Is Dermatology as perfect as everyone says it is?

[CidHighwind]

Whether it is on SDN, Reddit, or real life, whenever someone asks what they should do, Derm almost always gets brought up. Whenever attendings or residents bitch about their specialty, they almost always compare it to Derm and wish they did that instead. Whenever someone has high stats, they’ll have the “dilemma” of choosing between a “non competitive specialty” and Derm. So I want to hear from you guy’s side, is Derm the best field in medicine?

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[asmallchild]

Whether it is on SDN, Reddit, or real life, whenever someone asks what they should do, Derm almost always gets brought up. Whenever attendings or residents bitch about their specialty, they almost always compare it to Derm and wish they did that instead. Whenever someone has high stats, they’ll have the “dilemma” of choosing between a “non competitive specialty” and Derm. So I want to hear from you guy’s side, is Derm the best field in medicine?

It's a great field.

"Best" is subjective and depends on the person making the judgment.

 

[Skindoc83]

The grass is always greener. I love my job but it is high volume, often repetitious, and sometimes monotonous. I’m in a private practice so there are all of the uncompensated headaches that come with that. With the glut of private equity it’s hard to feel like the sky isn’t falling. Go into what interests you, because you will spend the majority of your life at work, so 40 hours a week in a field that you hate is more intolerable than 60 hours a week in a field that you enjoy.

 

[MOHS_01]

Whether it is on SDN, Reddit, or real life, whenever someone asks what they should do, Derm almost always gets brought up. Whenever attendings or residents bitch about their specialty, they almost always compare it to Derm and wish they did that instead. Whenever someone has high stats, they’ll have the “dilemma” of choosing between a “non competitive specialty” and Derm. So I want to hear from you guy’s side, is Derm the best field in medicine?

Sure.... we are in the catbird seat, the last man on the Titanic. All aboard.

 

[Solodyn]

It is as good as they say.

 

[dermie1985]

I would say there is no perfect specialty. Derm has many of the same problems that any specialty has - high volumes of patients, demanding patients, lots of administrative work / hurdles / prior auths, burden of documentation needs. Our hours are better, the call is less, and the pay is better than most specialties, especially on a per hour basis.

Derm salaries are also highly tied to the fact that (1) we can see patients relatively quickly and there are relatively favorable rules in terms of E&M code billing (e.g. should all return skin checks be a Level IV visit? they are, but not sure they should be) and (2) we do a lot of small procedures that can be billed to insurance for probably more than we should. Billing rules are always changing and who knows if this situation will continue.

I'd choose the specialty you love. Having said that, there's a lot to love about clinical dermatology regardless of work hours and pay, so give it a chance.

 

[Hotei]

So I want to hear from you guy’s side, is Derm the best field in medicine?

I'm not sure. I definitely don't regret choosing dermatology. If you're interested I'd recommend looking into it.

That being said, I've not spent years as an attending in all other fields of medicine. So I don't really know if it's the best.

 

[sore eye asses]

Yes, dermatology is the best field.

This is not anecdotal. This is proven.

Being a dermatologist is like starting every day with a CBD smoothie followed by a stem cell chaser, it’ll cure what ails you. It is a panacea.

Also, our codes are totally safe.

Finally, PE is a blessing. Benevolent business people who can magically convert our field into money, with literally no downside!

 

[sore eye asses]

Dermatology is a Final Fantasy, if you will. It wields the spear against the tyranny of world-ending forces. It is the smoking gun. Like Ben Affleck and Bruce Willis, it will intercept the comet moments before it destroys Arwen and the other nonelven denizens of this good planet just in time for Steven Tyler to belt out a seriously powerful, nay tear-jerking, ballad.

Neurology is Steve Buscemi.

 

[MOHS_01]

Dermatology is a Final Fantasy, if you will. It wields the spear against the tyranny of world-ending forces. It is the smoking gun. Like Ben Affleck and Bruce Willis, it will intercept the comet moments before it destroys Arwen and the other nonelven denizens of this good planet just in time for Steven Tyler to belt out a seriously powerful, nay tear-jerking, ballad.

