The "It" Job in Medicine

[TheWallnerus]

Yet another friction point for derm vs rad onc? I kid.

All except for 4-day work weeks, and social influencer stuff... very radoncish. Four day work week yet to become the norm afaik. Although supervision sanity is helping (at least that's the rumor).

https://www.wsj.com/lifestyle/careers/dermatology-jobs-salary-young-doctors-174cfe53

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[Reaganite]

There's so much going on in derm that would make you think the field is doomed, but I guess the volume and demand is so astronomical it doesn't seem to matter? It's like the norm in my area for 1 derm to open multiple offices and just staff with NPs. NPs are opening up cosmetic clinics, PCPs are doing botox and other cosmetic procedures, and PE is buying up practices everywhere.

 

[madchemist89]

Very high demand. Very low supply.

 

[RadRadRad]

Low barriers to entry (I mean a practice not what it takes to be a doctor )
Don’t need to be affiliated with hospital
Cash for cosmetics

 

[Gfunk6]

 

[Fpg1245]

Meanwhile over in rad onc world

 

[thesauce]

Very high demand. Very low supply.

The exact opposite of us

 

[ramsesthenice]

Yet another friction point for derm vs rad onc? I kid.

All except for 4-day work weeks, and social influencer stuff... very radoncish. Four day work week yet to become the norm afaik. Although supervision sanity is helping (at least that's the rumor).

https://www.wsj.com/lifestyle/careers/dermatology-jobs-salary-young-doctors-174cfe53

This plot is very familiar. Retrospective data says surgery is better. Must recommend surgery. Until we get our hands on a linac and can start billing for RT. What was the name of the original? Or right. Urorads.

I think simple resection of most NMSCs makes sense. Taking a 12 stages of what ends up being a partial rhinectomy? I don’t care how good you think your reconstruction looks…hard pass.

 

[medgator]

This plot is very familiar. Retrospective data says surgery is better. Must recommend surgery. Until we get our hands on a linac and can start billing for RT. What was the name of the original? Or right. Urorads.

I think simple resection of most NMSCs makes sense. Taking a 12 stages of what ends up being a partial rhinectomy? I don’t care how good you think your reconstruction looks…hard pass.

I try to send non face/pretibial back for surgery when I can lol.

 

[pikachu]

Low barriers to entry (I mean a practice not what it takes to be a doctor )
Don’t need to be affiliated with hospital
Cash for cosmetics

I get all this and i know they make bank but goddammit if derm does not seem like it is the most boring speclalty in all of medicine

 

[gmsquid]

 

[OTN]

Dermatology has always been competitive I'm not sure what the WSJ is on about

 

[fiji128]

Dermatology has always been competitive I'm not sure what the WSJ is on about

Way back in the 1970's and 1980's it was not considered competitive at all from what I have heard from the old heads.

 

[seper]

PP derms make 500K if they are busy 5d / week (little vacay). 4x per week is paying 400K. Hectic clinics

 

[Lamount]

Ever rash looks the same, has similar names, and is treated with steroids.... nah.

 

[Chartreuse Wombat]

Ever rash looks the same, has similar names, and is treated with steroids.... nah.

If its wet; keep it dry.
If its dry keep it wet.
Otherwise steroids

 

[radoncftw]

I think the sad thing for me is how much med oncs can make.
I found out recently through form 990s, that some of the busy hospital employed med oncs I work with make > 1 mill.
They are busy, but so am I.

 

[Gfunk6]

I think the sad thing for me is how much med oncs can make.
I found out recently through form 990s, that some of the busy hospital employed med oncs I work with make > 1 mill.
They are busy, but so am I.

Except that they have variable expenses. We are shackled to a multi-million dollar piece of hardware which requires physics, dosimetry, therapy and engineering support. CoL going up, inflation rising, but Medicare reimbursements dropping.

Not a winning equation.

Pediatricians and PCPs will argue that they are busy too. Physicians like that with a true entrepreneurial drive have switched to cocnierge, cash-only. Wish we had that option . . .

