Will physician's salaries go down?

[chondroblast]

I know salary is a touchy subject, but I think it's worth discussing.

A lot of people seem to think salaries will go way down. Here what seem to be the biggest contributing factors:

1. Increasing reliance on non-md/do providers such as PAs and Advanced level nurses. This will lower the demand (and incentives) for physicians.

2. Move towards more government-oriented insurance system. Will will move to a system more like in the UK where physician's aren't paid as much?

3. Increasing levels of technology mean providers will do fewer procedures themselves.

4. Public perception on salaries and overspending on healthcare.


Is this true?

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[Mad Jack]

No one knows. At all. We can't even predict health care policy 6 months from now let alone years down the road. Asking will just result in a bunch of speculation, from which you will self-select the answers that most conform to your existing beliefs, because people are suckers for their own confirmation bias.

The more important question is, "If salaries do decrease, or there is a government takeover of healthcare, will I still be willing to be a physician?" You can't change the world, but you can take an inventory of your own values and beliefs and determine the best path for yourself in regard to medicine. The answers that will be relevant to your choices and your life are not going to be found on some forum on the internet. They're somewhere inside you, so do some soul searching and figure it out.

 

[chondroblast]

Yeah my question has little to do with my personal values and beliefs. As long as I have enough to comfortably support a family (and even if salaries do go down I highly doubt they'll go that low) I'm happy.

 

[Wordead]

Post this in the premed forums brah

 

[KinasePro]

It's safe to assume physicians will always be paid well, specialists will always be paid better than generalists, and surgeons/proceduralists will be paid better than non-procedural physicians (in general). Procedures = more risk to patient/ more liability = higher skill/training required. The absolute value of compensation dollars will always change, but most would agree with these general principles.

 

[chondroblast]

It's safe to assume physicians will always be paid well, specialists will always be paid better than generalists, and surgeons/proceduralists will be paid better than non-procedural physicians (in general). Procedures = more risk to patient/ more liability = higher skill/training required. The absolute value of compensation dollars will always change, but most would agree with these general principles.

Understandable, but I think many people think that salaries as a whole will go down a lot.

And then there's derm

jk
not jk

 

[Mad Jack]

Yeah my question has little to do with my personal values and beliefs. As long as I have enough to comfortably support a family (and even if salaries do go down I highly doubt they'll go that low) I'm happy.

My point was that your question is completely unanswerable. Nothing but speculation can result from it, and the chances of things going one way or another are impossible to quantify given our wacky political system. The article might as well be, "what would have happened if the Nazis were victorious in their assault on London?" or "who will win the Super Bowl next year?" We can talk about it for days, but no one can say for sure, because we don't have a crystal ball, and the only thing that will result is people stating opinions and getting in nonsensical arguments. You've answered the only thing that's really important- you want to be a physician, and you're okay with a salary so long as its comfortable.

 

[Mad Jack]

And then there's derm

jk
not jk

It's pretty damn clear that the only reason derm is in its current state is due to how low the number of residencies is, which has artificially inflated the value of this lifestyle-based field. You don't need to be a genius to do derm, not by a long shot, but dat lifestyle and pay has drawn them all in. I once read an article by a PD that said something along the lines of, "Dermatology takes many of our most promising students and turns them into our least useful physicians."

 

[Psai]

It's pretty damn clear that the only reason derm is in its current state is due to how low the number of residencies is, which has artificially inflated the value of this lifestyle-based field. You don't need to be a genius to do derm, not by a long shot, but dat lifestyle and pay has drawn them all in. I once read an article by a PD that said something along the lines of, "Dermatology takes many of our most promising students and turns them into our least useful physicians."

Are you a dermatologist? How much do you actually know about the practice of dermatology? I'd rather cure a disease than spend time "optimizing" people's poor life choices.

 

[Wordead]

It's pretty damn clear that the only reason derm is in its current state is due to how low the number of residencies is, which has artificially inflated the value of this lifestyle-based field. You don't need to be a genius to do derm, not by a long shot, but dat lifestyle and pay has drawn them all in. I once read an article by a PD that said something along the lines of, "Dermatology takes many of our most promising students and turns them into our least useful physicians."

