derm-based family med practice?

[plasticsday1]

How much derm do family med residents learn throughout their training? Is it at all possible to do primarily derm stuff as a family med graduate? I've heard of PCPs tailoring their practices to a specific area such as obgyn, but was just wondering if a derm focus is possible

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[LebronManning]

Not really if you live anywhere that has a Chipotle. Patients are smarter these days and will take their derm problems to a dermatologist. Especially the derm patients you would actually want (cash or private insurance). And then there's the whole issue of the fact that insurance isnt gonna pay a FP for derm visits/procedures like they do a derm.

 

[alprazoslam]

If you want to do derm then do derm lol

 

[Lexdiamondz]

Once you're medically licensed you can kind of do whatever you want, so long as you can find an institution to credential you and insurance providers who will reimburse you for your work. Non-dermatologists do nevi resections, botox injections, etc all the time. You can go the cash route, but understand that the people willing to pay cash for cosmetic services generally care who is doing the procedure and may not want to pony up the $$$ for a non-dermatologist, but even then there are still avenues to make money.

With that said, medicolegally, you will be held to the Standard of Care should you ever end up in court - meaning if you fxck up you will be held to the standard of someone board certified in Dermatology. Just as how it's not usually a great idea for non-surgeons to do appendectomies or craniotomies, it's generally not the greatest idea for non-derm people to be prescribing biologics, steroids and doing Mohs surgeries.

 

[VA Hopeful Dr]

it's generally not the greatest idea for non-derm people to be prescribing biologics, steroids and doing Mohs surgeries.

You're kidding, right?

 

[Lexdiamondz]

You're kidding, right?

I'm talking the hi-dose systemic **** for crippling eczema that makes you cushingoid - not topicals lol. If your skin is so bad you're on prednisone and tacrolimus you should probably see a dermatologist

 

[Cuongoff]

How much derm do family med residents learn throughout their training? Is it at all possible to do primarily derm stuff as a family med graduate? I've heard of PCPs tailoring their practices to a specific area such as obgyn, but was just wondering if a derm focus is possible

It's possible but you're probably going to have to tailor your education during residency to add more dermatology. I think FM and IM only need 2 weeks of derm in 3 years of training. That's nowhere near enough to be comfortable. If you're thinking cosmetics- then you're going to have to go to conferences to get your training bc your program won't have that.

I'm talking the hi-dose systemic **** for crippling eczema that makes you cushingoid - not topicals lol. If your skin is so bad you're on prednisone and tacrolimus you should probably see a dermatologist

I mean- I've seen FM/IM give hydrocortisone 2.5% for rip roaring atopic

 

[operaman]

Once you're medically licensed you can kind of do whatever you want, so long as you can find an institution to credential you and insurance providers who will reimburse you for your work. Non-dermatologists do nevi resections, botox injections, etc all the time. You can go the cash route, but understand that the people willing to pay cash for cosmetic services generally care who is doing the procedure and may not want to pony up the $$$ for a non-dermatologist, but even then there are still avenues to make money.

With that said, medicolegally, you will be held to the Standard of Care should you ever end up in court - meaning if you fxck up you will be held to the standard of someone board certified in Dermatology. Just as how it's not usually a great idea for non-surgeons to do appendectomies or craniotomies, it's generally not the greatest idea for non-derm people to be prescribing biologics, steroids and doing Mohs surgeries.

This is somewhat inaccurate and quite a loophole in the whole standard of care thing. Standard of care is defined as what someone with similar background and training as YOU have would do. This actually saves many wannabe specialists. We have some cosmetic surgeons locally who have absolutely no real background in it but they do it on the cheap so people pay them. The thing that has saved them from some lawsuits is this very standard of care issue; they aren't judged about how a plastic surgeon or dermatologist would do it, only by how an OBGYN or FM doc would do it. Yes, it's crazy.

Edit to add: You are 100% correct though that once licensed you can basically do whatever you want so long as you can get credentialed and paid. The charlatans tend to own/operate their own centers to get around this whole issue.

 

[Lexdiamondz]

This is somewhat inaccurate and quite a loophole in the whole standard of care thing. Standard of care is defined as what someone with similar background and training as YOU have would do. This actually saves many wannabe specialists. We have some cosmetic surgeons locally who have absolutely no real background in it but they do it on the cheap so people pay them. The thing that has saved them from some lawsuits is this very standard of care issue; they aren't judged about how a plastic surgeon or dermatologist would do it, only by how an OBGYN or FM doc would do it. Yes, it's crazy.

