can any derm attendings weigh in on this??

[lovinlife23]

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http://forums.studentdoctor.net/showthread.php?t=969989


It started out as derm vs rads but there's something im really curious about. is it difficult to keep opening up shop as a derm? derms are in low numbers and there is high demand, right? i think most go into the field for a nice lifestyle so they open/join a practice and some build it up to a point at which it is self-sustaining. i then imagine they work less hours after this. my question is--if a derm were instead interested in expanding their business (rather than lowering hours) to create more revenue, would it simply be a matter of preference or is it not that easy?

 

[MOHS_01]

Not that easy and your assumptions on supply are outdated (although this is highly regional).

 

[lovinlife23]

Not that easy and your assumptions on supply are outdated (although this is highly regional).

i see. what do you mean by not that easy? is it feasible for me to expand if i put the time in? because if it's just a matter of time, i dont mind...

 

[MOHS_01]

i see. what do you mean by not that easy? is it feasible for me to expand if i put the time in? because if it's just a matter of time, i dont mind...

The ease of starting a solo practice varies according to the geographic location you are wanting to set up; there are many, many areas of the country that are exceptionally saturated -- so I would not even try to do it there. The volume through the door determines your revenue; the more concentrated this volume is, the more profitable you will likely be. You cannot simply keep the office open a few extra hours and expect to reap increasing rewards in most areas.... it's just not that simple.

I've started a solo shop up twice in two different towns. I would do it again if I had no better option (and often there is not), but it is not as simple -- or easy -- as many would lead you to believe. It may be easier for derm than many specialties, but that is not because of supply / demand characteristics predominantly -- it is because of the self directed nature of much of our business.

 

[lovinlife23]

The ease of starting a solo practice varies according to the geographic location you are wanting to set up; there are many, many areas of the country that are exceptionally saturated -- so I would not even try to do it there. The volume through the door determines your revenue; the more concentrated this volume is, the more profitable you will likely be. You cannot simply keep the office open a few extra hours and expect to reap increasing rewards in most areas.... it's just not that simple.

I've started a solo shop up twice in two different towns. I would do it again if I had no better option (and often there is not), but it is not as simple -- or easy -- as many would lead you to believe. It may be easier for derm than many specialties, but that is not because of supply / demand characteristics predominantly -- it is because of the self directed nature of much of our business.

hmm...do you mind me picking your brain as well as ask for some of your personal info? if it's too personal to post here would you consider inboxing me? Could you tell me why you decided to open up a solo practice instead of joining groups?

I see job listings online from a lot of different web sites but don't know how much truth there is to them. If you check out Merrit Hawkins, you'll see derm groups offering 350-450k starting, promising 40 hour work weeks. I've seen one recently saying how one derm is moving to another state (so they want to fill his spot) and that if you put the hours in at their group you could expect over a million a year. you'll also see that most of them say the income potential is over 700k. I don't just believe everything I read but still, I wanted your opinion on this. Is this complete BS?

OK, back to you--was your opening of the second practice a business move or something else? Also, what kind of hours and salary do you have and are they typical of most derms? Sorry for being nosy. I want to know all aspects of the specialties im interested in so I know what im facing. Im shadowing docs from all the fields im interested in but ill never ask them questions like this...so im hoping you could give me an idea. you've been very helpful, thanks.

 

[MOHS_01]

hmm...do you mind me picking your brain as well as ask for some of your personal info? if it's too personal to post here would you consider inboxing me? Could you tell me why you decided to open up a solo practice instead of joining groups?

I see job listings online from a lot of different web sites but don't know how much truth there is to them. If you check out Merrit Hawkins, you'll see derm groups offering 350-450k starting, promising 40 hour work weeks. I've seen one recently saying how one derm is moving to another state (so they want to fill his spot) and that if you put the hours in at their group you could expect over a million a year. you'll also see that most of them say the income potential is over 700k. I don't just believe everything I read but still, I wanted your opinion on this. Is this complete BS?

