Dermalicious123

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Been shadowing a dermatologist. Feels strangely like primary care, maybe because of the outpatient setting (charting, dictation, biopsy EVERYTHING lol etc.) I know that there are stories of derm residents switching out of derm to other specialties because they didn't like the pace. You end up seeing more patients in a day than a primary care doc (albeit simpler cases). So I guess the warning is, if you don't like outpatient medicine, you probably will hate derm (because it is WAY busier).
 

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Been shadowing a dermatologist. Feels strangely like primary care, maybe because of the outpatient setting (charting, dictation, biopsy EVERYTHING lol etc.) I know that there are stories of derm residents switching out of derm to other specialties because they didn't like the pace. You end up seeing more patients in a day than a primary care doc (albeit simpler cases). So I guess the warning is, if you don't like outpatient medicine, you probably will hate derm (because it is WAY busier).
Yes all that is a given. It is an outpatient specialty. It is a high volume specialty. That being said, which specialty doesn't feel the pressure to see ever increasing numbers of patients in less time?
 
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drkristy85

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see this is what i hate about medicine. it seems like every primary care job i interview at, they are all about seeing tons of patients, fast paced, stress etc, but make lots of money. production based. i would really like to make less money, see less patients, and be relaxed at work but i feel like this option is not being offered to me. my husband makes a good living, i've paid back about half my loans at this point....i really want to make less money and not be stressed after finishing residency which is stressful enough. all the private practices are owned by some doctor who wants to squeeze the life out of you so they can skim off the top. i dont want to open my own office. i would like them to hire me and just pay me less in exchange for me just chillaxing at work.... so frustrating....
 
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Dermalicious123

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see this is what i hate about medicine. it seems like every primary care job i interview at, they are all about seeing tons of patients, fast paced, stress etc, but make lots of money. production based. i would really like to make less money, see less patients, and be relaxed at work but i feel like this option is not being offered to me. my husband makes a good living, i've paid back about half my loans at this point....i really want to make less money and not be stressed after finishing residency which is stressful enough. all the private practices are owned by some doctor who wants to squeeze the life out of you so they can skim off the top. i dont want to open my own office. i would like them to hire me and just pay me less in exchange for me just chillaxing at work.... so frustrating....
true, on the flipside, primary care is one of the most flexible fields of medicine...aren't plenty of part time jobs available? also if you do hospitalist medicine which is 2 weeks on 2 weeks off, i've heard of people splitting a hospitalist position and working 1 week a month making about 125k+ a year, which doesn't sound bad.

i hope med students have had some real derm shadowing experience before applying--it really is for a specific kind of personality because the environment is very fast-paced and you always feel you don't have enough time...I was surprised by how busy dermatologists are. They are paid well but they really work for every dollar they earn.
 
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Dermalicious123

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Yes all that is a given. It is an outpatient specialty. It is a high volume specialty. That being said, which specialty doesn't feel the pressure to see ever increasing numbers of patients in less time?
The sad part is when all the idealists who entered med school realize what a **** show the entire med system in the US is...we're the wealthiest country in the world, arguably with some of the smartest people, but we can't figure out how to provide high quality healthcare for all. I've had more and more doubts about medicine and wonder if I am more fit for something else...(I do love studying medicine though...)
 

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1) There's a balance between being "too busy" (which can lead to burnout, career dissatisfaction, etc.) and being "not busy at all" (which means not having as many patients, not having as much work to do, perhaps not having as much earning potential, etc.). The happy medium for most people is probably being busy but not too busy.

2) In general, I think most people would probably prefer outpatients than inpatients. Ask yourself, would I rather work in a busy outpatient derm practice or in a busy ICU if I had no other choice? (I actually like the ICU, but maybe I'm weird.)

3) Just speaking anecdotally, so maybe this is mistaken, but in my experience it seems while people can be happy as hospitalists working 1 week on/1 week off (or similar), there seem to be many more who are burned out by it after a few years. It's currently good money, but I wouldn't say it's easy or relaxing work.

Then again, I guess it depends what you're comparing hospitalist work to. It's probably a more relaxed schedule than neurosurgery!

4) I agree the US healthcare system is pretty crazy right now. Here's an option: Why not (if you can) move and work in another healthcare system like Canada, Australia, New Zealand? I'm in Australia, and life-work balance as a doctor in most specialties is far better than back home in the US.
 