Edit to add: You are 100% correct though that once licensed you can basically do whatever you want so long as you can get credentialed and paid. The charlatans tend to own/operate their own centers to get around this whole issue.

My understanding of this is that standard of care is defined as what someone who is "minimally competent" to operate in scenario X would do, which by it's nature is pretty contextual and open for alot of debate. For example, in the case of running a code where the outcome is death "minimally competent" is pretty different to performing elective cosmetic procedures where the outcome is death or disability. With that said, I'm no lawyer and have never been sued so hell if I know.

 

[iqe2010]

My DPC doc does Botox injections.

 

[username456789]

Everybody wants to be a dermatologist but nobody wants to lift no heavy ass books.

OP, become a Dermatologist if you want to practice Dermatology.

 

[username456789]

I mean- I've seen FM/IM give hydrocortisone 2.5% for rip roaring atopic

This is usually the equivalent of throwing a Dixie cup full of water on a house fire.

 

[trapperjohn4077]

There is a 1 year FM fellowship for "Underserved Dermatology;" I only found the one but maybe there are others. That might allow you to get enough experience to be comfortable treating more derm conditions than a FM doctor would normally treat. There are many places in the US where it is very difficult to see a Dermatologist, so it might not be that bad of an option.

 

[username456789]

In all seriousness, I would be horrified to find an internal medicine or family medicine trained physician who felt competent to practice dermatology in any meaningful capacity. That’s bordering upon mid-level lunacy.

 

[libertyyne]

In all seriousness, I would be horrified to find an internal medicine or family medicine trained physician who felt competent to practice dermatology in any meaningful capacity. That’s bordering upon mid-level lunacy.

i was under the impression it was rampant for FP docs to offer "cosmetic services"
Even kim kardashians botox guy claims he is a cosmetic dermatologist, what ever that means.
Simon Ourian, M.D. | Epione Beverly Hills
Dr. Simon Ourian

 

[username456789]

i was under the impression it was rampant for FP docs to offer "cosmetic services"
Even kim kardashians botox guy claims he is a cosmetic dermatologist, what ever that means.
Simon Ourian, M.D. | Epione Beverly Hills
Dr. Simon Ourian

1. Did you not read my quote? Yes, this is horrifying. I know it happens. And meeting one would be phenomenally cringeworthy. (Additionally, I am talking more about actual medical dermatology, not cosmetic BS, but both apply)
2. Simon Ourian is a major black sheep of the derm world
3. Botox is about 0.00001% of what dermatology is (and is 0.000000% of my practice).

 

[username456789]

And as I said, paraphrasing Ronnie Coleman above, everybody wants a piece of our action. Dentists, nurses, family practice doctors. And we are usually left to clean up their messes when they screw it up.

 

[Obnoxious Dad]

My understanding of this is that standard of care is defined as what someone who is "minimally competent" to operate in scenario X would do, which by it's nature is pretty contextual and open for alot of debate. For example, in the case of running a code where the outcome is death "minimally competent" is pretty different to performing elective cosmetic procedures where the outcome is death or disability. With that said, I'm no lawyer and have never been sued so hell if I know.

You have two legal issues here: 1) medical malpractice; and 2) breach of contract.

On the medical malpractice front the standard of care will most likely vary from state to state. Will the standard depend on the physician's credentials or the type of care delivered? In general, credentials have defined standard of care. On the other hand physicians may be held liable for attempting a procedure for which they have little or no training. This is an issue for the law library and the answer will vary from state to state.

Although most physicians are paranoid about malpractice tort liability, they may also be found liable under a breach of contract theory. What did the physician promise? What did the physician deliver? Again, this is an issue for the law library on a state by state basis.

I know an osteopathic FP who eventually limited his practice to hair transplants. The guy must have made a fortune because he retired at about age 55.

 

[VA Hopeful Dr]

I'm talking the hi-dose systemic **** for crippling eczema that makes you cushingoid - not topicals lol. If your skin is so bad you're on prednisone and tacrolimus you should probably see a dermatologist

So you're saying long term systemic steroids, I can get behind that. The dose, if of short duration, isn't as big of a deal.

 

[deleted645092]

You don’t need to be a board-certified dermatologist to freeze AKs, cut off SKs or prescribe hydrocortisone cream for a first-time encounter for a new rash. Any family doctor that’s been in practice for more than 10 years will have been doing these kinds of things since they started. It’s us young bucks that have gotten skittish about “encroaching” into specialist cases and as a result we have the specialist overuse that you see today. Because everyone has come to expect that family docs prescribe Metformin and antihypertensives, and need to refer everything beyond that out.

