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WanderlustPA

Why is Derm pay so high?

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I was just wondering, what is it that makes pay in dermatology so much higher than any other PA specialty?  Especially when you break it down per hour, derm is way above the rest.

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Botox, cosmetics, mohs, etc. A lot of the procedures are out of pocket/elective from the patient. This = $ into the providers pocket.

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society for derm PAs has done a great job supporting their own and moving towards a productivity pay model so instead of the doc making unlimited $$ off the PA the PA gets are part of the profits and everyone is happy.

 

We all should be so lucky

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I was just wondering, what is it that makes pay in dermatology so much higher than any other PA specialty?  Especially when you break it down per hour, derm is way above the rest.

Medicine pays for procedures. Derm PAs do a lot of procedures. Derm PAs bring in more money than most. Pay for physicians and PAs mostly tracks how much money they bring in (procedures again paying more). 

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Thanks guys!  That's what I figured, but was just curious if there were any other reasons.  I prefer the idea of being paid based on productivity rather than salary, at least after a bit of experience.  I'm hoping to do a derm elective rotation.  I'm really interested in skin cancer/Mohs.  I've had it myself, and I'm sure I will have some more spots in the future.

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Derm pays as much as the practice/MD is willing to pay. I've heard of PAs assisting and closing (some) 8 mohs cases a day + skin checks/wound checks, and they still don't make six-figure salaries. But I also see a lot of Derm MD's hiring new grads mostly out of the lower tier programs as glorified medical assistants. 

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a local derm pa around here makes 187k/yr working 4.5 days week doing primary evals, biopsies, and first assist procedures. the doc only sees those folks who need surgery.

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a local derm pa around here makes 187k/yr working 4.5 days week doing primary evals, biopsies, and first assist procedures. the doc only sees those folks who need surgery.

What area is this? A PA making nearly 200k/year is unheard of to me….but obviously enticing. 

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What area is this? A PA making nearly 200k/year is unheard of to me….but obviously enticing. 

PAs can make 200k in a variety of fields if they are willing to work their butts off. the highest earning pa in my group (who works way too much) probably made 225k last year in em. I know several surgical and critical care pas making that kind of money, but once again, lots of hrs.

to make that kind of money plan on 60-72 hr weeks every week with the possibility of call. The most I have ever made is 150k about ten years ago working 60+ hrs/week. If I worked those hrs now at my current rates of pay that would likely be >180K. I just don't want to work that much. I'm fine with 45-50 hrs/week ( + going to school) and making less money.

if money is the priority though, go to medschool. docs I work with make 150-225 dollars/hr. depending on facility and shift.

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if money is the priority though, go to medschool. docs I work with make 150-225 dollars/hr. depending on facility and shift.

 

How common is it for these guys to work less than typical hours?  Just seems like it would be so tempting for them, since they could work less and still make an impressive salary.

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How common is it for these guys to work less than typical hours?  Just seems like it would be so tempting for them, since they could work less and still make an impressive salary.

none of the em docs at my primary job works more than 14 8-9 hr shifts/mo. Most work 10-12 shifts/mo.

1/2 my hours for 3x my pay.

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none of the em docs at my primary job works more than 14 8-9 hr shifts/mo. Most work 10-12 shifts/mo.

1/2 my hours for 3x my pay.

 

That doesn't sound frustrating at all!

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That doesn't sound frustrating at all!

those are the em boarded docs. the fp docs we work with only make 40/hr more than we do...doing exactly the same work....often with our input into their care plans....

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To the OP:

It all comes down to billing, and yes, procedures are where the $$$ is.

So for an office visit with a biopsy, they bill for the visit as well as the procedure. I think it's about $150 for the biopsy alone (of course that's not always what the insurance will pay), then add the visit ($80-200, depending) and all of this usually takes 15 minutes. If you freeze off more than 15 AKs, the charge is $300 + the visit, warts are $110 + the visit.... you get the idea. In a busy practice you can easily see 40 patients in the morning, so when you do the math, it adds up to a lucrative set up.

And that's just the medical side! The cosmetic side is a whole different ball of wax, people pay cash up front, and some of the procedures are thousands of dollars.

It's not the most exciting field out there and I was told it's where PAs and NPs go before they retire.