I have as little respect for derm as anyone here, but this is all wrong and you clearly know jack about the entire field

 

[chondroblast]

I have a lot of respect for dermatologists (helped me get rid of some itchy red bumps on my arm) but I agree that they have inflated lifestyles.

 

[@JackShephard]

Are you a dermatologist? How much do you actually know about the practice of dermatology? I'd rather cure a disease than spend time "optimizing" people's poor life choices.

Not sure if slinging mud at other specialties is the best way to support derm.

 

[jakeislove]

I guess it comes down to if people leaving residency with a buttload of debt can get by on IBR x 10 years or be happy in under-served areas.

 

[Psai]

Not sure if slinging mud at other specialties is the best way to support derm.

I don't like derm and I'm not slinging mud at other specialties. Medicine as a whole is broken and we are wasting enormous amounts of money.

 

[Mad Jack]

I have as little respect for derm as anyone here, but this is all wrong and you clearly know jack about the entire field

You don't need to be a genius to be in most fields of medicine. I wasn't knocking their intelligence, just saying the average doctor could go into a derm residency and do well. It's a damn important field, and there should definitely be more dermatologists, because I'd love to have someone to see if one of my moles decides to go all crazy on me. But I just don't feel that it is the best use of our best and brightest minds. Our average minds, sure. Our above average minds, why not. But the best of the best? These people could be curing cancer rather than screening for it, creating new surgical methods, and developing innovative treatments for some of the greatest killers in America (heart attack, stroke, whatever). Instead they're treating acne and doing biopsies, while padding the 3-5 slot with some cosmetic stuff to boost their income. It is a fine specialty, but should be a middle of the road residency, not the ****ing Holy Grail.

Just think about it from a top down level. If you were to build the incentives for the specialties from scratch, would you set derm up in such a way that it would draw your top people?

 

[SunsFun]

I actually heard dermatology is a pretty grueling residency due to the whole reading and memorizing tons of stuff at home aspect.

 

[sobored]

You don't need to be a genius to be in most fields of medicine. I wasn't knocking their intelligence, just saying the average doctor could go into a derm residency and do well. It's a damn important field, and there should definitely be more dermatologists, because I'd love to have someone to see if one of my moles decides to go all crazy on me. But I just don't feel that it is the best use of our best and brightest minds. Our average minds, sure. Our above average minds, why not. But the best of the best? These people could be curing cancer rather than screening for it, creating new surgical methods, and developing innovative treatments for some of the greatest killers in America (heart attack, stroke, whatever). Instead they're treating acne and doing biopsies, while padding the 3-5 slot with some cosmetic stuff to boost their income. It is a fine specialty, but should be a middle of the road residency, not the ****ing Holy Grail.

Just think about it from a top down level. If you were to build the incentives for the specialties from scratch, would you set derm up in such a way that it would draw your top people?

Lol. They do both.

http://dermatology.med.nyu.edu/melanoma-cooperative-group

 

[Mad Jack]

Lol. They do both.

http://dermatology.med.nyu.edu/melanoma-cooperative-group

I mean actual pharmacological and biomolecular research to cure cancer, melanoma included, not excising cancer to cure it in individual patients. If a patient ends up testing positive for melanoma, they usually get sent to the oncology service anyway post-excision, at least in my hospital. I don't think I've ever seen a malignant melanoma patient that was handled primarily by their dermatologist.

 

[@JackShephard]

I mean actual pharmacological and biomolecular research to cure cancer, melanoma included, not excising cancer to cure it in individual patients. If a patient ends up testing positive for melanoma, they usually get sent to the oncology service anyway post-excision, at least in my hospital. I don't think I've ever seen a malignant melanoma patient that was handled primarily by their dermatologist.

The dermatologists that I've worked with have been excellent.

I think when we start to look at the field and disparage their efforts, we're doing the wrong thing.

They do an excellent job, help a lot of people, they are smart and their patients are grateful for their services.

When we start to say, "well dermatologists aren't as important as _____" - what's the point of that? True or not, they are providing a unique service and doing their best. That's all we can ask for.