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If I was told I had to work in an ICU, I'd be out the door before I admitted the first patient. I'd go be a DJ or something.

One of my first big criteria for narrowing down what I wanted to do was 'less to no inpatient medicine'.
Exactly! :)

What I've heard:

No patient > Outpatient > Inpatient > ICU

(But speaking for myself I couldn't ever see "no patients". And I actually like the ICU, but not so much the hours or "lifestyle".)
 

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Maybe this should be moved to the pre-allo forum.

Anyhow, derm is not like primary care. In primary care, you're expected to see lots of patients who have numerous chronic health conditions who expect you to take care of all of them in a 10-15 minute visit. In derm, you're expected to handle one (or maybe two) skin specific problems in a quick visit. I am not intending to be supercilious, but when you start seeing patients as a med student, you'll realize that it is draining having to manage hypertension, hyperlipidemia, GERD, depression, chronic back pain, diabetes, and COPD in a patient versus getting to be the specialist who only has to manage one organ system. Another major difference is that in derm, most patients are compliant with their medications; the same cannot be said for many primary care patients who do not take their meds or follow diet/exercise recommendations. Seriously, having to manage diabetes in most patients is a pain in the ass: people don't take their insulin or they cannot afford their medication or they don't check their sugars regularly or they don't want exercise or they don't want to change their diet or they insist they take their meds but their A1C is always off the charts. Do you know what's great about managing rosacea? EVERYTHING. People take/apply their meds and when you finally get it under control, your patients are incredibly grateful.
 

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If I could offer another piece of (probably obvious) advice for pre-med students or maybe some med students too: Derm seems great on paper (e.g. great lifestyle, great income potential, in my experience dermatologists were mostly very nice people, specialties like derm tend to attract the best and the brightest so you often feel like you're around superstars which in turn brings out the best in you), but at the same time really do your best to make sure you want it as a career.

For instance, I did a rotation in derm in med school, and saw and did lots of wonderfully rewarding stuff, and for a while I thought I wanted to go into derm, but at the end of the day it just wasn't for me. On the other hand, it might be the perfect specialty for someone else.

So, I'd say listen to yourself, try to minimize the many pressures around you to choose this or that specialty because it's lucrative or because it currently has status, etc., and instead try to discern as best as you can (easier said than done) which specialty best fits "you", your person, your values, your goals in life. And (again easier said than done) try to picture where you'll be in 10 years or so, because what you want now in your mid 20s may not be what you want later in your mid 30s and are married, have kids, and so on.
 
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Dermalicious123

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Maybe this should be moved to the pre-allo forum.

Anyhow, derm is not like primary care. In primary care, you're expected to see lots of patients who have numerous chronic health conditions who expect you to take care of all of them in a 10-15 minute visit. In derm, you're expected to handle one (or maybe two) skin specific problems in a quick visit. I am not intending to be supercilious, but when you start seeing patients as a med student, you'll realize that it is draining having to manage hypertension, hyperlipidemia, GERD, depression, chronic back pain, diabetes, and COPD in a patient versus getting to be the specialist who only has to manage one organ system. Another major difference is that in derm, most patients are compliant with their medications; the same cannot be said for many primary care patients who do not take their meds or follow diet/exercise recommendations. Seriously, having to manage diabetes in most patients is a pain in the ass: people don't take their insulin or they cannot afford their medication or they don't check their sugars regularly or they don't want exercise or they don't want to change their diet or they insist they take their meds but their A1C is always off the charts. Do you know what's great about managing rosacea? EVERYTHING. People take/apply their meds and when you finally get it under control, your patients are incredibly grateful.
From what I've seen patient noncompliance is quite common in derm too...patients who have had numerous skin biopsies and cancers and have been advised to cover up and stay away from the sun STILL do...many don't wear sunscreen or take the drugs properly or apply creams and ointments properly (many skin ointments, creams, hair washes, face washes require you to leave them on for 5-10 minutes etc.)
 
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MOHS_01

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see this is what i hate about medicine. it seems like every primary care job i interview at, they are all about seeing tons of patients, fast paced, stress etc, but make lots of money. production based. i would really like to make less money, see less patients, and be relaxed at work but i feel like this option is not being offered to me. my husband makes a good living, i've paid back about half my loans at this point....i really want to make less money and not be stressed after finishing residency which is stressful enough. all the private practices are owned by some doctor who wants to squeeze the life out of you so they can skim off the top. i dont want to open my own office. i would like them to hire me and just pay me less in exchange for me just chillaxing at work.... so frustrating....
Good luck; what everyone needs to understand is that the relationship between revenue and profit is not linear.
 

