Is Dermatology as perfect as everyone says it is?

[MOHS_01]

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 know several.

I think they're nuts.

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[Solodyn]

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.

A dermatologist can easily make more money than neurosurgeons and cardiologists. Doesn't mean we all want to. Derm can leverage PAs and NPs much better than these other fields. You won't see neurosurgeons opening 10-15 clinics unless they hire tons of neurosurgeons. Same for cardiology. There are no Cardiology PAs running rampant. So if you are an ambitious derm, it is possible to make 7 figures while staying at home. This is done on a regular basis with the most successful one being the owner of Advanced Derm. I can name at least one entrepreneurial derm in pretty much every major city.

 

[doctalaughs]

A dermatologist can easily make more money than neurosurgeons and cardiologists. Doesn't mean we all want to. Derm can leverage PAs and NPs much better than these other fields. You won't see neurosurgeons opening 10-15 clinics unless they hire tons of neurosurgeons. Same for cardiology. There are no Cardiology PAs running rampant. So if you are an ambitious derm, it is possible to make 7 figures while staying at home. This is done on a regular basis with the most successful one being the owner of Advanced Derm. I can name at least one entrepreneurial derm in pretty much every major city.

Depends on your definition of “easily.” Most fields have business opportunities although you could argue that in certain cities in derm the barrier to entry is easier.

It’s true you can open 15 clinics and leverage PAs (and other docs) but then you are making money as a businessman, not a doctor- same as all the other Non-physicians that make a killing in healthcare.

Also depends on how ethical you are in terms of squeezing healthcare dollars out of a system that increasingly provides high-volume low quality care.

 

[Solodyn]

Not arguing that this is more of a "business" opportunity than Medicine. However, you also can't deny that it is not realistic to leverage mid-levels in other specialties like Neurosurgery or Cardiology. You can possibly do so with family medicine or pediatrics, but there are lot less in-office procedures to make it process lucrative.

Many Mohs surgeons have in the past hire mid-level to do biopsies to create a funnel for Mohs surgery cases. Then the physician's time is focused on lucrative surgeries. This is also not possible with other specialties. Dermatology presents a unique opportunity that is not available for non-physicians. Non-physicians simply cannot own individual medical practices.

I am not arguing over the ethics of leverage mid-levels; I certainly don't own 15 clinics. Nonetheless, we all know this can be done in derm more easily than other specialties.

 

[MOHS_01]

Not arguing that this is more of a "business" opportunity than Medicine. However, you also can't deny that it is not realistic to leverage mid-levels in other specialties like Neurosurgery or Cardiology. You can possibly do so with family medicine or pediatrics, but there are lot less in-office procedures to make it process lucrative.

Many Mohs surgeons have in the past hire mid-level to do biopsies to create a funnel for Mohs surgery cases. Then the physician's time is focused on lucrative surgeries. This is also not possible with other specialties. Dermatology presents a unique opportunity that is not available for non-physicians. Non-physicians simply cannot own individual medical practices.

I am not arguing over the ethics of leverage mid-levels; I certainly don't own 15 clinics. Nonetheless, we all know this can be done in derm more easily than other specialties.

This is actually less and less true; the corporate practice of medicine pendulum has been swinging away from protectionist policy for some time now while the scope of practice and midlevel autonomy regulations have been similarly getting more lax.

There's a structural race to the bottom going on now -- I would not want to be in the crosshairs of that particular train.

 

[mja75]

Ran into an old classmate now doing general derm. She works 20-something hours weekly for ~$400k. Forget the 7 figure salaries, this is true wealth. Making a mint and having the TIME to enjoy it.

 

[PhillyMed777]

20-something hours weekly for ~$400k.

how?
where do they work/are they making money not from dermatology directly?

 

[Skindoc83]

Ran into an old classmate now doing general derm. She works 20-something hours weekly for ~$400k. Forget the 7 figure salaries, this is true wealth. Making a mint and having the TIME to enjoy it.