 

[sobored]

I mean actual pharmacological and biomolecular research to cure cancer, melanoma included, not excising cancer to cure it in individual patients. If a patient ends up testing positive for melanoma, they usually get sent to the oncology service anyway post-excision, at least in my hospital. I don't think I've ever seen a malignant melanoma patient that was handled primarily by their dermatologist.

**whoosh**

Take a look at their publications on the left. They are performing biomedical research. In fact, they are at the forefront of microRNA work in melanoma. Most specialists at academic medical centers are doing the same thing.

 

[chasm-e-baddoor]

You don't need to be a genius to be in most fields of medicine. I wasn't knocking their intelligence, just saying the average doctor could go into a derm residency and do well. It's a damn important field, and there should definitely be more dermatologists, because I'd love to have someone to see if one of my moles decides to go all crazy on me. But I just don't feel that it is the best use of our best and brightest minds. Our average minds, sure. Our above average minds, why not. But the best of the best? These people could be curing cancer rather than screening for it, creating new surgical methods, and developing innovative treatments for some of the greatest killers in America (heart attack, stroke, whatever). Instead they're treating acne and doing biopsies, while padding the 3-5 slot with some cosmetic stuff to boost their income. It is a fine specialty, but should be a middle of the road residency, not the ****ing Holy Grail.

Just think about it from a top down level. If you were to build the incentives for the specialties from scratch, would you set derm up in such a way that it would draw your top people?

That's not really how things work. It's mainly about supply and demand.

Based on your argument, you should be saying that the "greatest minds" should be obtaining PhDs instead of becoming physicians. Like you said, you dont need to be a genius to be a good physician. However, geniuses make better vanguard scientists.

Yet, it's harder to become a physician (competitiveness-wise) than it is to become a PhD

 

[@JackShephard]

That's not really how things work. It's mainly about supply and demand.

Based on your argument, you should be saying that the "greatest minds" should be obtaining PhDs instead of becoming physicians. Like you said, you dont need to be a genius to be a good physician. However, geniuses make better vanguard scientists.

Yet, it's harder to become a physician (competitiveness-wise) than it is to become a PhD

"greatest minds" - I've never bought much into this.

Give me someone who is passionate about their field, committed to excellence, and with a great desire to serve their patients. Most people in medical school who are doing well on board exams, doing well clinically, etc. are great minds for the most part. Including those in the middle of the class. I don't think we need the top 1% of medical students to commit to the greatest area of need - many of the greatest inventions of the last 100 years have not come from the top 1% of the class.

 

[chondroblast]

I like turtles.

 

[chasm-e-baddoor]

"greatest minds" - I've never bought much into this.

Give me someone who is passionate about their field, committed to excellence, and with a great desire to serve their patients. Most people in medical school who are doing well on board exams, doing well clinically, etc. are great minds for the most part. Including those in the middle of the class. I don't think we need the top 1% of medical students to commit to the greatest area of need - many of the greatest inventions of the last 100 years have not come from the top 1% of the class.

Well, I agree with you to an extent. It is said that geniuses see things in ways non-geniuses do not (now, what defines a genius, etc? that is an arbitrary setting). So, it can be argued that these people who can see things so much differently will have a better chance at arriving at some scientific breakthrough assuming all else equal (of course that doesnt mean that a passionate scientist cannot do it - especially since i'd bet that passionate ones w ill put in a lot more time, effort and thought than an non-passionate - basically there is more than intelligence involved)

But yea, in a field like medicine, in which the focus is on patient care as a clinician, passion and commitment to excellence are hard to top, assuming that the competence and knowledge are there (which are what the boards are for lol). And yea, physicians are generally more intelligent than average anyway.

The main point of my post was to properly apply Mad Jack's system of assigning "greater minds" to "hardcore" fields (which i dont agree with)

 

[Mad Jack]

**whoosh**

Take a look at their publications on the left. They are performing biomedical research. In fact, they are at the forefront of microRNA work in melanoma. Most specialists at academic medical centers are doing the same thing.

