Finding Balance in Dermatology Practice
A successful dermatologist assesses opportunities, offers tips for finding balance, and shares her experience navigating personal and professional satisfaction in a dual-dermatologist household.
How did you get into dermatology?
Sandra Marchese Johnson, MD: The medical school I went to covered body systems and I enjoyed it all, but the last body system was skin and I really, really enjoyed it. Dr. Bob Brodell was in charge of training us in skin as part of basic science in our second year of med school. I loved it. None of my friends liked it at all. So they encouraged me to look into dermatology. At the time, I wanted to be a family practice doctor, because that’s the only kind of doctor that I knew growing up.
That summer between second and third year I spent quite a bit of time at Dr. Brodell’s office and was fascinated. We would start the morning at 7:00am at the hospital and work with lasers and then saw patients from 8:00 to 4:00. He had about 100 patients on his schedule at a time. And then we would do hospital consults and then he would read dermpath or write publications until about 7:00pm. So, he worked quite a bit and I loved it. I did that with him over the summer and that solidified my decision. He has remained an important mentor to this day.
Dr. Brodell helped me arrange a few away electives in medical school and I applied to only a few—I think, four—dermatology programs out of medical school. They were all four-year programs combined. I applied to Arkansas, which was my favorite, and fortunately I got into Arkansas for residency. It was there that I met my husband. So, when I was in residency, he was a medical student four years academically behind me. He saw lots of other specialties and some of his family is in medicine, but I think my friends and I convinced him to do dermatology. So, I stayed on faculty at The University of Arkansas for four years. I was in charge of their cosmetic training and restarted their clinical trials department. After his residency, we went to Ohio and he did a two-year derm surgery fellowship with the intention of going back to his home town in Greenwood, Arkansas to open up our own practice, and that’s what we did. Together we opened up our own practice, Johnson Dermatology, in 2006.
Why did you want to have your own practice?
Dr. Johnson: In the town where we were, there were two other practices affiliated with the hospitals. Both of them had two dermatologists. Neither of them offered Mohs surgery, and it was important to my husband that we be able to offer the latest and the best standard of care to our patients. I wanted to offer lasers and cosmetics and clinical trials and we didn’t know if we could do that working under that hospital structure. So, we decided we would take that leap and open up our own practice. Back then, 12 years ago, it was fairly common for people to open up their own practice or join a small dermatology practice. Whatever you want to say, for better or worse, that seems to be less likely now either by interest or by other opportunities.
Did considerations about raising a family affect your practice decisions?
Dr. Johnson: I think from a personal point of view we each have to decide what is important to us, and I think we should make decisions based on that. For me personally I put God first, and then family, and then my personal interests, but if I don’t take care of my personal interests I can’t take care of my family or anybody else. One of the things that was important to my husband is that we practice in his hometown where his parents are. My parents were from Ohio. We were blessed in the fact that my parents moved here and we share a backyard now, and so my kids have kind of a village to help take care of them. We are in a very special situation. My parents help take care of the kids. His family is all there. His friends and support network are there.
When we started our practice, we made the decision that one of us would start early in the mornings at 7:00, and one of us would finish late, so that when the kids were little one of us could take the kids to school and the other could be there when they came home from school or to pick them up after school, and that worked out really well for us. There are so many new opportunities now that I think whatever you choose, you can make it work if you make that a priority.
Do you think dermatology provides more flexibility than other specialties or is it up to the individual to find the right fit?
Dr. Johnson: I think you can make anything work. I have a friend who went into general surgery and they can make that work also. Now, with hospitalists I think internists and pediatricians can make that work also. I have a sister-in-law who’s a pediatrician and she sees patients three days a week. Physicians are in such high demand that if you want to work 80-plus hours per week you can, but if you want to work 20 hours per week you can, as long as you give your best during those hours that you’re there working.
Do you think dermatology needs a public relations push, especially to young students?
Dr. Johnson: I think so, definitely. I think the best PR people are dentists. They’ve done a really good job teaching us that we all have to brush our teeth twice a day. We have to floss once a day and we have to see the dentist at least twice a year. I think they’ve done a wonderful job marketing that. You know, “Four out of five dentists recommend Trident,” was what I heard growing up. As dermatologists, I think we’re doing a better job about the importance of sun block every day, but we’re really not doing a great job on choosing the right skincare products, relying on your dermatologist for your skincare advice, seeing your dermatologist yearly for your full-body exams, trusting your dermatologist with the skin, hair, and nails. I think we could do a better public awareness of that.
