Why do radiologists make so much $$?

[Picklesali]

Just wondering... Also, with dermatology, what's the deal?

I understand why a neurosurgeon should roll in the big bucks, but why so in these less 'high-risk' specialties?

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[armybound]

derm makes a lot because they see a ton of patients and they're all paying customers.

 

[etf]

it's all based on how much you can bill. dermatologists can have fancy private practices and take cash payments for lots of elective stuff. radiologists can do a high volume of work.

 

[Winged Scapula]

OT: cute avatar armybound.

I really thought there was a bug on my screen there for a minute!

 

[Dr_Dan_the_man]

OT: cute avatar armybound.

I really thought there was a bug on my screen there for a minute!

lol you and almost everyone else on this forum!

 

[Pinkertinkle]

20 bucks per film 200 films a day?

 

[Abilene85]

Just wondering... Also, with dermatology, what's the deal?

I understand why a neurosurgeon should roll in the big bucks, but why so in these less 'high-risk' specialties?

I wouldn't necessarily call radiology low-risk. Miss a dot on the image and someone can sue.

Why do they get paid so much? High volume of work, as was stated above. In general, they don't waste time dealing with patient questions, etc. They sit in a room, flip through their images, dictate, and move on to the next. They are also at the crossroads for pretty much every other guy in the hospital. When I shadowed, they were being consulted by cardiology, ob/gyn, neurology, emergency medicine, blah blah blah.

I'm sure there are more reasons, but those are two that jump to my mind.

 

[cystapharm]

derms make a lot of money cuz a lot of people come in with skin problems. For example, there are many different kind of acne but a lot of people don't know what kind they have and derms don't know either so they give wrong acne meds so the patient keeps coming back. for example, some people have acne because their skin is sensitive, not because they have bacterial infection. So because many ance meds are made to dry out the skin, this can aggravate already broken out skin. Also, a ton of people come in for laser treatment and these take up to 10 treatments at like 1000 a treatment. Skin problems affect everyone from teens to the elders, men and women. A lot of these people are cash paying customers because insurance doesn't pay for cosmetic procedures.

 

[nick_carraway]

derms make a lot of money cuz a lot of people come in with skin problems. For example, there are many different kind of acne but a lot of people don't know what kind they have and derms don't know either so they give wrong acne meds so the patient keeps coming back. for example, some people have acne because their skin is sensitive, not because they have bacterial infection. So because many ance meds are made to dry out the skin, this can aggravate already broken out skin. Also, a ton of people come in for laser treatment and these take up to 10 treatments at like 1000 a treatment. Skin problems affect everyone from teens to the elders, men and women. A lot of these people are cash paying customers because insurance doesn't pay for cosmetic procedures.

Seriously. I work for a derm and one time I got a lesion traveling up my arm. He said it was contact dermatitis, one of his fellows said it was lymphangitis, another fellow had no clue, and an ID doc they consulted was sure that it was an infection from contact dermatitis. Four docs, no definitive diagnosis. In the end, they gave me antibiotics and steroids to see which one would help more. This is why a lot of cases they see need to be biopsied and why their path reports are filled with so many big words. You can only tell so much from looking.

I should add for the sake of discussion that my boss is a dermatologic surgeon so his procedures are relatively high risk for Mohs surgery and cost a lot of cash for cosmetic procedures. The $6 million he takes home each year (profit--not gross sum) is a little obscene though.

 

[cyclingmo]

Seriously. I work for a derm and one time I got a lesion traveling up my arm. He said it was contact dermatitis, one of his fellows said it was lymphangitis, another fellow had no clue, and an ID doc they consulted was sure that it was an infection from contact dermatitis. Four docs, no definitive diagnosis. In the end, they gave me antibiotics and steroids to see which one would help more. This is why a lot of cases they see need to be biopsied and why their path reports are filled with so many big words. You can only tell so much from looking.

I should add for the sake of discussion that my boss is a dermatologic surgeon so his procedures are relatively high risk for Mohs surgery and cost a lot of cash for cosmetic procedures. The $6 million he takes home each year (profit--not gross sum) is a little obscene though.

Holy mother of god!!! 6 MILLION!!!

 

[PeepshowJohnny]

Also, these fields make a lot because they've tightly controlled the number of radiologists/dermatologists trained each year. By keeping their numbers relatively controlled, they can ensure that they can maintain their demand.