Less than a quarter of the people involved in that department are dermatologists. It's mostly path, onc, and PhDs. I doubt the bulk of any of their biomolecular or pharmacological research was done by actual dermatologists.

That's not really how things work. It's mainly about supply and demand.

Based on your argument, you should be saying that the "greatest minds" should be obtaining PhDs instead of becoming physicians. Like you said, you dont need to be a genius to be a good physician. However, geniuses make better vanguard scientists.

Yet, it's harder to become a physician (competitiveness-wise) than it is to become a PhD

That's why I said dermatology is largely limited by the number of residencies, which have been fairly static for almost 40 years. If they went the way of path, with derm residencies opening left and right, the competitiveness of dermatology would likely slide considerably. My point is, applicants to derm are often not attracted to dermatology itself, but the lifestyle and compensation of dermatology. I would like to see it brought down to being about equal with other specialties in its balance of lifestyle/compensation, so that the people going into derm are the people that actually love it, not a bunch of kids scoring in the high 200s on their Step 1 with piles of research that just want an easy life and don't give a damn what specialty they go into.

I do think we should be creating more MD/PhDs, personally, and that medical research should be the highest compensated field in medicine. I'm not saying that brilliant people should be forced into anything either. Just that the incentives should be there so that those with the most brains and research experience have a financial incentive to pursue such work. Because if research was paying spinal surg cash, you know a lot of those dermatologists would have gone a different direction with their life.

 

[Wordead]

You don't need to be a genius to be in most fields of medicine. I wasn't knocking their intelligence, just saying the average doctor could go into a derm residency and do well. It's a damn important field, and there should definitely be more dermatologists, because I'd love to have someone to see if one of my moles decides to go all crazy on me. But I just don't feel that it is the best use of our best and brightest minds. Our average minds, sure. Our above average minds, why not. But the best of the best? These people could be curing cancer rather than screening for it, creating new surgical methods, and developing innovative treatments for some of the greatest killers in America (heart attack, stroke, whatever). Instead they're treating acne and doing biopsies, while padding the 3-5 slot with some cosmetic stuff to boost their income. It is a fine specialty, but should be a middle of the road residency, not the ****ing Holy Grail.

Just think about it from a top down level. If you were to build the incentives for the specialties from scratch, would you set derm up in such a way that it would draw your top people?

Just think for a second about what you're saying. The laziest people who go into derm just for the cushy lifestyle and short hours should be the ones working to cure cancer? How is there no cognitive dissonance there?

 

[Psai]

You have no idea what you're talking about. You're obviously very clueless about dermatology. You don't know a thing about how medical students select a field. You also don't understand how physician payment works. Premeds spouting uninformed opinions is an epidemic that is tolerated in pre-allo but it doesn't fly here.

 

[notbobtrustme]

 

[@JackShephard]

Less than a quarter of the people involved in that department are dermatologists. It's mostly path, onc, and PhDs. I doubt the bulk of any of their biomolecular or pharmacological research was done by actual dermatologists.


That's why I said dermatology is largely limited by the number of residencies, which have been fairly static for almost 40 years. If they went the way of path, with derm residencies opening left and right, the competitiveness of dermatology would likely slide considerably. My point is, applicants to derm are often not attracted to dermatology itself, but the lifestyle and compensation of dermatology. I would like to see it brought down to being about equal with other specialties in its balance of lifestyle/compensation, so that the people going into derm are the people that actually love it, not a bunch of kids scoring in the high 200s on their Step 1 with piles of research that just want an easy life and don't give a damn what specialty they go into.

I do think we should be creating more MD/PhDs, personally, and that medical research should be the highest compensated field in medicine. I'm not saying that brilliant people should be forced into anything either. Just that the incentives should be there so that those with the most brains and research experience have a financial incentive to pursue such work. Because if research was paying spinal surg cash, you know a lot of those dermatologists would have gone a different direction with their life.

It's easy to judge others motivations, especially as a pre-clinical medical student or even as an M3/M4. (edit: are you pre-med? Then your attitude makes even more sense).

I think a better strategy is to focus on your own actions. Are you pursuing service? Do others look up to you as an example? Are you doing what you're asking of the dermatologists?