Some of ya’ll students need to rotate somewhere that isn’t in the heart of the metropolis and do a family medicine rotation where you get patients coming in to get cosmetic **** done because the local dermatologist or plastic surgeon quoted you a bill for $500 cash to take the .5” SK off your shoulder.

 

[IntheClouds4ever]

You don’t need to be a board-certified dermatologist to freeze AKs, cut off SKs or prescribe hydrocortisone cream for a first-time encounter for a new rash. Any family doctor that’s been in practice for more than 10 years will have been doing these kinds of things since they started. It’s us young bucks that have gotten skittish about “encroaching” into specialist cases and as a result we have the specialist overuse that you see today. Because everyone has come to expect that family docs prescribe Metformin and antihypertensives, and need to refer everything beyond that out.

Some of ya’ll students need to rotate somewhere that isn’t in the heart of the metropolis and do a family medicine rotation where you get patients coming in to get cosmetic **** done because the local dermatologist or plastic surgeon quoted you a bill for $500 cash to take the .5” SK off your shoulder.

Yup.. I’ve taken 5 SKs and a few other benign lesions off during my FM rotation this month alone. No reason to send someone to derm for that..

 

[Hotei]

In all seriousness, I would be horrified to find an internal medicine or family medicine trained physician who felt competent to practice dermatology in any meaningful capacity. That’s bordering upon mid-level lunacy.

Seconded

 

[ThomasP]

i was under the impression it was rampant for FP docs to offer "cosmetic services"
Even kim kardashians botox guy claims he is a cosmetic dermatologist, what ever that means.
Simon Ourian, M.D. | Epione Beverly Hills
Dr. Simon Ourian

Wait. I searched this guy up. Is it right that he did his residency in family medicine? Then why is he calling himself a cosmetic dermatologist? Or are the sources online wrong and he did his residency in dermatology?

 

[libertyyne]

Wait. I searched this guy up. Is it right that he did his residency in family medicine? Then why is he calling himself a cosmetic dermatologist? Or are the sources online wrong and he did his residency in dermatology?

once you have a license you can do almost anything. It doesnt mean you should. That was the point of my post.

 

[LoGo]

Wait. I searched this guy up. Is it right that he did his residency in family medicine? Then why is he calling himself a cosmetic dermatologist? Or are the sources online wrong and he did his residency in dermatology?

No, he’s a phoney. I don’t recall, but I think he was in anesthesia then bailed midway through residency. I don’t think he’s board certified in anything.

One poster above commented that patients are smarter and are going to board-certified specialists for their cosmetic work. Whether that’s true or not I’m not sure, but the other aspect is that frauds are advertising themselves as something they are not and patients can’t tell the difference - I don’t blame them for not knowing the inner workings of medical school, residency, licensing etc. For instance, if someone opens a clinic called “California Skin Center of Excellence”, and the physician calls themself a “cosmetic surgeon,” how is a patient supposed to know it’s not a dermatologist or plastic surgeon working there? Shady, shady business by people looking to get a slice of pie that wasn’t theirs to begin with.

 

[ThomasP]

No, he’s a phoney. I don’t recall, but I think he was in anesthesia then bailed midway through residency. I don’t think he’s board certified in anything.

One poster above commented that patients are smarter and are going to board-certified specialists for their cosmetic work. Whether that’s true or not I’m not sure, but the other aspect is that frauds are advertising themselves as something they are not and patients can’t tell the difference - I don’t blame them for not knowing the inner workings of medical school, residency, licensing etc. For instance, if someone opens a clinic called “California Skin Center of Excellence”, and the physician calls themself a “cosmetic surgeon,” how is a patient supposed to know it’s not a dermatologist or plastic surgeon working there? Shady, shady business by people looking to get a slice of pie that wasn’t theirs to begin with.

So what the hell is the point of doing 6 years of plastic surgery residency or killing yourself out to get into dermatology when you can just do this?

Why won't they shut down things like this? Do you think they will eventually stop this from happening?

 

[LoGo]

So what the hell is the point of doing 6 years of plastic surgery residency or killing yourself out to get into dermatology when you can just do this?

Why won't they shut down things like this? Do you think they will eventually stop this from happening?

