Is the derm bubble about to burst?

[K M R]

With the hordes of mid-levels encroaching upon medicine, I wonder ... is derm next? There are nurse practitioners specializing in dermatology, and there is even a DNP dermatology residency offered by the University of South Florida. Is this the beginning of the end? Sure, I would prefer to have a dermatologist look at my irregularly-shaped mole, but I can see why NPs would be eager to get in on the action, especially because of teh $$ and, perhaps, because a lot of dermatological procedures don't require physician-level training. Thoughts?

http://www.nadnp.net/AboutUs.html

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNA_Dermatology_Residency_Presentation.pdf

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[wolfie77]

If that really were to happen I see it as a great thing. I used to have acne problems and my dermatologist was one of the most expensive physicians I've ever seen. He was a great doctor but with a huge price tag.

 

[lobo.solo]

Interesting, I honestly don't care about dermatology and in fact I don't understand why it is a competitive field. I know it pays well, but I just don't get how some people find dermatology interesting...

 

[Charles Darwin]

Interesting, I honestly don't care about dermatology and in fact I don't understand why it is a competitive field. I know it pays well, but I just don't get how some people find dermatology interesting...

Nobody finds skin interesting. Literally zero people in the world find skin interesting. It's all about the cosmetics, cush lifestyle, and easy dough.

 

[gettheleadout]

Nobody finds skin interesting. Literally zero people in the world find skin interesting. It's all about the cosmetics, cush lifestyle, and easy dough.

Trolling or just wrong. Oh, and DNP's will never ever be able to do Mohs.


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[Charles Darwin]

Trolling or just wrong. Oh, and DNP's will never ever be able to do Mohs.


Sent from my iPhone using SDN Mobile

Really? Cut the reimbursements and jack up the hours on derm and let's see how many top med students still find skin so compelling. But we're getting off-topic here...

I believe derms will take on a more administrative role in their patients' healthcare as more NPs and PAs are introduced to the field.

 

[SoulinNeed]

With the hordes of mid-levels encroaching upon medicine, I wonder ... is derm next? There are nurse practitioners specializing in dermatology, and there is even a DNP dermatology residency offered by the University of South Florida. Is this the beginning of the end? Sure, I would prefer to have a dermatologist look at my irregularly-shaped mole, but I can see why NPs would be eager to get in on the action, especially because of teh $$ and, perhaps, because a lot of dermatological procedures don't require physician-level training. Thoughts?

http://www.nadnp.net/AboutUs.html

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNA_Dermatology_Residency_Presentation.pdf

It always amazes me how paranoid pre-meds are. It would take like a decade before we can get any real idea about how DNP's will truly impact Dermatology.

However, yes, it's over. Derm is finished. Pack it up guys.

 

[MedPR]

Speaking of Mohs, I shadowed one and it was pretty cool. I had no interest in derm before I saw that.

 

[sliceofbread136]

Oh look, more mid-level fear mongering. Good post OP, good post

 

[kpcrew]

Nobody finds skin interesting. Literally zero people in the world find skin interesting. It's all about the cosmetics, cush lifestyle, and easy dough.

This is not a DEMocracy but a DERMocracy on SDN and I am a DERMocrat, so please stop being so Skin Sensitive right now

 

[WorldChanger36]

Oh not again... Why is everybody so worried NP and PAs are going to take away their jobs?

 

[gettheleadout]

This is not a DEMocracy but a DERMocracy on SDN and I am a DERMocrat, so please stop being so Skin Sensitive right now

 

[Fivo]

OP why make threads like this? Is it for the attention?

 

[CopaceticOne]

Oh not again... Why is everybody so worried NP and PAs are going to take away their jobs?

My guess is that some are aware of the current job situation for most law grads and are worried that by the time they finish residency, due to increased tuition costs and compounding interest, they will end up in a similar position.

 

[NickNaylor]

Nobody finds skin interesting. Literally zero people in the world find skin interesting. It's all about the cosmetics, cush lifestyle, and easy dough.

