is it easy to get a job once you are out of derm residency?

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amherstguy

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with the economy being the way it is, is it easy to get a job as a dermatologist or MOHS surgeon??
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very. low supply, high demand, you do the math. obviously this is easier in rural places or locations that others consider undesireable. i do believe ny/la suffer from saturation but i'm sure there are still positions to be obtained.
 
amherstguy said:
with the economy being the way it is, is it easy to get a job as a dermatologist or MOHS surgeon??
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Easy to get a job -- yes. Easy to get a good job in the place where you want to live -- not always.

General derm -- very easy to find a job.

More than 1/2 time MOHS -- not easy (at all). Actually fairly difficult. Do not believe what the recruiters say -- they are more overpaid and biased than realtors.
 
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MOHS_01 said:
Easy to get a job -- yes. Easy to get a good job in the place where you want to live -- not always.

General derm -- very easy to find a job.

More than 1/2 time MOHS -- not easy (at all). Actually fairly difficult. Do not believe what the recruiters say -- they are more overpaid and biased than realtors.
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Why not get a job as a recruiter then?? Seems like a sweet gig :smuggrin:
 
why is it so tough for the mohs? it seems like there would be an even greater need for their services?
 
amherstguy said:
why is it so tough for the mohs? it seems like there would be an even greater need for their services?
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Not so... You can think about it several ways, but the more specialized one becomes, the larger the population base required to support the specialty. It comes down to incidence, prevalence, etc in a given population. Second, it takes several dermatologists to "feed" a Mohs doc and keep them busy.

The numbers that I have most often heard (and they reflect both mine and my friends experience) would be a required population of around 30k for a gen derm and well in excess of 100k for MMS . I believe that somewhere around 1 in 5 derm docs do a MMS/Procedural fellowship now (which is probably too many, but that is a different matter for another day) Simple math dictates more potential jobs for gen derm; likewise, it also dictates a changing MMS practice style going forward as we reap the benefits of the imbalance of gen derm : fellowship trainees over the past several years.
 
1/5 getting a Mohs or Procedural fellowship? That seems a little too high... where are these numbers from? Are you implying that we are getting a saturation of Mohs surgeons?

Also, what are the general incomes one can expect as a "full-time" Mohs Surgeon?
 
sdnetrocks said:
1/5 getting a Mohs or Procedural fellowship? That seems a little too high... where are these numbers from? Are you implying that we are getting a saturation of Mohs surgeons?

Also, what are the general incomes one can expect as a "full-time" Mohs Surgeon?
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Not implying, stating.... look it up and do the math... 300 give or take derm spots per annum, 60 give or take Mohs/Procedural spots filled per annum. Then look at the available opps listed on the recruitment sites, Mohs college site, etc.

As far as income expectations -- people always ask this without much understanding of what actually determines physician income... after the reimbursement change in 2008 Mohs docs do not make significantly more than your general dermatologists; the average will be a little higher, but the data is skewed due to the personalities and types of docs who often end up doing Mohs (we tend to be a little more financially driven, which translates into being more productive).
 
what is the difference between mohs and procedural fellowship?
 
Mohs = Mohs surgery for SCC, BCC, melanoma

Procedural = Excisions, cosmetic techniques

Dermsurg fellowships can be either all Mohs or a mix of Mohs and procedural.

Mohs_01, correct me if I'm wrong.
 
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The difference, in large part, is semantics... there really is no difference between a well rounded Mohs fellowship and the new procedural fellowship (since this was largely a conversion from one to the other rather than the creation of an entirely new entity). Procedural fellowships are accredited by the ACGME; Mohs fellowships are accredited through the ACMS -- which is a non-sanctioned, non-ACGME recognized entity. Procedural fellowships are converts from the older Mohs fellowships; some did not convert (primarily due to the added red tape, paperwork, bureaucratic burdens that come with anything governmental.... along with the accompanying inability to have restrictive covenants...). The reasoning behind their creation was twofold: to establish some uniformity amongst training program requirements, exposure, etc, and to lay the foundation for a political battle -- the creation of a ABMS recognized dermatologic surgery specialty. Just as an FYI -- the reason for "procedural" vs "surgical" nomenclature was in direct response to opposition from the "surgical" community... who did not want any dermatologist calling themselves "surgeon".

Procedural fellowships have "deemed equivalence" status from the ACMS; thus, there is no strategic reason to go the Mohs fellowship route rather than the Procedural route (unless there is someone in particular who you want to train under that only offers the Mohs fellowship).
 
so mohs and procedural derm are essentially the same thing??

procedural sounds much more "cosmetic"
 
MOHS_01 said:
Not implying, stating.... look it up and do the math... 300 give or take derm spots per annum, 60 give or take Mohs/Procedural spots filled per annum. Then look at the available opps listed on the recruitment sites, Mohs college site, etc.

As far as income expectations -- people always ask this without much understanding of what actually determines physician income... after the reimbursement change in 2008 Mohs docs do not make significantly more than your general dermatologists; the average will be a little higher, but the data is skewed due to the personalities and types of docs who often end up doing Mohs (we tend to be a little more financially driven, which translates into being more productive).
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Thanks for the info - much appreciated!