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true, on the flipside, primary care is one of the most flexible fields of medicine...aren't plenty of part time jobs available? also if you do hospitalist medicine which is 2 weeks on 2 weeks off, i've heard of people splitting a hospitalist position and working 1 week a month making about 125k+ a year, which doesn't sound bad.

i hope med students have had some real derm shadowing experience before applying--it really is for a specific kind of personality because the environment is very fast-paced and you always feel you don't have enough time...I was surprised by how busy dermatologists are. They are paid well but they really work for every dollar they earn.
If I could get part-time Peds, I would do it in a heartbeat. No one is offering part time jobs out there. Only full time peds outpatient or peds hospitalist. The number of women physicians is growing, and the number of part time physicians is growing as well, every single year. However, I'm beginning to wonder if these part time physicians start out full time and get hired full time, then later on, go on maternity, then afterwards discuss doing part time with their employer. Otherwise, I don't know how they are getting these part time jobs. I think employers would rather have one full time doc than two part time docs, since they need to provide each doc with an office, health care, benefits, etc.
 

MOHS_01

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how do you mean?
I mean the first 20 patients you see a day go to paying rent, malpractice, and staff. I mean your services would actually earn you exactly zero until that 21st patient, and from that point on you get to keep a growing percentage of whatever revenue you generate.

That is a gross oversimplification, but the gist is true.
 

MOHS_01

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If I could get part-time Peds, I would do it in a heartbeat. No one is offering part time jobs out there. Only full time peds outpatient or peds hospitalist. The number of women physicians is growing, and the number of part time physicians is growing as well, every single year. However, I'm beginning to wonder if these part time physicians start out full time and get hired full time, then later on, go on maternity, then afterwards discuss doing part time with their employer. Otherwise, I don't know how they are getting these part time jobs. I think employers would rather have one full time doc than two part time docs, since they need to provide each doc with an office, health care, benefits, etc.
In the same vein, there is a reason why part time positions are scarce -- they are fundamentally at odds with practice finance. Part time positions rarely generate enough enterprise profit to cover staff + salary, so anyone with a lick of sense and capable of simple arithmetic has arrived at the conclusion that they do not make sense to offer. In fact, current part time providers are being shown the door left and right -- and for cause. Our margins are really being squeezed and this has prompted people to put pencil to paper more than they once did... and what they are finding is that part time, low volume providers remove more from the table than they put on it. I don't begrudge the person who wants to work part time at all, but everyone needs to understand that the person who works 5 days a week and sees 50 people per day is -- and, indeed, should -- earn significantly more than twice what the person who sees 40 per day, 3 days per week does. It's simple math....

p.s. This is why most wRVU compensation formulas are inadequately structured. They should be very progressive by design.
 

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Seeing 40 a day in an efficient practice with 2-3 MAs, 3 rooms, and a good EMR is totally doable, dare I say, easy. However, what I've found in my limited time as an attending, very few practices will provide physicians with these resources so they can squeeze every drop of income out of the current system. What's with the 1 MA, 2 room model? And crappy EMRs? It seems to me a practice would want to be as efficient as possible and provide the resources to drive production. And I'm not simply talking about new untested associates being saddled with suboptimal resources, it's the more established partners too. I need an economics lesson from some of the more senior folks.
 

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Seeing 40 a day in an efficient practice with 2-3 MAs, 3 rooms, and a good EMR is totally doable, dare I say, easy. However, what I've found in my limited time as an attending, very few practices will provide physicians with these resources so they can squeeze every drop of income out of the current system. What's with the 1 MA, 2 room model? And crappy EMRs? It seems to me a practice would want to be as efficient as possible and provide the resources to drive production. And I'm not simply talking about new untested associates being saddled with suboptimal resources, it's the more established partners too. I need an economics lesson from some of the more senior folks.
When I was doing general derm regularly I would have 40 in the morning, 3 rooms, and two surg techs doubling as MA's. This was done both under a paper chart and Allscripts Enterprise charting (EMR took it from being busy but tolerable to a kick in the junk, btw).