I actually find derm pretty interesting because of the significant amount of pathology/histology that's involved. You do realize that not every dermatologist opens a cash-only acne mill, right?

 

[Charles Darwin]

I actually find derm pretty interesting because of the significant amount of pathology/histology that's involved. You do realize that not every dermatologist opens a cash-only acne mill, right?

Now I do, thanks for enlightening me.

 

[SpecterGT260]

Trolling or just wrong. Oh, and DNP's will never ever be able to do Mohs.


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he was extreme and it was hyperbole, but the point was valid.

You would not need a 260 to go derm if it werent for the cush lifestyle and big bucks in the current market. Take those things away and watch the matched step scores plummet to PCP levels.

 

[SpecterGT260]

I actually find derm pretty interesting because of the significant amount of pathology/histology that's involved. You do realize that not every dermatologist opens a cash-only acne mill, right?

there is some good stuff in there, but there is no reason that derm and plastics are so insanely competitive outside of the lifestyle.

 

[gettheleadout]

he was extreme and it was hyperbole, but the point was valid.

You would not need a 260 to go derm if it werent for the cush lifestyle and big bucks in the current market. Take those things away and watch the matched step scores plummet to PCP levels.

Ah but see what I said has nothing to do with that. My point was merely that there are people with subject interest in derm. I wasn't trying to make a claim about the competitiveness at all. On that note though, I have no doubt that the lifestyle and earnings make it competitive, but I don't see the lifestyle (as far as hours, lack of call) going away soon, even if reimbursements fall and cash practices somehow become impractical.


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[JackShephard MD]

With the hordes of mid-levels encroaching upon medicine, I wonder ... is derm next? There are nurse practitioners specializing in dermatology, and there is even a DNP dermatology residency offered by the University of South Florida. Is this the beginning of the end? Sure, I would prefer to have a dermatologist look at my irregularly-shaped mole, but I can see why NPs would be eager to get in on the action, especially because of teh $$ and, perhaps, because a lot of dermatological procedures don't require physician-level training. Thoughts?

http://www.nadnp.net/AboutUs.html

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNA_Dermatology_Residency_Presentation.pdf

Yup. In 10 years the landscape will be completely different. But that's most of medicine.

 

[username456789]

there is some good stuff in there, but there is no reason that derm and plastics are so insanely competitive outside of the lifestyle.

It's not purely exclusive to derm, and it certainly doesn't fill the entire void of which you speak, but dealing mostly with happier, healthier patients day in and day out certainly counts for something in my opinion.

 

[SpecterGT260]

Ah but see what I said has nothing to do with that. My point was merely that there are people with subject interest in derm. I wasn't trying to make a claim about the competitiveness at all. On that note though, I have no doubt that the lifestyle and earnings make it competitive, but I don't see the lifestyle (as far as hours, lack of call) going away soon, even if reimbursements fall and cash practices somehow become impractical.


Sent from my iPhone using SDN Mobile

fair enough. I didnt read his post as literal, but just an exaggeration of the scenario I posted.

 

[SpecterGT260]

It's not purely exclusive to derm, and it certainly doesn't fill the entire void of which you speak, but dealing mostly with happier, healthier patients day in and day out certainly counts for something in my opinion.

I did not consider that

 

[DrAwsome]

With the hordes of mid-levels encroaching upon medicine, I wonder ... is derm next? There are nurse practitioners specializing in dermatology, and there is even a DNP dermatology residency offered by the University of South Florida. Is this the beginning of the end? Sure, I would prefer to have a dermatologist look at my irregularly-shaped mole, but I can see why NPs would be eager to get in on the action, especially because of teh $$ and, perhaps, because a lot of dermatological procedures don't require physician-level training. Thoughts?

http://www.nadnp.net/AboutUs.html

http://health.usf.edu/nocms/nursing/AdmissionsPrograms/DNA_Dermatology_Residency_Presentation.pdf