The other thing that might be more controversial, but this hurts my heart, is that instead of us all working together we may be a little bit more divisive, subspecializing and promoting only certain groups, like only the derm surgeons or only the pediatric dermatologist or only the dermatopathologists, instead of promoting that we are all dermatologists. We are the experts in skin, hair, and nails. I wish we could be more unified and more cohesive, and I think we can give a more united front together.
When starting out, did you encounter any stereotypes or expectations, whether that be gender-based or even just perceptions of a “physician” in general?
Dr. Johnson: I think all of us could tell stories, whether we’re women or men. You know, I could be harsh or bitter. I could talk about a guy in my med school class who was upset that the top three people in the class ranking were women; he was in the top ten, and he was upset that all the women were at the top and they were going to take jobs away from him. You work hard; you earn your spot, and that’s the way it is.
I heard recently that a primary care doctor, I think in Texas, was quoted saying, “Women earn less than men in medicine because they make choices and work less.” I don’t think that’s true. I think we’re blessed in the fact that in medicine we get paid for the work we do. So, if you see more patients or you work harder or you do certain things, you’ll be paid based on that.
In private practice, as far as insurances, we’re paid based on RVUs or relative value units. So, the more RVUs you charge and collect for, the more money you will make. It’s fair. You get paid the same whether you’re a man or a woman. It doesn’t matter.
General compensation reports and surveys don’t consider the “trade-offs” people make. Do you have any thoughts on that?
Dr. Johnson: You could have it all if you want to. You know, when you say yes to one thing you’re saying no to something else, and you have to decide what you want to say yes to, whether that’s money or kids or family or academics or private practice or whatever. We can all do whatever we want to do. Let’s just work together to do it.
I had a few opportunities recently to speak at other places in our country about skin, and I said no to some opportunities because I wanted to be home with my kids this weekend because my husband was traveling. So, I think we just need to decide what we’re saying yes to and what we’re saying no to.
Do you have advice for young physicians who may be afraid that turning down certain professional opportunities will lead to fewer future invitations?
Dr. Johnson: If you’re good at what you do and if you show interest, even if you have to say “no” today, quality will win out and you’ll be asked again. Think about it: if you’re saying no to this opportunity now what do you get to say yes to? Are you getting to say yes to being home and being with your child or to go on a trip with your family or to go on a girl trip? By saying no to this opportunity you might get a better opportunity from something else later.
I think if it’s important to you, though, and you want to say yes to that opportunity, just know that you might be saying no to something else and be comfortable with your decision.
I think it comes down to really thinking about who you are. Write a mission statement and maybe write out some personal goals, short-term and long-term, and when those opportunities arise think ‘Does this opportunity keep in line with my goals?’
Do you have any advice for young physicians, especially on negotiating?
Dr. Johnson: I would tell people to find a few good mentors and do some comparison. We’re blessed that a dermatologist joined us a couple of years ago straight out of residency. He had had lots of offers and opportunities. He had lots of good salary information from around the country, and we presented him with what we thought was fair based on his productivity, and he came back and offered us something else. We thought he did a fine presentation and we accepted it and went with what he said.
If you don’t like negotiating or confrontation—and I really don’t like confrontation—write it out. Put it in an email and don’t attach emotion to it. Just make it the facts, and present the facts the way they are. Whatever that decision comes out to be, be comfortable with it.
Have good data to support why you’re asking for what you’re asking for. If you have good mentors to help you figure out how to ask, you should be able to negotiate for whatever you want.
Remember, too, that there’s more than just the financial package. Make sure you’re negotiating for other things that are important to you besides just that money line. You know, you spend a lot of time at work, so you want to make sure you’re joining a group or working with people who have similar values and concerns as yours because that’s important.
Especially for a younger woman looking at dermatology or starting off in dermatology, do you have any specific advice for them to be successful in their career?
Dr. Johnson: I would say first of all, congratulations for being a dermatologist. I think it’s the best specialty ever! I think the two most important decisions in life are choosing your career and choosing your partner in life, and if you can get those two right most of the little things fall into place. I’ve been blessed to both be a dermatologist and to work with and marry the best human being I’ve ever met. So, I feel very blessed. If you can get those two things right, hopefully everything else just works itself out.