Accuracy of Median Income and Contracts with Cosmetic Companies

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I looked up the median salary of dermatologists and found it to be $180,000. How reflective is this of a normal dermatologist's income?

I also heard that some dermatologists supplement their income by signing contracts with cosmetic companies.
How common is this?
What are the contracts for?
How much work does this entail?

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I looked up the median salary of dermatologists and found it to be $180,000. How reflective is this of a normal dermatologist's income?

I also heard that some dermatologists supplement their income by signing contracts with cosmetic companies.
How common is this?
What are the contracts for?
How much work does this entail?

These questions cannot be answered because there's no such thing as a "normal" dermatologist.

Your salary will depend on where you're located, what kind of patient population you service, how many hours you work, what your overhead is, if you choose to do any cosmetic work, what type of cosmetic work you do, how much you spend on advertisement for cosmetic work, etc... etc...

That being said, if you are indeed interested in cosmetic work, probably a good idea to keep that to yourself for as long as possible. I haven't met too many PD's who smile upon those aspirations.
 
I looked up the median salary of dermatologists and found it to be $180,000. How reflective is this of a normal dermatologist's income?

I also heard that some dermatologists supplement their income by signing contracts with cosmetic companies.
How common is this?
What are the contracts for?
How much work does this entail?

bam!


and bam!

I don't know why people are so secretive and vague about this. Dermatologist make a lot of moolah. Probably more (a lot? a little?) than what these survey reported. I think that's one of the main reason, if not THE main reason, why it's so competitive. yes.. there are people who truly love skin and all of it's pathologies, I hear a lot about it from my classmates who wanted to go into derm... (of course these are the same people who loved imaging for a period of time until they got their step 1 score back and honored derm, and even before that some loved IM). I for one find the research in derm to be quite interesting, but practicing derm... i'd rather shoot myself in the foot (that, and my step 1 score didn't come back high enough for me to realize my hidden passion for derm).
 
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it's difficult to interpret any of these surveys. dermpath attendings and moh's surgeons make much more than other dermatologists; there is a compensation difference between private vs. academic; does the survey include the many part-time dermatologists? for these reasons it's tough to get a true sense of income for "dermatologist x." frankly, i fail to see much difference between 150k and 250k per year in terms of my own future intentions. i wouldn't recommend that others trust any of these studies (or the numbers for other specialties) unless they specify exactly who's responding.
 
it's difficult to interpret any of these surveys. dermpath attendings and moh's surgeons make much more than other dermatologists; there is a compensation difference between private vs. academic; does the survey include the many part-time dermatologists? for these reasons it's tough to get a true sense of income for "dermatologist x." frankly, i fail to see much difference between 150k and 250k per year in terms of my own future intentions. i wouldn't recommend that others trust any of these studies (or the numbers for other specialties) unless they specify exactly who's responding.

true, no one can ever firmly confirm or deny these number, especially in derm. But it's fairly accurate (as an average) for the other field, so I can only assume that it's similar for derm. However, with derm, I think it may be an underestimation... I can give you many reason why, but it basically boils down to "it's a hunch"
 
I'm no expert, but I would imagine the median salary for a community-based Dermatologist who is at least reasonably well-established (5+ years) is a LOT higher than $180K. My guess would be around double that ($300-350K) for Derm practices that are primarily Medical with limited Cosmetics and Mohs. For Mohs, the median should be at least $500K. Cosmetic may fluctuate significantly (and be hardest to estimate), since you start butting heads with Plastics, ENT, etc.
One thing I've noticed with Derms (as discussed on a different thread) is that the supply of them tends to be skewed. There will be many areas that have enough (or more than enough) Derms to cover the demand (often in and around the major cities). However, there are smaller areas that need more Derms desperately and the ones that do go there must really be raking it in.
I'd agree with StaphAurues and applaud his/her courage in highlighting the fact that very high pay and limited hours (with almost no inpatient work) is the main reason people choose Derm, in light of what they say about loving skin, etc. There's absolutely nothing wrong with this as these people have done well and deserve to be rewarded for their successes. It would be nice if these reasons were less taboo, but it's just part of the game (esp as it relates to Residencies).
 
The $$ depends on several things - geographic location, patient mix, disease mix, but most importantly, how much you want to work. The derms who make the big bucks work for it -- seeing 60-80 patients/day on general dermatology days. Cosmetics is not as lucrative as one would believe, unless you do large volumes of it. MOHS got raped this year with the removal of the multiple surgery exemption -- I now collect as much on general derm days as I do on the MOHS days because I do not make people return for reconstructions. Dermpath still pays well.

I'll say it again -- don't go into it because of the money, for we are all one short piece of legislation away from being on a level playing field. I have a friend in general surgery (lives across the street from me) who actually works fewer hours than I do and pulled in $50k better than I did last year. Sure, he takes call (1 in 8 and no real trauma), but his lifestyle is actually better than mine (he can have a few beers with friends most of the time while I am "on call" for my surgical patients 7d/wk). I'm not complaining b/c I rarely get called, but it does put a damper on festivities.

