Dermatologists who responded to this year's Medscape compensation survey described their compensation, number of hours worked, practice changes resulting from healthcare reform, and how they have adapted to the new healthcare environment.

When asked about their compensation for patient care, dermatologists came in eighth from the top ($339,000). The lowest earners, starting from last place, are pediatricians ($189,000), family physicians ($195,000), and endocrinologists and internists (both at $196,000). The top earners this year are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000). The top earners have changed from the 2011 Medscape Compensation Report. Although orthopedists led that year as well, the next top earners were radiologists and anesthesiologists. The bottom earners then were still pediatricians, PCPs, and endocrinologists. Note: Values in the charts have been rounded. Caption sums may not agree with chart value sums due to rounding.

When comparing 2014 compensation with the prior year's, dermatologists reported an increase of 10%. Only rheumatologists experienced any large decrease in income (4%). Urologists were the only other specialists to see a decline, but by only 1%. The rest of the physicians reported an increase. The greatest increases appeared among infectious disease physicians (22%), followed by physicians who mostly work in hospitals: pulmonologists (15%) and emergency medicine physicians and pathologists (both at 12%).

Orthopedists, who make the most from patient-care work, are also at the top of the list for compensation from non–patient care activities ($29,000). Non–patient care activities include expert witness duties, product sales, and speaking engagements. At $26,000, dermatologists, whose non–patient care compensation previously was fourth among specialists, are now tied with urologists and plastic surgeons for second place. Physicians (and notably PCPs) who are at the lower end of patient-work compensation also tend to trail in non–patient care compensation.

This year, as in all previous years of the report, male dermatologists are earning more than their female counterparts. However, the percentage difference between self-employed male and female dermatologists (16%) is larger than between their employed counterparts (13%). Women tend to work shorter hours and fewer weeks than men, which may help account for the lower female compensation reported among dermatologists.^[1] (Note: This chart includes full-time workers only but does not control for hours worked.)

Fifty-two percent of female dermatologists are satisfied with their income, which is significantly lower than the rate reported by their male counterparts (65%). Female dermatologist satisfaction is also lower than what they reported last year (61%), when they were still less satisfied than their male counterparts (66%), though by a smaller margin.

In setting Medicare fees, the challenge for CMS is to address the higher cost of living in certain areas against the need to attract physicians to underserved places with lower costs of living.^[2] Additionally, competition and physician density play a role in physician salaries. This year, the highest earnings for dermatologists were reported in the North Central ($443,000) and Northeast ($380,000) regions, whereas the lowest were in the Northwest ($165,000) and the Mid-Atlantic ($298,000) regions. The 2011 Medscape Dermatologist Compensation Report indicates a significant change in these regional differences: The highest dermatologist earners were in the Northwest ($385,000), and the lowest were in the Mid-Atlantic ($242,500).

Employed dermatologists make $284,000, which is less than their self-employed counterparts ($398,000). A number of factors in 2015 might negatively affect compensation for employed or self-employed dermatologists, including the end of ACO shared-savings programs, meaningful use penalties, payment-reporting websites, and changes in CPT codes.^[3]

Given that employed dermatologists make less than those who are self-employed, it is of some interest that more than two thirds (69%) of employed dermatologists believe that they are fairly compensated, compared with just over one half (52%) of those who are self-employed. In the 2011 Medscape report , employed dermatologists reported much lower satisfaction (around 55%), and more self-employed (nearly 80%) dermatologists believed that they were fairly compensated at that time.

Dermatologists in healthcare organizations make the most ($395,000), followed by single-specialty groups ($375,000). Those who earn the least money are in hospitals ($197,000) and outpatient settings ($227,000). When these practice settings with are compared with those in 2014, dermatologists who earned the most last year were in office-based multispecialty group practices ($361,000). In 2014, dermatologists in hospitals earned the least ($169,000).

In the 2011 Medscape report, 76% of dermatologists said they would choose medicine again and 93% would select their own specialty. This year, only 55% would still choose medicine, and only 73% would select their own specialty. Furthermore, in 2011, 56% said they would choose their own practice setting, but this year only 14% would go that same route.

