what makes derm a competitive field?

[amherstguy]

what makes derm a very sought after field, talking to a bunch of my friends doing internatinal rotations- it seems that abroad derm is the most uncompetitive field. In europe my friend was telling me- the top med students go into surgical subspecialties?

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[asmallchild]

Different values here as opposed to abroad I guess.

Many of the surgical subspecialties are highly sought after fields as well here in the US.

 

[michaelrack]

what makes derm a very sought after field,

1. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

2. (close 2nd) favorable lifestyle

3. (distant 3rd) interesting subject matter

 

[Dermguy]

I think it's money per hour that is the big draw. Lots of doctors make more, but they work their *****es off.

 

[Domperidon]

it seems that abroad derm is the most uncompetitive field

Untrue. Derm is the most competitive in Spain and Italy, and quite competitive in England and France. I don't know about Germany and other countries, but frankly your statement is a bit inaccurate...

The only place I've heard of derm being that uncompetitive is India, but you can't really compare a third world country to the US or Europe.

 

[Palintology]

Untrue. Derm is the most competitive in Spain and Italy, and quite competitive in England and France. I don't know about Germany and other countries, but frankly your statement is a bit inaccurate...

The only place I've heard of derm being that uncompetitive is India, but you can't really compare a third world country to the US or Europe.

I have a Japanese friend who said derm is not at all competitive there. Maybe it's an Asian thing. Interestingly, she said that OBGYN was among the most competitive. Yuck.

 

[N-Surge]

If your background and interests are in basic science research then the subject matter moves up to being tied for first with lifestyle, lifestyle providing time to tackle research of understudied areas.

 

[Dermaholic]

I would have to say for myself:

1. Lifestyle - No real call, rare emergencies
2. Interest/Nature of the specialty - visual, tactile, treatable, interesting
4. Variety - Procedures and medicine, lots of different patients, all ages
3. Money - I put this 4th just because there's more money in other specialties that are easier to get into than derm

 

[Dral]

The fact that it overlaps with medicine is what makes it really attractive to me. I came to med school thinking I'd love medicine and all the problem solving involved, but it ended up being too tedious. For me, Derm keeps that spirit of medicine, but gets rid of the tedious aspect, since much of it is more focused.

Also, art major...visual, yep. Money and lifestyle matter too of course. If one liked something about equally as well, one would of course opt for the field with better lifestyle and compensation.

 

[Doublecortin]

I would have to say for myself:

1. Lifestyle - No real call, rare emergencies
2. Interest/Nature of the specialty - visual, tactile, treatable, interesting
4. Variety - Procedures and medicine, lots of different patients, all ages
3. Money - I put this 4th just because there's more money in other specialties that are easier to get into than derm

really. I thought derm was king in this aspect. What would those other specialties be?

 

[asmallchild]

really. I thought derm was king in this aspect. What would those other specialties be?

A lot: anesthesia, radiology, any of the surgical subspecialties, radiation oncology, etc... etc... Most of which are easier to get into than derm.

It's the derm lifestyle that trumps them.

 

[abcxyz0123]

I don't understand that. Wouldn't derm win in the salary category if you simply worked the same hours as the above mentioned specialties?

People say derm gets the most money per hour worked, but is not in the top 5 or 10 fields as far as annual salary go. This does not make sense to me. Wouldn't a specialty that makes the most money per hour automatically be the most paying...since all u have to do is simply equalize the hours?

 

[Dermaholic]

I don't understand that. Wouldn't derm win in the salary category if you simply worked the same hours as the above mentioned specialties?

People say derm gets the most money per hour worked, but is not in the top 5 or 10 fields as far as annual salary go. This does not make sense to me. Wouldn't a specialty that makes the most money per hour automatically be the most paying...since all u have to do is simply equalize the hours?

Hmmm not sure I've ever heard that dermatologists make the most money per hour. If you're doing Mohs surgery it pays well maybe in the $450-500K range if you're really busy. If you really look into all physician salaries Rad Onc top salaries are $700K+, Ophtho $750+, Interventional Rad $900K+, Ortho $700K-1M+, and the list goes on. The match rates are much better for these specialties than derm.

 

[asmallchild]

I don't understand that. Wouldn't derm win in the salary category if you simply worked the same hours as the above mentioned specialties?

People say derm gets the most money per hour worked, but is not in the top 5 or 10 fields as far as annual salary go. This does not make sense to me. Wouldn't a specialty that makes the most money per hour automatically be the most paying...since all u have to do is simply equalize the hours?

people choose not to work those hours

 

[Dral]

I don't understand that. Wouldn't derm win in the salary category if you simply worked the same hours as the above mentioned specialties?