The point of doing a derm or plastics residency and gunning hard to get into it is that you 1) primarily enjoy the non-cosmetic aspects of the job since that’s most of what you’ll be doing, and 2) if you do want to do cosmetics, it’s a heck of a lot easier to break into it through board certification in derm/plastics than to gamble on being the one in a million fraud that gets in by some other route.

 

[ThomasP]

The point of doing a derm or plastics residency and gunning hard to get into it is that you 1) primarily enjoy the non-cosmetic aspects of the job since that’s most of what you’ll be doing, and 2) if you do want to do cosmetics, it’s a heck of a lot easier to break into it through board certification in derm/plastics than to gamble on being the one in a million fraud that gets in by some other route.

one in a million fraud that gets in? Anyone that did FM can set up a practice and call themselves cosmetic dermatologists. It's actually much easier doing this. Really don't get your point and why people are actually liking it.

 

[LebronManning]

Idk why y'all are hating on Simon so much. Seems to me the dude is doing it BIG time and achieves better results with what he's doing than probably any derm on SDN

 

[VA Hopeful Dr]

Idk why y'all are hating on Simon so much. Seems to me the dude is doing it BIG time and achieves better results with what he's doing than probably any derm on SDN

Pretty sure there are prostitutes that earn more than I do as well, doesn't mean it's a good idea

 

[LoGo]

one in a million fraud that gets in? Anyone that did FM can set up a practice and call themselves cosmetic dermatologists. It's actually much easier doing this. Really don't get your point and why people are actually liking it.

Idk why y'all are hating on Simon so much. Seems to me the dude is doing it BIG time and achieves better results with what he's doing than probably any derm on SDN

The problem is you don’t know what you don’t know - I mean that in regards to people not trained in derm/plastics practicing as though it doesn’t matter.

 

[Tenk]

Derm as in rare skin conditions and skin cancers? I sure wouldn’t.

Derm as in cosmetics like Botox, fillers, microneedling, lasers, and cryo? Sure, anyone can learn that. It’s not hard. Probably would stay away from the surgical cosmetics though, those get botched quite often.

 

[username456789]

Derm as in cosmetics like Botox, fillers, microneedling, lasers, and cryo? Sure, anyone can learn that. It’s not hard. Probably would stay away from the surgical cosmetics though, those get botched quite often.

I clean up a lot of messes from non-derms who think like this.

 

[Splenda88]

I know a successful derm practice in south FL that is run by 3 FM docs. If it can be done in Palm Beach County of all places, it can certainly be done almost anywhere in the US.

 

[LoGo]

I know a successful derm practice in south FL that is run by 3 FM docs. If it can be done in Palm Beach County of all places, it can certainly be done almost anywhere in the US.

Then it’s a “successful” FM practice, not a successful derm one. Again, they don’t know what they don’t know. Appearing successful does not equal quality dermatologic patient care.

 

[AMEHigh]

Yes in family medicine we take care of a lot of derm, but of course it doesn’t replace a dermatologist. If one has a lot of interest in the bread and butter of derm then electives can be taken. I’m comfortable with removing and biopsies of lesions, rashes, allergic reactions, acne, etc. It’s not easy to get in with a dermatologist and I live in a huge city. So I practice within my scope and treat derm conditions and refer as needed.

 

[Tenk]

I clean up a lot of messes from non-derms who think like this.

I can say that about running a code with a dermatologist. They probably can’t do it. However, give me a couple day course with them and I’ll turn pretty much any dermatologist into a code running machine because codes aren’t that hard. The things I listed are also not hard and easily taught. They are pretty much all either temporary, automated or follow guided settings. If they were difficult there wouldn’t be midlevels opening spas and courses all over the US on how to do them. I have several friends who own successful spas and I’ve seen the machines. Definitely not hard. Personally I would never do cosmetics because I find it boring and the clientele are vain and annoying but whatever floats your boat. Derm is currently getting slaughtered on the cosmetic frontline but that’s what happens when you limit your specialty numbers...

 

[username456789]

I can say that about running a code with a dermatologist. They probably can’t do it. However, give me a couple day course with them and I’ll turn pretty much any dermatologist into a code running machine because codes aren’t that hard. The things I listed are also not hard and easily taught. They are pretty much all either temporary, automated or follow guided settings. If they were difficult there wouldn’t be midlevels opening spas and courses all over the US on how to do them. I have several friends who own successful spas and I’ve seen the machines. Definitely not hard. Personally I would never do cosmetics because I find it boring and the clientele are vain and annoying but whatever floats your boat. Derm is currently getting slaughtered on the cosmetic frontline but that’s what happens when you limit your specialty numbers...