As for the space issue -- if they have space readily available and sitting idle it is nuts.... but more often than not space is at a premium and the costs associated with changing space are neither inconsequential nor readily apparent to most. It's a huge undertaking. Beyond that, there is significant risk undertaken by the enterprise with the acquisition of additional space and our current practice environment makes large capital expenditures very risky.
 
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When I was doing general derm regularly I would have 40 in the morning, 3 rooms, and two surg techs doubling as MA's. This was done both under a paper chart and Allscripts Enterprise charting (EMR took it from being busy but tolerable to a kick in the junk, btw).

As for the space issue -- if they have space readily available and sitting idle it is nuts.... but more often than not space is at a premium and the costs associated with changing space are neither inconsequential nor readily apparent to most. It's a huge undertaking. Beyond that, there is significant risk undertaken by the enterprise with the acquisition of additional space and our current practice environment makes large capital expenditures very risky.
I don't know why derm is considered a lifestyle specialty today....they're really busy (because there's such an extreme shortage of dermatologists which has its pros and cons) and stressed on the job (although I guess between 8 and 5...). ROAD is not lifestyle anymore...you'll be working your ass off in every medical field.
 
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MOHS_01

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^^^ T R U T H
 

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...although i have serious doubts about the extreme shortage part.
 

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I don't know why derm is considered a lifestyle specialty today....they're really busy (because there's such an extreme shortage of dermatologists which has its pros and cons) and stressed on the job (although I guess between 8 and 5...). ROAD is not lifestyle anymore...you'll be working your ass off in every medical field.
Were you under the (misguided) assumption that lifestyle meant you could **** around and not actually do any work? The "ROAD" were specialties that paid well and had a relatively controllable schedule (something like 8-5 M-F without call). No one is going to pay you to stand around with your dick in your hand, in medicine or otherwise.
 
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smartparts

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Were you under the (misguided) assumption that lifestyle meant you could **** around and not actually do any work? The "ROAD" were specialties that paid well and had a relatively controllable schedule (something like 8-5 M-F without call). No one is going to pay you to stand around with your dick in your hand, in medicine or otherwise.
well, unless you're a urology intern, in the OR, in July.
 

MOHS_01

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Were you under the (misguided) assumption that lifestyle meant you could **** around and not actually do any work? The "ROAD" were specialties that paid well and had a relatively controllable schedule (something like 8-5 M-F without call). No one is going to pay you to stand around with your dick in your hand, in medicine or otherwise.
 

MOHS_01

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Really? Still takes me a couple weeks to get in with a derm...
O M G !!! A couple of weeks? Good God, man! The horror!

Have you tried to get into a PCP lately? How about an OB? Urologist?

...and yes, there absolutely is zero shortage of trained dermatologists; if the average hours works approached 40/week for the field there would be an epic glut of derms... even with the demand elasticity problem associated with medicine.
 

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@MOHS_01 you seem like the most pessimistic jaded derm that I've ever heard of. Ever consider retiring? Leaving medicine altogether?
 

MOHS_01

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@MOHS_01 you seem like the most pessimistic jaded derm that I've ever heard of. Ever consider retiring? Leaving medicine altogether?
The short answer is yes; the better answer would require a lengthy explanation as to why your experience in this regard is skewed.

I'm actually less jaded than many - if not most - of my colleagues who work behind the scenes and understand the system as it exists. Granted, there are tons of docs who practice with their heads in the sand unaware of the world around them and there are many more who take the "well, there is nothing that I can do about it anyway" and resort to rationalization as a crutch.... but the most likely scenario with regard to your experience is a combination of the before mentioned with a healthy dose of less than candid discussion with you on the matter (it is highly unlikely that the open conversation with someone coming through is ever frank or candid - as sad as that is).

There is much more to this than time permits right now. Cheers
 

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O M G !!! A couple of weeks? Good God, man! The horror!

Have you tried to get into a PCP lately? How about an OB? Urologist?

...and yes, there absolutely is zero shortage of trained dermatologists; if the average hours works approached 40/week for the field there would be an epic glut of derms... even with the demand elasticity problem associated with medicine.
I've often worried that, should the current healthcare climate continue to convince dermatologists to work longer hours/more days to stay afloat, a true excess will be evident. But by that time it may be too late, as I'm sure people will continue to convince the powers that be that we need to train more derms (or worse, "train" more fake Derm mid levels), resulting in an even larger glut.