Neurology is Steve Buscemi.

Wait -- I thought that we were the shield that guards the realms of doctors *who want a life*? Did someone change the #()*$&#$*&(# job description on me?

 

[Dral]

To OP, I never practiced anything else so I guess I can't say for sure. Well, it is better than intern year. I guess I can say that.

There you have it. Dermatology is better than a year of night float, vent settings, having to ask ID to use certain antibiotics, balancing Lasix doses, managing GI bleeds, being a part time care coordinator, and calculating insulin protocols. I wasn't totally independent, but it's the closest I got to that in another field.

 

[CidHighwind]

It is as good as they say.

Thanks for the straightforward answer. I feel like some here feel guilty about how good they have it. Even if you don’t like your job, it’s 30 hours out of your week, and then you have enough money to do whatever you want (making multiples of what the rest of your classmates will make if you do a fellowship). You don’t have geographical restrictions like a lot of other competitive specialties have, you don’t have to take bad call (answering questions>>coming in at 3 a.m. and staying there till morning). Plus I’ve yet to see a Derm resident that was overweight or visibly depressed. Sure you all see a lot of patients, but a lot of the time you can diagnose them by looking at the rash. i To me it seems like what the lay public think of when they think of what “a doctor’s life” is like.

 

[PhillyMed777]

Thanks for the straightforward answer. I feel like some here feel guilty about how good they have it.

It does not appear that you had a "straight forward question," meaning that you actually had a real question and were willing to learn and hear carefully the answers of people who actually work in the field.
It appears you just wanted to hear a specific answer and reinforce your own preconceived ideas.

The notion that "we can work 30 hrs" and "make multiples of what our classmates make" is the dumbest idea. I don't know your level of training and don't care, because I know you have zero real life experience and no real knowledge in this matter.

 

[CidHighwind]

It does not appear that you had a "straight forward question," meaning that you actually had a real question and were willing to learn and hear carefully the answers of people who actually work in the field.
It appears you just wanted to hear a specific answer and reinforce your own preconceived ideas.

I am reading everyone else’s posts, they’re saying things from “we are the last good specialty” to “I haven’t done other specialties, but this one is pretty good” to “we have our downsides, but certainly have our upsides as well”. So yes, I did listen and hear what everyone was saying. This isn’t the anesthesia or RadOnc board where posters are saying “run”.

 

[Dr. Doctor MD]

Thanks for the straightforward answer. I feel like some here feel guilty about how good they have it. Even if you don’t like your job, it’s 30 hours out of your week, and then you have enough money to do whatever you want (making multiples of what the rest of your classmates will make if you do a fellowship). You don’t have geographical restrictions like a lot of other competitive specialties have, you don’t have to take bad call (answering questions>>coming in at 3 a.m. and staying there till morning). Plus I’ve yet to see a Derm resident that was overweight or visibly depressed. Sure you all see a lot of patients, but a lot of the time you can diagnose them by looking at the rash. i To me it seems like what the lay public think of when they think of what “a doctor’s life” is like.

What is with you and your garbage posts both simultaneously trashing and glorifying dermatology? In the last 2 weeks, you've taken every opportunity to post about dermatology and everything you say is naive and misinformed. Seriously, find something better to do with your time.

 

[CidHighwind]

What is with you and your garbage posts both simultaneously trashing and glorifying dermatology? In the last 2 weeks, you've taken every opportunity to post about dermatology and everything you say is naive and misinformed. Seriously, find something better to do with your time.

How am I trashing the field? I, along with most other students, think dermatologists have the best jobs in medicine. The things I’m saying aren’t slights, and there’s no reason to get that upset about it.

 

[Dr. Doctor MD]

How am I trashing the field? I, along with most other students, think dermatologists have the best jobs in medicine. The things I’m saying aren’t slights, and there’s no reason to get that upset about it.

