Dermpath: applying for fellowship and job prospects

[PatsyStone]

I have (unfortunately?) realized I really like derm path, and I am unsure what to do next.

1. Are all positions offered two years in advance? I realize this is the norm for pathology fellowships, but I'm a PGY-3, and I am not sure if I am ready to commit by the end of the summer.

2. What do people do if they apply during their PGY-4 year? Do they work as an attending for a year in the program they will be doing Dermpath at?

3. Is the market still terrible and are dermatologists still taking a pay cut to do a hybrid derm and path job? How is the academic market for dermpath?

4. How competitive are fellowships? I know MMS has been a bloodbath in recent years, but I've gotten the sense that it's easy for a derm-trained resident to walk into a dermpath spot. Is this true? How competitive are "top" fellowship programs for derm residents?

The general derm market is great, and I do love general derm, but I think I would have a lot of fulfillment in my careeer if I could do both. At this point, I feel like I would be giving up a lot up to do dermpath, and I am trying to determine if it's worth it. I appreciate any thoughts you all might have

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[doctalaughs]

I have (unfortunately?) realized I really like derm path, and I am unsure what to do next.

1. Are all positions offered two years in advance? I realize this is the norm for pathology fellowships, but I'm a PGY-3, and I am not sure if I am ready to commit by the end of the summer.

2. What do people do if they apply during their PGY-4 year? Do they work as an attending for a year in the program they will be doing Dermpath at?

3. Is the market still terrible and are dermatologists still taking a pay cut to do a hybrid derm and path job? How is the academic market for dermpath?

4. How competitive are fellowships? I know MMS has been a bloodbath in recent years, but I've gotten the sense that it's easy for a derm-trained resident to walk into a dermpath spot. Is this true? How competitive are "top" fellowship programs for derm residents?

The general derm market is great, and I do love general derm, but I think I would have a lot of fulfillment in my careeer if I could do both. At this point, I feel like I would be giving up a lot up to do dermpath, and I am trying to determine if it's worth it. I appreciate any thoughts you all might have

I've been out of the game for awhile but my sense is you should think long and hard before doing that fellowship given current market conditions.

I know multiple recent derm-> dermpath colleagues and most of them ended up never using their dermpath training. Mainly because getting a hybrid position was difficult and required significant monetary, lifestyle or location sacrifices. Even some in academics could not pull it off. It's possible but make sure you really need it for career satisfaction and are willing to move for it. Because 1 year opportunity cost is about 400k plus no guarantee your salary will be same as straight derm with hybrid.


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[doc84]

What if you landed a fellowship would you quit the fellowship because of the job market? Also what will protect our specialty against these mid level providers or less who practice derm/cosmetic derm? Should we become even more specialized, i.e. Mohs or dermpath.

 

[Dral]

1. Are all positions offered two years in advance?
Most are. That's the norm. Some spots pop up if they aren't filled or if someone drops out before they start (since it is such a long time between starting and when one had accepted)

2. What do people do if they apply during their PGY-4 year? Do they work as an attending for a year in the program they will be doing Dermpath at?
Yep. Either at the program, or find a one year derm 'attending' spot somewhere else. Not too difficult to pull off.

3. Is the market still terrible and are dermatologists still taking a pay cut to do a hybrid derm and path job? How is the academic market for dermpath?
You'll probably take a pay cut. The academic market for dp isn't too bad. At the very least, you could probably work out an 'eat what you kill' type thing with derm and dermpath. I would go totally absolutely bat s$*t crazy doing clinical derm all day long so dp is super important for my career satisfaction. I'm soon going to be 60/40 dp/derm. I'm happy at that for now, but will likely increase the dp as my career moves forward.

4. How competitive are fellowships? I know MMS has been a bloodbath in recent years, but I've gotten the sense that it's easy for a derm-trained resident to walk into a dermpath spot. Is this true? How competitive are "top" fellowship programs for derm residents?
Not too difficult for a derm trained person.

 

[doc84]

Bump

 

[ERDOC555]

Very interesting topic. I knew the market for derm path was poor, but based on what you all are saying it seems to be a lot worse than I thought.

Why would a combo job pay less? I was under the impression that reading slides reimbursed extremely well and the time per slide was super minimal. Basically 40 hours of DP collected far more than 40 hours of gen derm. I could be completely wrong, but that seemed to be the impression I got based on some limited exposure. If that's the case, wouldn't doing part time dermpath theoretically raise salaries? Could someone explain to me why that's not the case?

 

[doc84]

I would think that adding dermpath would increase as well. Couldn't you open your own practice or add it to an existing practice?

 

[mario2010]

I would say that dermpath job market is getting better, the absolute worst time was 2012-2015 after all the TC cuts. Just in past 3-4 months alone, I think I got a at least 4-5 unsolicited calls and inquiries from recruiters looking for experienced dermpaths, based on the numbers that I heard, compensation has also gone up. Market is even better for derm/ dermpaths, specially in midwest and southeast, purely from financial standpoint, any derm group with 4+ FT providers will have enough volume to justify a derm-dermpath, reimbursement has gone down but its still better that general derm in comparison. With 4.5 FT providers, you are looking at around 7-8K biopsies annually, that's $700-$800K in global revenue just from dermpath alone, numbers speak for themselves.

