How dermatology became the 'it' job in medicine
Dermatology’s transformation into a highly paid, lifestyle-friendly specialty is highlighting broader problems in how the U.S. and other countries train and deploy doctors. Commenters point to long wait times, residency bottlenecks, and lobbying-driven caps on training slots as key drivers of physician shortages, even as cosmetic procedures boom and some surgeons pivot to Botox for better pay and hours. The thread contrasts U.S. dynamics with European and Scandinavian systems, noting trade-offs between doctor pay, training costs, access to care, and the growing reliance on nurse practitioners and physician assistants.
Residency Bottlenecks and Supply Constraints
- Core complaint: huge competition for a small number of dermatology residencies (e.g., 600+ applicants for 4 slots).
- Many blame an “artificial cap” tied to Medicare funding of residency positions and past lobbying to limit slots.
- Counterpoint: Medicare only caps subsidized positions; in theory, hospitals could self-fund, but most don’t, suggesting residencies are a financial or logistical burden.
- Some propose mandating every practice to train residents; others argue most offices lack necessary facilities and many physicians are unwilling or unsuited to teach.
Physician Pay, Incentives, and “Cartel” Accusations
- Strong criticism of U.S. physician incomes (e.g., dermatology ~$500k), framed as gatekept, exploitative, and driving scarcity.
- Others argue high pay reflects negotiating power, heavy taxation, debt, risk, and long training; see the main fix as expanding subsidized training, not punishing doctors.
- Accusations that professional groups act as cartels by restricting training spots; some note similar behavior in parts of Europe.
Healthcare Systems and International Comparisons
- Reports of specialist shortages and long waits in Denmark, Germany, Belgium, Switzerland, Sweden, and the U.S.
- In some EU countries, low pay and high workload reduce the attractiveness of medicine, leading to emigration.
- Sweden is cited as having more physicians per capita, earlier and cheaper training, and lower but acceptable pay.
Access and Wait Times for Care
- Multiple anecdotes of 6–18 month waits for primary care or dermatology in the U.S., especially for new patients.
- Commenters describe U.S. care as bifurcated into “emergency now” vs “sometime,” with poor access for non-urgent but concerning issues.
- Telehealth and medical tourism are used as workarounds.
Rise of Non-Physician Clinicians
- Patients increasingly see PAs, NPs, and ARNPs, especially in dermatology and primary care.
- One cited study suggests PAs perform more biopsies per cancer found and detect fewer early melanomas than dermatologists.
- Concern about rapid, lower-quality training pipelines (“strip mall schools”) for some advanced practice roles.
Values, Motivation, and Lifestyle Medicine
- Noted shift toward “lifestyle” specialties (like derm, cosmetics) with better hours, lower malpractice risk, and high pay.
- Tension between expectations of physician altruism and the reality of burnout, debt, and work–life tradeoffs.