Here's a Gandhi quote for you, "Be the change you want to see in the world."

Instead of complaining, why not be a light for future generations of physicians to follow. If you are passionate about what you're talking about then apply that to your work. What you're doing right now will turn to bitterness and envy. Bitterness leads to anger; anger leads to hate; hate leads to suffering.

 

[DH410]

It's easy to judge others motivations, especially as a pre-clinical medical student or even as an M3/M4. (edit: are you pre-med? Then your attitude makes even more sense).

I think a better strategy is to focus on your own actions. Are you pursuing service? Do others look up to you as an example? Are you doing what you're asking of the dermatologists?

Here's a Gandhi quote for you, "Be the change you want to see in the world."

Instead of complaining, why not be a light for future generations of physicians to follow. If you are passionate about what you're talking about then apply that to your work. What you're doing right now will turn to bitterness and envy. Bitterness leads to anger; anger leads to hate; hate leads to suffering.

Does that suffering perhaps lead to the darkside?

 

[Mad Jack]

It's easy to judge others motivations, especially as a pre-clinical medical student or even as an M3/M4. (edit: are you pre-med? Then your attitude makes even more sense).

I think a better strategy is to focus on your own actions. Are you pursuing service? Do others look up to you as an example? Are you doing what you're asking of the dermatologists?

Here's a Gandhi quote for you, "Be the change you want to see in the world."

Instead of complaining, why not be a light for future generations of physicians to follow. If you are passionate about what you're talking about then apply that to your work. What you're doing right now will turn to bitterness and envy. Bitterness leads to anger; anger leads to hate; hate leads to suffering.

I'm not complaining. Like I said, I don't even have a problem with dermatology or dermatologists. I just feel like right now, at this point in history, the incentives for going into dermatology are completely out of whack with where they should be. I would much rather people be going into the field because they, you know, actually like dermatology, but I'd bet for every person that's actually down with being a skin doctor, there's 10 or more that are just going into it for the lifestyle. That, coupled with the overall utility of dermatology as a whole as compared to its compensation and lifestyle, leaves a very good case for the idea that maybe, just maybe, the incentives aren't currently optimal and we could do well to open 150 or so residency slots per year (50% increase) and get the number of dermatologists more in line with where they should be. Dermatology has experienced virtually nil growth in residency in the past 40 years, it's about time to bump the numbers up.

And I've been doing my part in this world for quite some time, something I intend to very much continue doing. Just because I'm waiting to start classes in July doesn't mean I haven't had any semblance of a life in the last 29 years.

 

[jakeislove]

I'd love to do a Derm elective and become more educated about their job but hate wasting people's time. I'd never get a Derm residency, LOL!

It's kind of silly to pick on specialties because their lifestyles are perceived as better.

 

[SurgeDO]

What is it with pre-meds having an opinion on everything nowadays?

 

[deleted500612]

I know salary is a touchy subject, but I think it's worth discussing.

A lot of people seem to think salaries will go way down. Here what seem to be the biggest contributing factors:

1. Increasing reliance on non-md/do providers such as PAs and Advanced level nurses. This will lower the demand (and incentives) for physicians.

2. Move towards more government-oriented insurance system. Will will move to a system more like in the UK where physician's aren't paid as much?

3. Increasing levels of technology mean providers will do fewer procedures themselves.

4. Public perception on salaries and overspending on healthcare.


Is this true?

In response to 3, that is true that physicians in the UK are not paid as much. I would like to point out though that there are also other countries like Canada, who have a very government-oriented health system as well, and physicians in most specialties are paid close to what their counterparts make in the US, so it's not like every country with public healthcare the physicians can't make high salaries. Australia also has quite high doctor salaries, but not quite as high as US/Canada in general. Most European countries do tend to have lower physician salaries though.

 

[deleted500612]

I actually heard dermatology is a pretty grueling residency due to the whole reading and memorizing tons of stuff at home aspect.

This. Sure they dont spend as many hours in the clinic, but I've seen a few residency breakdown charts from schools showing estimated work hours, study hours, expected shift work etc, of the average resident in each respective specialty program. The expected self-study time outside of clinical hours in derm was the highest of any specialty by a noticeable margin. I somehow doubt that derm residency is as much of a cakewalk as some people are making it out to be.

