money

[phillystudent]

Please forgive me for asking about money (yes, I know it's not all about the money), but...

I keep hearing 200k as the figure dermatologists can expect to make. Do any of you folks know what dermatopathologists usually make?

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[PathOne]

As anyone will say, it hugely depends on a large number of variables: Location, lab setting, partnership status, referrals etc. etc.
However, generally speaking, a dermpath can expect to make more than a dermatologist, and often quite a lot more than a pathologist. Why? One reason is that an experienced dermpath can diagnose a case rather quickly. Obviously, there's the hard and time-consuming cases, but most are fairly straight forward. That means more billing (or more human working hours, depending on preference).

Specific numbers? 300K/year shouldn't be unattainable, and insurance, like in derm and path, is not a huge issue. Top? Well, Bernie Ackerman earlier this year gave 10 mil. to Harvard, so........

 

[LADoc00]

As anyone will say, it hugely depends on a large number of variables: Location, lab setting, partnership status, referrals etc. etc.
However, generally speaking, a dermpath can expect to make more than a dermatologist, and often quite a lot more than a pathologist. Why? One reason is that an experienced dermpath can diagnose a case rather quickly. Obviously, there's the hard and time-consuming cases, but most are fairly straight forward. That means more billing (or more human working hours, depending on preference).

Specific numbers? 300K/year shouldn't be unattainable, and insurance, like in derm and path, is not a huge issue. Top? Well, Bernie Ackerman earlier this year gave 10 mil. to Harvard, so........

Derm can make huge sums, Dermpath can make so much money I want to buy an AK47 and go crazy when I hear about it. j/k
My numbers
Starting dermies not in Kaiser: 175K on West Coast
At partner/max salary end: 275-300K
Dermpathies start: 200K
Max at: 400K usually and thats with about 3 months of vacation
But these assume you are A.) GOOD B.) well liked
That said I have seen (personally) starting offers in dermpath of between 500K-1million dollars, Im not BSing. Yes, for me life is not so good.

 

[phillystudent]

That said I have seen (personally) starting offers in dermpath of between 500K-1million dollars, Im not BSing. Yes, for me life is not so good.

holy crap....I guess I could live on that.

 

[Fermata]

holy crap....I guess I could live on that.

Yea.

I suppose that you'd have to pull back your lifestyle a bit.

 

[Hudson]

Yea.

I suppose that you'd have to pull back your lifestyle a bit.

I knew a mohs surgeon who had a factory going. 2 PA's(did most of his suturing), 3 nurses full-time, 2 medical assistants full-time. He also had his own lab with 3 cryo machines and two laba ssistants preparing slides full-time. He read all his own slides and probably knocked out 8-15 cases/day (multiple cases going on at once). He also did a ton of cyro/laser/x-ray tx as well. He worked Mon-F with one 1/2 day/wk and a few Fri's/mo off, no weekends, no call. Normal day was 10 hrs. He was easily making 1-1.5+ mil/yr. There is a TON of $$$ in derm if you are willing to work for it.

 

[phillystudent]

I knew a mohs surgeon who had a factory going. 2 PA's(did most of his suturing), 3 nurses full-time, 2 medical assistants full-time. He also had his own lab with 3 cryo machines and two laba ssistants preparing slides full-time. He read all his own slides and probably knocked out 8-15 cases/day (multiple cases going on at once). He also did a ton of cyro/laser/x-ray tx as well. He worked Mon-F with one 1/2 day/wk and a few Fri's/mo off, no weekends, no call. Normal day was 10 hrs. He was easily making 1-1.5+ mil/yr. There is a TON of $$$ in derm if you are willing to work for it.

So I guess this guy is both a Mohs surgeon and and Dermatopathologist since he reads his own slides? What type of setting did you see this guy in? Is he the only MD at his practice and has all this support staff working with him?

 

[wooo]

dermies can read their own slides w/o a dermpath fellow. Thet usually read the BCC's, AK's, SK's, KA's, and SCC's and sent the tricky stuff such as melanocytic things to dermpaths

 

[Hudson]

dermies can read their own slides w/o a dermpath fellow. Thet usually read the BCC's, AK's, SK's, KA's, and SCC's and sent the tricky stuff such as melanocytic things to dermpaths

Woo described it to a "T." This guy read all the BCC/SCC/AK's and anything that was melanocytic in nature was a full excision and went straight to path. From my understanding the staining process for melanocytic tissue is differenct from the other types of skin cancer. Some of the trickier SCC's would be sent stat to path to see if they were truly"clear." This guy definitely knew his limits but was VERY good at what he did. There were multiple other MD's in the office, however none were Mohs trained. It worked out well for them. They key to his success was his support staff. His PA's kept him moving and there was very little wasted time or effort. He also worked pretty closely with the plastics guys for repairs. he would do a lot of the simplier flaps and grafts himself, but would utilize plastics when needed. In return they refered him a lot of Skin cancer patients.