Take derm for example, probably one of the most competitive fields because there are so few programs. Let's say they double the number of derms out there. There'll be many more dermatolgists competiting for the same patient base. More competition lowers prices. A lot of people picked derm because it pays a ton with a good lifestyle (although a few don't like to admit this) so they don't want to see this happen so they limit how many they train.

 

[Pinkertinkle]

I hear all these anecdotes about the billion dollars dermatologists make, but I see no real data. Anyone want to post some?

 

[TheRealMD]

Radiology easily fits into your lifestyle and you can work from practically anywhere (at home if you like). Thus, it's pretty easy to want to do your job, increased job satisfaction, then wanting to work more, thus big bucks if you like.

Besides, without radiologists, I'd argue that the whole hospital stops. Most doctors don't know how to read the subtitles of an X-ray.

 

[armybound]

Well of course it depends on the dermatologist. My boss is certainly the exception because he's not only a workaholic but he's got a brilliant mind for business and he drove out his partner in an established practice by the time he was 38 years old.

I hear that the chief of derm surgery at the local university makes $500,000. A previous Mohs fellow who is now a pediatric reconstructive surgeon makes $200,000. These are more anecdotes but the point is to be made that not everybody is going to build a $20 million dollar home when they're 40 years old.

yeah but you're from California, so a $20mil home is probably a 2 bedroom shack in some back alley.

 

[Jolie South]

yeah but you're from California, so a $20mil home is probably a 2 bedroom shack in some back alley.

i like california as much as the next person, but would never live there for this fact alone.

 

[mikedc813]

I'm surprised no one's talking about radiation oncology. Now THAT is a field where you can make a decent living... You'd be surprised how interesting the field is especially if you're into gadgets and computers.

 

[nick_carraway]

I'm surprised no one's talking about radiation oncology. Now THAT is a field where you can make a decent living... You'd be surprised how interesting the field is especially if you're into gadgets and computers.

Yeah except for the physics parts <commits seppuku>

 

[KifsterDDS]

Also, these fields make a lot because they've tightly controlled the number of radiologists/dermatologists trained each year. By keeping their numbers relatively controlled, they can ensure that they can maintain their demand.

Take derm for example, probably one of the most competitive fields because there are so few programs. Let's say they double the number of derms out there. There'll be many more dermatolgists competiting for the same patient base. More competition lowers prices. A lot of people picked derm because it pays a ton with a good lifestyle (although a few don't like to admit this) so they don't want to see this happen so they limit how many they train.

Finally, a correct answer! Radiologists and especially dermatologists are few and far between.

Dermatology, you have to remember, is also very competitive because of the nature of the work they do. As far as I know, they rarely admit people into hospitals and rarely deal with emergencies. Don't get me wrong, dermatology is definitely a very challenging field, but dermatologists typicaly don't have to deal with many of the hassles that other physicians do.

 

[Auron]

Yeah one time a fellow was on call for a resident at UCSF (we're 45 min away from UCSF at best) and I was like... what I asked him what'd he do if there was an emergency. He just winked and said that there are no emergencies in derm.

radiology just plain rules...

 

[armybound]

J.D.: I need a dermatologist over here, stat!

Dr. Johnson: [Throwing down his magazine] Oh yeah! Time to shine!
[Crouching over the "patient"] What do you need? Is it a rash?

J.D.: Look, I paid this guy to fake a heart attack. He wants fifty bucks, we only have twenty.

Dr. Johnson: You know, I feel like you guys just use me for my money.

 

[mikedc813]

Yeah except for the physics parts <commits seppuku>

The real physics are done by the physicists in the department. You really have to apply very little to no physics on a daily basis. BTW, I'm applying to rad onc and I have almost no physics background.

 

[45408]

Yeah except for the physics parts <commits seppuku>

isn't that actually the job of the docimetrist?

 

[MDpride]

Hii

why they make that much sounds to me like what after death?

every person thinks that their job is hard. In fact, they are hard but not to the degree that person thinks.

Dealing with skin is risky. What if u screw up somebody's physical appearance by wrong treatment? think about embarrasment that person has to go through.


With so many imaging technologies and instrument and also with many to come with increasing complexity of diseases, radiologist will be in demand.

It will be very hard to judge which field deserves the most?

I am disappointed with primary care making less money compared to others.Their diagnosis is critical in preventing further down hill of our body.Also, whom to consult for further evaluation.

