After years of undergraduate studies, medical school, and residency, you’ve finally narrowed down your career opportunities and settled on practicing dermatology. There’s still one choice left for you to make: how to do you want to structure your clinical work? While dermatology affords opportunities to practice in a variety of areas, including Mohs surgery, pediatric dermatology, and dermatopathology, most board certified dermatologists choose to practice in medical dermatology, cosmetic dermatology, or a combination of the two fields.
There are pros and cons to both medical and cosmetic dermatology, and the factors affecting your decision may not be obvious at first glance — for instance, location. A cosmetic dermatologist is less likely to be needed in rural America than in places like New York City or Los Angeles. The need for medical dermatologists, however, is widespread, and many areas of the US are underserved. Regardless of economic status, people develop skin diseases and seek out expert dermatologic help for their medical and surgical needs. This means a steady stream of patients who will utilize insurance to see the dermatologist, and consistent job opportunities for medical dermatologists across the country. Your expert training as a board certified dermatologist will allow you to better recognize and treat medical conditions and stand out from others with less qualifications who are practicing in our field.
In cosmopolitan areas, the general population may be more interested in aesthetic services and have the disposable income to invest in their appearance. However, in desirable and metropolitan areas, a cosmetic dermatologist will find themselves with stiff competition for patients. This competition will come from other dermatologists, plastic surgeons, physician assistants, nurses, other doctors who have developed an interest in aesthetics, and various uncertified providers. Many will utilize marketing, PR, and more to assert themselves as the most desirable practitioner for the public.
With respect to work environment, medical dermatologists are reimbursed for seeing patients and performing procedures. With decreasing insurance reimbursements in the context of continued inflation, medical dermatologists are feeling increasing pressure. Unfortunately this means seeing more patients for less money. Cosmetic dermatologists, on the other hand, may enjoy a less stressful work environment. In general they experience less burnout, enjoy a higher quality of work-life balance, and tend to earn higher incomes. There is no need to deal with the drudgery of insurance, reimbursement, and prior authorizations. Patients aren’t coming in to have a potentially life-threatening disease diagnosed and treated. Since small things like ambience, aesthetic, and staff friendliness are of a higher priority, cosmetic practices may have a more luxurious atmosphere, longer appointments, and less demand for quick patient turnover. That being said, there is a different level of expectation that comes from patients who are paying fee for cosmetic service rather than those who are using insurance for their medical care. While most interactions remain pleasant, some doctor-patient interactions may be more time-consuming and there may be a larger proportion of “difficult” patients with expectations that may not be in alignment with reality.
Just like the life of a medical dermatologist is not for everyone, the life of a cosmetic dermatologist isn’t for everyone either. Some may find the practice of staying up to date on beauty trends to be too much of a departure from medicine, or worse, too superficial. The emphasis on marketing and branding may be a headache to those who want a more traditional lifestyle. If you’re a doctor who entered the field with the intent of saving lives, you’ll have moved far from this goal practicing in cosmetic dermatology. However you will have the opportunity to build long-term patient relationships and have a major impact on patient quality of life and self-confidence. As a medical dermatologist you’ll be much closer to the House of Medicine and likely be granted the opportunity to perform cosmetic procedures regardless, but the opposite cannot be said for a cosmetic-only setting.
At the end of the day, of course, very few decisions are final and your decision about clinical practice is no exception. Many dermatologists complete residency only having dabbled in a few areas, and are not confident about a singular focus. Others enter the workforce with confidence in one niche, only later to learn that their true interests lie elsewhere. The first few years of your career can be very informative about the type of dermatologist you wish to be and the type of practice you would like to have. Over the course of your career, you’ll have the chance to embark on a variety of paths, should your current situation no longer suit you. It’s always important to take a moment for introspection and ask yourself: is this what’s right for me?