 

[WaylonS]

You don't need to be a genius to be in most fields of medicine. I wasn't knocking their intelligence, just saying the average doctor could go into a derm residency and do well. It's a damn important field, and there should definitely be more dermatologists, because I'd love to have someone to see if one of my moles decides to go all crazy on me. But I just don't feel that it is the best use of our best and brightest minds. Our average minds, sure. Our above average minds, why not. But the best of the best? These people could be curing cancer rather than screening for it, creating new surgical methods, and developing innovative treatments for some of the greatest killers in America (heart attack, stroke, whatever). Instead they're treating acne and doing biopsies, while padding the 3-5 slot with some cosmetic stuff to boost their income. It is a fine specialty, but should be a middle of the road residency, not the ****ing Holy Grail.

Just think about it from a top down level. If you were to build the incentives for the specialties from scratch, would you set derm up in such a way that it would draw your top people?

This is HILARIOUS. Seriously though, you don't know what you're talking about. When you actually start med school, you should attend derm didactics. I think many physicians would be overwhelmed by the sheer volume of minutia dermatologists need to know (it's like memorizing biochem for Step 1, except much, much worse). Not only do dermatologists learn medicine and minor surgeries, they also have to study dermatopathology extensively. I think most physicians would not enjoy having to spend a substantial portion of their residency having to memorize and interpret dermpath slides

Are you aware that dermatologists use chemotherapy and biologics for treating autoimmune disorders and malignancies? Are you aware that dermatologists write infusion and apheresis orders? Derm is a lot more than just acne, Botox, and punch biopsies. Many autoimmune and complex, systemic diseases have cutaneous signs, and dermatologists are expected not only to recognize them, but to coordinate care with other specialists.

Let's be honest, if the "if it's wet, make it dry; if it's dry, make it wet" mantra were actually true, there would be no need for dermatologists

 

[notbobtrustme]

Most European countries do tend to have lower physician salaries though.

They have lower salaries, but at the same time, they still are in the top 1-5% of earners. It's not like they are begging on the street for cash, they still do very well. Remember that they enter practice at 24-25, work around 40 hours a week regardless of specialty, have no student debt and have a guaranteed 6-8 weeks of paid vacation.

 

[NickNaylor]

Are you a dermatologist? How much do you actually know about the practice of dermatology? I'd rather cure a disease than spend time "optimizing" people's poor life choices.

I'm currently on the 3rd week of my derm elective. I don't want to minimize the field, but 99% of derm is relatively straightforward and simple. The "procedures" and "surgeries" that get done are quick, 99.99% effective, and have very little risk for anything beyond cosmetic damage, and yet they get can bill for a zillion dollars. Of course you have to study for the rare 1% of zebras - and this is absolutely true in derm - but at the end of the day, disease is going to be inflammatory, infectious, or neoplastic, and you're either going to blast it with steroids, blast it with antimicrobials, or cut it out. I'm being somewhat facetious here, but that truly is not far from derm practice as I've seen it.

It's a great field, and having now been in a clinic I totally get why people go into it. However the value is highly inflated IMO compared to other specialties, and it truly is a lifestyle specialty. I don't begrudge them of that at all and I certainly don't claim to be even a crappy dermatologist, but I do think it's pretty incredible how much gets billed for 15 minute appointments.

E: I should add that in the academic environment things definitely do seem more interesting - more cancer, more zebras, etc.. That stuff is definitely more difficult. But in the community setting, most issues are about cancer prevention, acne, eczema, psoriasis, and cosmetic stuff. You'll get the occasional folliculitis and cancer follow-up, but most days only included 2-3 cases like that a day.

 

[GadRads]

"greatest minds" - I've never bought much into this.

Give me someone who is passionate about their field, committed to excellence, and with a great desire to serve their patients. Most people in medical school who are doing well on board exams, doing well clinically, etc. are great minds for the most part. Including those in the middle of the class. I don't think we need the top 1% of medical students to commit to the greatest area of need - many of the greatest inventions of the last 100 years have not come from the top 1% of the class.

