Where does the high income for Derms come from?

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HEME-ONC

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I recently read in a posting that Derms arent doing many cosmetic procedures. So where does the great income come from. How much do derms get reimbursed by insurance and how much is a cash business?

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they do lots of minor procedures, which are quick (=volume), and reimburse well. botox, laser treatments, etc, are some of the things they do that bring in the cash.
 
doc05 said:
they do lots of minor procedures, which are quick (=volume), and reimburse well. botox, laser treatments, etc, are some of the things they do that bring in the cash.
I agree,Dermatologists tend to see very large numbers of patients and do many procedures.They do cosmetic work increasingly and it has been a financial boost but is not responsible for the bulk of most derms incomes.Excisions,flaps etc which are done commonly and the MOHS subspecialty are lucrative.Some dermatologists read their own path slides as well.
 
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ny skindoc said:
I agree,Dermatologists tend to see very large numbers of patients and do many procedures.They do cosmetic work increasingly and it has been a financial boost but is not responsible for the bulk of most derms incomes.Excisions,flaps etc which are done commonly and the MOHS subspecialty are lucrative.Some dermatologists read their own path slides as well.

When I think of lucrative salaries, I'm thinking of salaries in excess of 500K. Dermatologists typically do not earn in excess of this amount. They typcially earn anywhere from 200-300K. What makes Derm appealing is their lifestyle but it's not a lucrative career. Cosmetic work only accounts for about 5% of dermatologist's practice and many other fields are chipping away at this cosmetic work like plastic surgeons, ENT facial plastics, OMF surgeons, FP, IM, estheticians at spas, dentists, you name it. And flaps are not done commonly. It's very uncommon for a derm to perform flaps unless he or she has established a reputation for performing them over several years. Otherwise, plastic surgeons and ENT's perform the bulk of them. I agree with everything else you have said. And this trend will continue with plastic surgeons doing the bulk of these procedures because most patients do not simply want laser resurfacing as an example. They usually seek such services while they are getting other work done like breast agumentation and liposuction. So dermatologists will always be at a disadvantage to PRS and "Cosmetic" Surgeons. The vast majority of a derm's income comes from their office visits. Most of these visits are brief in nature and thus a dermatologist can see a large volume of patients while billing them at a specialist's rate.

The lucrative dermatologists that earn 7 figures are unique. These dermatologists were both hardworking, forunate and willing to take risks. They spent years establishing and marketing their practice toward cosmetic procedures and perform a large volume of these and sell their own products. However, doing this was extremely risky because they had to invest a lot of capital to initially start this process. Other dermatologists have tried to do the same and not achieved the same success while incurring increasing debt. There are other areas of medicine that pay quite a bit more than derm but when you account for the relaxed lifestyle and training, derm is still one of the best fields you can enter.
 
maybe so, but even at just 200k for a 40-hour week with no call, I'd say derms have got it made.
 
Obviously, the money's in cosmetic work, where there's no insurance to worry about. Patricia Wexler in NYC is certainly making seven figures, and got a huge surge after being featured on Oprah. (she's almost exclusively cosmetic, and also does liposuctions+give advice on where to buy shoes...)

But I also know of people who can make 300K on a four-day workweek, which doesn't sound too bad to me... Also, mal insurance is fairly low for most derms, which certainly helps.
 
doc05 said:
maybe so, but even at just 200k for a 40-hour week with no call, I'd say derms have got it made.

You didn't say anything I didn't say in my above post: "There are other areas of medicine that pay quite a bit more than derm but when you account for the relaxed lifestyle and training, derm is still one of the best fields you can enter."
 
PathOne said:
Obviously, the money's in cosmetic work, where there's no insurance to worry about. Patricia Wexler in NYC is certainly making seven figures, and got a huge surge after being featured on Oprah. (she's almost exclusively cosmetic, and also does liposuctions+give advice on where to buy shoes...)

But I also know of people who can make 300K on a four-day workweek, which doesn't sound too bad to me... Also, mal insurance is fairly low for most derms, which certainly helps.

Patricia is rare and she has been in practice for a long time. The popularity of cosmetic work escalated dramatically in the past 10 years. It was much easier for a dermatologist to establish herself 15-20 years ago when cosmetic work was still considered taboo. Back then, the only people who got cosmetic work were celebrities and the wealthy. Now, you elemetary school teacher can go on a payment plan and pay off her breasts over a period of years as if she bought a new car. Today, nearly every physician is competing in the cosmetic market. That wasn't the case 15 years ago. And like Patricia, you can find exceptions in any field. There are FP docs that make 7 figures too. The point is it's rare for someone to become like Patricia and do high volume cosmetic procedures since nearly everyone wants a piece of the cosmetic pie. The competition is brual and it isn't realistic for a dermatologist to earn 7 figures unless he or she is willing to relocate to an area in which they are not competing with many plastic and cosmetic surgeons etc.