 

[novacek88]

I think Derm salaries will significantly drop within the next decade. Family Practice physicians are now incorporating many dermatological procedures that were once practiced only by dermatologists and plastic surgerons. Laser resurfacing, hair removal, vein removal, microdermal abrasion, chemical peels, photo facials etc. can be practiced by non-dermatologists. For example, a lot of family practice physicians are performing botox. And while the general public would prefer a dermatologist perform these procedures, they realize they can save significant amounts of money by seeing an FP albeit with potential additional risk. Furthermore a lot of non-physicians and spas are doing simple things such as chemical peels, hair removal and microdermal abrasion. All of this will take income away from many dermatologists.

 

[ny skindoc]

I think Derm salaries will significantly drop within the next decade. Family Practice physicians are now incorporating many dermatological procedures that were once practiced only by dermatologists and plastic surgerons. Laser resurfacing, hair removal, vein removal, microdermal abrasion, chemical peels, photo facials etc. can be practiced by non-dermatologists. For example, a lot of family practice physicians are performing botox. And while the general public would prefer a dermatologist perform these procedures, they realize they can save significant amounts of money by seeing an FP albeit with potential additional risk. Furthermore a lot of non-physicians and spas are doing simple things such as chemical peels, hair removal and microdermal abrasion. All of this will take income away from many dermatologists.

A recently published study indicates that only 6% of most dermatologists' time was spent on doing cosmetic procedues, a level that has stayed the same over the past few years even though overall compensation has increased since 2002.Income gains have been significant through MOHS and non cosmetic surgical procedures which are receiving much more focus in derm residencies.The supply of dermatologists is so limited relative to the population and numbers of other medical practitioners that the demand for specialists with this expertise is unlikely to drop in the near future. There are many higher paying specialties in medicine,the big advantage in Derm is that the time spent for the income earned and the overall quality of life is difficult to beat.

 

[novacek88]

A recently published study indicates that only 6% of most dermatologists' time was spent on doing cosmetic procedues.

Wow, that is really interesting! I had no idea that cosmetic procedures accounted for such a small percentage of a derm practice. Yes, then by all means I agree their income will not really be affected to such an extent as I once thought. Thanks for the prompt response ny skindoc.

 

[bigfrank]

Many people desiring cosmetic "procedures" will visit a plastic surgeon first and foremost and, generally, the plastic surgeon will be more than happy to oblige.

 

[scootad.]

speaking from personal experience?

 

[bigfrank]

Of course!

 

[vinisew]

Just curious what is the difference between a dermpath and a derm?

 

[donvicious]

Just curious what is the difference between a dermpath and a derm?

I believe dermpaths must complete a path residency then do a derm fellowship.

 

[Pyroclast]

I've seen this discussed on the forums before. What I've read is that a dermpath fellowship is open to people who have completed either a derm or path residency, and takes one year to finish. But it's not like getting double boarded. Going the path route and becoming a dermpath does not qualify a physician to practice dermatology, just like a dermatologist who becomes a dermpath would not be qualified to look at non-derm slides. I'm sure both routes lead to making insane money. You can find more about them if you search these forums.

 

[vinisew]

I believe dermpaths must complete a path residency then do a derm fellowship.

ok i understand that, but what are the differences in what they do? this is my first time hearing about a dermpath.

 

[ny skindoc]

ok i understand that, but what are the differences in what they do? this is my first time hearing about a dermpath.

A dermatopathologist is a specialist in the pathology of the skin.They read path slides of skin biopsies.It is a subspecialty of pathology although many programs are run by dermatology depts and requires a fellowship following a path residency. It is also possible to enter this fellowship after derm residency.In the past that was the usual route but now most dermpath fellows are pathologists.It is highly lucrative and in big demand.

 

[PathOne]

Actually, a derm doing dermpath will do clinical rotations in path, while someone with a path background will have to do clinical derm as part of the fellowship. But since most progs only last a year, that of course only gives you a general idea about the other specialty.

It's an eternal debate which background is best, and the true answer is that it depends on the individual. Example: Bernie Ackerman, who more or less invented modern dermpath, is a derm by training. But the new director at his academy, Geoff Gottlieb, is a path. What IS true, though, is that a dermpath would on average earn more than both a derm and a path, with reasonable working hours to boot. So competition for fellowships isn't likely to lessen.
Trivia of the day: In Europe, dermpath is almost exclusively a path subspec. Although, as in the US, som derms read their own slides, and often proficiently so.