Mohs surgery job market

[ymeacisrej]

Hello, I am unsure if I want to pursue a fellowship in Mohs surgery. I enjoy procedures, but I am concerned about the opportunity cost and job market. I was hoping that you all could help shed some light on a few questions I have.

a) How is the job market for Mohs surgery graduates? Is the job market saturated such that there are difficulties in finding a job even for part time (1-2 days per week of Mohs)?

b) What types of practice opportunities do new graduates obtain? Are they mainly private practice or academics? I imagine most do not try to open their own private practice given overhead costs and lack of referral base.

Thanks in advance for any help or anecdotal experiences you can share.

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[asmallchild]

Hello, I am unsure if I want to pursue a fellowship in Mohs surgery. I enjoy procedures, but I am concerned about the opportunity cost and job market. I was hoping that you all could help shed some light on a few questions I have.

a) How is the job market for Mohs surgery graduates? Is the job market saturated such that there are difficulties in finding a job even for part time (1-2 days per week of Mohs)?

b) What types of practice opportunities do new graduates obtain? Are they mainly private practice or academics? I imagine most do not try to open their own private practice given overhead costs and lack of referral base.

Thanks in advance for any help or anecdotal experiences you can share.

My last job hunt was quite a few years ago so please take this with a grain of salt

a) My understanding is that if you are interested in part time Mohs, the job market still exists and is probably fairly robust. If you are willing to work in more remote regions or for a PE-owned group, full time Mohs still exists. Immediately starting with full time Mohs in a competitive location is not common

b) I actually think there's a fair bit of flexibility here. I was surprised to see how many of my colleagues entered academics after fellowship. I think it is still more common to pursue private practice. Immediately opening your own practice is still doable. There is obviously larger overhead concerns but this is something still manageable in dermatology compared to other specialties. Without a strong referral base, I think opening your own practice means doing a fair bit of general derm at the beginning to generate your own Mohs cases.

In short, if you have an inkling that you want to do the fellowship, I don't know anyone who has ever regretted it. I think it's a fantastic experience to be a fellow.

 

[Skindoc83]

I agree with the above poster with the one caveat being anyone can now take the mohs board exam and become a “board certified mohs surgeon.” I believe more people took the test this year than the entire membership of the mohs college so I hesitate to predict the future job market. And don’t forget the clowns at the ASMS are opening up their weekend training to non dermatologists.

 

[coroner]

And don’t forget the clowns at the ASMS are opening up their weekend training to non dermatologists.

This surprises me. I always thought Derm was pretty protective of their own. And how is "weekend training" by the people offering these courses deemed sufficient enough to perform Mohs, when the standard is a 1 yr fellowship? I mean it's not like injecting Juvaderm...

 

[confused_doc]

I agree with the above poster with the one caveat being anyone can now take the mohs board exam and become a “board certified mohs surgeon.” I believe more people took the test this year than the entire membership of the mohs college so I hesitate to predict the future job market. And don’t forget the clowns at the ASMS are opening up their weekend training to non dermatologists.

Can you cite the source for this as from what I've seen online, you have to be a dermatologist and have done a fellowship to be eligible to be board certified in mohs surgery.

 

[asmallchild]

Can you cite the source for this as from what I've seen online, you have to be a dermatologist and have done a fellowship to be eligible to be board certified in mohs surgery.

there's a <insert obscenity of choice> "practice pathway" for the first five years

Candidates for the MDS subspecialty certification must:
1. Possess a current, valid, full and unrestricted license to practice medicine or
osteopathy in at least one state or province within the United States or Canada;
2. Hold primary certification in general dermatology from ABD;
3. Be up to date in Maintenance of Certification (MOC) if certification
by ABD is time-limited;
4. Demonstrate experience in the subspecialty by:
successfully completing the ACGME-accredited MSDO fellowship
OR
attesting to active practice of micrographic surgery as part of
one’s patient care activities*
* during an initial five-year practice pathway eligibility period only.
5. Pass the MDS certification examination.

 

[Skindoc83]

This surprises me. I always thought Derm was pretty protective of their own. And how is "weekend training" by the people offering these courses deemed sufficient enough to perform Mohs, when the standard is a 1 yr fellowship? I mean it's not like injecting Juvaderm...

Anyone can bill any medical code, just a matter of whether or not insurance carriers will reimburse. A paper was published once showing that there is at least one doc in Florida, from every medical field, doing mohs, meaning at least one board certified pediatrician or neurologist is performing mohs. Is this safe? Nope. Is this stupid? Absolutely. But stupid doesn’t stop some people from doing things for money. I don’t know why the ASMS is selling out the specialty by offering to train gastroenterologists other than they realize that after the grandfathering window closes their society will die out. But then again the president of that college already works for Forefront dermatology, so he’s used to selling out.

 

[Skinvestigator]

there's a <insert obscenity of choice> "practice pathway" for the first five years

Candidates for the MDS subspecialty certification must:
1. Possess a current, valid, full and unrestricted license to practice medicine or
osteopathy in at least one state or province within the United States or Canada;
2. Hold primary certification in general dermatology from ABD;
3. Be up to date in Maintenance of Certification (MOC) if certification
by ABD is time-limited;
4. Demonstrate experience in the subspecialty by:
successfully completing the ACGME-accredited MSDO fellowship
OR
attesting to active practice of micrographic surgery as part of
one’s patient care activities*
* during an initial five-year practice pathway eligibility period only.
5. Pass the MDS certification examination.

"Hold primary certification in general dermatology from ABD" --> This would cut out many of the non-Dermatologists, so even if ASMS opens up their training to others, they cannot be board certified in MDS.

 

[asmallchild]

"Hold primary certification in general dermatology from ABD" --> This would cut out many of the non-Dermatologists, so even if ASMS opens up their training to others, they cannot be board certified in MDS.

IMO, it's still a poor system that confuses patients (heck, it's confusing to physicians)

Now you can have fellowship-trained Mohs surgeons, you can have board certified Mohs surgeons (who may or may not necessarily be fellowship trained), and you have the ASMS desperately trying to stay relevant by opening their doors to non-dermatologists looking to practice Mohs

Incidentally, results for the first board certification in MDS went out earlier this week. Congratulations to those who passed. I haven't heard stories yet of people who actually failed the exam which just confirms in my mind the exam is a giant cash grab. (EDIT: you can actually see all 1600+ who passed the exam on the ABD site, 95.1% pass rate)