People say derm gets the most money per hour worked, but is not in the top 5 or 10 fields as far as annual salary go. This does not make sense to me. Wouldn't a specialty that makes the most money per hour automatically be the most paying...since all u have to do is simply equalize the hours?

I think the potential is certainly there. Part of what makes derm attractive is that it is an easier lifestyle to control than many other fields that are higher on compensation. Sure, spine surgeons make a ton, but they have to work a ton because there aren't enough of them (I guess 'not enough of them' sorta applies to derm too, heheh). Surgeons and medicine non-hospitalists will pretty much have to always serve some sort of call, even if it's 3 times a month or something like that. It's just something they really can't easily control.

And basically, as asmallchild commented, most dermatologists don't choose to work those hours. If you want to make a name for yourself as a specialist, dermpath, or procedural person, then you would probably choose to put in more hours and subsequently make more moolah. It's all about finding your personal 'niche' that balances happiness with the amount of compensation you desire. Ok, I'm starting to ramble.

 

[Dermguy]

Hmmm not sure I've ever heard that dermatologists make the most money per hour. If you're doing Mohs surgery it pays well maybe in the $450-500K range if you're really busy. If you really look into all physician salaries Rad Onc top salaries are $700K+, Ophtho $750+, Interventional Rad $900K+, Ortho $700K-1M+, and the list goes on. The match rates are much better for these specialties than derm.

Of course it depends what you do with during those hours, but an experienced dermatologist can see a LOT more people per hour than other ambulatory specialties, and they can do a ton of procedures that pay extremely well for the 10-15 minutes they require (eg, Botox, fillers, laser stuff). Plus, you can have nurse practitioners, estheticians, and/or physician assistants working for you who also see a TON of people per hour, sometimes doing procedures themselves. If money per hour is your goal (it's not mine), and a huge salary per year is your objective, then derm is better per hour than anybody else. Also, if you want to put in Ortho, Plastics, or Neurosurgery hours by staying open 12 hours per day 6-7 days per week I'm sure you'll make ridiculous cash, man. I'm sorry you'll never have time to spend it, though.

 

[deltamed]

Radonc wins for money per hour. M-F office hours never get called in even during residency and make about what a radiologist does.

 

[asmallchild]

Radonc wins for money per hour. M-F office hours never get called in even during residency and make about what a radiologist does.

True but you do have to cope well with cancer-stricken patients.

 

[Nilf]

Untrue. Derm is the most competitive in Spain and Italy, and quite competitive in England and France. I don't know about Germany and other countries, but frankly your statement is a bit inaccurate...

I could add several other Asian countries to the mix.

 

[bonran]

Hmmm not sure I've ever heard that dermatologists make the most money per hour. If you're doing Mohs surgery it pays well maybe in the $450-500K range if you're really busy. If you really look into all physician salaries Rad Onc top salaries are $700K+, Ophtho $750+, Interventional Rad $900K+, Ortho $700K-1M+, and the list goes on. The match rates are much better for these specialties than derm.

Dont forget Neurosurg 500-1M, INR 400-700, VIR 350-700.

 

[opencomedo]

I try to not think of the money, as it will likely change in the near future (who knows...), but here are you guys getting this salary information???

Rad Onc $700K+, Ophtho $750+, Interventional Rad $900K+, Ortho $700K-1M+??

Alll the surveys online (like this one http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm)
dont really jive with any of those figures. Granted they prob grossly underestimates in many cases... but it does have the mean derm being close to 350,000. If we are going anecdotally, I have heard of procedural derm guys making close to a mil/yr (even with a 30% compensation reduction that is still $700K).

Derm is great because you get to have exposure to path, surgery and medicine all at once in the same clinic while looking at what you are treating the majority of the time (while getting compensated extremely well too ).

 

[MOHS_01]

I try to not think of the money, as it will likely change in the near future (who knows...), but here are you guys getting this salary information???

Rad Onc $700K+, Ophtho $750+, Interventional Rad $900K+, Ortho $700K-1M+??

Alll the surveys online (like this one http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm)
dont really jive with any of those figures. Granted they prob grossly underestimates in many cases... but it does have the mean derm being close to 350,000. If we are going anecdotally, I have heard of procedural derm guys making close to a mil/yr (even with a 30% compensation reduction that is still $700K).

Derm is great because you get to have exposure to path, surgery and medicine all at once in the same clinic while looking at what you are treating the majority of the time (while getting compensated extremely well too ).

Point # 1: Those numbers are neither median, mean, nor mode -- they may represent the 90th percentiles for respective specialty, but seems even high for that.

Point # 2: (and this is important) a 30% reduction on revenue translates into much more than a 30% reduction on net. Don't believe the talking heads and do not delude yourself any further.