You are going around incorrectly painting a picture of dermatology as if dermatologists are hardly working, never deal with call or administrative burdens, and somehow making absurd salaries, and the truth is that's not the case. Go shadow some dermatologists, and I promise you they work very hard for everything they get.

The job market is tightening in most major cities, PE is laying waste to the field, inappropriate midlevel usage is expanding at unprecedented rates, residencies have expanding at an alarming rate, and the people making the salaries you are thinking about are likely working 50+ hours per week or spent years building up a successful private practice.

Dermatology is a great field, and for sure has it better than numerous other fields, but this unrealistic picture you are painting is not helpful nor is it accurate. More importantly it's misleading to people who then think that dermatology is this perfect field, work hard to match into it, and then realize that everything that they read on SDN or Reddit, wasn't actually true, and then they end up hating their job for the next 40 years, even if it is "only" 40-50 hours per week.

Every field has its pros and cons, and no field is perfect including dermatology (just read the replies above), so please stop propagating this misinformation.

 

[MOHS_01]

Thanks for the straightforward answer. I feel like some here feel guilty about how good they have it. Even if you don’t like your job, it’s 30 hours out of your week, and then you have enough money to do whatever you want (making multiples of what the rest of your classmates will make if you do a fellowship). You don’t have geographical restrictions like a lot of other competitive specialties have, you don’t have to take bad call (answering questions>>coming in at 3 a.m. and staying there till morning). Plus I’ve yet to see a Derm resident that was overweight or visibly depressed. Sure you all see a lot of patients, but a lot of the time you can diagnose them by looking at the rash. i To me it seems like what the lay public think of when they think of what “a doctor’s life” is like.

Tell me you were high when you wrote that.

 

[Hotei]

It does not appear that you had a "straight forward question," meaning that you actually had a real question and were willing to learn and hear carefully the answers of people who actually work in the field.
It appears you just wanted to hear a specific answer and reinforce your own preconceived ideas.

The notion that "we can work 30 hrs" and "make multiples of what our classmates make" is the dumbest idea. I don't know your level of training and don't care, because I know you have zero real life experience and no real knowledge in this matter.

I didn’t know which gif to use so I used them all. Well said.

 

[CidHighwind]

Tell me you were high when you wrote that.

The MGMA has Mohs making 800k a year, unless that’s wrong.

 

[MOHS_01]

The MGMA has Mohs making 800k a year, unless that’s wrong.

Some do - most do not... but you're high af if you think any of them making that are only working 30hrs a week. I'd place those statements somewhere approaching the peak of the curve in in my avatar.

 

[CidHighwind]

Some do - most do not... but you're high af if you think any of them making that are only working 30hrs a week. I'd place those statements somewhere approaching the peak of the curve in in my avatar.

Ok, so like 40-50? MGMA has that as the average, how offbase would you say that is in your opinion?

 

[MOHS_01]

Ok, so like 40-50? MGMA has that as the average, how offbase would you say that is in your opinion?

For the guys making 800? I'd bet the lion's share of them are working 50-60+. It's a helluva lot harder to generate those revenues than you know (or want to believe).

 

[Dr. Doctor MD]

Ok, so like 40-50? MGMA has that as the average, how offbase would you say that is in your opinion?

Good luck finding a job that will let you start out at even 2 days a week Mohs in 2019... A Mohs fellowship probably gives a modest bump in salary, but it doesn't double your dermatology salary for the vast majority of people.

 

[doctalaughs]

Ok, so like 40-50? MGMA has that as the average, how offbase would you say that is in your opinion?

Moreover, you don’t walk into a practice as a new mohs hire and make that type of bank. Those guys built up their referral base over years making much less for a while. And likely spend a lot of non-clinical hours building their practices.

If I hire a new mohs person and they aren’t bringing on new referral streams (ie I as partner have built the practice and generate the mohs referrals) no way I’m paying them that salary. Why would I when I can easily find another fellowship-trained mohs that is dying to do full-time for a reasonable but small bump above genderm?