 

[doctalaughs]

Very interesting topic. I knew the market for derm path was poor, but based on what you all are saying it seems to be a lot worse than I thought.

Why would a combo job pay less? I was under the impression that reading slides reimbursed extremely well and the time per slide was super minimal. Basically 40 hours of DP collected far more than 40 hours of gen derm. I could be completely wrong, but that seemed to be the impression I got based on some limited exposure. If that's the case, wouldn't doing part time dermpath theoretically raise salaries? Could someone explain to me why that's not the case?

Sure 40 hours of reading slides might reimburse more than 40 hours of derm (although it depends on how many procedures/excisions/cosmetics we are assuming on the derm side, and also whether you are counting just the professional fee for the slides vs some portion of the tech/prep fee).

However, someone is generating those slides for you to read and MOST arrangements you won't be allowed to keep 100% of the profit you generate. Certainly not working for a big system (academics, kaiser etc) and probably not in a partnership/ practice large enough to generate that many slides. After all, why not just send the slides out to a "big reputation" name they trust if there is no financial incentive to the dermatologists giving you the slides.


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[laxman310]

Dermpath here, recently finished fellowship.

So first & foremost, if I could give you one piece of advice, it would be this:
-Fellowships are (usually) only a year, and mid-levels won't be taking over Mohs or Dermpath as fast as they have general derm. If you want to protect your hard-work getting into derm, do an ACGME recognized fellowship.

I liked all of derm (except the sales part of cosmetics) & knew that some quiet time at the scope served my personality. I'm now working at a corporate lab full time DP but have the option to practice clinical derm up to 2 days a week. My contract is flexible & would pro-rate me those days.

1. Yes, most are offered far in advance, but b/c of this there are also a lot of last minute drop-outs & positions open up. If you keep your ear to the street you may be able to start fellowship sooner.

2. I did several years med derm @ an academic institution. I think this padded my CV a lot when applying for jobs, and I trained residents so if I go solo one day it'll be old hat to get some mid-levels going.

3. The market isn't great, but its still better for you than most path/dermpaths. Most of my job interviews were for MOSTLY derm with 1-2 days of dermpath, but I lucked out & am doing full time DP. I'm definitely taking a pay cut in the short run, but after a few years of this I'll be able to reassess & see if there are better opportunities. At the end of the day you get paid about 1/3 of what the professional component generates at a lab, whereas if it was your own practice & you sent out the technical your only overhead would be malpractice + cost of generating the report (EMR + dictation), so closer to 2/3 of the professional.

 

[doctalaughs]

Dermpath here, recently finished fellowship.

So first & foremost, if I could give you one piece of advice, it would be this:
-Fellowships are (usually) only a year, and mid-levels won't be taking over Mohs or Dermpath as fast as they have general derm. If you want to protect your hard-work getting into derm, do an ACGME recognized fellowship.

I liked all of derm (except the sales part of cosmetics) & knew that some quiet time at the scope served my personality. I'm now working at a corporate lab full time DP but have the option to practice clinical derm up to 2 days a week. My contract is flexible & would pro-rate me those days.

1. Yes, most are offered far in advance, but b/c of this there are also a lot of last minute drop-outs & positions open up. If you keep your ear to the street you may be able to start fellowship sooner.

2. I did several years med derm @ an academic institution. I think this padded my CV a lot when applying for jobs, and I trained residents so if I go solo one day it'll be old hat to get some mid-levels going.

3. The market isn't great, but its still better for you than most path/dermpaths. Most of my job interviews were for MOSTLY derm with 1-2 days of dermpath, but I lucked out & am doing full time DP. I'm definitely taking a pay cut in the short run, but after a few years of this I'll be able to reassess & see if there are better opportunities. At the end of the day you get paid about 1/3 of what the professional component generates at a lab, whereas if it was your own practice & you sent out the technical your only overhead would be malpractice + cost of generating the report (EMR + dictation), so closer to 2/3 of the professional.

Good for you.

I would dispute the wisdom of always doing a fellowship though. Do one if you definitely want to practice in the subspecialty, but do not "just to have the option." Unlike specialties like pathology, radiology and anesthesia, where fellowship(s) are increasingly required to find a job, genderm is still wide open. Easier to find a job than in mohs, peds-derm and certainly dermpath. Whether this changes in the future due to midlevel encroachment or whatever is pure speculation.

From a pure financial standpoint you stand to lose the future value of 1 yr attending salary which could easily be 400k -> 1.5-2 million over a career. Not to mention possibly a lower starting salary (except probably mohs). So do the fellowship if you are sure, but not for nebulous reasons like "job security" and "future business opportunities" which have very little connection to fellowship training at this time.




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