Graduating into the Real World

Every year, we experience an influx of new dermatologists from residency programs and watch the transition from college to medical school, and then eventually to residency. This year, there seems to be greater angst about the world our newest dermatologists are entering.

With the advent of Obamacare and the changes it will bring in medicine, more concerns pertaining to the world in which they will practice and their ultimate ability to achieve success as a practicing dermatologist (or physician) are present. Will there be steady erosion in their income and will their independence be compromised as data are more obvious to government and insurance-related entities?

Clearly, the answer to both questions is “yes” from a logical perspective, yet there is some feeling that life may be even better for our newest generation of doctors and dermatologists. We need only remember the calls of doom and gloom in the 1980s, when managed care was being introduced, yet salaries continued to increase over the ensuing years. The same may be true for our new colleagues in the future.

New methods of diagnosis for nevi and skin cancers may yield more patients than before and allow for the earlier diagnosis and treatment of conditions such as melanoma. This could lead to an influx of patients and better outcomes, resulting in positive thoughts about the benefits of visiting a dermatologist.

Additionally, the ongoing acceptance and ‘cachet’ of dermatologists as cosmetic specialists and as purveyors of cosmeceuticals argues for an increase in demand over time. While we certainly have competition from non-core and even core-trained physicians and extenders, there is a surprisingly loyal and vocal group of patients who realize the virtues of seeing a specialist who understands the skin better than the nurse injector around the corner.

Whether these positive trends prevail remains to be seen, but certainly the trends have been positive in my practice over the years in many cosmetic treatment areas. This doesn’t mean that we stayed with the same group of procedures or the same pricing strategies. We have expanded procedures and moved into some areas, such as Ultherapy and newer laser treatments early on, even though the prices to purchase these modalities/machines were clearly higher than expected. Our willingness to change allowed us to move ahead of medi-spas that had to wait for more reasonable prices in order to justify their expenditures.

Our newest class of graduates will also be more likely to engage with electronic medicine. A new area of expertise— electronic/digital dermatology—may very well emerge. This may be a great option for those who don’t wish to spend the money to set up a practice or invest in a physical presence. The opportunities and life-work balance possibilities are endless if this area of dermatology is fully explored.

The future could be brighter than any of us can imagine, but it will always be important to consider options carefully and plan for a future that is of your own choosing, while always keeping a careful watch on trends and competitors. I wish all those entering our illustrious field much success, as that success will benefit all of us in the end.