General derm is still not all that difficult to find a job in, but finding the job you want, in the location you want, will likely prove increasingly difficult as the years go by. All one has to do is look at the number of searches conducted by the larger recruitment firms to see the trend. You can also look at the number of jobs posted in throw aways over the years and subtract the number of practices for sale (predominantly older guys who could either not attract or not retain a successor) and get a similar idea. While I have not followed the dermpath job market all that closely, I can assure you that, for Mohs at least, the job search difficulty is not limited to the coastal cities. My instinct is that that a similar patten holds true for dermpath... that those who are derm trained and willing to provide general derm services are much more employable than those who do not meet these criteria.
There are a number of reasons behind this. Not to derail the topic entirely, but we have had a massive increase in the number of trainees over the past decade (percentage wise), and we should all be aware of how small changes in a steady state equilibrium can have disproportionate consequences. This problem is compounded by a number of things ranging from the natural maturation of most dermatology practices (going from doing a little bit of everything --> more surgical, procedural, etc -- NOT because of $$, but because people get tired of the charting, administrative hassles, staff requirements (overhead), and sheer energy expenditure required to churn through the volumes required by general derm), the expansion of cheaper labor (mid-levels) who doubly contribute to the mix without having to split the pie into smaller pieces, to the uncertainty of future reimbursement / financial outlook (which leads to a form of protectionism and apprehension on the hiring of new mouths to feed).
As far as what practices value in a general derm -- that will vary from practice to practice and what perceived need they wish to fill. If there is a MMS or dermpath guy in the mix, a sufficient demand/wait time/volume requirement, etc -- the unspoken reason for the position is to drive volume. Sometimes the elder doc wants to dump those things they no longer wish to do on the younger doc. Occasionally they will want someone to fill a specific need (medical derm, peds, etc). Sometimes they just want some help.
