Resources & Articles
February 8, 2024

The Dermatology Job Hunt Part I - practice types, pay structures, job considerations

Career Paths
General Dermatology

A curated discussion of topics ranging from practice types, industry trends, contract negotiations, and more to help you thrive in your dermatology career.

Nader Aboul-Fettouh MD
Dr. Aboul-Fettouh is a double board certified dermatologist and fellowship trained Mohs Surgeon who practices in Houston, TX.

Alternative job boards

Although we aim to be the #1 hub for job listings, we understand that not all listings may be available on our website. Note that these job boards may require hundreds of dollars in listing fees and may exclude smaller niche practices that may fit your career preferences. Here are additional websites that may be helpful in your job search.

  • AAD Career Compass Job Board
  • Dermatology Authority Job Board
  • JAMA Career Center
  • NEJM Career Center
  • Texas Dermatological Society Job Board
  • American College of Mohs Surgery Career Center
  • American Society for Mohs Surgery Classifieds
  • Facebook (TBCD Group + TBCD Career Center Group)

Practice Types


Navigating the various practice environments and ownership types is crucial for a dermatologist looking for a job. Understanding the nuances of each can help you align your career aspirations with the right setting. Here's a breakdown of the practice types and ownership models in dermatology:

Solo Practices:

Advantages: Complete autonomy in decision-making; close, personal relationships with patients; and potential for higher profit margins.
Disadvantages: Greater administrative burdens; sole financial responsibility; challenging to take time off; and a potential feeling of isolation.

Group Practices:

Advantages: Shared resources and costs; collaborative environment; ability to cover for each other; diverse expertise within the group.
Disadvantages: Less autonomy than solo practice; profit-sharing; potential for conflicts within the group; decision-making may be more complex.

Multi-Specialty Groups:

Advantages: Access to a broad patient base; opportunities for inter-specialty referrals; diverse clinical opinions and support within the practice.
Disadvantages: You may have less focus on dermatology-specific needs; potential for competing interests among different specialties; complex organizational structure.

Hospital/Academic Groups:

Advantages: Access to cutting-edge research and technology; opportunities for teaching and professional development; usually come with a built-in referral network.
Disadvantages: May have less clinical autonomy; more significant administrative oversight; productivity may be tied to academic responsibilities.

Ownership Types

Solo Owner:
Advantages
: Total control over practice decisions; retention of practice profits; ability to sell or pass on the practice.
Disadvantages: Financial risks are not shared; can be challenging to expand; significant administrative responsibilities.

Partnerships:
Advantages: Shared financial risk; collaborative decision-making; shared administrative tasks.
Disadvantages: Profits are split; potential for partnership disputes; exit strategy can be complicated if a partner wishes to leave.

Hospital/Mega Corporations:
Advantages: Financial stability; less administrative work; potential for better work-life balance.
Disadvantages: Less autonomy in clinical decisions; may have productivity and performance targets; corporate culture may not suit all.

Private Equity:
Advantages: Potential for higher earning through shared savings and efficiencies. Specialists such as Mohs surgeons may have a higher case load due to in-house referrals.
Disadvantages: Less control over practice direction; emphasis on profitability can impact clinical decisions; potential for cultural shift towards a more corporate environment.

When considering these options, reflect on what balance of autonomy, support, risk, and collaboration you prefer. Each setting has its unique set of challenges and rewards. It’s also important to think about your long-term goals, such as whether you want to manage a business, focus on patient care, engage in teaching or research, or have a predictable work schedule. Choosing the right type of practice and ownership can significantly impact your job satisfaction and professional growth in dermatology.

Job Criteria to Consider

Pay Structures

Base Salary Plus Production: A fixed salary with additional compensation based on productivity. This provides a stable income while also rewarding efficiency and a higher volume of services.
Production-Based Pay:
Collections-Based: Compensation is a percentage of the fees collected for services rendered. This incentivizes high-quality patient care and efficient billing practices.
RVU-Based: Compensation is based on Relative Value Units, which reflect the value assigned to each service. This can be more objective, as it’s based on service rather than purely financial metrics.