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Can a PA theoretically open their own botox clinic without MD supervision? Maybe just an MD signing the charts, but not actually involved in the procedures. 

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Can a PA theoretically open their own botox clinic without MD supervision? Maybe just an MD signing the charts, but not actually involved in the procedures. 

that's supervision and most docs want a few thousand/mo + their own malpractice policy to do that.....

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those are the em boarded docs. the fp docs we work with only make 40/hr more than we do...doing exactly the same work....often with our input into their care plans....

Do they keep the FP docs working in the ER off of the high acuity/trauma stuff? I can understand the board certified EM physicians being the top pay tier, but didn't guess that other docs would have that much disparity.

 

Would a residency trained PA with EM CAQs make substantially more than a PA that just started in EM at the same time; 10 years out?

 

 

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Do they keep the FP docs working in the ER off of the high acuity/trauma stuff? I can understand the board certified EM physicians being the top pay tier, but didn't guess that other docs would have that much disparity.

 

Would a residency trained PA with EM CAQs make substantially more than a PA that just started in EM at the same time; 10 years out?

 

 

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the fp docs only work at our affiliated urgent care center.

all PAs at my full time group make the same amt of base pay regardless of degree or years of experience, we have folks with 3-30 years of experience and certs only through PhDs. senior PAs tend to make more/hr due to better production #s.

the advantage of the residency and/or CAQ is the ability to get a better job and/or solo coverage position at a higher rate of pay. at my best per diem job they have 5 PAs total. 2 have been there forever, 2 of us "newer guys" are CAQ certed and the other is taking the CAQ this year. to get fully credentialed for all em procedures there now requires CAQ status (except for the 2 guys with > 10 yrs there who have been grandfathered). my hope is to get the full time job there when the most senior guy retires at some point. if not I will just keep working there as many shifts/mo as possible. this full scope/solo job pays 20/hr more than my regular job. my other per diem job pays 8/hr more for double coverage/full scope alongside a doc.

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So when you fly solo or have full scope, that's what really affects your pay. Makes sense; as both of those criteria increase your level of responsibility.

 

 

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So when you fly solo or have full scope, that's what really affects your pay. Makes sense; as both of those criteria increase your level of responsibility.

 

 

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yup, at the place that I practice full scope/solo I don't make much less than the docs working shifts there (they schedule either a single doc or single pa interchangeably).

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Can a PA theoretically open their own botox clinic without MD supervision? Maybe just an MD signing the charts, but not actually involved in the procedures. 

This is a tricky situation, and I heard of a PA that is being investigated for doing this. The patient population for something like this can be very litiginous, so I'd be careful.

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The patient population for something like this can be very litiginous, so I'd be careful.

"You made me look like a duck, I'm suing! quack, quack, quack...."

 

Sorry, people indignant over elective cosmetic procedures that aren't repairing deformities or injuries, just normal ageing; strike a nerve with me.

 

 

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I was just wondering, what is it that makes pay in dermatology so much higher than any other PA specialty?  Especially when you break it down per hour, derm is way above the rest.

It is because the cost of beauty of treatments is a lot higher than other health specialties. Botox, Juvederm and Ultherapy like procedures are one of the most expensive treatments in the anti-aging field, which is a root branch of dermatology.

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those are the em boarded docs. the fp docs we work with only make 40/hr more than we do...doing exactly the same work....often with our input into their care plans....

Reviving your old post here E

Aren't non-EM boarded docs a rarity now? Except for those grandfathered in I'm surprised if places are privileging non-BC EM docs.

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Reviving your old post here E

Aren't non-EM boarded docs a rarity now? Except for those grandfathered in I'm surprised if places are privileging non-BC EM docs.

in big cities this is true but get 1 hr outside a metro area and most of the docs are fp with em experience. go really rural and 80% are. more rural in really small depts and it's all pas with a single doc acting as sp of record(like the kind of places where kargiver, boatswain, and I work). there are not close to enough em residency trained docs to staff every ER in the country. even at my primary job at a trauma ctr many of the docs are still fp boarded, although all the new guys hired in the last 10 years are em only. at my primary per diem job the er director, hired within the last 2 years, is an fp doc younger than me.

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