As someone who is coming from the derm field and switched into something else, I would say so. I think there are a lot of derms who have an entitled attitude, and think just because their field is so "competitive" they are the greatest thing on earth. What makes derm competitive is not the field in and out of itself, but rather the small # of spots. If spots were increased, competitiveness of derm would be absolutely gone. A minute amount of people find derm problems interesting imo, but the lifestyle is quite good and the money is pretty good. However, when there is such a bottleneck, inevitably midlevels encroach. Does derm need physician level training? Probably a good 70-80% of cases can be resolved with much less training. In these days, bread and butter derm involves a lot of biopsing which is sent to path, and prescribing a combination of steroids/etc for random rashes and other conditions which never get diagnosed.

As far as cosmetics, a lot of people have started getting a piece of that pie, myself included. Dont need much training/smarts to open up a spa with some minor training and good business savvy. If derm was smarter, they would not make it so that there is such a huge deficit in terms of providers. When I suggested we increase spots at my program, I got looked at like I had 3 heads. Oh well.

While midlevels will never be as good as physicians, there are shortages that need to be filled. I think in maybe a decade or so, things will revert, given that midlevels will never be as knowledgeable and people won't have as good outcomes in general, and medicine will rebound. For the next decade or so, I think any specialty that has allowed midlevels will see some pain.

 

[DrAwsome]

there is some good stuff in there, but there is no reason that derm and plastics are so insanely competitive outside of the lifestyle.

You would be absolutely correct. If derm paid the same as primary care, interest in the field would fall drastically.

 

[K M R]

As someone who is coming from the derm field and switched into something else, I would say so. I think there are a lot of derms who have an entitled attitude, and think just because their field is so "competitive" they are the greatest thing on earth. What makes derm competitive is not the field in and out of itself, but rather the small # of spots. If spots were increased, competitiveness of derm would be absolutely gone. A minute amount of people find derm problems interesting imo, but the lifestyle is quite good and the money is pretty good. However, when there is such a bottleneck, inevitably midlevels encroach. Does derm need physician level training? Probably a good 70-80% of cases can be resolved with much less training. In these days, bread and butter derm involves a lot of biopsing which is sent to path, and prescribing a combination of steroids/etc for random rashes and other conditions which never get diagnosed.

As far as cosmetics, a lot of people have started getting a piece of that pie, myself included. Dont need much training/smarts to open up a spa with some minor training and good business savvy. If derm was smarter, they would not make it so that there is such a huge deficit in terms of providers. When I suggested we increase spots at my program, I got looked at like I had 3 heads. Oh well.

While midlevels will never be as good as physicians, there are shortages that need to be filled. I think in maybe a decade or so, things will revert, given that midlevels will never be as knowledgeable and people won't have as good outcomes in general, and medicine will rebound. For the next decade or so, I think any specialty that has allowed midlevels will see some pain.

These are my thoughts exactly. I've never had to see a dermatologist, so I don't know precisely what they do, but I'm guessing much of what they do is extremely routine. Like you said, stuff like biopsies, oral steroids, maybe some topical creams here and there. You probably don't need 15 years of expensive training to be able to do those things.

 

[lobo.solo]

you would be absolutely correct. If derm paid the same as primary care, interest in the field would fall drastically.

+1

 

[JackShephard MD]

It's not purely exclusive to derm, and it certainly doesn't fill the entire void of which you speak, but dealing mostly with happier, healthier patients day in and day out certainly counts for something in my opinion.

I've never understood the doctors who say they want to deal with healthy patients.

 

[Drrrrrr. Celty]

Plenty of Dermatologists deal with skin cancers. I've seen plenty of dermatologists preform biopsies and other procedures. And skin is an interesting organ in my opinion.


Anyway, the answer is no. Too few dermatologists are being produced and way too many customers need them, which is why the average line to see one is 3 months. So demand is high and NPs can't do any of the crap dermatologists do from biopsies to freezing things to mohs, etc.

 

[K M R]

Plenty of Dermatologists deal with skin cancers. I've seen plenty of dermatologists preform biopsies and other procedures. And skin is an interesting organ in my opinion.


