After years of undergrad work, medical school, and residency, you can finally take a breath of relief and feel gratified that you chose the field of dermatology as your lifelong career path. So, as you are finishing your last year of residency, or maybe looking for your first practice or already working, a question may still be looming in your mind: do you want to focus on medical or cosmetic procedures?
There are pros and cons to both fields and the factors affecting your decision may not be obvious at first glance, such as for instance, location. The need for cosmetic dermatologists is increasing, however the need for medical dermatologists is more widespread, and more are needed in the underserved areas. A cosmetic dermatologist is less likely to be needed in rural Oklahoma, for instance, than in New York City or Los Angeles. Nonetheless, there are many successful dermatologists with small practices doing very well in small towns, as long as there is demand and you are the only one providing the services. Nowadays, there are companies that can analyze and generate reports of density of cosmetic dermatological services in any area, which can be helpful to someone deciding where to start a cosmetic practice or whether to invest in a costly cosmetic device to make sure there is demand and not too much saturation.
The good news is that even the pandemic hasn’t slowed the roll for demand of cosmetic treatments. Those working from home see themselves on their webcams every day and they have become increasingly more self-conscious about how they appear over Zoom. It can be difficult to set up a flattering webcam shot from home, causing many to seek a professional to fix the perceived flaws that are so prominent on-camera. There is even a rising phenomenon in cosmetic procedures that emulate Instagram filter effects!
Cosmetic dermatologists may also enjoy a less stressful work environment than medical dermatologists. They experience less burnout, and they enjoy a higher quality of work-life balance. There is no need to deal with the drudgery of insurance, reimbursement, and pre-authorizations. Patients aren’t coming in to have a potentially life-threatening disease diagnosed. Since little things like ambience and staff friendliness are of a higher priority and a cosmetic practice is more dependent upon positive reviews, the practice may have a more luxurious atmosphere.
The life of a cosmetic dermatologist isn’t the life for everyone, of course. The cosmetic patient is not always a breeze. There is still stress in pleasing a patient who is paying out of pocket, and whose expectations need to be met and/or temporized. It takes a particular personality, to razzle and dazzle, deal with fussy patient, maintain rapport and deal with possibly irreversible complications of a procedure that is cosmetic and not medically necessary.
Moreover, some may find the practice of staying up to date on beauty trends and social media to be shallow and very time consuming. It may feel intimidating to compete with other, more tech savvy, providers on Instagram, YouTube channels and Tiktok, where daily posting and being bubbly is the norm. The emphasis on marketing and branding may be a headache to those who want a more cut-and-dry lifestyle. (Of note, you would be surprised how many non-cosmetic dermatologists are also endeavoring to be more present on social media to try to increase the bottom line or gain peer awareness.)
Plus, the ever-expanding world of cosmetic energy devices/lasers, cosmeceuticals and injectables generates the pressure to stay on top of these cosmetic procedures. As a medical dermatologist you’ll likely be granted the opportunity to perform cosmetic procedures regardless, as your patients will always be asking you about cosmetic advice.
If you’re a doctor who entered the field with the intent of saving lives, you’ll likely do no such thing when dermal fillers and beautifying procedures are on your daily schedule. Having said that, I have personally worked in a highly successful medical and cosmetic office, where I was able to feel that I was saving lives by diagnosing melanomas and making a huge improvement in my medical patients’ lives with bullous pemphigoid and hidradenitis supprativa. In the same practice I was able to also perform my favorite cosmetic procedures from injectables of neuromodulators and fillers, to fat transfer and liposuction. Besides, I often hear from more seasoned dermatologists and agree myself that the best patients are ones that you grow out of your medical practice, who trust and know you. And make no mistake, that when you help your patients boost their self-esteem, it can be quite life changing.
At the end of the day, of course, it’s not a life-or-death situation. 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. The beauty of being a dermatologist is that you can mold your practice into what you want. With so many resources on social media and conferences, a medical dermatology practice can easily grow into a hybrid medical and cosmetic practice, given the right staffing, resources and patient demand in the area you practice. It’s always important to take a moment for introspection and ask yourself: is this what’s right for me?
“Dermatology, as a field, is an extremely gratifying field that allows for one to care for younger and older patients, patients of all races, and of all genders. The impact we can have on our patients’ self-esteem is tremendous whether we help to clear full-body psoriasis or we improve the appearance of their skin and smooth their wrinkles. There is a balance that can be achieved in which most of us can offer both general dermatology services to our patients while catering to their aesthetic desires. This may mean specializing in general or cosmetic dermatology and having another physician offering the opposite coverage in your practice. This way, our patients can continue to have all of their needs met. If you cannot balance both in your practice, then my recommendation is to strive to be your best at delivering the best results and care possible.
If you choose to follow the cosmetic dermatology route, be prepared for the ups and downs, the wonderful results and the complications, the need to hire a very professional staff and to deliver treatment in an aesthetic setting and be prepared for the monthly costs of maintaining filler and neuromodulator inventory and purchasing/maintaining all your lasers and devices. Start slowly and build up yearly to allow your patients to have access to the latest technology. Learn from what devices work and which do not fit your patient base. Most importantly, you must love the aesthetic side of dermatology to become well respected in your area by both patients and other physicians in order to grow your patient base organically.” Suzan Obagi, MD
Dr. Obagi is an associate professor of dermatology and plastic surgery at the University of Pittsburgh Medical Center. She is the director of the Cosmetic Surgery and Skin Health Center.