Tinfoil hat-wearing on my part? Or is this a legitimate possibility?
 

MOHS_01

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I've often worried that, should the current healthcare climate continue to convince dermatologists to work longer hours/more days to stay afloat, a true excess will be evident. But by that time it may be too late, as I'm sure people will continue to convince the powers that be that we need to train more derms (or worse, "train" more fake Derm mid levels), resulting in an even larger glut.

Tinfoil hat-wearing on my part? Or is this a legitimate possibility?
Not tinfoil at all; in fact, I could point to several emerging trends that would demonstrate this is already underway.

More to follow as time allows....
 

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The short answer is yes; the better answer would require a lengthy explanation as to why your experience in this regard is skewed.

I'm actually less jaded than many - if not most - of my colleagues who work behind the scenes and understand the system as it exists. Granted, there are tons of docs who practice with their heads in the sand unaware of the world around them and there are many more who take the "well, there is nothing that I can do about it anyway" and resort to rationalization as a crutch.... but the most likely scenario with regard to your experience is a combination of the before mentioned with a healthy dose of less than candid discussion with you on the matter (it is highly unlikely that the open conversation with someone coming through is ever frank or candid - as sad as that is).

There is much more to this than time permits right now. Cheers
I guess I'm one of the "rationalization" ones you describe above but I'm not so sure it's really a crutch more than an attitude of acceptance.

I agree our healthcare system is messed up. I agree we are overtraining, spending money in the wrong areas and generally making a mess. But unfortunately there's not a lot I can do other than write emails to my politicians and donate to some PACs.

By having this attitude Im fairly happy at work, not jaded and can see my patients with a smile. And most important I will save money aggressively so if things really go to hell I could cut back or retire early.
 
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MOHS_01

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I guess I'm one of the "rationalization" ones you describe above but I'm not so sure it's really a crutch more than an attitude of acceptance.

I agree our healthcare system is messed up. I agree we are overtraining, spending money in the wrong areas and generally making a mess. But unfortunately there's not a lot I can do other than write emails to my politicians and donate to some PACs.

By having this attitude Im fairly happy at work, not jaded and can see my patients with a smile. And most important I will save money aggressively so if things really go to hell I could cut back or retire early.
I think that I might be overemphasizing my personal, day to day level of disdain for the job; while it is ever present, it really does not creep in while I'm in the room doing the actual work and I have little problem with that function. Where it does rear its ugly head is with the management and oversight of an ever eroding income statement as well as with my discussions with colleagues, placement on various boards and panels, etc. There seems to be primarily two quite distinct populations that I have to cater to within the field: those that have some involvement behind the scenes and are true chicken littles and those employed (regardless of the setting) who are much less predisposed to the woe is me mentality. The problem is with bridging the chasm between the two, lessening the information gap, and doing so in such a way as to not dismiss the general feelings in either camp. It's quite the tight wire to walk, I must say.

What you are really looking at is a supply / demand argument; there are pressures at both ends here that come into play. First, the supply side: we have massively increased our number of trainees in relative terms over the past two decades, accelerating this trend more recently. The reasons behind this are too much to go into right here and now, but, as always, seem to come down to a combination of misguided good intentions and frank self interest. Simultaneously, the rise of the part time doc has occurred, temporarily (so far, at least) mitigating the observed effects of this large percentage change. All of this has happened against a backdrop of rising -- and relatively unrestrained -- demand. An aging population consumes more health services in general and dermatologic services in particular, so we have a demographic push toward more need. There have been few restraints to seeking this care for several years, and when taken together has resulted in a burgeoning demand for skin services. Artificially high demand for services (due to few barriers / restraints / rationing of care) plus artificially low provider resource utilization (large number of docs working part time) leads to an artificial shortage -- and both of these factors are independently moving in the opposite direction as the resurgence of the gatekeeper model, ACO's, etc increase and margins are squeezed.

Fun times when you start digging into the numbers. Fun. Times. Indeed.
 

doctalaughs

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I think that I might be overemphasizing my personal, day to day level of disdain for the job; while it is ever present, it really does not creep in while I'm in the room doing the actual work and I have little problem with that function. Where it does rear its ugly head is with the management and oversight of an ever eroding income statement as well as with my discussions with colleagues, placement on various boards and panels, etc. There seems to be primarily two quite distinct populations that I have to cater to within the field: those that have some involvement behind the scenes and are true chicken littles and those employed (regardless of the setting) who are much less predisposed to the woe is me mentality. The problem is with bridging the chasm between the two, lessening the information gap, and doing so in such a way as to not dismiss the general feelings in either camp. It's quite the tight wire to walk, I must say.

