Falling compensation in Derm Path.... :(

[futurederm2010]

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Hi,
I recently have decided to go into derm and was having dinner tonight with a dermatopathologist, he and I discussed the recently significantly decreased compensation for dermsurg and how it may be coming to the pathology side of derm next. He seemed to think that the coding system will change in the next 5-7 years for Derm path specifically. Thoughts? I know this had happened to the surgical aspects, I was hoping it wouldn't happen to this, I really wanted to do dermpath.

 

[asmallchild]

High paid fields will always be targeted. Not a good idea to pick a specialty based on salary sadly.

 

[SushiKitty]

Haha, please! You can still do dermpath (afterall, you chose it for the intellectual challenge, right? 🙄). You'll just be making $200,000 instead of $400,000. How much money do you really need?

 

[Doublecortin]

Haha, please! You can still do dermpath (afterall, you chose it for the intellectual challenge, right? 🙄). You'll just be making $200,000 instead of $400,000. How much money do you really need?

don't hate, dermapth is probably way more intellectually stimulating than spending your day trying to convince people who have been eating, drinking, and smoking themselves to death for the last 40 years to change their habits 🙄

 

[sensitive skin]

don't hate, dermapth is probably way more intellectually stimulating than spending your day trying to convince people who have been eating, drinking, and smoking themselves to death for the last 40 years to change their habits 🙄

haha, zing!

 

[SushiKitty]

don't hate, dermapth is probably way more intellectually stimulating than spending your day trying to convince people who have been eating, drinking, and smoking themselves to death for the last 40 years to change their habits 🙄

Believe you me that I will not be that doctor. I'm pathology😉. Just wanted to make the point that dermpath compensation is NOT commensurate with that seen in other surg path specialties (GI, GU/GYN, etc) and at some point - who knows when, people will take notice of this. Can't say you didn't see it coming.

I don't want to see any physician's salary decrease. Especially not mine. I just find it humorous that this dermwannabe no longer wants to do dermpath because of possible decline in future salary - which would still be >> average physician salary.

 

[N-Surge]

I don't find any humor in the fact that one still needs to make a living...

 

[Doublecortin]

Believe you me that I will not be that doctor. I'm pathology😉. Just wanted to make the point that dermpath compensation is NOT commensurate with that seen in other surg path specialties (GI, GU/GYN, etc) and at some point - who knows when, people will take notice of this. Can't say you didn't see it coming.

I don't want to see any physician's salary decrease. Especially not mine. I just find it humorous that this dermwannabe no longer wants to do dermpath because of possible decline in future salary - which would still be >> average physician salary.

that goes to show that even derm boards have trolls 😉

 

[bakanoisha]

I don't find any humor in the fact that one still needs to make a living...

I don't think he was arguing against that point, he was just suggesting that a 200K/yr living should be plenty, even with the student debt.

 

[N-Surge]

I don't think he was arguing against that point, he was just suggesting that a 200K/yr living should be plenty, even with the student debt.

It wasn't a matter of argument. It was a matter of humor poorly placed.

 

[MOHS_01]

Haha, please! You can still do dermpath (afterall, you chose it for the intellectual challenge, right? 🙄). You'll just be making $200,000 instead of $400,000. How much money do you really need?

Ahhhh.... spoken like someone who either:

1. has yet to experience the joy of paying back mountains of student loans with after tax dollars or
2. does not benefit from having a family to support, retirement to fund, etc, or
3. wishes to forcibly impose their value structure on others who do not share the belief that one should have their efforts systematically devalued year in and year out...

in any event, those of us working find these views infuriating...

I would suggest not letting them be known on rotations or you will quite likely find your raw fish loving tail doing some specialty other than the one desired.

Oh, BTW -- dermpath is definitely on the chopping block. 30% is the number most often floated around... which also has further implications for micrographic surgery as a significant portion of the 17300 series of codes incorporates path RVU's... so we're taking another hit. (To make matters even worse, they are attempting to devalue reconstruction codes and biopsies as well).

Derm and its subspecialties are victims of their own success, much like ophtho in the 90's. The pendulum is going to swing too far back in the opposite direction; fairness and justness, according to defined RVU determination standards, has precious little to do with any of it. It is cost driven, and the new "redistributionist society" is all to happy to intervene.

I should have ja***** off through medical school too, apparently..........

 

[Taurus]

Can anybody tell me how much the reimbursement cuts were for Moh's surgery?

