Rural Derm Salary?

[tubeofbread]

Just curious about what salaries/practice outlooks look like in more rural areas. I know you can get a premium in some fields, but wasn't sure how well that translated to derm. I grew up in a rural area and it's honestly something I wouldn't mind (or would even prefer). I could definitely imagine practicing somewhere like NH/Vermont/Maine or upper midwest.

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[asmallchild]

Just curious about what salaries/practice outlooks look like in more rural areas. I know you can get a premium in some fields, but wasn't sure how well that translated to derm. I grew up in a rural area and it's honestly something I wouldn't mind (or would even prefer). I could definitely imagine practicing somewhere like NH/Vermont/Maine or upper midwest.

Same premium exists in dermatology for the same reasons it does in other fields: low number of physicians, high number of patients, typically LCOL, typically better reimbursements

 

[zanzizic]

If you are in a smaller city and the only game in town you are going to make MUCH more than a big city dermatologist

 

[nimbus]

Many rural areas are very impoverished. Where does the money come from?

 

[asmallchild]

Many rural areas are very impoverished. Where does the money come from?

Insurance. Patients in rural areas are typically coming for medical dermatology, not cosmetic dermatology.

 

[OraclePL]

You'll definitely see better offers in non-competitive markets. Bigger salaries, bigger bonuses. You'll also be busier because of the scarcity of dermatologists.

Add in the lower cost of living and it's a strong financial decision, but one most people don't want to make because they want to be in the city.

You won't see specific numbers, and I don't think it's a helpful exercise anyway. Figures can vary so much depending on if it's a PE group, hospital-employed, small private practice, and even within the same state/region. Even looking at some other threads, I see some misleading numbers both ways. People aren't trying to purposely mislead you - they're just giving you numbers based on their experience, which shows you how much variance there can be.

 

[MOHS_01]

Same premium exists in dermatology for the same reasons it does in other fields: low number of physicians, high number of patients, typically LCOL, typically better reimbursements

I really think those days are in the rear view, unfortunately. It's been known for some time now that rural populations are more governmental insured, Medicare or Medicaid, have a higher percentage of exchange plans, have lower household incomes, and these lower household incomes translate into higher burden with high deductible plans. I believe any positive differential would be explained by the greater volume of work due to fewer providers.... but more work for same or less money does not exactly scream WIN!!! to me any more. There are definitely positive intangibles, but the financial argument is getting harder to make as the years go by.

 

[reno911]

I really think those days are in the rear view, unfortunately. It's been known for some time now that rural populations are more governmental insured, Medicare or Medicaid, have a higher percentage of exchange plans, have lower household incomes, and these lower household incomes translate into higher burden with high deductible plans. I believe any positive differential would be explained by the greater volume of work due to fewer providers.... but more work for same or less money does not exactly scream WIN!!! to me any more. There are definitely positive intangibles, but the financial argument is getting harder to make as the years go by.

I agree it's mainly a volume thing. But often it works out to more work for more money.

For example I know a person who joined a private practice. They put him in a suburb of a large metro area. He was seeing about 15 pts a day for the first year. He would very gladly have traded that for 30 pts a day even if he got 20% less per pt.

But you don't have to end there. I know a good number of docs in these underserved areas who have a limitless supply of pts. So 50+ per day is common. Also there is no competition, so they're really don't have to worry about coddling patients as much as derms in competitive markets do, so they can go faster. They also have easy opportunities to hire extenders and make money off them.

All that volume translates to more money, even if they get less per patient encounter. In more competitive markets, these options are just not as easily available.

 

[MOHS_01]

I agree it's mainly a volume thing. But often it works out to more work for more money.

For example I know a person who joined a private practice. They put him in a suburb of a large metro area. He was seeing about 15 pts a day for the first year. He would very gladly have traded that for 30 pts a day even if he got 20% less per pt.

But you don't have to end there. I know a good number of docs in these underserved areas who have a limitless supply of pts. So 50+ per day is common. Also there is no competition, so they're really don't have to worry about coddling patients as much as derms in competitive markets do, so they can go faster. They also have easy opportunities to hire extenders and make money off them.

All that volume translates to more money, even if they get less per patient encounter. In more competitive markets, these options are just not as easily available.

I know a guy, in semi-rural solo practice, who produces well above the 90%th in wRVU production for specialty yet can only manage around the 10th% in compensation per wRVU, translating into a little over median for specialty. He's watched his volume increase and his take home stable to down (significantly, over time) for each of the past 7 years. Spinning the wheel harder for diminishing returns is a losing proposition; it's the reason rural hospitals are shuttering the doors and extension clinics are closing. The consolidation in the health insurance marketplace hit low population density areas the hardest, resulting in fee schedule erosion out of scale compared to large number of employers geographic settings. It's been a remarkable flip of fortune on that end. Shocking, really.

 

[reno911]

I know a guy, in semi-rural solo practice, who produces well above the 90%th in wRVU production for specialty yet can only manage around the 10th% in compensation per wRVU, translating into a little over median for specialty. He's watched his volume increase and his take home stable to down (significantly, over time) for each of the past 7 years. Spinning the wheel harder for diminishing returns is a losing proposition; it's the reason rural hospitals are shuttering the doors and extension clinics are closing. The consolidation in the health insurance marketplace hit low population density areas the hardest, resulting in fee schedule erosion out of scale compared to large number of employers geographic settings. It's been a remarkable flip of fortune on that end. Shocking, really.

Interesting. I guess if that's true, maybe the true sweet spot is not rural, but just a small town that's a step above rural. Just big enough to sustain a reasonably-sized local economy, but small enough that people really don't want to move there to live and practice unless they happen to have strong ties to the area.

 

[MOHS_01]

Interesting. I guess if that's true, maybe the true sweet spot is not rural, but just a small town that's a step above rural. Just big enough to sustain a reasonably-sized local economy, but small enough that people really don't want to move there to live and practice unless they happen to have strong ties to the area.

Agreed.

By the way, I know it is true -- I'm that guy. Ha. It's a revenue shortfall that is a combination of poor payer mix (due to demographics, my payer mix is still better than the general population, believe it or not, simply because I no longer am a participating provider for Medicaid), bad debt due to high deductibles, and poor reimbursements on the private insured market thanks to Anthem market dominance and shrinking PPO / traditional plans. When the number one and two employers in a region are .gov / quasi-.gov entities (as is the case for much of rural America), you're basically looking at Medicare rates as the baseline with some CPTs above and others below, lucky if you average out at break even. Couple that with the fact that rural areas take it on the chin with Medicare rates thanks to the geographic price index component of the fee schedule and the problem only compounds. My area is at the geographic floor for MC.