Partnerships

Equal Partnership: All partners share equally in profits, losses, and decision-making.
Tiered Partnership: New partners may enter at a lower tier with less financial benefit and decision-making power, with the potential to progress to higher tiers over time.
Buy-In Partnership: Requires an upfront investment or gradual earning of equity in the practice. When considering a partnership, understand the terms, the process of becoming a full partner, and any financial obligations or benefits involved.

At times, partnership may be a misnomer and include a higher tier of collections or benefits but without true ownership or decision-making power.

Staffing:

The number of medical assistants and support staff can significantly affect a dermatologist's workflow.
Medical Assistants: How many you will have per provider and their level of training.
Administrative Staff: The support for billing, scheduling, and patient communications. A higher ratio of support staff to providers typically indicates better support.

Supervision of Physician Assistants (PAs) or Nurse Practitioners (NPs)

Supervising mid-level providers can expand a practice's capacity but also comes with additional responsibilities.

Scope of Practice: Understand the legal scope of practice for PAs and NPs in the state.
Supervision Requirements: Familiarize yourself with the level of supervision required and your comfort level with it.
Pay bonus: Pay bonus should be specified in the contract. Determine the dollar value of that bonus and whether it is of fair value.

Autonomy

Autonomy is a critical factor for many physicians.

Scheduling: How much control you have over your schedule and the number of patients you see.
Clinical Decisions: Your freedom to make decisions about patient care without undue interference.
Equipment and Instruments: For specialists like Mohs surgeons, the availability of necessary equipment and the process for acquiring new instruments if needed.

Other Considerations

Contract Terms: Understand the length of the contract, non-compete clauses, and what happens if the contract is terminated.
Professional Development Opportunities: Look for practices that support continuing education, research opportunities, and professional growth.
Geographic Location: Consider the community, local amenities, schools, and lifestyle.
Practice Culture: A practice's culture can have a significant impact on your daily work life. It's important to find a place where you feel valued and fit in with the team.

By carefully considering these job criteria, a dermatologist can find a position that not only meets their financial needs but also supports their professional goals, work-life balance, and personal values.

Understanding Private Equity

Private equity refers to investment funds that acquire stakes in companies, including medical practices, with the aim of increasing their value over time before eventually selling them for a profit. In dermatology, as in other medical fields, there's been a noticeable trend of private equity firms purchasing practices. This infusion of capital can lead to rapid expansion, technological upgrades, and the implementation of more sophisticated business practices. For dermatologists, these changes can mean an alleviation of administrative duties, potential for higher earnings, and access to a broader network of resources.

It is important to be aware that private equity firms are primarily focused on financial returns. This focus can lead to shifts in practice culture, an increased emphasis on the bottom line, and potential changes in the way care is delivered. The eventual sale of the practice could introduce further changes in management and operations. Dermatologists considering opportunities in practices owned by private equity should thoroughly understand the terms of the investment and how it might affect their day-to-day work, autonomy in clinical decision-making, and the overall direction of the practice. While the promise of reduced administrative burdens and improved infrastructure can be appealing, it's essential to consider how such changes align with personal and professional priorities.

Note that not all private equity firms operate in the same manner. While there are general trends in the industry, some private equity-owned practices maintain a strong commitment to clinical excellence and patient care. These firms may view their investment as a partnership with physicians, aiming to enhance operational efficiency without compromising the quality of medicine practiced. They often bring in management expertise, financial resources, and business acumen that can help a practice grow and flourish while allowing dermatologists to focus on what they do best — caring for their patients. When considering an association with a private equity-owned practice, it's crucial for dermatologists to conduct due diligence. This includes researching the firm's track record, speaking to current and former physicians in their network, and understanding the firm's approach to medical practice. Some private equity groups may indeed prioritize patient care and invest in their practices to support top-tier medical services, which can be a significant benefit.

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