Dermatopathology

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What is the postgraduate training involved in becoming a dermatopathologist? And do I have a shot with my numbers at MD or DO Derm?
USMLE 246/99
COMLEX 687/89 98th percentile

 

[ForSkin]

dermpath fellowship can be had via one of two routes, through either derm residency or through path residency. most programs prefer derm-trained people, but few derm residents are attracted and a great majority of spots end up going to paths. if dermpath is your desired endpoint, i would recommend you do a path residency. the reality is that DO's have a much tougher time getting into derm and would require you to do a few years of solid research to even have a meager chance at a spot. DO's in path are fairly commonplace.

What is the postgraduate training involved in becoming a dermatopathologist? And do I have a shot with my numbers at MD or DO Derm?
USMLE 246/99
COMLEX 687/89 98th percentile

 

[ny skindoc]

dermpath fellowship can be had via one of two routes, through either derm residency or through path residency. most programs prefer derm-trained people, but few derm residents are attracted and a great majority of spots end up going to paths. if dermpath is your desired endpoint, i would recommend you do a path residency. the reality is that DO's have a much tougher time getting into derm and would require you to do a few years of solid research to even have a meager chance at a spot. DO's in path are fairly commonplace.

More recently Dermpath has become increasingly popular with derm residents as this subspecialty has become highly lucrative.
Because fewer derm residents apply they are valued in many programs and so generally you have a much better chance of getting into it as derm resident then a path resident-it varies by individual program.I believe this would be true even from a DO derm program.However path is a much easier residency to get.There are a good number of DOs who are dermatopathologists generally from pathology.Its competitive.

 

[ForSkin]

More recently Dermpath has become increasingly popular with derm residents as this subspecialty has become highly lucrative.
Because fewer derm residents apply they are valued in many programs and so generally you have a much better chance of getting into it as derm resident then a path resident-it varies by individual program.I believe this would be true even from a DO derm program.However path is a much easier residency to get.There are a good number of DOs who are dermatopathologists generally from pathology.Its competitive.

nyskindoc - how practical is it for derms to read their own slides without a dermpath fellowship? apparently it's commonly done out on the west coast, "outsourcing" only the more difficult melanocytic lesions.

i do agree that dermpath is having a resurgence of sorts among derm residents. still, the numbers applying are low enough that derms remain a "prized" commodity and should have their pick of dermpath fellowships.

 

[ny skindoc]

nyskindoc - how practical is it for derms to read their own slides without a dermpath fellowship? apparently it's commonly done out on the west coast, "outsourcing" only the more difficult melanocytic lesions.

i do agree that dermpath is having a resurgence of sorts among derm residents. still, the numbers applying are low enough that derms remain a "prized" commodity and should have their pick of dermpath fellowships.

Its not typical for a practicing general dermatologist to read their own slides in most places.I dont hear much of that on the east coast.Certainly its possible especially for MOHs trained individuals.Most derm residencies dont have enough dermpath training so that its graduates would feel comfortable reading their own slides.However if one is very into path and puts a special focus on it, its entirely possible to master the ability to read the great majority of slides and to recognize those needeing an expert opinion.Most dermatologists are too busy with patients to sit down and start reading slides.But it can be a big financial boost to a practice.If one was interested in that,then as a resident they should try to read as many slides as possible and take path electives and take continuing ed programs in dermpath that are regularly offered.It can work for the right person.

 

[DermMatch]

Bump for dermpath career commentary

 

[Long Dong]

i do agree that dermpath is having a resurgence of sorts among derm residents. still, the numbers applying are low enough that derms remain a "prized" commodity and should have their pick of dermpath fellowships.

I thinks it's gotten more of a resurgence with dermies since mohs got slashed.

From this website: http://mdsalaries.blogspot.com/2006/05/dermatologist-salaries.html

"A dermpath can look at 100 slides a day charging about $75 each. Thus revenues can approach 2 million per year per doc. And typical overhead is about 30%."

So I did some math if you looked at 100 slides a day, $75 a slide, 4 days a week, 48 weeks a year (1 month vacation), gross $1,440,000, 30% overhead, net $1,008,000 a year. Not bad working 4 days a week. No wonder all those path guys are so hard up for a dermpath fellowships.

 

[scumbagderm]

I thinks it's gotten more of a resurgence with dermies since mohs got slashed.