 

[MOHS_01]

Can anybody tell me how much the reimbursement cuts were for Moh's surgery?

Yes; with the loss of the multiple surgery reduction exemption, revenue was cut approximately 30% on average. This can vary from case to case, but it works out over the course of the year. The 30% reduction in revenue tranlates into a 40-50+% cut in pay, however, for like work. Virtually everyone has changed their practice model; some do more cases per day, some have decreased the amount of Mohs that they do, some have reworked their compensation formulas to represent the new realities....

 

[Taurus]

Derm and its subspecialties are victims of their own success, much like ophtho in the 90's. The pendulum is going to swing too far back in the opposite direction; fairness and justness, according to defined RVU determination standards, has precious little to do with any of it. It is cost driven, and the new "redistributionist society" is all to happy to intervene.

Medicine today is a zero sum game. Every field will get hit eventually. Radiology was hit hard a few years ago too. The saving grace of derm is cosmetics. However, there's no preventing other physicians and even NP's from getting into the cosmetics game either.

 

[DermMatch]

Newsflash: They're already in.

 

[amherstguy]

even with the falling compensation, derm is a sweet deal. you can see a ton a patients per day- and spend five minutes with each max if u want. your malpractice is typically low, and regardless of other people jumping on the boat for cosmetics the only real competition are ents and plastics people. most educated/wealthy people will not let a np put botox into their face. and while the compensation will drop across all fields, derm included, cosmetics is always an option AND you will not be working like a dog to make ure money. the only other field like this i can think of would be ent.

 

[DermMatch]

ENT is too rough a residency. A lot of those guys carry trauma pagers.

Ophtho, too: Blown orbit.

Now * rads * is a sweet deal, although not as a resident when the MICU orders you in at 3 am for an echo.

 

[N-Surge]

Some people let ENTs do tummy tucks, so I've heard. That is one LONG chin! 😵

 

[Long Dong]

Some people let ENTs do tummy tucks, so I've heard. That is one LONG chin! 😵

When I was a med student on ent they did a SCC neck dissection (down to the trachea) and then a jaw reconstruction with a fibular flap. The ent's harvasted it from the leg. So I guess the do cut below the head and neck.

 

[N-Surge]

When I was a med student on ent they did a SCC neck dissection (down to the trachea) and then a jaw reconstruction with a fibular flap. The ent's harvasted it from the leg. So I guess the do cut below the head and neck.

Yeah, my wife just saw a same/similar procedure on her ENT rotation. Cool stuff, imo.

But a tummy tuck?! 😵

 

[Dral]

So wait, ENT's can do tummy tucks, but Dermies are supposed to refer H&N melanomas? 😛

 

[N-Surge]

So wait, ENT's can do tummy tucks, but Dermies are supposed to refer H&N melanomas? 😛

No one said ENTs "should" do anything other than head and neck. I just heard this has happened. Truth or myth? Who knows...

 

[asmallchild]

ENT is too rough a residency. A lot of those guys carry trauma pagers.

Ophtho, too: Blown orbit.

Now * rads * is a sweet deal, although not as a resident when the MICU orders you in at 3 am for an echo.

Radiology is rapidly losing its rep as a lifestyle field (especially during residency) because of the massive utilization of imaging studies.

I did a rotation in radiology as a 3rd year and call was just brutal. (Brutal for the resident and the poor student who couldn't do anything but was still asked to say until 11PM)

Nonstop calls from the ER for wet reads on CXRs, CTs, ultrasounds, etc...

That same resident covers all the reads on the floors as well.

Plus, call responsibility includes the local rehab center and children's hospital.

Not to mention the techs leave after 7PM which means any manual scanning (like with the ultrasound machine) requires the resident to go down and do it.

Rough rough rough. Tack on the fact that radiology is definitely one of the fields that rivals dermatology in terms of how much reading their residents need to do in order to stay afloat.

 

[asmallchild]

Ahhhh.... spoken like someone who either:

1. has yet to experience the joy of paying back mountains of student loans with after tax dollars or
2. does not benefit from having a family to support, retirement to fund, etc, or
3. wishes to forcibly impose their value structure on others who do not share the belief that one should have their efforts systematically devalued year in and year out...

in any event, those of us working find these views infuriating...

I would suggest not letting them be known on rotations or you will quite likely find your raw fish loving tail doing some specialty other than the one desired.

