Mohs vs. Cosmetics

[sunshine02]

Can someone shed some light on the current and/or projected job market for Mohs vs. Cosmetics? Also, is cosmetic derm equally as lucrative as Mohs?

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[asmallchild]

Can someone shed some light on the current and/or projected job market for Mohs vs. Cosmetics? Also, is cosmetic derm equally as lucrative as Mohs?

I currently practice almost all Mohs with very little cosmetics. It hasn't taken me very long to create this kind of practice although admittedly, I practice in the middle of nowhere. I do not think I would have been able to do this or certainly do it as quickly in a more popular area to live.

Projections are all over the place, I see more and more skin cancers every day so my volume has been growing steadily each year I've been out in practice. We hear of complaints of overutilization of Mohs every day as well so who knows where the market is headed. It's trite advice but it's true, you will make a very good living doing gen derm or Mohs or cosmetics. Pick the one you like the most so if/when reimbursements get slashed, you still (somewhat) enjoy what you do.

From the other dermatologists in my part of town, it seems like it is easier to start an all cosmetic practice but overhead and competition are greater. You also need the right kind of personality/patience to deal with cosmetic patients.

As mentioned earlier, all of them are on the higher paying side of medical specialties. Numbers like that change all the time. I would not select one over the other based on current pay.

 

[PhillyMed777]

Agreed -- stop being so "money-centric."
Medicine on the whole is going down money-wise. Never know if the field you pick is the next one on the chopping block, even if its one that currently does decently.

 

[Slack3r]

It’s only a matter of time before they eliminate billing by level.

 

[Skindoc83]

I’m less worried about them no longer paying by the stage then slashing reimbursement for flaps.

 

[MOHS_01]

I’m less worried about them no longer paying by the stage then slashing reimbursement for flaps.

Oh, the flap cut is coming. It’s a given - anything with a global is going to get cut, relatively simple things with 90 day globals will absolutely be crushed. As for the stage payment - that is not one that I have heard seriously discussed, but it is not surprising.

Philosophically speaking - and this probably goes against my personal best interest - I do believe that they need to go to a size / location reconstruction payment metric wherein a 2cm defect on the nasal tip pays X, cheek pays Y, etc, if the goal is to avoid the gaming of the system. The number of 1 - 1.5 cm grafts and flaps that I’ve seen is damn near criminal... and there is but one reason for it.

 

[trobinsonmd]

I was deciding between derm and rad onc last year when I was picking my speciality and ultimately picked derm because I love the level of intricacy and diverse population, but if you are interested in a similar lifestyle and if compensation is big factor (and you don't mind living in the middle of nowhere), you can do rad onc, work 40-50 hours a week, and easily clear 7 digits if you are willing to move to somewhere super rural/remote

 

[Solodyn]

Do Mohs, then after established, do cosmetic

 

[Skindoc83]

Do Mohs, then after established, do cosmetic

If you’re relying on referrals for your mohs then this is a quick way to stop docs from referring you cases. Don’t bite the hand that feeds you

 

[Solodyn]

If you’re relying on referrals for your mohs then this is a quick way to stop docs from referring you cases. Don’t bite the hand that feeds you

No... I mean after you get bored of doing Mohs and become financially independent, (with bonus step of selling practice to PE firm) then do cosmetic for challenge and personal enrichment and get out of insurance game.