I think they will assume patient management activity more with increasing complexity of disease which requires specialist

 

[BlackSails]

3rd degree burn victims are an emergency...

Burn victims go to plastic surgery.

 

[capn jazz]

I also feel like burn victims spend a long time in the ICU healing before any kind of reconstruction is considered.

 

[gujuDoc]

I wouldn't necessarily call radiology low-risk. Miss a dot on the image and someone can sue.

Why do they get paid so much? High volume of work, as was stated above. In general, they don't waste time dealing with patient questions, etc. They sit in a room, flip through their images, dictate, and move on to the next. They are also at the crossroads for pretty much every other guy in the hospital. When I shadowed, they were being consulted by cardiology, ob/gyn, neurology, emergency medicine, blah blah blah.

I'm sure there are more reasons, but those are two that jump to my mind.

That and I think things which involve procedures and a lot of use of technology often seem to show increased amount of pay. The procedures and what not are where the money is from in surgery. Radiology probably also pays a lot for similar reasons. Derm can also make a ton of money not just due to cash pay as not all derm is cash pay. I payed with insurance when i went for acne help. But a lot of derm also involves procedures in the forms of laser treatments and what not. These things also have an impact on the amount of pay.

 

[mikedc813]

isn't that actually the job of the docimetrist?

No, there are physicists and dosimetrists. They're entirely separate positions. Dosimetrists create the plans, but don't necessarily have to know anything about physics. There are usually 2 or 3 physicists per department while there are usually many more dosimetrists.

 

[kronickm]

Radiologists are whining now because the updates to Medicare (in that they can now adjust the reimbursement values across individual specialties or something like that) are sort of screwing them over. I am too lazy to post a link to the article I saw that in though so you're on your own.

 

[medguy83]

It's funny because I read somewhere of radiologists having x-ray images and slides digitally sent to thier laptops while on vacation. You can be on the slopes in CO while diagnosing Mr. Johnson's PCP in Tampa. Just thought I'd throw that out there. Anyways, I think Radiologists and Derm.s make so much from the sheer volume of patients they're able to go through. After looking at MRI's and X-ray scans all day for 20 some-odd years you get pretty good at it. You can soon wade through a ton of films pretty quickly and thus are able to rack up quite a nice sum. Derm.'s also go through a lot of patients and are nicely compensated even for cosmetic procedures. I guess that's why it's #2 in terms of residency competitiveness (plastics #1?).
Regardless whether this specialty makes $200K or that one $300k, go into something you can see yourself happily doing for the next 40 years.

 

[baylormed]

J.D.: I need a dermatologist over here, stat!

Dr. Johnson: [Throwing down his magazine] Oh yeah! Time to shine!
[Crouching over the "patient"] What do you need? Is it a rash?

J.D.: Look, I paid this guy to fake a heart attack. He wants fifty bucks, we only have twenty.

Dr. Johnson: You know, I feel like you guys just use me for my money.

Was that the same episode where the dermatologist gets paged for an emergency (first time in a LONG LONG LONG time), and he is really excited? He is running down the hallway yelling "get out of my way, skin doctor coming through!" Basically milking the page for all it was worth, since he never gets to be a hero.

Hilarious.

 

[JaggerPlate]

Making money in medicine is quite far from picking the most difficult speciality you can. Private practice ... elective procedures, choosing which insurance companies you deal with etc etc. I find this to be one of the biggest misconceptions on sdn.

 

[Picklesali]

Note to some responses: I have no interest in radiology/derm, I simply asked out of curiosity. I want to go into academic medicine in immunology or oncology (and since I plan to do research....obviously money is not my motive!!)

 

[elwademd]

Radiology easily fits into your lifestyle and you can work from practically anywhere (at home if you like). Thus, it's pretty easy to want to do your job, increased job satisfaction, then wanting to work more, thus big bucks if you like.

Besides, without radiologists, I'd argue that the whole hospital stops. Most doctors don't know how to read the subtitles of an X-ray.

i would imagine it's more difficult to read the subtleties of x rays. if there were subtitles with every x ray, radiologists wouldn't be needed period!

 

[Gut Shot]

Also, these fields make a lot because they've tightly controlled the number of radiologists/dermatologists trained each year. By keeping their numbers relatively controlled, they can ensure that they can maintain their demand.