In the simplest sense, physician income derives from reimbursement (which depends on payor mix, % cash procedures, hours worked, etc.) minus overhead.

The overhead for Mohs has to be higher than general derm given all the specialized equipment (microtome, staining) and people it takes. Obviously, the reimbursement must account for this, and then some.

A 1-year Mohs fellowship is a loss of $300k of general derm income (worst case scenario). If the difference in income between general derm and Mohs is 100k/year, then this is probably worth it, assuming you can find a job doing Mohs surgery most of the time. If the difference is much less, it may not be worth it (from a purely financial standpoint)... so that's why I was asking about the average income of a "full-time" Mohs surgeon.
 
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300k for general derm? that sounds awfully generous
 
Average $300K for urban private general derm is accurate, if not even a tad low.
 
Make connections, and getting any job can be easier. Start attending regional and national derm conferences, connect with derm residency alumni, scout out your favorite/home city. Make friends with important academic and private practitioners, who will undoubtedly open doors for you.

Start now...doesn't hurt, only helps. The hardest part of the uphill battle is over once you get into residency. Now it's just a little slope upwards.
 
How much can a full-time academician make right out of residency? As tenured faculty?
 
iluvskin said:
No wonder people are wanting to do dermpath --- I heard they can make as much as 600-900K, even in academia...
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Very true, for now... but we all must accept the fact that reimbursement profiles change over time. Mohs was hot for 20+ years. Dermpath is even better... until CMS instructs the AMA RVU update committee to create a CPT specific for cutaneous pathology, which will, overnight, significantly impair earning potential. This is coming... it has been discussed. Costs (i.e. provider payments) will decline. Radiologists will, more than likely, be the next hit, but, rest assured, none of us are immune.

The single best piece of advice is to find something that you can tolerate doing, and balance that with breadth of the scope of practice and potential revenue streams if you want to have some protection built into your earning power. Oh, and don't be afraid to work harder than most everyone else...
 
mdjkim said:
Stick with laser and you'll be golden.
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I'm awful at reading online sarcasm.

But my limited experience thus far shows that lasers usually end up costing a practice more than the revenue it brings in.

Of course, I wouldn't mind practicing with the Fraxel laser during residency. I've got a couple of blemishes that could be zapped away :p
 
asmallchild said:
I'm awful at reading online sarcasm.

But my limited experience thus far shows that lasers usually end up costing a practice more than the revenue it brings in.

Of course, I wouldn't mind practicing with the Fraxel laser during residency. I've got a couple of blemishes that could be zapped away :p
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x 2.
 
Getting a job is relatively easy. If nothing else, submit a resume to a few of the big headhunters and tell them where you want to work and they will arrange everything. there are few parts of the country that are saturated, probably none in fact.

my impression is that 300K is the base starting point after residency for private practice, and that for every 50-100 miles from the epicenter of a 1 million person metropolitan are is worth an extra 50-100K, depending on how desperate they are for someone.
 
Then what derm practice except for the established big name ones or academic centers can afford lasers if it costs more than it brings in? I suppose we have to rent then if we're a small practice.
 
one of our int med professors mentioned today that his dermatologist friend is now "fighting tooth and nail to stay alive in this economy"? whats up with that?
 
solidly over 300k for ft med derm with a 'big box' provider in a high cost of living area, right out of res.
 
I am really surprised that so many people want to enter dermatology. The lifestyle and money may be great now, but what if the economy worsens or if healthcare becomes socialized. It seems like the filed will take an even bigger hit since many of the $$$ derm procedure are elective. Seems like other areas of medicine don't require as much business savvy -same sentiment applies to prs.
 
RedState said:
I am really surprised that so many people want to enter dermatology. The lifestyle and money may be great now, but what if the economy worsens or if healthcare becomes socialized. It seems like the filed will take an even bigger hit since many of the $$$ derm procedure are elective. Seems like other areas of medicine don't require as much business savvy -same sentiment applies to prs.
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well you answered your question. Yeah, in a bad economy people will have less disposable income, but if you are really good, there will always be people willing to pay $$$ for elective procedures, no matter how bad the economy
 
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RedState said:
I am really surprised that so many people want to enter dermatology. The lifestyle and money may be great now, but what if the economy worsens or if healthcare becomes socialized. It seems like the filed will take an even bigger hit since many of the $$$ derm procedure are elective. Seems like other areas of medicine don't require as much business savvy -same sentiment applies to prs.
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This is true for people who do cosmetic stuff, but many people have dermatologic conditions--i.e., real medical conditions best treated by a dermatologist that are not simply elective procedures. Most dermatologists have no trouble making ends meet even in tough economic times, as most dermatologists do not focus exclusively (or even mainly) on cosmetics.
 
Doublecortin said:
well you answered your question. Yeah, in a bad economy people will have less disposable income, but if you are really good, there will always be people willing to pay $$$ for elective procedures, no matter how bad the economy
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Check out the plastics forum. Cosmetics have actually been trending upwards in March for a couple of the docs there.
 
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