From this website: http://mdsalaries.blogspot.com/2006/05/dermatologist-salaries.html

"A dermpath can look at 100 slides a day charging about $75 each. Thus revenues can approach 2 million per year per doc. And typical overhead is about 30%."

So I did some math if you looked at 100 slides a day, $75 a slide, 4 days a week, 48 weeks a year (1 month vacation), gross $1,440,000, 30% overhead, net $1,008,000 a year. Not bad working 4 days a week. No wonder all those path guys are so hard up for a dermpath fellowships.

will you be trying for dermpath, longdong?

 

[mohderm]

I thinks it's gotten more of a resurgence with dermies since mohs got slashed.

From this website: http://mdsalaries.blogspot.com/2006/05/dermatologist-salaries.html

"A dermpath can look at 100 slides a day charging about $75 each. Thus revenues can approach 2 million per year per doc. And typical overhead is about 30%."

So I did some math if you looked at 100 slides a day, $75 a slide, 4 days a week, 48 weeks a year (1 month vacation), gross $1,440,000, 30% overhead, net $1,008,000 a year. Not bad working 4 days a week. No wonder all those path guys are so hard up for a dermpath fellowships.

Just curious. How much does the average mohs doc make. I see you say their reimbursement has been slashed.

 

[Dral]

If you look at the link he posted, you'll see this:

"- Mohs Micrographic surgery (MMS). This is the most common kind of skin cancer surgery today. Huffman says it can generate $1.5 million per year in revenue, with overhead of about 40%."

However, that was from a 2001 report. Not sure about now. I would assume it's still higher than straight derm since the overhead is lower.

 

[RWillan]

The billing for MMS has changed. For example, let's say you do four stages and then a repair. Because of the changes in billing procedure, you're compensated 50% less for each stage. You are also compensated 50% for closure. So if the first stage is $600, the second is $300, third is $150 and the fourth is $75. And if the normal cost of a closure is $200, you get $100. Correct me if I am wrong, but I think this is how billing is done now for MMS.

 

[IzzyMD09]

does that take into account the difficulty of the closure, because some of the closures take more than one two or even three sessions i.e. rotating flaps from the forehead to the nose?

 

[RWillan]

No, I don't believe the difficulty of the closure matters for billing purposes.

 

[oracle07]

Overall I think Mohs is less competitive because of the changes in reimbursement. Dermpath is the "golden ticket" right now.

I'm of the impression that reimbursement will go down with all fields of medicine... so it doesn't really matter to me. I figure I'll just do whatever I like the most.

 

[tripleJ]

I believe dermpaths now get about 35.00 to "read" the slide, which keeps going down. You get about 65.00 additional to process the slide, but you have to own the lab for that (that is where the real $ is).

 

[discontinuebed]

It's only a matter of time before dropping reimbursements hit dermpath too

 

[Long Dong]

will you be trying for dermpath, longdong?

Thought about it, even put it in my personal statement. Thought I was pretty smart as a med student, now as a resident feel like a ******* surounded by geniuses as classmates. Don't think it's going to happen now. Well be more then happy being a regular dermie.

I believe dermpaths now get about 35.00 to "read" the slide, which keeps going down. You get about 65.00 additional to process the slide, but you have to own the lab for that (that is where the real $ is).

Well not the golden ticket anymore then, but still would do it if only they let a brother in.

 

[sdnetrocks]

The estimates above may be way too conservative. 100 slides in an 8-hour day is only 12.5 slides an hour (almost 5 minutes per slide). That would be the case if they were all inflammatory lesions. Experienced dermpaths can read BCCs and other simple things at low power in <5 seconds - figure another 10 seconds for dictation (if you have an efficient system), and you're pushing out at least 4 BCCs per minute...

Obviously, there is a mix of simple and complicated inflammatory things, but my guess is that it's at least >50% simple things in the community... so the numbers you came up with at $75/slide are still roughly accurate with $30/slide since in reality the read rate is about twice as fast...

 

[Long Dong]

So there was always this hype about Leboit at UCSF pulling 2 million a year doing dermpath. http://www.tuitionreliefnow.org/campaign/news/press_extra/

Now it's all about Silvers at Columbia pulling 5 million a year. http://www.nydailynews.com/ny_local...columbia_dermatology_professor_tops_nonp.html