That's part of it, when it comes to rads, at least. It wasn't too long ago (late 90's) that radiology was in the toilet. The job market sucked. They couldn't give residency spots away.

Then suddenly this flurry of new imaging techniques, each with a very generous reimbursement rate, came onto the scene. Overnight the number of studies being ordered skyrocketed, and the amount of cash flowing in went along for the ride.

The fee schedule took a hit, though, last year I believe (17% cuts in some areas). There's still a lot of money in it, but it's not quite the open trough it has been.

 

[PeepshowJohnny]

I guess that's why it's #2 in terms of residency competitiveness (plastics #1?).

Regardless whether this specialty makes $200K or that one $300k, go into something you can see yourself happily doing for the next 40 years.

Plastics is #1 for highest board score average. Derm is second for boards score, but has the highest % of AOA members (around 50%).

Interesting that the 1 and 2 most competitive fields are those that often are compensated out of pocket or by insurance for a more affluent clientale. Kinda speaks for the problems with reimbursements doctors are facing today.

Your last sentence is wonderful advice so I left it

 

[EM_Rebuilder]

Rads, Derm, Plastics, etc make so much money because they do not have to deal with stupid people...

The general public of America is stupid, stinky, and under-educated. Those are the people that frequent Emergency Departments, need DM/HTN medications, diabetic feet cut off, etc.

The 'decent' people of America who happen to have money are the ones that care about the size of their boobs, rear end, or the fact that they have a pimple......and the doctors that take care of those factors are derm and plastics.

Therefore, 90%+ of those doctors practice are upper middle class and higher individuals, who tend to shower regularly, are often personable, and pay either out of pocket or have awesome insurance. Therefore, every patient is profit.....versus other fields where 1 in 10 carries the other 9.


Just the facts...and do not do something just because of money. I enjoy dealing with the 'general public' no matter how smelly or how many times I have to explain some tiny simple thing...thats just one more reason why I like Emergency Medicine as we tend to deal with these people the most. Many of the patients in the ED rarely shower, let alone take meds for their complexion....

 

[nick_carraway]

Rads, Derm, Plastics, etc make so much money because they do not have to deal with stupid people...

The general public of America is stupid, stinky, and under-educated. Those are the people that frequent Emergency Departments, need DM/HTN medications, diabetic feet cut off, etc.

The 'decent' people of America who happen to have money are the ones that care about the size of their boobs, rear end, or the fact that they have a pimple......and the doctors that take care of those factors are derm and plastics.

Therefore, 90%+ of those doctors practice are upper middle class and higher individuals, who tend to shower regularly, are often personable, and pay either out of pocket or have awesome insurance. Therefore, every patient is profit.....versus other fields where 1 in 10 carries the other 9.


Just the facts...and do not do something just because of money. I enjoy dealing with the 'general public' no matter how smelly or how many times I have to explain some tiny simple thing...thats just one more reason why I like Emergency Medicine as we tend to deal with these people the most. Many of the patients in the ED rarely shower, let alone take meds for their complexion....

I'm sorry but I have the point out the fallacy of your argument. Working at a derm surgeon's office, I can tell you that some of the stupidest people I've met have been patients of this office. Albeit some are very successful, but some are very very stupid in terms of common sense.

 

[Long Dong]

I hear all these anecdotes about the billion dollars dermatologists make, but I see no real data. Anyone want to post some?

Not what your looking for but I was told during a derm lecture when I rotated at ucsf that the makers of proactive (2 dermies) made net 500 mil, a uci derm faculty confirmed this as well when I rotated with them. The only data I could find was this "The biggest infomercial company, with more than $1 billion in revenue,. about half of that from Proactiv" from here: http://www.guthy-renker.com/pdfs/adage.pdf

A dermpath guy at ucsf pulled 1.5 million in one year, go here: http://sfgate.com/news/special/pages/2005/ucsalary/

But yeah not to much evidence of the billion dollar dermies around.

 

[Long Dong]

Yeah one time a fellow was on call for a resident at UCSF (we're 45 min away from UCSF at best) and I was like... what I asked him what'd he do if there was an emergency. He just winked and said that there are no emergencies in derm.

TEN

 

[NonTradMed]

Also, these fields make a lot because they've tightly controlled the number of radiologists/dermatologists trained each year. By keeping their numbers relatively controlled, they can ensure that they can maintain their demand.