I agree. the skills necessary to do well in medicine and research are not the same. The top scoring students may not make the best researchers and vice versa. Many Nobel winners were B average students. It is hard to teach creativity and new ways of looking at problems, and tests can't measure that.

 

[sinombre]

I would much rather people be going into the field because they, you know, actually like dermatology, but I'd bet for every person that's actually down with being a skin doctor, there's 10 or more that are just going into it for the lifestyle.

Just pointing out that these are not mutually exclusive. I think it's pretty obvious that compensation and lifestyle provide a large incentive for medical students to go into derm, but I doubt there are many people who match into derm that don't actually enjoy it.

 

[Mad Jack]

Just pointing out that these are not mutually exclusive. I think it's pretty obvious that compensation and lifestyle provide a large incentive for medical students to go into derm, but I doubt there are many people who match into derm that don't actually enjoy it.

And that's totally cool. But how many people do you hear that rave about treating skin conditions and that's why they want to get into derm? I doubt most people in the field dislike it, it's a pretty nice job, but I'd bet that if other fields were more well compensated or had better hours, they would have chosen otherwise.

 

[Anastomoses]

I'm not so interested in whether physician salaries are going down. Okay, so if they go down...what? Give me a thread discussing what we have to do to make salaries go up or put this topic to bed already. I don't understand the fretting over nothing.

 

[circulus vitios]

I have a lot of respect for dermatologists (helped me get rid of some itchy red bumps on my arm) but I agree that they have inflated lifestyles.

Or they have the lifestyles that every other physician should have.

 

[chondroblast]

Or they have the lifestyles that every other physician should have.

 

[circulus vitios]

gif

I don't get it.

 

[evilbooyaa]

I don't get it.

He's pondering what you posted about.

Love the de-rail this thread took. For the 99% of common stuff, FMs can handle the vast majority of that as well. But people want the expertise of someone who only deals with skin lesions. Dermatopath is constantly taking cuts and stuff like MOHS (which is super technical, super skillful, etc.) is taking pay cuts rather than the common stuff.

I'm not interested in derm (b/c screw dealing with skin all day) at ALL, but ya'll need to have some damn respect for dermatologists. The amount of reading they have to do is probably very similar (if not more) to a Rad Onc residency.

Increasing residency supply for dermatology is going to lead to dermatologists not being able to find jobs (like Pathology before it). Why would a practice hire when they already have the max amount of dermatologists they need? If the dermatologists in a certain area can handle the volume of derm-related complaints that come their way, then why increase the number of dermatologists? Just to cut pay?

 

[mercaptovizadeh]

He's pondering what you posted about.

Love the de-rail this thread took. For the 99% of common stuff, FMs can handle the vast majority of that as well. But people want the expertise of someone who only deals with skin lesions. Dermatopath is constantly taking cuts and stuff like MOHS (which is super technical, super skillful, etc.) is taking pay cuts rather than the common stuff.

I'm not interested in derm (b/c screw dealing with skin all day) at ALL, but ya'll need to have some damn respect for dermatologists. The amount of reading they have to do is probably very similar (if not more) to a Rad Onc residency.

Increasing residency supply for dermatology is going to lead to dermatologists not being able to find jobs (like Pathology before it). Why would a practice hire when they already have the max amount of dermatologists they need? If the dermatologists in a certain area can handle the volume of derm-related complaints that come their way, then why increase the number of dermatologists? Just to cut pay?

It's not that these fields are broader than, say, IM or neurology or ophtho. It's because they have a comparably lighter clinical burden that they get the time (and are expected to) read up extensively on conditions they haven't seen in residency. IM and many other busier residencies could read Harrison's + all the subspecialty textbooks (or the analogous for another specialty) during their off time. It's just that they're not given that off time because they're always running around managing patients (some of them crashing).

 

[evilbooyaa]

It's not that these fields are broader than, say, IM or neurology or ophtho. It's because they have a comparably lighter clinical burden that they get the time (and are expected to) read up extensively on conditions they haven't seen in residency. IM and many other busier residencies could read Harrison's + all the subspecialty textbooks (or the analogous for another specialty) during their off time. It's just that they're not given that off time because they're always running around managing patients (some of them crashing).