The days of MOHS being a lock for $500k/yr ended in December 2007....
 
MOHS_01

I was sympathetic with the rule change affecting MOH's last year, but it got impossible to continue to justify the exception they were getting no one else got for bundling issues & multiple procedure reimbursement. I guess it was good while it lasted!
 
droliver,

I guess that it was (good while it lasted); unfortunately I only got to experience 18 months and 300 cases of the good times.

Here's the problem -- the removal of the exemption violates the very intent and purpose for the exemption list's existence. The major component of the RVU associated with the 17300 series of codes lies in the pathology and technical component, which are (and continue to be) exempt from multiple surgery reduction. The multiple surgery exemption was already factored into the 17300 series when their original values were determined (subsequent stages performed on the same date of service were already reduced to accomodate the preoperative efficiencies).

I really would not even complain all that much if the payment for subsequent first stage MOHS in one day were reduced, but the real kick in the teeth relates to reconstructive efforts, which are truly unique and identifiable operative sessions, performed at different times, with different packs, and often in a different setting.

When distilled down, it works out something like this: practice expenses prior to 2008 ran approximately 45%. When compared year over year, with the approximately 30% loss in revenue (magnified by stagnant Medicare rates and increasingly difficult private payors), expenses have jumped to 67%. This is with me referring more people out for their reconstruction (which is usually performed on a later date and in the hospital / ASC, further driving up costs) and increasing volume where possible.

There really is limited realized efficiencies in performing the removal and reconstruction in one day as it is performed in seperate operative sessions -- therein lies the major problem. I really do not believe that those sitting on the AMA RUC have a sufficient grasp on the practice of the procedure, and the leaders of the MOHS community did not respond well or handle the situation appropriately.
 
In a nutshell, what happened with the legislature? I am poised to do a derm residency and am only considering a Mohs fellowship. However, general derm is procedural enough for me to have plenty of excisions/scrapings/injections without the fuss of Mohs. Granted, Mohs is much more advanced and seems intrinsically more important. But if the income does not go up any after fellowship then it seems unfair for someone to do it unless they absolutely want to spend the bulk of their practice doing micrographic surgery.
 
In a nutshell (and the only reason that I went into dermatology was for MOHS and reconstructions -- I should have done plastics in hindsight, but oh well, at least I enjoy my job):

Prior to Jan 1, 2008 the 17300 series was exempt from the multiple surgery reduction exemption. This meant that the all MOHS cases were paid at 100% of their fee schedule. The reconstructions, however, were not exempt from multiple surgery reduction. Case in point:

2007 and all years prior: two tumors, two reconstructions, each cleared in first stage
17311 x 2 paid at 100% allowable, highest code reconstruction 100%, second reconstruction 50%

2008: same scenario:
highest code (could be reconstruction or MOHS, it all depends) 100%, then 50% for everything else

It roughly translates into a 25-30% reduction in revenue for the same work.

Put in real simple terms:

average case 2007 & prior -- $1100-1200 in collections
average case 2008 -- $750-900 in collections
 
a drop? sure

but probably not severe enough to warrant sympathy from other fields :p
 
That is significant, certainly. I don't know at what point the sympathy starts to flow (referencing above post), but I'd imagine that the shift in reimbursements is infuriating. With my essential tremor maybe I'll stick to gen-derm then :)
 
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The $$ depends on several things - geographic location, patient mix, disease mix, but most importantly, how much you want to work. The derms who make the big bucks work for it -- seeing 60-80 patients/day on general dermatology days. Cosmetics is not as lucrative as one would believe, unless you do large volumes of it. MOHS got raped this year with the removal of the multiple surgery exemption -- I now collect as much on general derm days as I do on the MOHS days because I do not make people return for reconstructions. Dermpath still pays well.

I'll say it again -- don't go into it because of the money, for we are all one short piece of legislation away from being on a level playing field. I have a friend in general surgery (lives across the street from me) who actually works fewer hours than I do and pulled in $50k better than I did last year. Sure, he takes call (1 in 8 and no real trauma), but his lifestyle is actually better than mine (he can have a few beers with friends most of the time while I am "on call" for my surgical patients 7d/wk). I'm not complaining b/c I rarely get called, but it does put a damper on festivities.

The days of MOHS being a lock for $500k/yr ended in December 2007....
It amazes me how everybody in the Mohs community sat on their collective behinds and let scummy politicians to take their hard-earned income away from them:(
 
It amazes me how everybody in the Mohs community sat on their collective behinds and let scummy politicians to take their hard-earned income away from them:(

It's hard to worry when you're banking 500k a year.....
 