Anyway, the answer is no. Too few dermatologists are being produced and way too many customers need them, which is why the average line to see one is 3 months. So demand is high and NPs can't do any of the crap dermatologists do from biopsies to freezing things to mohs, etc.

You just described the bubble. My thinking is that NPs can do much of what dermatologists do, thus it's just a matter of time before they're allowed to. I hope the lack of dermatologists can be blamed on too few residency spots, because if the AMA/AAD was restricting the flow of new dermatologists, that would be incredibly unethical. High costs and long wait times are not good for patient health.

 

[username456789]

I've never understood the doctors who say they want to deal with healthy patients.

That's fine, and that's while you probably will avoid Derm and Ophtho.

It's fun dealing with patients who are pleasant and happy. I have found through my years in medical school and prior to medical school that these tend to make up a larger percentage of specialties such as those listed above than many others.

 

[JackShephard MD]

That's fine, and that's while you probably will avoid Derm and Ophtho.

It's fun dealing with patients who are pleasant and happy. I have found through my years in medical school and prior to medical school that these tend to make up a larger percentage of specialties such as those listed above than many others.

Oh, I don't doubt that it's fun to deal with pleasant and happy patients. I'm sure it's less work and less stress.

It's an interesting philosophy for a physician.

You're right, I will avoid derm and have little interest in it. I'd probably have difficulty matching derm though anyway.

 

[catzzz88]

I do derm research--melanoma. I work in clinic with patients quite a bit but I also do wet lab research.

Although there are a lot of people here saying that interest in Dermatology is not genuine and is money-driven, I felt compelled to point out that Derm is not all rashes, pimples, and warts.

Dermatology is a very visual specialty; I think that this side of the field is really interesting. A patient can point to the area of concern and a doctor can visually examine it. In the hospital where I work, we are following clinical trials patients who have melanoma. Sometimes, the results of a successful treatment can shrink a visible melanoma lesion considerably, or even cause it to shrivel up and fall off completely. Sometimes sites of metastasis are palpable and just under the skin. After treatment, you can sometimes no longer feel the lump. Visualizing this -- something you can take a picture of and compare from week to week -- is really exciting to me. There are not many other specialties like this. Improvement--measurements of success--are quantifiable and tangible... not just subjective or quantitative. I think that this could translate to other more general procedures and treatments in derm. Acne can be humiliating and debilitating for young people and with proper treatment, you can give a kid confidence and watch the acne subside over time. I could never treat acne or pop pimples my whole life though. Oncology will always hold a special place in my heart--it just feels so much more meaningful.

I am not saying that I will definitely or even probably go into dermatology. I have not yet even entered medical school and I have a lot of other specialties to explore, but I can still say that out of the other specialties that I have been a part of in the clinic--all oncology--derm has a special "visual" quality that I find very appealing. This may have to do with my background as an artist.

Idk I just felt like this thread needed a bit of derm love and a little bit of consideration of the other side of the story.

Best,
C

 

[AestheticGod]

I didn't read the whole thread, but here's my idea of dermatology future.

Internet will take over. Except for the surgery part, which isn't a lot.

 

[RogueUnicorn]

my #1 goal in medical school is to be interested in skin. not lookin good so far

 

[HoltMD]

I heard RNs and PharmDs will be taking over cardiology.

I am so bummed. I think I need a hug.

 

[KnuxNole]

That's fine, and that's while you probably will avoid Derm and Ophtho.

It's fun dealing with patients who are pleasant and happy. I have found through my years in medical school and prior to medical school that these tend to make up a larger percentage of specialties such as those listed above than many others.

Optho probably has a ton of unhealthy patients too.

 

[KnuxNole]

Personally, derm makes me sleepy. During skin pathology I wanted to rip my eyeballs out. Reading about it for Internal medicine was rough.

