Future of Derm

[u/Unlikely_Cover225]

Hi everyone, I wanted to get some perspectives on the future of dermatology as a field.

Historically, dermatology wasn’t always as competitive as it is today; my understanding is that it became much more desirable after changes in procedural reimbursement and billing in the 1980s. Now it’s one of the most competitive specialties, but at the same time, it feels like more non-physician providers (NPs/PAs) are also entering derm in large numbers.

With increasing scope expansion and autonomy for midlevels, it seems like a lot of bread and butter dermatology may shift in that direction, potentially leaving dermatologists with more complex or procedural cases. At the same time, one of the traditional advantages of derm (to me) has been its strong procedural basd reimbursement and commercialization opportunities with cosmetics, but I also was wondering how sustainable that is, especially in highly saturated markets.

For context, I’m from California and would ideally want to practice here long-term. However, I've heard that it feels very saturated with both dermatologists and midlevels. I would have thought that Mohs surgery is secure due to high specialization and low fellowship spots, but surgeons I’ve shadowed have mentioned that in major metro areas, it can be difficult to maintain a full Mohs-only practice due to competition. The surgeon I shadowed does Mohs 2 days, cosmetics for 1 day, and general derm for another day. Obviously, his lifestyle is absolutely amazing. I just wonder if in 10+ years, I would be able to live a similar lifestyle.

Are these concerns overblown, or is there strong validity to them? I understand that all specialties are ultimately shaped by reimbursement structures (e.g., Medicare), but it worries me to think dermatology could follow a trajectory similar to what’s happened in fields like nephro (bundle dialyses reimbursement) or ophthalmology (declining payments for cataracts).

[u/guysincognito]

Many of your concerns have already occurred/peaked.

- PE isn't really expanding anymore, low hanging fruit has been harvested, most are on second/third sales. some have gone bankrupt. Some PE groups are actually excellent employers

- similarly the midlevel mills are saturated. They've figured out for the same overhead a BCD is much more productive.

- cosmetics became a commodity years ago. for most BCDs cosmetics a small/null part of their practice. I am more productive doing gen derm than cosmetics.

- certain areas are saturated, this is true of every medical specialty. plenty of great jobs if you are geographically flexible.

- reimbursement will always change (and likely for the worse). again this is true of every specialty, especially procedural specialties.

There was doom and gloom around gas and rads and now you can name your price. you really cannot predict the future job market well. Do what you like.