Thanks so much for contributing! I feel like we spend so much time amongst academics that we don't know what goes on outside of that after training. As far as what I've heard, in a major city, you can expect to get job offers of about 250k starting within the city and 350k if you go out to the burbs. My knowledge is limited however, so I have a few q's:
1) Geography - Everybody says pay varies with geography, but how so beyond the small town single derm practice. I read an article that said all areas of medicine make the most in towns of 50 to 250k ppl and less in the biggest metropolitan areas. How does income vary by geography within the country in comparably sized cities? For example, a nyc vs san fran vs chicago vs miami. Equivalent pay in nyc will go much farther in chicago.
2) If ppl are making a certain amount working 4 days per week, can u assume that if you work 5 days a week you get 20 percent more, or is there an issue with not enough work to go around?
3) Why do you say somebody who does a fellowship has less flexibility than a general dermie? Can't a mohs surgeon just do medical derm in addition? I would think a fellowship would provide MORE flexibility, just giving you another skill set.
4) Cosmetics - obviously that's a way to boost income, but how difficult is that to get into? Do you need to learn that during residency? What if your program doesn't give you that experience?
5) Geography again - how is it if you want to jump around a little bit geographically? When you leave residency and start working, does anybody move after that or is the location you choose gonna be where you stay because you don't want to restart building a practice? How about the job search out of residency from a geographical perspective, how hard is it to find a job on the other coast with no connections?
Thanks in advance for all advice!
I'm not sure that these answers are going to be helpful, because your questions are just so general. Every one of these answer should have a bunch of qualifiers attached, which I'm not going to include in the interest of brevity.
1. For the cities that you've listed, the differences in income are likely not as large as the differences in the cost of living.
2. You've answered your own question here. It depends on the market. If you're in a saturated market, then you may not have enough demand so you won't make 20% more. On the hand, if you're in a market that is not saturated (i.e., most of them), and there's plenty of patients to go around, then you as an employee will probably make 20% more.
But if you own your own practice, you might make >20% more. The reason is because some components of your overhead, like rent, are fixed no matter how many days a week you work. For example if you pay 10K a month for your office space, it doesn't matter whether you work 4 or 5 days a week. So working 5 days vs 4 effectively reduces your overhead, meaning that once expenses are paid, you would have a >20% increase.
3. This one is an interesting one and there are really several reasons, but I'll just expound on one. If you are a subspecialist you rely on other dermatologist for referrals. That is, as a Mohs surgeon you need other dermatolgists to send you cases and as a derm path you need other dermatologists to send you biopsies. Thus the key to success in these subspecialties is that you need to find a group of dermatologists who will send cases to you. Because of the glut of Mohs and dermpath folks, this is pretty hard.
The problem that often arises if you are do both general derm and Mohs (for example), then you are going to find yourself competing with the very same general derms you will rely on for referrals. Since you're doing general derm also, you're competing with the general derms in the community for the general dermatology patients. But then at the same time your going to be asking them to send you their Mohs cases. That never works out well. General derms who are competing with you in one arena are unlikely to help you out in another. In fact, they may go out of their way not to send patients to you even if it would be more convenient for the patient.
4. It depends on what you mean by cosmetics. If you're just talking about botox, fillers, lasers, and chemical peels, then these are things that you can pick up in residency, going to meetings, etc. The skills are not very hard to learn. If you're talking about things like liposuction, face lifts, blepharoplasties, hair transplants, and the like, then I strongly recommend you do a fellowship.
5. Lots of people move around. The nice thing about derm is if you need to move for family or other reasons, you know that you will be able find a job wherever you need to go. And even the worst derm job is still a pretty good job compared to just about anything else. Difficulty depends on how saturated the market you're looking at is.