Is derm more competitive this year than last?

[lesterfreamon]

As a neurotic MS3, I am already thinking about the stress of matching into derm. With 8-10 people in my class interested in derm, is it getting harder and harder?

Do most people have a backup?

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[doc MD]

i think it is getting easier since it is not as lucrative as before.

 

[Slack3r]

i think it is getting easier since it is not as lucrative as before.

I think it'll take a while before those changes actually filter down and become apparent to med students. Radiology has taken hit after hit for a few years now and it still seems to be fairly competitive at most places.

 

[NSight8]

And in reality, what in medicine hasn't or will not take a hit. Perhaps primary care. Although I did hear chiropractor reimbursement just went up by 12%. Maybe we should encourage dropping out of residency match to pursue that route.

 

[Balderdash]

In all likelihood yes with more medical schools and the same number of residency slots. We have had 75 more applications at our program this year.

Additionally, with cuts across the board, Derm may still maintain high interest levels as it still allows for more freedom as far as scheduling compared to others.

 

[pinecat]

I

As a neurotic MS3, I am already thinking about the stress of matching into derm. With 8-10 people in my class interested in derm, is it getting harder and harder?

Do most people have a backup?

I threw caution to the wind

 

[asmallchild]

As a neurotic MS3, I am already thinking about the stress of matching into derm. With 8-10 people in my class interested in derm, is it getting harder and harder?

Do most people have a backup?

At my home program, I've found it's getting more competitive and not less despite reimbursement cuts. I always recommend checking with an advisor within the dermatology department to see if they recommend a backup or not

 

[Medicine123abc]

I'm wondering if the attendings could comment on how Dermatology has become "less lucrative". I understand Dermpath suffered major cuts in recent years. Just today, a NYTimes article essentially singles out Dermatology as the highest growth in regards to physician revenue for the past 25 years.

 

[asmallchild]

I'm wondering if the attendings could comment on how Dermatology has become "less lucrative". I understand Dermpath suffered major cuts in recent years. Just today, a NYTimes article essentially singles out Dermatology as the highest growth in regards to physician revenue for the past 25 years.

I wouldn't put too much stock in what the NYTimes has to say as it is a notoriously liberal (and seemingly anti-doctor) paper.

There have been numerous code cuts in the past years that have been unfriendly to dermatology. Popularity among medical students still seems to be high as hopefully dermatology offers something else to them beyond financial benefit. Yet another reminder that while finances certainly should play a role in specialty selection, it should not be the sole or overriding factor as that is a guaranteed road to disenchantment.

 

[MOHS_01]

I'm wondering if the attendings could comment on how Dermatology has become "less lucrative". I understand Dermpath suffered major cuts in recent years. Just today, a NYTimes article essentially singles out Dermatology as the highest growth in regards to physician revenue for the past 25 years.

In 2008 Mohs lost its multiple procedure reduction exemption; this results in a 25-35% cut in reimbursement for like work compared to 2007. This was partially offset by increases in the reimbursement for certain reconstruction codes, but not completely. Two years ago carriers began to change the interpretation of E&M services with minor procedures; initial visit, diagnosis, and counseling was no longer sufficient to warrant an E&M. Last year they pushed the envelope even further by applying increasingly stringent (and arbitrary) "medical necessity" requirements to this. Given that many visits to the dermatologist result in a discussion on the dangers of tanning, smoking, dry skin, best soaps, SK's, lentigines, maybe a few AK's here and there -- they are now trying to balk at payment for the balance of issues discussed if you perform a local destruction or biopsy something. You can win on appeal quite often, but it adds man hours in cost and ***** with your revenue cycle.

Said simpler: if in 2007 you did $500k of business and it cost you $250k to operate (not unreasonable for most general derms, both numbers probably just a hair low -- but not by much), you made $250k before taxes and retirement contributions. If you take a 20% haircut due to reimbursement changes, that $500k book of business in now only $400k in revenues -- but your expenses remain $250k. Nice haircut. Of course it is not quite so clean and neat as people with options don't just take things like that on the chin without making some kind of changes. Odds are you increase the volume of services you provide... which increases the costs to provide them... and on and on the vicious cycle goes until you end up in the same rat race as everyone else, a rat race you swore you would avoid.

Fun times.

 

[Silent Cool]

Yes, Derm is more competitive this year than last. Next year it will be more competitive. The increase in competitiveness is exponential such that it will eventually form an asymptote and no one will get in....unless you have a 367 board score.

No I'm just f****** with you I have no idea.

 

[DermViser]

As a neurotic MS3, I am already thinking about the stress of matching into derm. With 8-10 people in my class interested in derm, is it getting harder and harder?