I don’t believe those numbers. A general dermatologist, in private practice, accepting insurance, is not making anywhere close to that working only 20 something hours a week. There are other factors at play here if she is actually being truthful with regards to her earnings and hours worked.

 

[mja75]

how?
where do they work/are they making money not from dermatology directly?

I don’t believe those numbers. A general dermatologist, in private practice, accepting insurance, is not making anywhere close to that working only 20 something hours a week. There are other factors at play here if she is actually being truthful with regards to her earnings and hours worked.

I understand your skepticism guys. SDN is rife with so many anecdotal stories, most of which are likely false. I don't doubt her story but I can't 100% say its a real figure. However, there are indeed great gigs all around you. (I consider my own gig one of those.)

I reiterate though that having the time to enjoy your life/family/money as a physician is waaay more important than matching or beating any number on the MGMA survey.

 

[Dr. Doctor MD]

I understand your skepticism guys. SDN is rife with so many anecdotal stories, most of which are likely false. I don't doubt her story but I can't 100% say its a real figure. However, there are indeed great gigs all around you. (I consider my own gig one of those.)

I reiterate though that having the time to enjoy your life/family/money as a physician is waaay more important than matching or beating any number on the MGMA survey.

If I've learned one thing after going through medical school, it's that medical students (and unfortunately some residents/attendings) lie for clout incessantly. Seeing the glut of instagram influencer classmates just further proves how status obsessed and fake these people can be. Some of these students are bottom of the class, close to dropping out, but on Instagram they are acting like they are running codes all day and saving lives 2 months into MS1. Very easy to smell the BS as someone in medicine, but the general public worship these posts. Every students likes to talk about how they got a 95% on the exam by cramming the night before, when in reality they actually studied 40 hours a week for a month, but hate to admit it. I have no doubt these same people go on to brag about how they make X $$$ or only work Y Hours. Sure some people have great jobs, great pay, and great hours in many fields. But no one is just sitting back, barely working, and getting handed absurd salaries. Maybe 20-30 years ago, but doctors work damn hard for every penny, and I think your colleague is leaving out some very important details if she is telling you she's making $400K working 20 hours a week.

and hey, maybe she does have some sweet gig doing only botox and filler 2.5 days per week, all day, cash pay, with just a single MA or has some other real job where this is the case, but regardless it would be a single data point and a pretty significant outlier even if it was true.

 

[mja75]

What is a realistic figure for a part time dermatologist?

 

[Dr. Doctor MD]

What is a realistic figure for a part time dermatologist?

I don't believe there's any single answer for this. I think it would vary greatly based on location, payor-mix, practice setting (PP vs Specialty group vs locums vs PE) and what patient volume procedures you do daily. Also overhead is largely a fixed cost so working less days/hours leads to overhead eating up a larger % of your revenue/income. I would expect in general that a 50% reduction in hours would lead to a >50% reduction in pay for pretty much most medical specialties.

 

[Slack3r]

6 patients an hour, 20 hrs per week, 50 weeks per year at an average of $135 per encounter would put you at approx $800k gross. 50% of collections...

I still highly doubt it for multiple reasons ($ per encounter is prob high nowadays and doubt she’s getting 50% of collections for a part time gig), but it’s not entirely outside the realm of possibility.

 

[MOHS_01]

6 patients an hour, 20 hrs per week, 50 weeks per year at an average of $135 per encounter would put you at approx $800k gross. 50% of collections...

I still highly doubt it for multiple reasons ($ per encounter is prob high nowadays and doubt she’s getting 50% of collections for a part time gig), but it’s not entirely outside the realm of possibility.

You really think anyone who only wants to work 20hr/week will work a full 50 weeks/yr? With holidays and vacation, I'd venture a guess that the number of "full" 20hr weeks is less than 46....

We agree -- this is very generous.