National average dermatologist overhead runs 50%. For high producers, it is possible to get this number down to 40%, although 45% is more reasonable.
If you assume a 1mill income, that required 1.8 in revenue. 800k in costs. Next year, 30% revenue drop. Now 1.26 in revenue. Assuming overhead remains flat (not realistic assumption, generally), that leaves 460k for profit.

While in practice it is not quite so drastic as practice patterns would change reflecting changes in the marketplace, the basic equation for like work holds true.

This is why it is important for everyone to understand basic healthcare financing and medical economics, including reimbursement structures, private practice cost structures, etc.

 

[bonran]

Derm is great because you get to have exposure to path, surgery and medicine all at once in the same clinic while looking at what you are treating the majority of the time (while getting compensated extremely well too ).[/QUOTE]

Exposure to path--ok, but medicine or surgery!!! ha, what does a derm person know about the E of an EKG or C of reading a Chest X ray. Ok, most derm problems can be solved by prescribing an antiinflammatory cream (steroids)/ anti bacterial cream/ anti fungal cream. That is pretty much the extent of medicine in derm. I havent seen derm come into the ICU to manage fluid balance or electrolytes in someone with TEN or pemphigus. You know what, in the last 5 years a a resident & fellow I have called in derm thrice, always to do a punch biopsy (which I could do in my country) for confirming a diagnosis we suspected. Not that it made a big difference in managing the patient. We did stop the medication causing the drug rash.
As far as surgery is concerned, if doing a wide excision biopsy (MOH's surgery in the US) is someones idea of surgery, it is laughable. This is not orthopedics/neurosurg/abdominal surgery or plastics. This is a microscopic wide excision biopsy not rocket science. Physicians in the 3rd world do it at the bedside, without any complications as good results as in the US & without specialist training (read fellowship in MOH's). This is just a gimmick & a creation of turf wars & the US health care system.

Its a joke!!!

 

[asmallchild]

Exposure to path--ok, but medicine or surgery!!! ha, what does a derm person know about the E of an EKG or C of reading a Chest X ray. Ok, most derm problems can be solved by prescribing an antiinflammatory cream (steroids)/ anti bacterial cream/ anti fungal cream. That is pretty much the extent of medicine in derm. I havent seen derm come into the ICU to manage fluid balance or electrolytes in someone with TEN or pemphigus. You know what, in the last 5 years a a resident & fellow I have called in derm thrice, always to do a punch biopsy (which I could do in my country) for confirming a diagnosis we suspected. Not that it made a big difference in managing the patient. We did stop the medication causing the drug rash.
As far as surgery is concerned, if doing a wide excision biopsy (MOH's surgery in the US) is someones idea of surgery, it is laughable. This is not orthopedics/neurosurg/abdominal surgery or plastics. This is a microscopic wide excision biopsy not rocket science. Physicians in the 3rd world do it at the bedside, without any complications as good results as in the US & without specialist training (read fellowship in MOH's). This is just a gimmick & a creation of turf wars & the US health care system.

Its a joke!!!

Uhh, the whole point of MOHS surgery is to avoid performing a wide excisional biopsy.

Way to spout off on something you evidently know little-to-nothing about



EDIT: It would help if you knew how to quote as well.....

 

[MOHS_01]

Derm is great because you get to have exposure to path, surgery and medicine all at once in the same clinic while looking at what you are treating the majority of the time (while getting compensated extremely well too ).

Exposure to path--ok, but medicine or surgery!!! ha, what does a derm person know about the E of an EKG or C of reading a Chest X ray. Ok, most derm problems can be solved by prescribing an antiinflammatory cream (steroids)/ anti bacterial cream/ anti fungal cream. That is pretty much the extent of medicine in derm. I havent seen derm come into the ICU to manage fluid balance or electrolytes in someone with TEN or pemphigus. You know what, in the last 5 years a a resident & fellow I have called in derm thrice, always to do a punch biopsy (which I could do in my country) for confirming a diagnosis we suspected. Not that it made a big difference in managing the patient. We did stop the medication causing the drug rash.
As far as surgery is concerned, if doing a wide excision biopsy (MOH's surgery in the US) is someones idea of surgery, it is laughable. This is not orthopedics/neurosurg/abdominal surgery or plastics. This is a microscopic wide excision biopsy not rocket science. Physicians in the 3rd world do it at the bedside, without any complications as good results as in the US & without specialist training (read fellowship in MOH's). This is just a gimmick & a creation of turf wars & the US health care system.[/QUOTE]

Its a joke!!!

 

[opencomedo]

 

[OntheRoof55]

just going back to the whole earnings issue, why do program chairs make so much more than the other staff dermatolgists in academics?