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Questions about derm ppl don't like to hear!?

Discussion in 'Dermatology' started by MyGenome, Jun 15, 2013.

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  1. MyGenome

    MyGenome

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    I am not considering going into derm, but am wondering: So why do dermatologists make so much?

    I had always thought it was from cosmetic stuff - like acne, botox, fillers, etc, but I can't help but notice I am getting daily emails from listservs like Groupon advertising cosmetic things, and most of the docs advertising these procedures are NOT actually dermatologists (family medicine, IM moreso). So if other fields can and do the cosmetic things, why is derm a more "lucrative field"?

    How do dermatologists feel about other specialties doing cosmetic procedures traditionally done by derms? Is it even "legal"? I wonder where the skills to do these procedures come from if one has not done a derm or plastics residency.

    Second, I have heard rumors (on SDN mostly) that accepting medicare could one day be linked to licensing; how would this affect the future of derm, when many of the profitable things are elective?
  2. asmallchild

    asmallchild Moderator Lifetime Donor

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    This has the potential to spiral downhill quickly so let's keep the comments civil.

    Any specialty that is predominantly procedurally based has been lucrative over the last 10-20 years.

    You are wrong in thinking it is primarily from cosmetics.

    It has been covered numerous times. Cosmetics patients are paying out of pocket, they are increasingly web savvy, it isn't hard to figure out what specialty someone has trained in. Some prefer dermatologists, some prefer plastic surgeons, some prefer ENT, and others just want the absolute lowest price. Like most things in life, you usually get what you pay for.

    Cosmetic procedures are not covered by Medicare.
  3. MyGenome

    MyGenome

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    Thanks for the response. But when you saw it is procedure based, but not from cosmetics, are you saying the revenue is from other procedures, non-cosmetic?

    Elsewhere on SDN, it has been said that the revenue is from seeing a high number of patients within a short period of time (short appointments seem to mean no procedure occurs at those appointments), but it seems like there are other fields that can do this too... any field in which there are just "med checks"?
  4. WaylonS

    WaylonS

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    A general dermatologists can do cryosurgery, skin shavings/punch biopsies, skin excisions, laser ablation/resurfacing (if they have the lasers), hyfrecating skin growths, patch testing, and steroid injections (think keloids, cystic acne, and chronic inflammatory lesion). Dermatologists (more so in academics) also write orders for phototherapy, photopheresis, and chemotherapy/biologics infusions.

    Remember, there are many dermatologists who don't do any cosmetics, and even the most cosmetic-heavy dermatologists often practice a fair amount of general dermatology.
  5. MyGenome

    MyGenome

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    So is this to say derm is profitable because it is a field with lots of procedures, like those mentioned above (not all cosmetic), that are reimbursed well and do not take that much time do? Or is it more because of the 5 minute appointments and many of them per day?

    To what extent then do cosmetic things help a dermatologist's salary?

    Also, on my family medicine rotation earlier in the year, half of the procedures mentioned above were also done, which is why I am wondering why FM docs have such a low salary, and derms have such a high one.
  6. WaylonS

    WaylonS

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    I'll answer the last part. An FP may do some of the procedures above, but they're probably doing them a few times a week/month unlike a dermatologists who is doing several a day
  7. MyGenome

    MyGenome

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    Thanks for the response

    Is it also billed/reimbursed differently when a FM doc does it vs a derm? Like does a derm get paid more to do the same thing?
  8. CDI

    CDI Senior Member Gold Donor

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    Honest question...

    How does one answer the question, "So, why do you want to do derm?"
  9. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    How do you plan on answering "why IM?"?
  10. CDI

    CDI Senior Member Gold Donor

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    Might want to want to post that in the IM thread.
  11. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    Nope. I'm asking you.
  12. CDI

    CDI Senior Member Gold Donor

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    I'd like to keep it related to derm. If you have no answer to my question, thats fine. Hopefully someone else does.
  13. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    I'm trying to help you reach the answer to your own question on your own.