Do most people have a backup?

It gets more competitive every year. Even with salaries slated to go down across the board due to Obamacare, Derm is 1) a completely outpatient based specialty thus the ability to not be under the thumb of a hospital, 2) relatively very quick visits in comparison to say General Internal Medicine visits, 3) the chance to go completely outside of the system and do complete cash pay. On top of that the lifestyle is one of the best in medicine. So yes it's competitive and will likely stay that way, even with decreased salary as there are other very good reasons that make the field very attractive.

 

[angry cow]

ya'll make too much money and you train too few residents per year. i can't wait for the medicare axe to come down on y'all. haha.

 

[DermViser]

ya'll make too much money and you train too few residents per year. i can't wait for the medicare axe to come down on y'all. haha.

 

[angry cow]

why should you be paid 2-4x as much as someone who provides more benefit to society like an internist or pediatrician? answer: you shouldn't

medicare will fix this problem

 

[DermViser]

why should you be paid 2-4x as much as someone who provides more benefit to society like an internist or pediatrician? answer: you shouldn't

medicare will fix this problem

Contrary, to thinking you have all the answers, you're continuing to show how stupid you are, as you have no idea how actual reimbursement, much less reimbursement for Medicare, works. Obvious troll is obvious.

 

[angry cow]

Contrary, to thinking you have all the answers, you're continuing to show how stupid you are, as you have no idea how actual reimbursement, much less reimbursement for Medicare, works. Obvious troll is obvious.

look at other western countries, kid. canada, UK, australia, etc. all pay dermatologists a more sensible salaries (100k-200k). y'all have no where to go but down, down, down lol

 

[DermViser]

look at other western countries, kid. canada, UK, australia, etc. all pay dermatologists a more sensible salaries (100k-200k). y'all have no where to go but down, down, down lol

Your post is rich, considering you yourself are going into Radiology in which ordering repeat X-rays, CTs, MRIs, is much huger problem in our health care system. Of course, this is why Radiology is getting hit hard with imaging cuts. The popping up of Teleradiology is even a bigger problem for your specialty.

 

[angry cow]

lol you're such a stalker...

dermatology a parasite. ya'll are gonna make the same as a family practice physicians soon enough. in fact they could do your job just as well.

 

[DermViser]

lol you're such a stalker...
dermatology a parasite. ya'll are gonna make the same as a family practice physicians soon enough. in fact they could do your job just as well.

Yawn. Hospitals largely control which specialties they want to create residency spots in to bring in revenue to the hospital. If Family Doctors could actually do all that encompasses Dermatology, then there would be absolutely no need for Dermatologists. Obviously, this is nowhere close to being the case, or this would have happened a long time ago. Family Medicine continues to refer derm cases in which they don't know what to do, to Dermatologists.

Oh, you mean finding context for your 5 posts? I think it's interesting how you try to portray yourself as somehow loving of primary care, when you yourself are going for Radiology. One can make the SAME arguments you're making against Derm - against Radiology.

Several arguments that can be made against Radiology:
1) Many specialties, EM/Surgery/Ortho, etc., read their own studies and act on it, without needing to wait for the final read done by Radiology. Many times the final read comes back LONG AFTER the team has carried out the plan and the pt. has been discharged. If any specialty can be labeled a "parasite" by other specialties, as you have, it would be Radiology: http://www.epmonthly.com/columns/in-my-opinion/the-life-cycle-of-a-parasitic-specialist/

2) Teleradiology firms that have popped up in droves in which Radiologists get licenses in several states and read for many hospitals. Thus making it cheaper to hire them, than to hire attending radiologists or have a residency program: http://forums.studentdoctor.net/threads/sorry-your-residency-program-is-closing.984634/

3) Overuse and overreliance on imaging which is well-established in the literature - thus resulting in the flood of reimbursement cuts your specialty is getting: http://www.fiercemedicalimaging.com/story/imaging-reimbursement-cuts-enough-enough/2013-12-01

It's not our problem, that your specialty was stupid enough to create so many radiology spots, in even the worst no-name, non-academic places, thus overflooding the market with new grads and that your many of your established radiologists are refusing to retire.. Your specialty is hospital-based and thus HIGHLY dependent on government reimbursement, unlike Dermatology. Enjoy!

 

[angry cow]

lol i must have struck a nerve

just like a dermatologist to be so money crazed...

i can be happy on 150k-200k. can you?

 

[asmallchild]

Closing as this is getting off topic.

I remind people to remain courteous on these forums. It's fine to have a difference of opinion (erroneous as it may be). Trolling with inflammatory comments is not acceptable.