We physicians are at the mercy of the lawmakers who determine Medicare reimbursements, and although we are supposedly a powerful group there is little cohesion amongst us. I think it's because physicians are generally unwilling to talk publicly about money, as if it's some grotesque topic that is completely unrelated to a noble "calling." This is pathetic and shortsighted on the parts of physicians. We are certainly a group who should continue to be compensated reasonably for our investment in a costly education, the high-pressure work, and the enormous responsibility.

(Insert hot, loftier-than-thou reply from a trust-fund baby about his or her altruism.)
 
We are certainly a group who should continue to be compensated reasonably for our investment in a costly education, the high-pressure work, and the enormous responsibility.

As a medical student, do I agree? Absolutely.

Good luck finding a lawmaker / member of the general population who will side with that claim.
 
Exactly - but I'm not looking for one to agree, because they're all ******s.
 
a drop? sure

but probably not severe enough to warrant sympathy from other fields :p

They came first for the Communists,
and I didn't speak up because I wasn't a Communist.
Then they came for the Jews,
and I didn't speak up because I wasn't a Jew.
Then they came for the trade unionists,
and I didn't speak up because I wasn't a trade unionist.
Then they came for the Catholics,
and I didn't speak up because I was a Protestant.
Then they came for me,
and by that time no one was left to speak up.

just a thought.... and I never saw $500k.... barely half that, actually.
 
It amazes me how everybody in the Mohs community sat on their collective behinds and let scummy politicians to take their hard-earned income away from them:(


it's not like we sat on our a**es... quite the contrary, but we faced an impossible battle when we were offered up as sacrificial lambs and slaughtered at CMS's altar by our beloved AMA... who betrayed us with a kiss.
 
As a medical student, do I agree? Absolutely.

Good luck finding a lawmaker / member of the general population who will side with that claim.

Mariah,

I believe that you would actually be quite surprised to find the number of the general population who DOES agree with that claim (I know that I was). The problem is that they are quite silent when viewed in comparison to the flag bearers of socialism and its concepts.
 
Mariah,

I believe that you would actually be quite surprised to find the number of the general population who DOES agree with that claim (I know that I was). The problem is that they are quite silent when viewed in comparison to the flag bearers of socialism and its concepts.

This is absolutely true.
 
We physicians are at the mercy of the lawmakers who determine Medicare reimbursements, and although we are supposedly a powerful group there is little cohesion amongst us. I think it's because physicians are generally unwilling to talk publicly about money, as if it's some grotesque topic that is completely unrelated to a noble "calling." This is pathetic and shortsighted on the parts of physicians. We are certainly a group who should continue to be compensated reasonably for our investment in a costly education, the high-pressure work, and the enormous responsibility.

(Insert hot, loftier-than-thou reply from a trust-fund baby about his or her altruism.)
and you know what, I blame the previous generation of physicians for this. They had it really nice time in the 70s and 80s before managed care started spreading its tentacles and started squeezing physician incomes. And they did nothing when scumbag politicians and health insurance executives started dictating how we should practice medicine. They didn't fight, they just folded their hands, nodded, and said to themselves that they went into it to help people not to make bank.

I think our generation of doctors will be much more politically involved and active ( at least I hope so :scared:)
 
As a medical student, do I agree? Absolutely.

Good luck finding a lawmaker / member of the general population who will side with that claim.

You have to be smart, you have to hire the top notch PR firms to educate the general population that doctors ain't as rich as everybody thinks and that we deserve to be properly compensated for all the sacrifices and enormous responsibility of our profession.

AMA is definitely not doing their job if the congress cuts medicare payments every year. But who is surprised?!!?? It's filled with doctors who practiced in the golden years of medicine and are partly responsible for the mess the doctors are in these days
 
With my essential tremor maybe I'll stick to gen-derm then :)

Hey me too, I've got a little tremor as well that's why I ruled out Mohs along time ago, and also because of the stories of how mad competitive it is to get into thats why I have been thinking dermpath. But with the cut in Mohs reimbursements I think dermpath might get more competitive. I guess eventually dermpath well get slashed too.
 
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Yes -- your average dermatologist currently earns more than your average internist, this is true. The figures quoted as averages, however, are less than reliable. Your "average" dermatologist does not net $390k -- averages are statistically biased with the upper end greatly skewing the average.

I know that this has been beaten to death, but surveys vary widely because they do not appropriately reflect the marketplace, and, as such, must be interpreted accordingly. MGMA has always reported numbers higher than other well know surveys (AMGA, AMA, Sullivan Cotter, Coker, Medical Economics, etc). Compensation also varies widely within a specialty.

Too much to cover in this forum, but I urge everyone to take any and all physician surveys with a 50lb block of salt -- a much better measure, in both statistical and real terms, would be surveys of recent physician placement compensation packages. There are simply too many variables involved in physician compensation to adequately summarize in a survey number.
 
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