What are some cons of practicing dermatology?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

DermDerp

Ermagerd
10+ Year Member
Joined
Sep 4, 2013
Messages
1
Reaction score
0
I am an MS3 strongly considering pursuing dermatology. However, most of the information I have come across in learning about the field from residents and attendings at my school and online reading has been overwhelmingly positive, touting the advantages of the specialty. This is certainly a good thing but I realize that there are bound to be some cons/disadvantages/undesirable aspects of dermatology. Also the satisfaction rate for dermatologists from the Medscape survery has dropped from 80% in 2011 to 64% now and 93% would choose dermatology again in 2011 vs only 74% in 2013. And most surprising: among dermatologists, 76% would choose medicine as a career in 2011 vs. only 37% in 2013! Any insights on this trend?

tl;dr: What are some of the 'cons' to consider in dermatology alongside the plethora of 'pros'?

PS. I tried searching the forum but couldn't find any threads discussing this. If there are already any good threads about this already, please do post them here.

Members don't see this ad.
 
Last edited:
To be honest, there are very few. I suspect the change in satisfaction is a result of health care changes that affect all fields (falling reimbursement, increasing oversight, increasing volume to meet previous revenue, etc)

Part of it may also be "grass is greener on the other side" syndrome. All in all, if you have to be a doctor, it's hard to complain about being a dermatologist
 
If you truly love the O.R. / surgery / bigger cases than a post-Mohs excision reconstruction / repair with advancement flaps / skin grafts / z-plasty...

then derm may not satiate your needs.
 
Members don't see this ad :)
Meh -- derm is not a bad gig relative to much of medicine, although I do believe that it suffers from more "grass is greener" professional envy than it deserves. We are not a particularly loved specialty in the house of medicine and compensation is set to tank when the local destruction and biopsy codes get hit in the next year or so -- even more of a hit if your practice relies on Mohs or path to help pay the bills. The volumes we run through the clinic to make the money represented in surveys is nothing to be sneezed at; few in medicine compare to our throughput. As documentation requirements escalate, this throughput will be severely hindered... and pay will fall disproportionately due to simple operational economics. The dissatisfaction reflected in the survey referenced likely stems from the realization that this is the reality facing us -- and many are not all that enamored with the prospects.

You will also find that there are more derms with their fingers on the pulse of coming changes than what you see in most specialties. I guess it makes sense -- the more you have to lose, the closer attention you'll be paying to the game.
 
Derm will always have quicker visits with similar billing for general exams since our full exam is much quicker than primary care, to echo MOHS' comment about throughput. I hope that primary care reimbursements increase but I doubt we will fall to the level of primary care and our hours are still way way better.

Derm training affords many economical benefits beyond straight clinical care that are frequently not capitalized by many who train, including consulting and such opportunities. The biggest thing is that you will HAVE MORE TIME to do this. Many don't care and are content to park themselves in a big group setting. But realize that there are way more opportunities than are normally presented to you in a typically academically biased setting in residency.

I think our grass is pretty damn green.
 
Derm will always have quicker visits with similar billing for general exams since our full exam is much quicker than primary care, to echo MOHS' comment about throughput. I hope that primary care reimbursements increase but I doubt we will fall to the level of primary care and our hours are still way way better.

Derm training affords many economical benefits beyond straight clinical care that are frequently not capitalized by many who train, including consulting and such opportunities. The biggest thing is that you will HAVE MORE TIME to do this. Many don't care and are content to park themselves in a big group setting. But realize that there are way more opportunities than are normally presented to you in a typically academically biased setting in residency.

I think our grass is pretty damn green.

Unfortunately, my friend, this is not necessarily true. There has been significant discussion as to how they could change this -- and their options are legion. It would not be all that difficult to change the E&M criteria to require more body systems to be examined to jump up a level. Think you'll just throw on a stethoscope and document heartrate? Uh-uh --- that will be fraudulent activity for the purposes of upcoding.... There has even been discussion of paying certain specialties a premium "to correct for the disparity and discriminatory pricing inherent to the RVU valuation paradigm".

You can't win when playing against the house... especially when the house makes the rules up as it goes.
 