Botox and fillers don’t use machines, so I’m not sure which machines you’re talking about.

Lasers are 5% administering, and 95% planning. If you don’t have an understanding of the physics behind them, you end up in trouble quickly.

Again, your overconfidence is a good example of not knowing what you don’t know. As a result, you are unlikely to realize the error in your thinking.

FWIW, I do almost zero cosmetics. No interest. But I do have compassion for patients harmed by greedy non-derms.

 

[username456789]

If they were difficult there wouldn’t be midlevels opening spas and courses all over the US on how to do them.

I just had to go out back and specifically highlight this idiotic line. I’m sure you’re a nice guy and reasonably intelligent, but I hope you see how absurd this statement is. Not even Dermatology specific. It was just an embarrassingly not smart thing to say.

 

[Tenk]

Botox and fillers don’t use machines, so I’m not sure which machines you’re talking about.

Lasers are 5% administering, and 95% planning. If you don’t have an understanding of the physics behind them, you end up in trouble quickly.

Again, your overconfidence is a good example of not knowing what you don’t know. As a result, you are unlikely to realize the error in your thinking.

FWIW, I do almost zero cosmetics. No interest. But I do have compassion for patients harmed by greedy non-derms.

Lasers and cryo use machines. Botox and fillers are all temporary. If you actually read what I wrote I used the word “either” as in either this or that. You can look it up in the dictionary. I know what I’m talking about btw. Thanks though.

 

[Tenk]

I just had to go out back and specifically highlight this idiotic line. I’m sure you’re a nice guy and reasonably intelligent, but I hope you see how absurd this statement is. Not even Dermatology specific. It was just an embarrassingly not smart thing to say.

This is actually happening btw. They use an MD as an oversight. Google it.

 

[username456789]

Lasers and cryo use machines. Botox and fillers are all temporary. If you actually read what I wrote I used the word “either” as in either this or that. You can look it up in the dictionary. I know what I’m talking about btw. Thanks though.

All fillers are not temporary. Neither is a retinal artery occlusion.

I lost my dictionary.

 

[username456789]

This is actually happening btw. They use an MD as an oversight. Google it.

Wait are you seriously implying you don’t think I didn’t know that? Yikes.

What I am saying is that for you to equate “lots of undereducated people open these places” with “ performing these procedures safely and effectively is easy” is laughably uninformed.

 

[Tenk]

All fillers are not temporary. Neither is a retinal artery occlusion.

I lost my dictionary.

They are if you only use temporary ones so people come back for more filler.

Go buy one. I’m sure you can afford it. Sorry this upsets you so much.

 

[username456789]

Anyway, I’m not here to get in a pissing contest with you, it would just benefit all people to understand that hubris is dangerous regardless of what you think you know.

 

[username456789]

They are if you only use temporary ones so people come back for more filler.

Go buy one. I’m sure you can afford it. Sorry this upsets you so much.

I accept your apology.

 

[Tenk]

Wait are you seriously implying you don’t think I didn’t know that? Yikes.

What I am saying is that for you to equate “lots of undereducated people open these places” with “ performing these procedures safely and effectively is easy” is laughably uninformed.

Not once did I say that midlevels perform these procedures safely and effectively. I hate midlevels. I said they are doing it because it is easy to do which it is. They don’t care about safety. Your reading comprehension today is pretty bad...

 

[Tenk]

Anyway, I’m not here to get in a pissing contest with you, it would just benefit all people to understand that hubris is dangerous regardless of what you think you know.

There is no pissing contest. You are literally not understanding my posts and misconstruing what I type and getting upset about it. All I said is that these procedures are pretty easy to do (compared to like a tummy tuck or face lift) so you have tons of encroachment. Everything else you got upset about on your own.

 

[username456789]

There is no pissing contest. You are literally not understanding my posts and misconstruing what I type and getting upset about it. All I said is that these procedures are pretty easy to do (compared to like a tummy tuck or face lift) so you have tons of encroachment. Everything else you got upset about on your own.

I see where you’re coming from. They are easy to set up shop and perform which is why we attract a higher number of mid-level and physician imposters. Got it.

 

[Splenda88]

There is no such thing as midlevel neurosurgeons or radiologists. Some specialties are easy for midlevels to encroach on. That is the truth. That does not mean that they are good at them.