It's like this - procedures will always be paid more, and dermies do procedures all day long. Pay may be getting cut, but that's just an argument for why derm life is better - work fewer hours for the same money. As for FP's doing cosmetics, well, you can get psychiatrists to do hair transplants too, but if you have money, you won't. It's sad in a way, but it comes down to this. Uninsured patients will balk at paying for life-extending beta blockers or HTN meds until they are carried by tax money in incredibly expensive ED vists and hospital stays, so that the whole current system will truely collapse in on itself. But the number of people paying top dollar to the best trained people to look better will never decrease. For that to change, you would need to get rid of not only the insurance system, but the wealth stratification in this country. Things would change if there were 100x as many derm spots. But there aren't. So it goes.