How dermatology became the 'it' job in medicine

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.