    Jesus, ya try to teach a man to fish and he just gets the hook caught in his own eye.
  14. asmallchild

    asmallchild Moderator Lifetime Donor

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    Honest answer...

    Honestly.

    Everyone has their own reason. You have to come up with your own. I sense what you are fishing for. I can tell you the answers "big money" and "cush lifestyle" do not fly.
  15. GuyWhoDoesStuff

    GuyWhoDoesStuff I got the skills to pay the bills

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    Bingo.
  16. CDI

    CDI Senior Member Gold Donor

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    I'm not looking for those answers and I'm not "fishing". I was curious as to the real motivation people have (not money and lifestyle - which could be said about many fields). That obviously can't be the only force here.

    I know I would not go into derm only because I would get bored of treating - acne, rashes, etc. So the opposite to me seems that someone actually enjoys treating such conditions/finds it interesting. If that's the answer, so be it.

    Not sure why people got so offended by the question. If there's a taboo question in derm...I guess that's it.
  17. MyGenome

    MyGenome

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    Back to the original question, before it was derailed ...
  18. CDI

    CDI Senior Member Gold Donor

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  19. asmallchild

    asmallchild Moderator Lifetime Donor

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    It is not billed differently. Your ability to attract those patients, your ability to confidently perform the procedures, and your ability to have an office that is setup to efficiently perform those procedures may account for the discrepancy
  20. xyzyx

    xyzyx

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    how did your friend feel about the results after going to him for cosmetic procedures? just curious.

    personally, i'd feel much more comfortable going to a dermatologist for any sort of skin related procedure. however, i admit it is possible for someone in a different field who does high volume cosmetics work to eventually get good at it, vs a dermatologist who only does cosmetics occasionally.
  21. CDI

    CDI Senior Member Gold Donor

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    It was a very minor procedure, $200 cash, out in 15 mins. She was really happy with the results, enough to go back in the future if needed. I was curious as well so I followed up and asked her. She went to a dermatologist once and was really disappointed.

    The derm had examined her, gave their 'expert' opinion and kicked her out after collecting what she felt was an excessive co-pay. Lost her future business as a result.

    She just wanted someone who could get the job done without the run around, she found someone who did just that.

    I've gone to a derm before and had a good (time-efficient) experience though but my condition needed actual meds. [Plus my derm was really hot, which was an added bonus. :laugh:]
  22. sore eye asses

    sore eye asses

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    There's a lot of hot guys in derm.
  23. Substance

    Substance

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    Penis wrinkle.
  24. CDI

    CDI Senior Member Gold Donor

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    She wasn't a dude. Lucky for me.
  25. Dermography

    Dermography

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    $200 for a cosmetic procedure? wow that's really cheap! what kind of minor cosmetic procedure are we talking about here?
  26. CDI

    CDI Senior Member Gold Donor

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    Just a nevus removal. It was already so small no one would ever even notice, but yeah. I'll double check on that but I think that figure is right. I do know it was very fast though and all on the same visit - consult, rx and out.
  27. CDI

    CDI Senior Member Gold Donor

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    She should've just asked the doc to send it for a biopsy and bill it to insurance :naughty:, but maybe thats a derm-only procedure then.
  28. xyzyx

    xyzyx

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    wow... she should have gone to a doctor who takes insurance, instead of a cosmetics oriented practice which probably doesn't take any insurance. removal of nevi is almost always covered by insurance unless the insurance is really bad....
    just FYI, a lot of primary care practitioners even remove nevi in their clinics.
  29. CDI

    CDI Senior Member Gold Donor

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    She did, but the doctor was just a not helpful and she got nothing in return for a co-pay. So she just paid cash the next time and was happy with the outcome. Done deal.
  30. sore eye asses

    sore eye asses

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    there are a good number of hot hermaphrodites too.
  31. CDI

    CDI Senior Member Gold Donor

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    Dermaphrodites?
  32. MOHS_01

    MOHS_01 audemus jura nostra defendere

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    This thread reminds me of a line from Tropic Thunder.
  33. sore eye asses

    sore eye asses

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    yeah, we done gone full retard.

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