Dermpath

[Gracile]

Couple questions about dermpath:

1. Is it frowned upon (for the purposes of residency application) if a student expresses interest in dermpath?

2. How feasible is a full-time dermpath position or are most jobs a mix of general derm and dermpath?

Thanks.

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[asmallchild]

Couple questions about dermpath:

1. Is it frowned upon (for the purposes of residency application) if a student expresses interest in dermpath?

2. How feasible is a full-time dermpath position or are most jobs a mix of general derm and dermpath?

Thanks.

1. Hard to say, I'm sure someone out there might frown upon it. I personally would keep this quiet unless I was being interviewed by someone in dermpath

2. I have limited knowledge on this subject but my understanding is that full-time dermpath positions are pretty rare with most being a mix

 

[molmol]

1. yes.
2. dermpath market is bad these days -- you'll likely need to do something extra (ie. derm or gen path).

 

[MOHS_01]

We are guilty of overtraining for all derm subspecialties; too many Mohs / procedural, too many pathologists... and probably by a significant factor. I still believe derm trained dermpath to be the very best route, however, given the flexibility (and benefit) it provides you.

 

[sore eye asses]

We are guilty of overtraining for all derm subspecialties; too many Mohs / procedural, too many pathologists... and probably by a significant factor. I still believe derm trained dermpath to be the very best route, however, given the flexibility (and benefit) it provides you.

not peds.

 

[MOHS_01]

not peds.

True -- but that's in its infancy, is the lowest paid, and is not referral dependent. Folks are not exactly beating down the door to get in and, more importantly, when viewed through the meaningful metric that is equilibrium dynamics (which is what we are actually discussing here), the relative annual increase for ped derm has been huge over the past decade. It will take a while to determine what the actual need for peds is... but I doubt there's much danger in the flooding of that market given the pressures highlighted above.

 

[Silent Cool]

1. yes.
2. dermpath market is bad these days -- you'll likely need to do something extra (ie. derm or gen path).

Interesting. I remember LAdoc saying a few years back that dermpath was, per hour, the highest paid field in medicine. Is that still true? Or have reimbursements been cut sufficiently that it's no longer numero uno?

 

[doc MD]

if reimbursements are cut, they just read more slides than they usually would to make up the difference, working 5 instead of 4 hours a day....

 

[MOHS_01]

Interesting. I remember LAdoc saying a few years back that dermpath was, per hour, the highest paid field in medicine. Is that still true? Or have reimbursements been cut sufficiently that it's no longer numero uno?

Cut significantly, yes, and probably no longer true.

 

[MOHS_01]

if reimbursements are cut, they just read more slides than they usually would to make up the difference, working 5 instead of 4 hours a day....

Wrong. Your assumption is that they have an excess of cases to begin with -- something that is not true for the vast, vast majority of practicing dermatopathologists.

 

[doc MD]

Wrong. Your assumption is that they have an excess of cases to begin with -- something that is not true for the vast, vast majority of practicing dermatopathologists.

well, that's just unfortunate...

 

[sore eye asses]

True -- but that's in its infancy, is the lowest paid, and is not referral dependent. Folks are not exactly beating down the door to get in and, more importantly, when viewed through the meaningful metric that is equilibrium dynamics (which is what we are actually discussing here), the relative annual increase for ped derm has been huge over the past decade. It will take a while to determine what the actual need for peds is... but I doubt there's much danger in the flooding of that market given the pressures highlighted above.

haha, i hope that was on purpose.

re relative annual increase, yes it's been huge. they've doubled!! from 4/yr to 8/yr. If this PCR-like growth is maintained we'll have billions of peds dermatologists in just 40 years. I will keep my fingers crossed for this scenario. If this doesn't equilibrate the dynamism, nothing will.

 

[MOHS_01]

haha, i hope that was on purpose.

re relative annual increase, yes it's been huge. they've doubled!! from 4/yr to 8/yr. If this PCR-like growth is maintained we'll have billions of peds dermatologists in just 40 years. I will keep my fingers crossed for this scenario. If this doesn't equilibrate the dynamism, nothing will.

I know, right?

Seriously, though -- 10 years ago there were zero peds derm; then anyone who wanted could take a test and be grandfathered (which is a bunch of ****, but that's another story).

Like I said, though -- don't expect peds derm to ever be saturated in the near future, at least, because so few people want to do it. As Wyatt so aptly said in Tombstone: "It's not my game. There's no money in it."