Take derm for example, probably one of the most competitive fields because there are so few programs. Let's say they double the number of derms out there. There'll be many more dermatolgists competiting for the same patient base. More competition lowers prices. A lot of people picked derm because it pays a ton with a good lifestyle (although a few don't like to admit this) so they don't want to see this happen so they limit how many they train.

I was going to post that but you beat me to it. Derm is definitely constrained by the numbers of residency spots. The reason they can do this is because there is typically not outcry for 'shortage of dermatologists' by the general public. Hence, derms can fly under the radar and restrict their numbers, making their practices pretty lucrative.

That's part of it, when it comes to rads, at least. It wasn't too long ago (late 90's) that radiology was in the toilet. The job market sucked. They couldn't give residency spots away.

Then suddenly this flurry of new imaging techniques, each with a very generous reimbursement rate, came onto the scene. Overnight the number of studies being ordered skyrocketed, and the amount of cash flowing in went along for the ride.

The fee schedule took a hit, though, last year I believe (17% cuts in some areas). There's still a lot of money in it, but it's not quite the open trough it has been.

That's true also. And let that be a warning to all med students when it comes to matching. Anesthesia was also the unwanted child, so much so that FMGs could match into it (no offense to them, but they do tend to get leftover picks....). Now, it's considered the R.O.A.D to success.

Pick a specialty that you can see yourself doing, because you will most likely be stuck with it for better AND for worse.



I wanted to add one more thing to the discussion. This issue hasn't been brought up before but I theorize that women entering medicine also ratchet up the demand for 'lifestyle' specialty like derm and and rad.

I glanced at my med school's class picture from the 60's and it was almost all males, except for a couple of women in there. Now, the gender split nationwide is 50-50.

Since girls tend to be more concerned with work/life balance, it stands to reason that come match time, when many are in serious relationship/married/looking to the future, they would match into stuff like derm/rad/gas/etc rather than surgery. The only guys who've spoken on the work/life issue are usually married and/or have kids. Many guys brush the issue off, some saying that they will have wives to take care of the home etc.

From MS1, I've seen girls restrict themselves to perceived 'lifestyle' specialties in order to accommodate family time into their career. I wonder how much of that attitude, now so prevalent in med school due to the influx of girls into med school, contributes to the overall competitive nature of so-called lifestyle specialties.

This isn't a strike against the gals, since I find work/life issues very relevant but it may be a factor in the run towards more family friendly medical professions.

 

[capn jazz]

Rads, Derm, Plastics, etc make so much money because they do not have to deal with stupid people...

The general public of America is stupid, stinky, and under-educated. Those are the people that frequent Emergency Departments, need DM/HTN medications, diabetic feet cut off, etc.

The 'decent' people of America who happen to have money are the ones that care about the size of their boobs, rear end, or the fact that they have a pimple......and the doctors that take care of those factors are derm and plastics.

Therefore, 90%+ of those doctors practice are upper middle class and higher individuals, who tend to shower regularly, are often personable, and pay either out of pocket or have awesome insurance. Therefore, every patient is profit.....versus other fields where 1 in 10 carries the other 9.


Just the facts...and do not do something just because of money. I enjoy dealing with the 'general public' no matter how smelly or how many times I have to explain some tiny simple thing...thats just one more reason why I like Emergency Medicine as we tend to deal with these people the most. Many of the patients in the ED rarely shower, let alone take meds for their complexion....

I'm kind of horrified that you're a resident and have such a view of non-cosmetic health issues. Having interacted with hundreds of patients who are "regular" patients (ie, came in through the ER, have lots of medications, diabetes, whatever), they're not "stinky" or "stupid." Undereducated, yes, but most people of their age group did not even finish high school, let alone go to college. Most people of their generation who went to college were rich, or had a family history of college attendance, which means they're rich.

And I don't think caring about the size of your breasts or one pimple makes you "decent." I think it makes you superficial and shows you've probably not had many real problems in life, if this is your biggest concern. But that's why I would never go into plastics or derm. To each his own.

Thank god the idiots have a hero like you to set them straight. Really, you're so superior to them.

 

[Droopy Snoopy]

Rads, Derm, Plastics, etc make so much money because they do not have to deal with stupid people...

The general public of America is stupid, stinky, and under-educated. Those are the people that frequent Emergency Departments, need DM/HTN medications, diabetic feet cut off, etc.