To determine the level of general career satisfaction, Medscape averaged the percentage of dermatologists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 63%, dermatologists came in first in overall satisfaction—which is also the ranking they had in 2014, though the percentage was slightly higher in that year (65%). According to the calculation, dermatologists are followed in career satisfaction by pathologists and psychiatrists (both at 57%) and emergency medicine physicians and pediatricians (56%). The least satisfied, from the bottom up, are internists (47%) and then nephrologists and general surgeons (48% and 49%, respectively).

Despite considerable publicity, cash-only and concierge practices are still not significant payment models for dermatologists.^[4] This has changed little since last year. Participation in ACOs has increased only slightly, from 22% last year to 25% currently, with 5% more expecting to be part of an ACO this year.

The American Medical Association has warned that the "'regulatory tsunami' facing US physicians could cut Medicare payments by more than 13% by the end of the decade."^[5] Nevertheless, the percentage of both employed (66%) and self-employed dermatologists (56%) who said they will continue taking new and current Medicare or Medicaid patients has increased from last year, when 58% of employed and 54% of self-employed dermatologists said they would take these patients. A slight increase was observed in those not taking Medicaid or Medicare. There was a slight change among undecided employed or self-employed dermatologists between last year and now, from one third of both to 23% and 29%, respectively.

In a Medscape report on insurers conducted in 2014, well over half (58%) of all physicians received less than $100 from private insurers for a new-patient office visit. In the current report, when asked whether they would drop insurers who pay poorly, 41% of dermatologists said they would and 27% would not. (The question was not applicable to the remaining survey respondents.)

According to Medscape survey findings, 17% of employed and 26% of self-employed dermatologists say they have offered new ancillary services within the past 3 years. Ancillary services in dermatology practices can include in-house lab services, light treatments, and radiography.

Ninety-one percent of dermatologists say they discuss the cost of treatment with patients, although only 44% do this regularly. Only 3% are unaware of the cost of treatment. A 2013 editorial in the New England Journal of Medicine stressed the benefits of such discussions, including finding lower-cost alternatives and making trade-offs, and noted that it is "well within physicians' traditional duties to discuss such matters with our patients."^[6]

Seventy-nine percent of dermatologists spend 30-45 hours per week seeing patients. Only 12% spend more than that. A JAMA study of all physicians found that between 1997 and 2007, there was a decrease among all physicians of nearly 4 hours per week in seeing patients, which may be in part related to the declining fees over that same period.^[7] Another reason for the decline is the increasing proportion of female physicians and older physicians, who tend to work shorter hours and fewer weeks.^[1]

In a 2012 survey, physicians reported spending 22% of their time on nonclinical paperwork.^[8] This year, paperwork load is nearly equal among self-employed dermatologists compared with those who are employed: 50% of those who work for themselves spend 10 or more hours per week on these tasks, compared with 46% of those who work for others. Of interest, more self-employed (68%) and employed (61%) PCPs spend this amount of time on paperwork than dermatologists do, which might be attributed to their wider range of cases, requiring more complex billing and coding.

A large majority (82%) of dermatologists spend 16 minutes or less per patient. Only 16% spend more than that.

Forty-one percent of female dermatologists and 21% of male dermatologists work part-time, higher percentages than those in the general physician population, where nearly one quarter (24%) of female and 13% of male physicians work part-time.

The oldest dermatologists (aged 50 or older) make up the largest part-time age group (70%). Eleven percent of those younger than 35 years and 27% of those aged 35-49 years work part-time.

Female and male dermatologists reported slight differences in what they found most rewarding about their jobs. Thirty-seven percent of women and 32% of men believed that relationships with patients are a major source of satisfaction. Slightly more men (35%) than women (32%) cited being very good at their job as a reward, and more male (17%) than female (14%) dermatologists named making good money. Being proud of their job was last on the list as a reward for both genders. A discouraged 5% of women and 2% of men found nothing rewarding about being dermatologists.

Only 19% of dermatologists are planning on participating in health insurance exchanges, which is down very slightly from 20% last year. This year, 29% of dermatologists said they were not participating, up from 25% in the 2014 Medscape report.

Dermatologists were asked what impact health insurance exchanges would have on their income. Many physicians may have already felt their effect, and dermatologists expect to have a harder time than PCPs. Only 5% of dermatologists believe that their income is likely to increase with health insurance exchanges, whereas 10% of PCPs think it will rise. Fifty percent of dermatologists believe that their income will decrease, compared with 27% of PCPs.