At one time (not sure if it is still the case) there was a distinct subspecialty of immunologic dermatology... really don't hear much about that one, either.

 

[asmallchild]

I know, right?

Seriously, though -- 10 years ago there were zero peds derm; then anyone who wanted could take a test and be grandfathered (which is a bunch of ****, but that's another story).

Like I said, though -- don't expect peds derm to ever be saturated in the near future, at least, because so few people want to do it. As Wyatt so aptly said in Tombstone: "It's not my game. There's no money in it."

At one time (not sure if it is still the case) there was a distinct subspecialty of immunologic dermatology... really don't hear much about that one, either.

I've been (jokingly I assume) told that contact dermatitis specialization is the new realm for profit-minded individuals

 

[sore eye asses]

I know, right?

Seriously, though -- 10 years ago there were zero peds derm; then anyone who wanted could take a test and be grandfathered (which is a bunch of ****, but that's another story).

Like I said, though -- don't expect peds derm to ever be saturated in the near future, at least, because so few people want to do it. As Wyatt so aptly said in Tombstone: "It's not my game. There's no money in it."

At one time (not sure if it is still the case) there was a distinct subspecialty of immunologic dermatology... really don't hear much about that one, either.

I'm your huckleberry...

and, i'm with you on grandfathering. It's gotten out of control. Grandmothering, on the other hand, I have no problem with.

 

[MOHS_01]

I've been (jokingly I assume) told that contact dermatitis specialization is the new realm for profit-minded individuals

No, not jokingly. It pays well and requires precious little physician time.

It too will fall in reimbursement as more start chasing it, though. That is how the system is designed.

 

[Pam fyck us]

Grandmothering, on the other hand, I have no problem with.

"Just give her Captique, before you both freak."

- Johnnie Cochran

 

[asmallchild]

We are guilty of overtraining for all derm subspecialties; too many Mohs / procedural, too many pathologists... and probably by a significant factor. I still believe derm trained dermpath to be the very best route, however, given the flexibility (and benefit) it provides you.

Curious what you meant by this, best route for a dermatologist? For a dermatopathologist? In all of medicine?

 

[reno911]

Curious what you meant by this, best route for a dermatologist? For a dermatopathologist? In all of medicine?

It is definitely the best in terms of income potential and lifestyle/practice flexibility. As far as what you can do with dermatology training.

I couldn't say for sure in all of medicine since I don't know all the various niches in all of the specialties well enough. But if it is not the best in all of medicine it is still very close to the top.

 

[MOHS_01]

Curious what you meant by this, best route for a dermatologist? For a dermatopathologist? In all of medicine?

Echo what Reno said - best for derm, has to be near the top for all of medicine.

Straight EP is pretty swank from what I hear, too.

There are many unique positions in medicine that can be pretty damn sweet. I have a good job and perform at the upper end for specialty; even at that I earn less than half what the partners at the large urology group in town make. Less than 1/3 of what the interventional cards and EP guys in town make. I am ashamed to say what the big big interventional pain guys make. I put in more hours, but my call is constant (just dead). All in all, I have it better than I deserve - but there are better paths to maximize income /lifestyle.

 

[MilkIsGood]

Echo what Reno said - best for derm, has to be near the top for all of medicine.

Straight EP is pretty swank from what I hear, too.

There are many unique positions in medicine that can be pretty damn sweet. I have a good job and perform at the upper end for specialty; even at that I earn less than half what the partners at the large urology group in town make. Less than 1/3 of what the interventional cards and EP guys in town make. I am ashamed to say what the big big interventional pain guys make. I put in more hours, but my call is constant (just dead). All in all, I have it better than I deserve - but there are better paths to maximize income /lifestyle.

more hours than cards and interventional pain?

 

[MOHS_01]

more hours than cards and interventional pain?

Interventional pain? Hell yes -- not even close. The same for the cards guys I'm talking about... who miss no opportunity to give me **** about how they always see my lonely truck in the parking lot when they're headed out to do whatever. The cards have a ****tier call life than I do, but that is shared across a huge group, some of which "buy out" of call. The local hospital has some grandfathering mechanism for call wherein, after so many years of faithful duty, service call is no longer a requirement. I'm not sure of the particulars (mostly because I told them to piss off, I wasn't taking ER call -- ever), but I do know that the young guys complain and the little older guys like it.

In any event, the guys who do a fair number of Mohs cases and the majority of their own reconstructions put in some pretty long days -- especially for derm.

