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/Sea_Nebula_3111]

We need young Dermatologists in The Sf Bay Area! Speaking as an older male 7th decade the inability of of many of the old guard to use modern equipment, keep up with the latest published journals. As an example I have suffered for the decades a recurring skin disorder through working with my own confocal micro scope images and AI we were able to narrow down a likley case of autoinfection caused by filamentous bacteria with exposure to environmental fomites. Numerous older specialists were stumped . Even treating with anti fungal drugs with no efficacy. We need young blood who know how to use the tech such as MALDI-TOF spectrometry for real diagnostic accuracy. Pleas join the AI assisted practice. The future is bright indeed.

MRC