300K on a 4 day work is certainly feasible depending upon your location. In desnsely populated areas, however, it's not very feasible earning this pay while working only 4 days per week due to the competition.
 
doc05 said:
maybe so, but even at just 200k for a 40-hour week with no call, I'd say derms have got it made.

By that logic, allergists, endocrinologists, ER specialists, opthalmologists, pathologists, physiatrists, radiologists(in a large group), and rheumatologists also have it made.
 
azcomdiddy said:
So dermatologists will always be at a disadvantage to PRS and "Cosmetic" Surgeons. The vast majority of a derm's income comes from their office visits. Most of these visits are brief in nature and thus a dermatologist can see a large volume of patients while billing them at a specialist's rate.
The cosmetic work done by dermatologists has some overlap with plastic surgeons and ENT(filling agents,peels,botox etc..) but overall their practices are quite different.Surgical specialties focus far more on various lifts and tucks,liposuction which are much more lucrative procedures.One advantage Derms have is that from their large established patient base its easy to get patients for the lower level cosmetic work.
 
novacek88 said:
By that logic, allergists, endocrinologists, ER specialists, opthalmologists, pathologists, physiatrists, radiologists(in a large group), and rheumatologists also have it made.
These fields can all be very lucrative.Allergists,Rheum,Endo have to go through an internal medicine residency first,(some would consider that a negative) and their work often involves much general internal medicine generally longer patient visits,more complex problems.Allergists absolutely have it made..the derm of internal medicine for sure.
 
ny skindoc said:
The cosmetic work done by dermatologists has some overlap with plastic surgeons and ENT(filling agents,peels,botox etc..) but overall their practices are quite different.Surgical specialties focus far more on various lifts and tucks,liposuction which are much more lucrative procedures.One advantage Derms have is that from their large established patient base its easy to get patients for the lower level cosmetic work.

There are very few plastic surgeons whose offices do not provide these procedures in conjuction with the heavy surgical ones you already listed. Yes, the plastic surgeon may personally not perform these procedures but they usually have assistants or technicians who perform these lower level cosmetic work. I'm not suggesting that dermatologists don't perform cosmetic work. However, there is a reason cosmetic work only accounts for 5-6% of their practice on average and it's not because dermatologists prefer to do less cosmetic work.
 
ny skindoc said:
These fields can all be very lucrative.Allergists,Rheum,Endo have to go through an internal medicine residency first,(some would consider that a negative) and their work often involves much general internal medicine generally longer patient visits,more complex problems.Allergists absolutely have it made..the derm of internal medicine for sure.

A medicine residency is far more malign and intense than a dermatology residency. Therefore, I agree the relaxed residency of derm is certainly a plus. However, I don't think the nature of dermatology is what draws people to it. Many people feel dermatology is boring and disgusting. I know several people who avoided derm because it wasn't complex enough. Others would rather not look at acne and rare forms of toe nail fungus for the rest of their lives. I'm not suggesting derm is worse than the IM fields you mentioned. At the same time, I don't think the nature of their work is any worse. So I don't think it's fair to suggest the nature of dermatology has any advantages over endocrine, rheum and other medicine subspecialties.. How many people do you think would apply to derm if its residency required the same call schedule, intensity and work hours of an IM residency? Likewise, how popular do you think Endocrine and Rheum would be if an IM residency wasn't a pre-requisite for them, and they had their own residency with the hours and call schedule of a dermatology residency?

Let's be honest, the main draw of dermatology is the lifestyle both during and after residency. You take those element away, and suddenly the average Step 1 score for accepted derm applicants drops by 30 points.
 
azcomdiddy said:
There are very few plastic surgeons whose offices do not provide these procedures in conjuction with the heavy surgical ones you already listed. Yes, the plastic surgeon may personally not perform these procedures but they usually have assistants or technicians who perform these lower level cosmetic work. I'm not suggesting that dermatologists don't perform cosmetic work. However, there is a reason cosmetic work only accounts for 5-6% of their practice on average and it's not because dermatologists prefer to do less cosmetic work.