OK, back to you--was your opening of the second practice a business move or something else? Also, what kind of hours and salary do you have and are they typical of most derms? Sorry for being nosy. I want to know all aspects of the specialties im interested in so I know what im facing. Im shadowing docs from all the fields im interested in but ill never ask them questions like this...so im hoping you could give me an idea. you've been very helpful, thanks.

1. You should always be skeptical of what someone with an agenda tells you.

As for myself -- there simply were no jobs available (without unacceptable strings attached) in the areas I had chosen to live; that is both the long and short of it. In my experience -- and, in all fairness, I have looked into this more than most -- the numbers given above are optimistic (although not impossible). You have to ask yourself, though, what the real story is when it sounds too good to be true (such as when someone is paying a recruiter to find a warm body who would be willing to make >median starting out and >90%tile once established).

You should also consider the fact that choosing how to navigate life by looking at someone else's rear view mirror is not always the best method. 😉 Healthcare "reform" is changing the game -- don't get caught trying to play by yesterday's rules.

 

[drdan766]

what area of the country, what derm subspecialty, what "strings"?
what has healthcare reform changed for practicing derms, private vs academic?

 

[MOHS_01]

what area of the country, what derm subspecialty, what "strings"?
what has healthcare reform changed for practicing derms, private vs academic?

Southeast, subspecialty should not be all that difficult to decode, and restrictive covenants that were entirely unreasonable relative to:

- investment
- income guarantee
- open ended partnership tract
- at will employment status

Reform is coming, not here yet Dan. Look at the proposals, the proliferation of ACO's, the trends toward consolidation, payment bundling, etc, and tell me where that leaves an outpatient specialty with little ancillary revenue driving potential.

 

[doctalaughs]

I'm a derm attending who recently finished residency and went through the job search and I agree with mohs01.

The dermatology market is not what it used to be 10 years ago, although it's certainly still better than some specialties (path, radiology etc). Many large city markets are saturated (even more so for mohs and dermatopathology, but its also getting there for general dermatology).

In most markets, you can find a job but it may not be anything close to what you are seeing in those job ads. Given these markets are near saturation, the practice owners can easily take advantage of a new grad offering low salaries and promises of partnership which never pan out. Opening your own practice can be a big risk in these markets as well with a large investment and no promise of a good patient stream.

The days of automatically making 250-400k starting in these markets are over (it can still happen, but not for a large percentage of grads). Less desirable areas the market is still good for general derm, less so for subspecialties. We'll see what happens. I think they are training too many dermatologists at this point.

 

[lovinlife23]

you were all really helpful. thanks for taking the time to help me out.

 

[pupster]

I think they are training too many dermatologists at this point.

true dat....

 

[ijn]

true dat....

Have you tried to get a dermatology appointment recently? They'll have a spot for me in 3 months.

 

[kindasorta]

Have you tried to get a dermatology appointment recently? They'll have a spot for me in 3 months.

Child psych can be a year.

 

[pupster]

Have you tried to get a dermatology appointment recently? They'll have a spot for me in 3 months.

? I'm able to get my patients in right away.

 

[ijn]

? I'm able to get my patients in right away.

I'm in a city of 250,000 with no residency program. Huge waiting lists for appointments. Most people here seem to go to their family medicine doc for skin issues.

 

[drdan766]

I suppose its fair to say becoming a dermatologist is not a free ticket to riches and fame. I would imagine that every market is unique but that if you want demand for your skills, you will have to find a place with limited supply or be able to sell yourself to patients in a saturated market.

What I believe the original question was, is the following:
Can a derm with an established practice, who works 40 hours a week, simply work 60 hours a week and increase their bottom line accordingly?

I think we are hearing that it is possible, and even probable, if you can get the patients to come. What is not easy, it seems (I am not even close to having any experience with this, just what I gleam from sdn), is getting paid as an EMPLOYEE to work in a group for big bucks. It also seems that it will take a significant amount of time (years) to build a practice to the point where you have a waiting list that you can merely just start seeing as pts in the evenings/weekends, or other weekdays.

