High Pay, Low Stress: The Dermatology Boom

When Dara Spearman, MD, attended medical school 20 years ago, she remembers learning all about ROAD, the four specialties — Radiology, Ophthalmology, Anesthesia, and Dermatology — that promised to offer the best lifestyle for physicians.

“We all heard that these four specialties would be the best ones,” the Fort Wayne, Indiana, dermatologist said. “There would be no need to work weekends and these specialties had a reputation for being the ones that would put you on a ‘road’ to a nice life and good pay.”

However, while dermatologists rank right below orthopedists and plastic surgeons as the highest doctors paid, only 42% of respondents suggested that pay was a major motivator in picking the specialty.

“We make decent money, and I’m not mad about that fact, but we also spend a ton of time with our patients,” Spearman said. “We deal with serious health conditions, and some of our patients are quite sick, whether they have skin cancer, eczema, psoriasis, or other inflammatory conditions.”

The specialty has remained competitive. As of 2023, there were 12,040 dermatologists practicing in the United States, according to the Bureau of Labor Statistics, and that same year, 141 dermatology residency programs were open for applications, offering a total of 499 positions, according to the National Resident Matching Program.

“Dermatology has always been a popular specialty and one of the toughest residency training spots to get,” Corinne Erickson, MD, a dermatologist in Atlanta, said. “Ten years ago, I attributed that to the great lifestyle it lends providers, but I don’t think the lifestyle that features a 5-day work week, no overnights, and little if any hospital calls are the only drivers anymore.”

Saving Lives is a Major Motivator

Despite headlines pointing to the popularity of cosmetic dermatology, diagnosing skin conditions and skin cancers — early — using artificial intelligence mole mapping and annual skin checks — is something 28% of those dermatologists who participated in the Medscape Medical News report said was the most fulfilling part of the specialty.

That aspect of the work inspires Vinh Chung, MD, a Colorado dermatologist with eight offices across the southern part of the state.

“When a patient walks into my office with a life-threatening skin cancer, I can perform a procedure in the office, and they can walk out cancer-free,” he said. “No other field allows that. It’s immediate, it’s satisfying, and you do it every day. That never gets old.”

Treating skin cancer faced by her patients, many of whom are farmers, is a big part of Spearman’s practice, too.

“I trained at Michigan, where we had a big melanoma clinic,” she said. “When I came here, I noticed the care was disjointed, so I worked with a hospital system to start a multidisciplinary melanoma clinic. Now, we meet and discuss cases with multiple specialists. It’s very important work.”

Job Satisfaction Comes from Collaborations With Other Specialties and Patients

Ask Michele Green, MD, a board-certified cosmetic dermatologist in New York City, who has been in practice for 30 years, and she’ll tell you that dermatology appealed to her when she was training because she got to work with so many other physicians.

“We would interface with infectious disease, with pediatrics, with adult medicine, and rheumatology, which made it really interesting,” she said. “Also, when you were called for a consult, you were the person who figured out a lot of things that might be happening with that patient.”

In the Medscape Medical News report, 28% of respondents added that connecting with patients was the most rewarding part of the specialty.

“At my clinic, I’ve seen two-week-old babies all the way up to a 102-year-old patient,” Spearman said. “We get to form really good relationships with our patients, and I get to see entire families. That’s one of the best parts of being a dermatologist.”

The Zoom Effect is Forever

The other important reason dermatologists are thriving is that how we look — and how our skin appears — will always be critical to many people, especially in the current Zoom and social media era. This means there will always be a need for qualified physicians who can offer Botox, lasers, and fillers, along with other cosmetic procedures.

“Our country is skincare obsessed,” Erickson told Medscape Medical News. “This is especially true for the generation currently in medical school. I think the world of skincare and skin treatments that fill our social media feeds is driving more interest in dermatology, too.”

The quest for longevity and the preponderance of anti-aging formulas are also having more of a moment.

“The skin is the first noticeable aging organ in our bodies, so this is yet another reason patients have an increased interest in seeing a dermatologist,” Erickson added.

Blending Medical and Cosmetic Procedures Bolsters Business

Another distinction between dermatologists and other specialties: Dermatologists can supplement services that are covered via insurance with treatments patients pay for out-of-pocket.

“With insurance companies cutting reimbursements, offering services paid for in cash can give you backup income that you can control,” said Jocelyn Lieb, MD, founder of the Skin and Laser Center of New Jersey, Ramsey, New Jersey, who has been practicing since 2010. “With other specialties, you don’t have a say in billing, but because of the two things we offer, we’re able to bolster our incomes and give our patients quality care.”

This cash revenue serves another purpose, too.

“The ability to have cash pay revenue from aesthetic procedures and skin care product sales make our overall revenue more resilient when Medicare cuts occur,” stressed Erickson. “It also offers an opportunity for providers to practice without the headaches of managed care contracts.”

Ultimately, dermatologists said that the field offers plenty to be happy about. No wonder the specialty is booming.

“You get the chance to learn about exciting and popular developments in skincare and aesthetic technologies,” Erickson said. “You also get a front-row seat to what’s happening in the longevity space, and versatile revenue streams that are not all at the mercy of managed care.”

Lambeth Hochwald is a New York City–based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.