pathology, anesthesia, and rads over the past decade - you will see these trends hold across specialties. Derm was positioned better, so we are later to the party - but the driving forces remain the same.

 

[Tamahawk]

Yes, most certainly. As reimbursements and income get cut, groups are less likely to have the desire to divide the pie ever further.... and physician productivity will increase in an effort to offset these losses, further eroding demand for new hires.

If path and Mohs codes are cut further, they may not remain the revenue drivers for derm practices as they have traditionally been. If you understand derm group dynamics, it has been these two referral driven subspecialties that have pushed for general derm expansion. Lessening that reward will lessen the incentive to recruit new hires.

It is always more beneficial to the groups' bottom line to secure additional productivity from existing providers (versus the addition of new faces).

Look at what has happened to pathology, anesthesia, and rads over the past decade - you will see these trends hold across specialties. Derm was positioned better, so we are later to the party - but the driving forces remain the same.

I agree 100%. I experienced this firsthand, as I was looking for Dermpath jobs before, during, and after the huge 88305 cut a few years back. Derm groups that were initially interested in bringing on a Dermpath guy to start an in-office lab were much less interested in doing so once the technical component reimbursement precipitously fell by 52% (this is the cut that the office usually pockets). After the cut occurred, there were a grand total of 2 Dermpath job postings on an otherwise-barren, oversized poster board at the ASDP! People >5yrs out of training were competing with the current fellows for these 2 rather undesirable jobs. So yes, the #of jobs decreases when reimbursement drops.

Moreover, Dermpath is especially rough for dermatologists since pathology-trained dermatopathologists are more willing to work at a much lower salary than Derm-trained ones. This amounts to even fewer openings for us. Hilariously, I was given 2 offers by the same practice (large MSG): one for Derm only, and one for a combination of Derm and Dermpath. The offer was lower if I did a mix rather than just Derm. When the cut to MOHs comes, it will not be too different. Sub specialties that rely so heavily on one code for their livelihood are the ones that will suffer the fastest and the most in the coming years. For this reason, Gen Derm is, in many ways, the safest bet for the future.

 

[MOHS_01]

I agree 100%. I experienced this firsthand, as I was looking for Dermpath jobs before, during, and after the huge 88305 cut a few years back. Derm groups that were initially interested in bringing on a Dermpath guy to start an in-office lab were much less interested in doing so once the technical component reimbursement precipitously fell by 52% (this is the cut that the office usually pockets). After the cut occurred, there were a grand total of 2 Dermpath job postings on an otherwise-barren, oversized poster board at the ASDP! People >5yrs out of training were competing with the current fellows for these 2 rather undesirable jobs. So yes, the #of jobs decreases when reimbursement drops.

Moreover, Dermpath is especially rough for dermatologists since pathology-trained dermatopathologists are more willing to work at a much lower salary than Derm-trained ones. This amounts to even fewer openings for us. Hilariously, I was given 2 offers by the same practice (large MSG): one for Derm only, and one for a combination of Derm and Dermpath. The offer was lower if I did a mix rather than just Derm. When the cut to MOHs comes, it will not be too different. Sub specialties that rely so heavily on one code for their livelihood are the ones that will suffer the fastest and the most in the coming years. For this reason, Gen Derm is, in many ways, the safest bet for the future.

The big cut to Mohs codes predates the path cut; our whack came in the form of the multiple procedure reduction exemption loss followed by a RVU loss for the Mohs series and, subsequently, repair codes. The multiple procedure exemption loss represents about a 35% loss in revenue for like work; income surveys have not represented this as well as they should due to the selection bias in their data collection methods and the increase in billing as docs tried to make it up in volume. When it is apparent, however, is the comp per wRVU metric; we don't fare nearly as well in that metric compared to other specialties.

 

[Tamahawk]

The big cut to Mohs codes predates the path cut; our whack came in the form of the multiple procedure reduction exemption loss followed by a RVU loss for the Mohs series and, subsequently, repair codes. The multiple procedure exemption loss represents about a 35% loss in revenue for like work; income surveys have not represented this as well as they should due to the selection bias in their data collection methods and the increase in billing as docs tried to make it up in volume. When it is apparent, however, is the comp per wRVU metric; we don't fare nearly as well in that metric compared to other specialties.

Like Rock em Sock em robots, we took that whack and kept our heads on. But doesn't mean we aren't gonna get another one in the form of a 17311 cut soon...

I too wish that MPRR was the last of the cuts coming our way, but I suspect you also know that that is not the case

 

[DermatoFIGHT]

Great informative posts by two attending physicians. Thank you for sharing insight with everyone

 

[Slack3r]

I think if you accept, in any field, that you will have to work harder, see more patients, and accept less compensation than previous generations all while paying more in tuition and loan interest, it all becomes much more palatable.

 

[MOHS_01]

Like Rock em Sock em robots, we took that whack and kept our heads on. But doesn't mean we aren't gonna get another one in the form of a 17311 cut soon...

I too wish that MPRR was the last of the cuts coming our way, but I suspect you also know that that is not the case

It will be hard to cut 17311 further given the methods employed in RVU determination; they have tried on three separate occasions over the past decade and the resultant recommendations were actually an increase in the valuation. Where we may be hit, however, is by the ipab... and likely utilization requisites.

 

[asmallchild]

It will be hard to cut 17311 further given the methods employed in RVU determination; they have tried on three separate occasions over the past decade and the resultant recommendations were actually an increase in the valuation. Where we may be hit, however, is by the ipab... and likely utilization requisites.

Yup, already seeing utilization requisites in Florida where they don't follow the AUC and require a ridiculous amount of documentation every step of the way

 

[Tamahawk]

It will be hard to cut 17311 further given the methods employed in RVU determination; they have tried on three separate occasions over the past decade and the resultant recommendations were actually an increase in the valuation. Where we may be hit, however, is by the ipab... and likely utilization requisites.

What are your thoughts on the upcoming switch to Value Based reimbursement (vs fee for service)? Some of my orthopedic friends in private practice are #2'ing bricks

 

[MOHS_01]

What are your thoughts on the upcoming switch to Value Based reimbursement (vs fee for service)? Some of my orthopedic friends in private practice are #2'ing bricks

They should be; anyone who operates (or offers services with significant overlap) out of a hospital should be very worried as a structural power imbalance between provider and facility has been codified into law. What it means for us, however, is much less clear as the same levers to influence and direct are not in place.

Even those involved behind the scenes and in lobbying efforts do not know what this will mean for us. Like many things in recent history, the law does not outline or explain particulars; instead they delegate power and responsibility to the administrative / regulatory arm of government that is afforded the privilege to operate outside of the normal system of checks and balances inherent to the elective process.

The only thing that is relatively certain is that we will be made more the pawns and peasants by the ruling kings of society the more involved gov't gets in healthcare.

 

[MOHS_01]

Yup, already seeing utilization requisites in Florida where they don't follow the AUC and require a ridiculous amount of documentation every step of the way

So I've heard... which I suppose is why, with every successive update to EMA, I have more *(&*&(*&(^ boxes that I have to click.

I can't really throw a lot of rocks at the administrators on this one, though. FL is MC fraud central.... and if you cannot meet AUC -- which is very generous in what it considers appropriate for Mohs -- you probably should forfeit your right to do it to begin with.