 

[FuturDocteur]

I thought Mohs surgery was the best route for a dermatologist. How do the 2 subspecialties (Mohs and dermpath) compare?

 

[reno911]

I thought Mohs surgery was the best route for a dermatologist.

Maybe 15 years ago. Not anymore. Only reason to do a Mohs fellowship is if you REALLY enjoy doing it.

What made you think this?

 

[FuturDocteur]

I think I might have heard this being discussed among some dermatologists. I really have no solid evidence. Thanks for responding.

 

[Tamahawk]

Dermpath is definitely NOT the hotness for new graduates these days (cats who have been in the game a while, that's a different story). Job market took a epic turn for the worse this past year (after the 88305 cut). Multiple fellows from top tier programs (programs with dermpath faculty who everyone in Derm knows about...I'm not gonna name names) have had no luck getting a Dermpath job (even 1/2 time) straight out of fellowship this yr. some are deciding to just do clinical Derm and others are taking whatever small amount of glass they are offered (in many cases that is far less than .4 FTE as Dermpath)...even those lucky few of us who did get a job with a significant amount of Dermpath are not making ANY more money than if we did full time clinical Derm. One offer I was given was going to actually pay me 15% less (after my expected production bonus) for doing Derm + Dermpath vs clinical Derm alone.

So, don't do Dermpath for the money. Those days are already gone...

 

[sore eye asses]

Dermpath is definitely NOT the hotness for new graduates these days (cats who have been in the game a while, that's a different story). Job market took a epic turn for the worse this past year (after the 88305 cut). Multiple fellows from top tier programs (programs with dermpath faculty who everyone in Derm knows about...I'm not gonna name names) have had no luck getting a Dermpath job (even 1/2 time) straight out of fellowship this yr. some are deciding to just do clinical Derm and others are taking whatever small amount of glass they are offered (in many cases that is far less than .4 FTE as Dermpath)...even those lucky few of us who did get a job with a significant amount of Dermpath are not making ANY more money than if we did full time clinical Derm. One offer I was given was going to actually pay me 15% less (after my expected production bonus) for doing Derm + Dermpath vs clinical Derm alone.

So, don't do Dermpath for the money. Those days are already gone...

why hard to get a job? yes, less pay, I get that, but why harder to get a dermpath job? With 88305 cut, are current dermpaths reading more slides/day to keep a decent income, creating a drought for new grads? there must be some other factors.

 

[Transformers]

Hows the Mohs market vs. general derm?

 

[MOHS_01]

maybe 15 years ago. Not anymore. Only reason to do a mohs fellowship is if you really enjoy doing it.

What made you think this?

word.

 

[MOHS_01]

Hows the Mohs market vs. general derm?

Gen derm >>>>>>>>> Mohs. Even with gen derm one can no longer pick their spot on the map and be guaranteed success.

Yay central planners. *******s.

 

[Transformers]

Silly few questions:

1.) Does where you do residency dictate where you practice i.e.- does where you do your residency (i.e. in new york) mean thats the area where you'll build contacts and practice in and hence ultimately practice in the new york area?

2.) How variable is gen derm salary regionally? The northeast sounds tempting the salary hits and high costs seem dissuading.

 

[reno911]

Silly few questions:

1.) Does where you do residency dictate where you practice i.e.- does where you do your residency (i.e. in new york) mean thats the area where you'll build contacts and practice in and hence ultimately practice in the new york area?

2.) How variable is gen derm salary regionally? The northeast sounds tempting the salary hits and high costs seem dissuading.

1. It often works out that way, but there is no need to limit yourself. Where you do residency definitely does not dictate where you can work. It just makes it easier to work in the same community, if that is what you want. This factor is important when you know you want to live in a relatively saturated area (e.g., for family reasons)

2. It is quite variable. Basically desirable areas pay more poorly than underserved ones. It's just supply and demand.

 

[FuturDocteur]

Is it a good idea to do a dermpath rotation as a medical student instead of clinical dermatology?

 

[Dral]

Not instead. If you're planning on applying derm, a clinical rotation will give you so much more. If you're hardcore, you could do both, but I'd do clinical first if you plan on getting anything out of dermpath.

You'd probably do a derm research elective and away clinicals before path also.

 

[FuturDocteur]

I'm doing 2 derm rotations. 1 is definitely clinical but I'm debating between clinical vs dermpath for the second rotation.