However, I think in order to get the demand for your services, a derm has many options. I have been shocked by how many patients AND physicians do not know about all of the things that dermatologists do. Most of the people I talk to think of going to their PMD first, or want to go directly to plastics. Many PMD's I talk to think they are wasting their time trying to get an appointment with derm, so they refer to plastics for skin cancer, and treat the gen derm cases themselves.

I would imagine a possible strategy a derm with a solo practice could have would be to partner with local PMD's in their area. Maybe offer fridays as the day that you take walkins or last minute appointments from X,Y,Z PMD's. Only take your established pt population on Mon through Thurs. Then scale as desired.

What I think is the real challenge is managing no-shows in a specialty that often has many. Again, I wonder if partnerships with PMD's could be the solution. Perhaps opening a practice in the same building as a large Primary Care practice could help if you take walk-ins that are already their to see their PMD, and only need to walk next door to your office.

I am only an intern, so please take my ideas with a mountain of salt, but I have been trying to make relationships with my co-interns all year in the hopes that when we are all attendings, they will trust their patients to me for their skin care needs. I know their are many things I don't know, but I am constantly seeing academic derm practices that are inundated with patients and struggle to take on all of the new patients referred by their attached hospitalists/PMDs. Perhaps a derm's best chance is to go through internship and residency in the same location and then use that elaborate network of physicians to generate a referral pool.

All feedback is appreciated, constructive feedback > quips, but I will take what I can get!

 

[MOHS_01]

I'm in a city of 250,000 with no residency program. Huge waiting lists for appointments. Most people here seem to go to their family medicine doc for skin issues.

That's odd -- how far north do you live? As others have said, the shortage is WAY overstated. I believe the national appointment wait time is something like 3-4 week, either par or below many specialties / generalists.

 

[MOHS_01]

I suppose its fair to say becoming a dermatologist is not a free ticket to riches and fame. I would imagine that every market is unique but that if you want demand for your skills, you will have to find a place with limited supply or be able to sell yourself to patients in a saturated market.

What I believe the original question was, is the following:
Can a derm with an established practice, who works 40 hours a week, simply work 60 hours a week and increase their bottom line accordingly?

I think we are hearing that it is possible, and even probable, if you can get the patients to come. What is not easy, it seems (I am not even close to having any experience with this, just what I gleam from sdn), is getting paid as an EMPLOYEE to work in a group for big bucks. It also seems that it will take a significant amount of time (years) to build a practice to the point where you have a waiting list that you can merely just start seeing as pts in the evenings/weekends, or other weekdays.

However, I think in order to get the demand for your services, a derm has many options. I have been shocked by how many patients AND physicians do not know about all of the things that dermatologists do. Most of the people I talk to think of going to their PMD first, or want to go directly to plastics. Many PMD's I talk to think they are wasting their time trying to get an appointment with derm, so they refer to plastics for skin cancer, and treat the gen derm cases themselves.

I would imagine a possible strategy a derm with a solo practice could have would be to partner with local PMD's in their area. Maybe offer fridays as the day that you take walkins or last minute appointments from X,Y,Z PMD's. Only take your established pt population on Mon through Thurs. Then scale as desired.

What I think is the real challenge is managing no-shows in a specialty that often has many. Again, I wonder if partnerships with PMD's could be the solution. Perhaps opening a practice in the same building as a large Primary Care practice could help if you take walk-ins that are already their to see their PMD, and only need to walk next door to your office.

I am only an intern, so please take my ideas with a mountain of salt, but I have been trying to make relationships with my co-interns all year in the hopes that when we are all attendings, they will trust their patients to me for their skin care needs. I know their are many things I don't know, but I am constantly seeing academic derm practices that are inundated with patients and struggle to take on all of the new patients referred by their attached hospitalists/PMDs. Perhaps a derm's best chance is to go through internship and residency in the same location and then use that elaborate network of physicians to generate a referral pool.

All feedback is appreciated, constructive feedback > quips, but I will take what I can get!

Things will likely change quite a bit over the next 3-4 years... the same as they have changed quite a bit over the last 3-4 years... and the 3-4 before that. Keep your head down and don't burn too many bridges is the best advice I can give.

Quips are so much less work (and so much more enjoyable). 😉