Yeah, but the buck stops with them (Derm). That's why IM can consult out if they don't fully understand a certain process. Once derm is involved for a skin condition, that's the end of the consult chain. I imagine once you enter a fellowship post-IM, the amount of reading shoots up considerably as a nephrologist should be able to recognize EVERY nephrological condition, even if it is not seen in their fellowship. If an IM resident starts seeing a Cr creeping up, they go through the first few in-hospital treatments (fluid management, drug reconciliation, etc.). If he can't figure it out (or fix it), he consults nephrology. It would not be feasible for a general IM resident to know everything in Harrison's (+ all subspecialty textbooks). There's a reason each organ system (generally) has it's own sub-specialty.

I'm not sure if Derm residents have the ability to cite studies or trials during treatment discussions, but another "lifestyle/overpaid" specialty (Rad Onc) requires residents to discuss which clinical trial proved the superiority (or non-superiority) of one treatment modality vs another modality. Maybe some of the Derm residents that were posting earlier can confirm/deny this.

 

[@JackShephard]

I'm not complaining. Like I said, I don't even have a problem with dermatology or dermatologists. I just feel like right now, at this point in history, the incentives for going into dermatology are completely out of whack with where they should be. I would much rather people be going into the field because they, you know, actually like dermatology, but I'd bet for every person that's actually down with being a skin doctor, there's 10 or more that are just going into it for the lifestyle. That, coupled with the overall utility of dermatology as a whole as compared to its compensation and lifestyle, leaves a very good case for the idea that maybe, just maybe, the incentives aren't currently optimal and we could do well to open 150 or so residency slots per year (50% increase) and get the number of dermatologists more in line with where they should be. Dermatology has experienced virtually nil growth in residency in the past 40 years, it's about time to bump the numbers up.

And I've been doing my part in this world for quite some time, something I intend to very much continue doing. Just because I'm waiting to start classes in July doesn't mean I haven't had any semblance of a life in the last 29 years.

I know it's hard to bite your tongue. It's especially hard to bite your tongue as a pre-med, then still as an M1/M2. Once you start working in the clinic 50 hrs a week or more and realize how little you know, then you will be less quick to form opinions on things.

Dermatology has a good knowledge base and most of them work hard. Take advice from those above you right now and just learn all you can and hold judgement. Think about this, you couldn't come close to passing Step 1 right now - and even those who can do that know very little about clinical medicine.

What I'm saying will make more sense in 3-4 years - but now you know too little to understand why no one will value your opinions on such things.

 

[@JackShephard]

I'm currently on the 3rd week of my derm elective. I don't want to minimize the field, but 99% of derm is relatively straightforward and simple. The "procedures" and "surgeries" that get done are quick, 99.99% effective, and have very little risk for anything beyond cosmetic damage, and yet they get can bill for a zillion dollars. Of course you have to study for the rare 1% of zebras - and this is absolutely true in derm - but at the end of the day, disease is going to be inflammatory, infectious, or neoplastic, and you're either going to blast it with steroids, blast it with antimicrobials, or cut it out. I'm being somewhat facetious here, but that truly is not far from derm practice as I've seen it.

It's a great field, and having now been in a clinic I totally get why people go into it. However the value is highly inflated IMO compared to other specialties, and it truly is a lifestyle specialty. I don't begrudge them of that at all and I certainly don't claim to be even a crappy dermatologist, but I do think it's pretty incredible how much gets billed for 15 minute appointments.

E: I should add that in the academic environment things definitely do seem more interesting - more cancer, more zebras, etc.. That stuff is definitely more difficult. But in the community setting, most issues are about cancer prevention, acne, eczema, psoriasis, and cosmetic stuff. You'll get the occasional folliculitis and cancer follow-up, but most days only included 2-3 cases like that a day.

Plus or minus. I think many of the sub-specialties in IM are relatively straightforward and simple also. Pick whatever IM sub specialty and you see the same things over and over. Maybe even less variety than derm in many cases.