With that said, it has an amazing lifestyle, lots of pt satisfactions, lots of neat procedures, etc. So I can see why it's very competitive. I signed up for a derm elective just cause there was next to no exposure to derm during 3rd year, and my skin diagnosis is limited to "Uh...it looks red and bumpy!". Plus the hours are really, really cush

 

[235788]

If that really were to happen I see it as a great thing. I used to have acne problems and my dermatologist was one of the most expensive physicians I've ever seen. He was a great doctor but with a huge price tag.

why didn't you just have your family doc take care of it?


oral antibiotics + topical. Easy mode.

 

[shamwowzer]

why didn't you just have your family doc take care of it?


oral antibiotics + topical. Easy mode.

Certain types of acne aren't able to be taken care of with just oral antibiotics/topical creams. I had cystic acne but luckily my dermatologist treated me with accutane and allowed me to avoid having scars.

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[235788]

Certain types of acne aren't able to be taken care of with just oral antibiotics/topical creams. I had cystic acne but luckily my dermatologist treated me with accutane and allowed me to avoid having scars.

Sent from my DROID2 using Tapatalk

I saw a derm at first and then just had my family med doc take over. Luckily, I didn't need anything serious like accutane.

 

[wolfie77]

why didn't you just have your family doc take care of it?


oral antibiotics + topical. Easy mode.

I saw a derm at first and then just had my family med doc take over. Luckily, I didn't need anything serious like accutane.

i did need the accutane. i don't think primary care doctors usually prescribe that stuff out.

 

[Haislip]

*This may be stupid or whatever but I am serious"

Do DNPs, NPs or PAs really serve as a threat to the job securiy of MD/DOs in any field. I am talking 20-30 years down the road.I am not sure if anyone can say for certain but any insight is appreciated.

 

[235788]

*This may be stupid or whatever but I am serious"

Do DNPs, NPs or PAs really serve as a threat to the job securiy of MD/DOs in any field. I am talking 20-30 years down the road.I am not sure if anyone can say for certain but any insight is appreciated.

ughhh yeah

 

[SpecterGT260]

*This may be stupid or whatever but I am serious"

Do DNPs, NPs or PAs really serve as a threat to the job securiy of MD/DOs in any field. I am talking 20-30 years down the road.I am not sure if anyone can say for certain but any insight is appreciated.

No.... they are job security. Someone will have to repair all the damage done after they are through with the patient if they get autonomous practice

 

[235788]

No.... they are job security. Someone will have to repair all the damage done after they are through with the patient if they get autonomous practice

family medicine is going to get hit hard by them (IMO) and I base this off of nothing other than speculation.

It makes sense.

Optometrists can now do eye surgery (2 states), Pods do surgery on up hips in some states, crna's can gas under supervision of surgeon, NPs think theyre derms and will soon think they're cardiologists/GE/Every other internal med fellowship


NP's can also independently bill for the same rates as MD/DO's in some states. They are a major threat.


Only Surgery is safe

 

[Haislip]

No.... they are job security. Someone will have to repair all the damage done after they are through with the patient if they get autonomous practice

lol ok

 

[SpecterGT260]

family medicine is going to get hit hard by them (IMO) and I base this off of nothing other than speculation.

It makes sense.

Optometrists can now do eye surgery, Pods do surgery on up hips in some states, crna's can gas under supervision of surgeon, NPs think theyre derms and will soon think they're cardiologists.

Surgery is safe

that's where I'm going xf, and that is where they stand as job security my statement was mostly joking. All we need is for an RN to kill 1 senator due to overstepping their bounds and this entire problem goes away....

 

[lobo.solo]

i did need the accutane. i don't think primary care doctors usually prescribe that stuff out.

Yeah, accutane is a serious drug with some pretty bad side effects maybe that's why they leave it to derm people to prescribe. I know the drug strength is related to your weight or something like that...

 

[wolfie77]

Yeah, accutane is a serious drug with some pretty bad side effects maybe that's why they leave it to derm people to prescribe. I know the drug strength is related to your weight or something like that...

Yeah when he prescribed it, the derm sat there and did some calculations on paper to decide how many pills i'd need per day.