Oh, BTW -- dermpath is definitely on the chopping block. 30% is the number most often floated around... which also has further implications for micrographic surgery as a significant portion of the 17300 series of codes incorporates path RVU's... so we're taking another hit. (To make matters even worse, they are attempting to devalue reconstruction codes and biopsies as well).

Derm and its subspecialties are victims of their own success, much like ophtho in the 90's. The pendulum is going to swing too far back in the opposite direction; fairness and justness, according to defined RVU determination standards, has precious little to do with any of it. It is cost driven, and the new "redistributionist society" is all to happy to intervene.

I should have ja***** off through medical school too, apparently..........

Knowing what you know now, would you still pick dermatology if you were a student today?

 

[MOHS_01]

Knowing what you know now, would you still pick dermatology if you were a student today?

Honestly? No, I would have done plastics. Don't get me wrong, though -- if you are going to be a doc, derm is a pretty sweet gig. Everyone has to be honest with themselves and determine what their internal reward structure is. Once you have determined that, you can make a more informed decision. Mohs was a good gig when I made the decision to go into it; the compensation was adequate and appropriate when viewed in comparison to cosmetic procedures; now that revenue has been cut by 30% or more the trade is no longer equitable....

...which is why I tell people to find something that they enjoy. If you do that, at least you have something tolerable when they decide to bend your wallet over the table.

 

[dgruntledmizzou]

Honestly? No, I would have done plastics. Don't get me wrong, though -- if you are going to be a doc, derm is a pretty sweet gig. Everyone has to be honest with themselves and determine what their internal reward structure is. Once you have determined that, you can make a more informed decision. Mohs was a good gig when I made the decision to go into it; the compensation was adequate and appropriate when viewed in comparison to cosmetic procedures; now that revenue has been cut by 30% or more the trade is no longer equitable....

...which is why I tell people to find something that they enjoy. If you do that, at least you have something tolerable when they decide to bend your wallet over the table.

I had a great disdain of plastics after watching the cr@p that populates TV (especially Dr. 90210)

I have a great deal of respect now for plastics after rotating through at my school. Most of them don't turn out to be the next Dr. Rey and any plastics residency (integrated or not) is brutal. They get whailed on almost as bad as ortho/neurosurg. Not sure if I could turn on derm to pursue something so grueling (no matter what pot of gold is at the end of the rainbow)

 

[futurederm2010]

what kind of cosmetic procedures do dermatologists do? Can they do facelifts, blephs etc?

 

[N-Surge]

what kind of cosmetic procedures do dermatologists do? Can they do facelifts, blephs etc?

Resurfacing, injections, ...

 

[Dermguy]

what kind of cosmetic procedures do dermatologists do? Can they do facelifts, blephs etc?

a few places will train residents to do facelifts & blephs (Miami comes to mind as a place that advertised that on interview day. Anybody else heard that?)

 

[Doublecortin]

I am curious as to what current residents and attendings think about immunoderm fellowships. I am currently doing research in immuno derm and it seems pretty cool.

I haven't seen immunoderm discussed here yet.

How does immunoderm compare with dermpath in terms of job outlook, compensation, overall job satisfaction and so forth?

Thanks

 

[MOHS_01]

I am curious as to what current residents and attendings think about immunoderm fellowships. I am currently doing research in immuno derm and it seems pretty cool.

I haven't seen immunoderm discussed here yet.

How does immunoderm compare with dermpath in terms of job outlook, compensation, overall job satisfaction and so forth?

Thanks

It doesn't.

 

[Doublecortin]

It doesn't.

how so? would you mind elaborating?

 

[MOHS_01]

very small, ultrasubspecialist field, essentially relegating yourself to academic settings, low volume, etc...

 

[N-Surge]

I am curious as to what current residents and attendings think about immunoderm fellowships. I am currently doing research in immuno derm and it seems pretty cool.

I haven't seen immunoderm discussed here yet.

How does immunoderm compare with dermpath in terms of job outlook, compensation, overall job satisfaction and so forth?

Thanks

If you are headed for an academic career then I think you are probably doing yourself a favor. If research and medical derm is your thing then I would think the job outlook in the academic setting would be rather good and that you should be fairly satisfied in the job you land.

Immunoderm = hot area for disease mechanism and drug discovery, in my humble opinion.

I can think of a few diseases one could work on with a rather nice sized patient population.