What you are really looking at is a supply / demand argument; there are pressures at both ends here that come into play. First, the supply side: we have massively increased our number of trainees in relative terms over the past two decades, accelerating this trend more recently. The reasons behind this are too much to go into right here and now, but, as always, seem to come down to a combination of misguided good intentions and frank self interest. Simultaneously, the rise of the part time doc has occurred, temporarily (so far, at least) mitigating the observed effects of this large percentage change. All of this has happened against a backdrop of rising -- and relatively unrestrained -- demand. An aging population consumes more health services in general and dermatologic services in particular, so we have a demographic push toward more need. There have been few restraints to seeking this care for several years, and when taken together has resulted in a burgeoning demand for skin services. Artificially high demand for services (due to few barriers / restraints / rationing of care) plus artificially low provider resource utilization (large number of docs working part time) leads to an artificial shortage -- and both of these factors are independently moving in the opposite direction as the resurgence of the gatekeeper model, ACO's, etc increase and margins are squeezed.

Fun times when you start digging into the numbers. Fun. Times. Indeed.
Sounds like you may be in a position to change things more than me, so all the power to you. If I had any stomach for politics or administration I'm sure it would keep me up more at night too.

As is, Im happy to continue donating some money to hopefully reverse some of these trends and advocate for our specialty although sometimes it does feel like pissing into the wind.
 
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reno911

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@MOHS_01 you seem like the most pessimistic jaded derm that I've ever heard of. Ever consider retiring? Leaving medicine altogether?
I strongly agree w/ 95% of what Mohso1 writes and while I'm quite pessimistic about the future of medicine in general and my specialty in particular, I think he is many levels above me. It's just a matter of perspective, I guess.
 

MOHS_01

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Status
Attending Physician
I strongly agree w/ 95% of what Mohso1 writes and while I'm quite pessimistic about the future of medicine in general and my specialty in particular, I think he is many levels above me. It's just a matter of perspective, I guess.
Thanks. I think. :unsure:

Quick question for anyone not worried: how familiar are you with the changes that have already occurred over the past decade regarding reimbursement, regulatory, and coverage criteria? The financial impact on practices that resulted? How familiar are you with the RUC system and the challenges that have been both won and lost over the past few years? The coming changes to our RVU valuations? The planned abolition of FFS payment methods? Just curious....
 

bronx43

Word.
10+ Year Member
Apr 22, 2006
2,002
714
Status
Attending Physician
Thanks. I think. :unsure:

Quick question for anyone not worried: how familiar are you with the changes that have already occurred over the past decade regarding reimbursement, regulatory, and coverage criteria? The financial impact on practices that resulted? How familiar are you with the RUC system and the challenges that have been both won and lost over the past few years? The coming changes to our RVU valuations? The planned abolition of FFS payment methods? Just curious....
I am worried, but I don't have a good grasp of those things. If you can give us some insight that would be great... I'm currently employed by a large academic center so it doesn't have a direct impact (yet), but I plan on going private in the future if that is still feasible...
 

reno911

10+ Year Member
Jul 16, 2009
271
97
Status
Attending Physician
Thanks. I think. :unsure:

Quick question for anyone not worried: how familiar are you with the changes that have already occurred over the past decade regarding reimbursement, regulatory, and coverage criteria? The financial impact on practices that resulted? How familiar are you with the RUC system and the challenges that have been both won and lost over the past few years? The coming changes to our RVU valuations? The planned abolition of FFS payment methods? Just curious....
I am very familiar with all of those things. I am worried, especially as a Mohs surgeon that does nothing else. But I'm probably not quite as worried as you are.
I'd be less worried if I did general derm.
 

Dral

10+ Year Member
Jan 8, 2009
1,846
1,026
Dermatomicroscope
Status
Attending Physician
Hmm, I always thought it feels more like cosmetology sometimes...but that's honestly because I assumed a lot of my patients during residency were coming to me to get stuff removed instead of them worrying if something was dangerous or not.