 

[Slack3r]

I believe OP is an MS4 applying for ortho. No use humoring him/her.

 

[avidrapper]

only thing anyone needs to know is that working 40 hours/week in something you hate is much worse than 70/week in something you love. If you aren’t wanting to spend the extra hours in dermatology (regardless of whether or not you need to), it probably won’t be the right field for you.

also I hope slack3r’s username references runescape.

 

[dermie1985]

only thing anyone needs to know is that working 40 hours/week in something you hate is much worse than 70/week in something you love. If you aren’t wanting to spend the extra hours in dermatology (regardless of whether or not you need to), it probably won’t be the right field for you.

also I hope slack3r’s username references runescape.

This is kind of simplistic - I personally would be miserable working 70 hours/week, even if it was something I love. I think picking the right specialty is a balance of lots of different competing things - but obviously don't go into a specialty you aren't passionate about at some level.

 

[CidHighwind]

This is kind of simplistic - I personally would be miserable working 70 hours/week, even if it was something I love. I think picking the right specialty is a balance of lots of different competing things - but obviously don't go into a specialty you aren't passionate about at some level.

You should like it at some level, but you’re kidding yourself if you think a specialty is competitive JUST because a lot of students share a passion for it.

 

[Splenda88]

You should like it at some level, but you’re kidding yourself if you think a specialty is competitive JUST because a lot of students share a passion for it.

Naive med students and premeds think this way...

 

[CidHighwind]

Naive med students and premeds think this way...

Of course. A job is a means to an end. Hobbies are things you enjoy. Sure you should have some interest in whatever you’re doing, but short of an intense surgery residency, one can still power through whatever for the lifestyle. Which is fine, just that some people get indignant when you mention these things *coughdrdoctormdcough*

 

[Laradd]

Yeah I do agree. It is the best field to have!

 

[Splenda88]

Of course. A job is a means to an end. Hobbies are things you enjoy. Sure you should have some interest in whatever you’re doing, but short of an intense surgery residency, one can still power through whatever for the lifestyle. Which is fine, just that some people get indignant when you mention these things *coughdrdoctormdcough*

Ask these people if they would do medicine if salary were only ~100k/yr...

 

[Jenghiz_Khaan]

It's not seen as "badass" as neurosurgery or cardiology, but the pay will definitely make up for it

 

[yungspleen]

It's not seen as "badass" as neurosurgery or cardiology, but the pay will definitely make up for it

The average neurosurgeon or cardiologist is trumping the average dermatologist's salary unless it's some rural mohs surgeon. If anything it's the hours that will makeup for it. You won't be making 500k for 30 hours a week these days

 

[sore eye asses]

Pay is not based on hours worked but instead on a combination of your own personal efficiency, quality of MAs, payor mix, and patient population.

If you want to make 700K+ as a general dermatologist it’s not really that difficult. It is achievable in the right market just a few years out of residency or even sooner if you can find the holy grail of taking over a retiring physician’s patients.

 

[reno911]

Pay is not based on hours worked but instead on a combination of your own personal efficiency, quality of MAs, payor mix, and patient population.

If you want to make 700K+ as a general dermatologist it’s not really that difficult. It is achievable in the right market just a few years out of residency or even sooner if you can find the holy grail of taking over a retiring physician’s patients.

I'm not sure that "instead" is the right word here. All of those things you list are huge factors, but hours worked is also a factor.

 

[sore eye asses]

Semantics, meh. Obviously, if you work 7 hours a week you’ll make peanuts.

Hopefully nobody read my post and thought “gosh, now that I know the recipe for success, I’ll just do this two days a week and I’ll be rich.”

Typical 4-day week implied.

 

[yungspleen]

Semantics, meh. Obviously, if you work 7 hours a week you’ll make peanuts.

Hopefully nobody read my post and thought “gosh, now that I know the recipe for success, I’ll just do this two days a week and I’ll be rich.”