The biggest cons of doing derm have to do with the fact that there are many negative changes on the horizon. Those of us who have been doing it for a while are going to have to get used to these things and it's not going to be pleasant.

If you're just starting out however, all of these "new" things will seem relatively normal to you and so it won't seem that bad. You can't miss what you never had.
 
The biggest cons of doing derm have to do with the fact that there are many negative changes on the horizon. Those of us who have been doing it for a while are going to have to get used to these things and it's not going to be pleasant.

If you're just starting out however, all of these "new" things will seem relatively normal to you and so it won't seem that bad. You can't miss what you never had.

In a moment of clarity I’ve stumbled upon what I think is the solution to protecting our minds against the impending doom that is set to befall the once vibrant field of dermatology. It requires time travel, but the film looper has shown us that this technology is near at hand.

I envision the following scenario:

The year is 2034, and dermatologists are complaining much more about their pay than they did 20 years ago. In this inevitable future there is a governmental agent (we'll call him/her The Rainmaker) who is very annoyed with these dermatologists constant whining, and he arranges to have a representative bunch of these annoying troublemakers sent back through time to the good ol' days of 2014. These whiners were sent by the rainmaker with the express purpose of making contact with their former selves just as they were making ready to enter practice, and instruct them that indeed things only get much worse and to stop their bellyaching. What the rainmaker has overlooked is the vast insatiable greed of dermatologists, and once the Derm Elder/Derm Youth chimera forms, it creates a rift in the space-time continuum, ripping the universe to shreds. This plays out on an infinite loop in all parallel universes forever, and unfortunately, at this point is completely inevitable. I guess the moral is: enjoy the next 20 years, because it's all we’ve got.
 
Unfortunately, my friend, this is not necessarily true. There has been significant discussion as to how they could change this -- and their options are legion. It would not be all that difficult to change the E&M criteria to require more body systems to be examined to jump up a level. Think you'll just throw on a stethoscope and document heartrate? Uh-uh --- that will be fraudulent activity for the purposes of upcoding.... There has even been discussion of paying certain specialties a premium "to correct for the disparity and discriminatory pricing inherent to the RVU valuation paradigm".

You can't win when playing against the house... especially when the house makes the rules up as it goes.

For now the full exam is quicker and, if they change the E&M criteria, then you are right although hasn't happened yet and would get a lot of push back from several specialities (not just derm). To date they have kept it more open to choose form either of the two coding criteria so it would be a big change to go to something totally exclusive and new altogether. Could happen but don't see it actually going through for a while and don't see that becoming exclusive criteria. That said, the point about the house is well taken. Derm needs a seat at the table when they make or change these rules and there aren't too many derms that are sitting at that table.
 
For now the full exam is quicker and, if they change the E&M criteria, then you are right although hasn't happened yet and would get a lot of push back from several specialities (not just derm). To date they have kept it more open to choose form either of the two coding criteria so it would be a big change to go to something totally exclusive and new altogether. Could happen but don't see it actually going through for a while and don't see that becoming exclusive criteria. That said, the point about the house is well taken. Derm needs a seat at the table when they make or change these rules and there aren't too many derms that are sitting at that table.

We've had a seat at the table the whole while and it has worked out pretty well for us; the problem is we are now seeing interests realign and not in a way beneficial to exclusively outpatient ambulatory specialty care. The medical necessity criteria, conveniently arbitrary as it is, will continue to play a bigger role in limiting dermatology revenues for E&M as CMS hands down orders to its contract medical directors (those gents whose name you find authorizing denials for multiply recurrent sclerosing BCC's on the nasal ala, geniuses that they are) to identify and contain costs.

The argument that keeps being made -- as intellectually baseless as it is -- centers on the trivial fact that dermatologist collect 3% of Medicare payments while only representing less that 2% of the total physician pool. Well...whoop-e-de-****ing-doo! Guess what? Our patient base has a greater Medicare composition than most specialties too! Not only that, we provide a number of procedures in the office setting; payment for such includes the functional equivalent of a site of service differential (or facility fee) -- something their kindergarten level metric conveniently ignores. They're comparing apples to cats...

Nope, we've done well over the past two decades.... and now they say it's time to pay the piper. The pendulum is swinging back on us now... and like most pendulums, it will overshoot center for some time.
 
Top