The 'decent' people of America who happen to have money are the ones that care about the size of their boobs, rear end, or the fact that they have a pimple......and the doctors that take care of those factors are derm and plastics.

Therefore, 90%+ of those doctors practice are upper middle class and higher individuals, who tend to shower regularly, are often personable, and pay either out of pocket or have awesome insurance. Therefore, every patient is profit.....versus other fields where 1 in 10 carries the other 9.


Just the facts...and do not do something just because of money. I enjoy dealing with the 'general public' no matter how smelly or how many times I have to explain some tiny simple thing...thats just one more reason why I like Emergency Medicine as we tend to deal with these people the most. Many of the patients in the ED rarely shower, let alone take meds for their complexion....

You mean medicine is not all fairies and puppy-dog tails? Blasphemy! Off with his head!

 

[MOHS_01]

TOTAL BS... You would be hard pressed to bill 6mill/year, no way in hell to collect 6 million / year, IMPOSSIBLE to net anywhere near that.

 

[Disinence2]

As soon as you take your first exam having to Identify parts of an X-ray, or trace abnormalities through and MRI, u'll know why they make the big bucks. They are capable of doing alot more than writing "possible pulmonary infiltrates"


Oh and its not so "low risk" they get sued just as much as other specialties if not more.

 

[QuantumMechanic]

TOTAL BS... You would be hard pressed to bill 6mill/year, no way in hell to collect 6 million / year, IMPOSSIBLE to net anywhere near that.

Attending vs. Prehealth student... this should be good

 

[nick_carraway]

Attending vs. Prehealth student... this should be good

I know that he knows more about dermatologic surgery in general but I know what my boss makes in private practice. I admit that my boss is the exception and that those around him only make $500,000 in academic medicine but his former partner who is a general derm doc and did no surgeries already made $1 million each year.

 

[baylormed]

I know that he knows more about dermatologic surgery in general but I know what my boss makes in private practice. I admit that my boss is the exception and that those around him only make $500,000 in academic medicine but his former partner who is a general derm doc and did no surgeries already made $1 million each year.

Hopefully tomorrow, I'll grab the price list for those procedures and get the list for all cosmetic patients in the past year and we'll do some more accurate math.

I'm concerned that as time goes on, however, the attending will be able to piece together who exactly my boss is.

Yes, only that much. It must be an awful life.

 

[luv2sd]

I know that he knows more about dermatologic surgery in general but I know what my boss makes in private practice. I admit that my boss is the exception and that those around him only make $500,000 in academic medicine but his former partner who is a general derm doc and did no surgeries already made $1 million each year.

Hopefully tomorrow, I'll grab the price list for those procedures and get the list for all cosmetic patients in the past year and we'll do some more accurate math.

dude seriously what's your point? making half a million dollors is not much different than making 6 million dolloars a year... both grant you a very comfortable life...

 

[nick_carraway]

dude seriously what's your point? making half a million dollors is not much different than making 6 million dolloars a year... both grant you a very comfortable life...

I'm not saying that one is better. If you look back to earlier, I said nothing about $6 million being a good thing--just that it happens. The attending who posted was saying that it does not happen and that's when I disagreed.

I happen to completely agree with you and think that $6 million is a little obscene, which is something that I mentioned earlier in the thread.

 

[MOHS_01]

First off -- your boss would have your a** if he/she knew that you were spouting off about their supposed income.

Second -- if they are performing 1500 MMS cases/year, they are not doing all of the cosmetic cases that you state.

Third -- there maybe a handful of dermatologic surgeons in the country performing that volume of major cosmetic procedures, especially full face lifts

Fourth -- you completely neglected operational expenses

3 million in billing is not 6 million in collections.

MOHS is paid at approx 600 per first stage, 380 for subsequent stages..

on and on.


Here is what a busy Mohs surgeon could expect working 5days/week 48 weeks/year:

>1000 cases
1.2 -1.8 mill in revenue, assuming you do all your reconstructions, you have a healthy mix of cosmetic and general derm, etc, in addition to the Mohs

90th percentile for MOHS was 800K two years ago, and not much has changed.

Botox, laser, fillers, etc -- the cosmetic mix that dermatologists generally enjoy -- has a very high operational cost. You are not going to get "rich" that way very easily.

If your boss bought a 20 mill dollar mansion, he/she has other income streams/sources than their medical practice.