Typical 4-day week implied.

700k for a 4-day week?

 

[sore eye asses]

Yes.

 

[yungspleen]

Yes.

Sign me up

 

[reno911]

Semantics, meh. Obviously, if you work 7 hours a week you’ll make peanuts.

Hopefully nobody read my post and thought “gosh, now that I know the recipe for success, I’ll just do this two days a week and I’ll be rich.”

Typical 4-day week implied.

Sure. And if you work 5 days a week, you'll make more. Likely more than the 25% more one may expect. Same for 6 days. There are derms who do this. People then hear how much they make and they are floored. The problem is that they don't hear about the hours worked and they just assume it's a standard work week.

 

[doctalaughs]

Sure. And if you work 5 days a week, you'll make more. Likely more than the 25% more one may expect. Same for 6 days. There are derms who do this. People then hear how much they make and they are floored. The problem is that they don't hear about the hours worked and they just assume it's a standard work week.

With the caveat this is true in *some* markets. In other markets you can be super efficient but there isn’t the patient volume to go around.

 

[sore eye asses]

I don’t have any hard numbers to support this, but I’d estimate the number of derms working 5 or more days a week in private practice is less than 10%. I don’t know a single colleague who does this, but I’ve heard of people doing it. Seems to be more popular with PAs, academia and multi-specialty. And obviously if you have your own practice there’s never a “day off.”

Seeing ~40 pt a day, 4 days a week is plenty to keep anybody busy and will pay the bills, anything more than that (for an employed physician) is trading too much time for money IMO. My whole point was that if you maximize your efficiency, are supported by a good team, and have reasonably good contracts you shouldn’t need to work 5 days a week to make a very healthy living as a general dermatologist.

 

[Splenda88]

I don’t have any hard numbers to support this, but I’d estimate the number of derms working 5 or more days a week in private practice is less than 10%. I don’t know a single colleague who does this, but I’ve heard of people doing it. Seems to be more popular with PAs, academia and multi-specialty. And obviously if you have your own practice there’s never a “day off.”

Seeing ~40 pt a day, 4 days a week is plenty to keep anybody busy and will pay the bills, anything more than that (for an employed physician) is trading too much time for money IMO. My whole point was that if you maximize your efficiency, are supported by a good team, and have reasonably good contracts you shouldn’t need to work 5 days a week to make a very healthy living as a general dermatologist.

I like when physicians are dancing around #... Based on your posts, it appears that you work 4 days/wk.... Let's just cut to the chase! What did you make last year working 4 days/wk?

 

[sore eye asses]

*

 

[sore eye asses]

I fear you completely utterly missed the point.

 

[asmallchild]

I like when physicians are dancing around #... Based on your posts, it appears that you work 4 days/wk.... Let's just cut to the chase! What did you make last year working 4 days/wk?

a very healthy living

That's the same answer I would give you if you asked me in person or on an "anonymous" message board. (although I work 5 days/week)

Derm is not a perfect field. It is a great field. One of the great things about it is the lifestyle.

That being said ; one of the things med students and residents often times overlook is that for most fields, you may not be able to control your lifestyle in training but you can reasonably control it as an attending. Yes, there are a few fields that are exceptions. So while the advice is trite and overplayed, it is true: pick what you think you would like to do for the next 20-30 years. Pay and lifestyle are important but they can and will change so I would not base my specialty decision solely on those two factors.

 

[Jenghiz_Khaan]

The average neurosurgeon or cardiologist is trumping the average dermatologist's salary unless it's some rural mohs surgeon. If anything it's the hours that will makeup for it. You won't be making 500k for 30 hours a week these days

True but also keep in mind that working hard in derm is much different than working hard in NS. Maybe comparing the salary to an NS would be overkill but I'd wager the average established dermatologist will be making as much as a general cardiologist.

 

[deleted941485]

Honestly the pay does mean as much to me as the sheer geographic flexibility. Im in Rad Onc and I’d readily give it up for a more secure field.