Do you think most dermatologists themselves perform these procedures? Just like the plastics guys, the dermatologists employ technicians to perform these procedures while they consult with patients. The difference is the dermatologist can't offer rhinoplasty, breast augmentation and liposuction in addition to the laser resurfacing a patient is seeking.
 
OK. Who's kidding who where? If it's about the money, I have little doubt that most investment bankers, and quite a few lawyers, beats all but a handful of docs, hands down. A third yr inv. banking associate makes avg. 225K, with far less educational investment.
So if it's about the size of the paycheck, derm is as wrong as most other med specialities. You should be a derm because you like the work. Sounds banale, but I'm serious. True, derm has the advantage that most procedures, with experience, is fairly straight forward. Still, if you don't like what you do, I don't think it matters much how much money you make.

I'm a dermpath. NOT because it's lucrative (actually, I'm currently 100% research) but because I found out it was the field that interested me the most. Yes, I'm fortunately enough to be around a lot of clearly very brilliant people, which makes my work all the more enjoyable. But frankly, and not to sound naive, it's about more than the money. It has to be. Otherwise, most of us on this board is wasting our time, because we could probably all make much more in other walks of life.
I can understand that people with eight years of college to pay off and four years on measly resident's pay would be concerned about how much money they'll make. But, seriously, you're talking about what will occupy most of your life until you retire. So I certainly hope that you both enjoy what you do, and think that you make a difference.

Sorry if this sounds like sour grapes. But - please - sometimes discuss WHY you want to do derm. NOT "How much can I expect to earn".
 
PathOne said:
But - please - sometimes discuss WHY you want to do derm. NOT "How much can I expect to earn".

I would agree with you and I think it's definitely worth pointing out that money shouldn't be the only consideration in choosing a specialty, but I also think it's somewhat unfair to criticize people for talking about money on these boards. This is one of the only places that people can annonymously talk about the financial aspects of a specialty without worrying about whether others will think that money is all you care about. Financial issues may be overrepresented in these discussions, but that's probably because it is fairly easy to get information about other aspects of a specialty during your med school rotations but practically impossible to talk to your attendings about salaries.
 
phillystudent said:
I would agree with you and I think it's definitely worth pointing out that money shouldn't be the only consideration in choosing a specialty, but I also think it's somewhat unfair to criticize people for talking about money on these boards. This is one of the only places that people can annonymously talk about the financial aspects of a specialty without worrying about whether others will think that money is all you care about. Financial issues may be overrepresented in these discussions, but that's probably because it is fairly easy to get information about other aspects of a specialty during your med school rotations but practically impossible to talk to your attendings about salaries.

Excellent response!

Agreed, I think our society has gotten so ridiculously p.c. that forums like these are the only place we can truly gather salary information. Everything else can be gathered in the real world. If you can't ask these type of questions on anonymous message board, where can you ask them?

The thing I can't understand for the life of me is why is it a sin to enoy what you do AND enjoy making a lot of money doing it? And why is it incomprehensible that someone could enjoy 2 or 3 fields at the same? Why is it that we all have to be born liking one field of medicine? The truth is many of us could practice in more than one area of medicine. Therefore, salary, lifestyle and other aspects does help people decide between various fields they are interested in.

And I think most medical students are extremely facetious because I highly doubt the most lucrative fields are those that people just "love for the job duties itself." You couldn't give away a radiology, derm and alllergy immunology spot 15 years ago but now people have suddenly developed a true passion for these fields. B.S.
 
azcomdiddy said:
When I think of lucrative salaries, I'm thinking of salaries in excess of 500K.

And I think of excess of $250,000. Sometimes our mindframes are shifted by our professions, but the average US income is still in the 40k range.
 
doc05 said:
they do lots of minor procedures, which are quick (=volume), and reimburse well. botox, laser treatments, etc, are some of the things they do that bring in the cash.

Exactly. I had a sebaceous cyst removed from my back a few months ago by a derm. The H&P consisted of nothing, the diagnosis was already made before I came to the derm, and the total procedure took under a half hour. All of the other care (under a half hour total) was done by assistants. After insurance reimbursement and what I paid out of pocket, the take by the derm was around $500. Of course, the office visit was billed as level III, when it should have been a level I, but with procedures like that, you begin to understand where the cash is coming from...
 
ItsGavinC said:
And I think of excess of $250,000. Sometimes our mindframes are shifted by our professions, but the average US income is still in the 40k range.

Incorrect: The average household income is around 40k
 
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