 

[OTN]

I know some breast surgeons who have gone concierge, cash-only. Seem to be doing ok.

 

[A_DeMichele]

Dermatologists are under pressure to do procedures; typical Mohs day (everyone now is getting certified) consists of like 5 surgeries stacked back to back; you go back to seeing new patients and biopsying after lunch

 

[metallica81788]

Dermatologists are under pressure to do procedures; typical Mohs day (everyone now is getting certified) consists of like 5 surgeries stacked back to back; you go back to seeing new patients and biopsying after lunch

Then maybe they should do less inappropriate Mohs that leave craters in people's faces and send to a different modality instead...

😉

 

[Fpg1245]

Then maybe they should do less inappropriate Mohs that leave craters in people's faces and send to a different modality instead...

😉

Which they might also offer…and charge daily IGRT for in the office. Derm is cooked anyway…I really don’t understand the purpose of the wsj even doing a piece on it. The really story is about PE in this space not some derm who makes tik tok videos

 

[Doctorer]

Which they might also offer…and charge daily IGRT for in the office. Derm is cooked anyway…I really don’t understand the purpose of the wsj even doing a piece on it. The really story is about PE in this space not some derm who makes tik tok videos

Does anyone have insight to this? Seems like the derm market is overrun with these PE groups, and tangentially, the dermatologists don't seem thrilled. With the demand for dermatology services and low startup costs, shouldn't it be easier to start a solo/small group practice?

 

[DebtRising]

Derm has practically judged to respect themselves and young physicians by balancing training programs and rigors, and not simply selling out the young minds who join them. Kudos to them for respecting their own.

 

[DrProtonX]

Imagine if the greedy boomer rad oncs with 8-figure net worth actually retired and passed on the practice to the next generation instead of selling it to PE for a quick payday that wouldn’t make any difference in their quality of lives…

 

[drowsy12]

Imagine if the greedy boomer rad oncs with 8-figure net worth actually retired and passed on the practice to the next generation instead of selling it to PE for a quick payday that wouldn’t make any difference in their quality of lives…

Best of luck with that!

 

[DoctwoB]

Does anyone have insight to this? Seems like the derm market is overrun with these PE groups, and tangentially, the dermatologists don't seem thrilled. With the demand for dermatology services and low startup costs, shouldn't it be easier to start a solo/small group practice?

Same problems as any other small practice. Private insurance will offer you 80% of Medicare while happily paying a dermatologist for the big healthcare system across the street 300% Medicare for the same service. Consolidate or die.

 

[Doctorer]

Same problems as any other small practice. Private insurance will offer you 80% of Medicare while happily paying a dermatologist for the big healthcare system across the street 300% Medicare for the same service. Consolidate or die.

Gotcha. Assumed going cash-only was a bit easier in derm, but guessing that's also saturated.

 

[radoncftw]

Gotcha. Assumed going cash-only was a bit easier in derm, but guessing that's also saturated.

this is anecdotal, but it seems that in my neck of the woods (major metro, midwest), the MOHS surgeons are all leaving large systems and opening their own shops.

 

[BobbyHeenan]

this is anecdotal, but it seems that in my neck of the woods (major metro, midwest), the MOHS surgeons are all leaving large systems and opening their own shops.

We went from having two fantastic, reasonable, fellowship trained MOHS surgeons a decade ago to now every other derm (and even some plastics) in town are doing "MOHS." I don't know what certification or Holiday Inn they stayed in, but it seems like now everyone is doing it.

The vast majority of my skin cases are patients that refuse MOHS in a new lesion elsewhere after their MOHS #1 was a more involved fiasco than they were sold.

 

[medgator]

The vast majority of my skin cases are patients that refuse MOHS in a new lesion elsewhere after their MOHS #1 was a more involved fiasco than they were sold.

Or it recurred and I got the referral lol

 

[gmsquid]

As a head and neck and skin guy, you can’t underestimate the value of a quality Mons surgeon. Good ones are really good. And then you get the case where somebody tried to Mohs a merkel…