Evidence depth: moderate · High public-data fit
Dermatology
Where to start
Best-fit Dermatology paths
Directional, modeled. Your priorities decide. Build a report to make it yours.
If you want the highest income
Mohs Micrographic Surgery
Extremely high.
$560k - $710k
See this path →If you want the best lifestyle
General Medical / Cosmetic
High, volume and cash-driven.
$445k - $725k
See this path →If you want ownership upside
General Medical / Cosmetic
High, volume and cash-driven.
$445k - $725k
See this path →Data Highlights
Specialty Insights
Competitiveness context: very competitive - NRMP 2024
- Modeled Paths
- 2
- Top Modeled Ceiling
- $900k - $1.8M+
- Best Lifestyle Path
- General Medical / Cosmetic
- Highest Equity Upside
- General Medical / Cosmetic
Public data · CMS Medicare Part B
What this specialty actually bills Medicare
- Aggregate allowed amount
- $3.5B
- Medicare Part B, not income
- Providers in panel
- 18,202
- NPPES individual NPIs
- NPI → Medicare join
- 66%
- billed Medicare in the year
- Open Payments physicians
- 11,518
- transfers of value, not income
Medicare allowed-$ by subspecialty sector (public CMS data)
Top procedures by Medicare allowed-$ (public CMS data)
- 17311 · Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks$385M
- 17000 · Destruction of precancer skin growth, 1 growth$196M
- 11102 · Biopsy of related skin growth, first growth$188M
- 17110 · Destruction of skin growth, 1-14 growths$183M
- 17312 · Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks$150M
Source: CMS Medicare Physician & Other Practitioners (public). This is not W-2 salary, total collections, or take-home income. Aggregate allowed amounts are a partial, biased slice of one payer; sector labels are keyword-inferred from public procedure descriptions and are directional, pending physician review.
Paths
Path families to test
General Medical / Cosmetic
High, volume and cash-driven.
External benchmark reference: ~$450k
DoctorCalculator modeled estimate: Owner/Partner Ceiling: $700k - $1.5M+
Mohs Micrographic Surgery
Extremely high.
External benchmark reference: ~$600k
DoctorCalculator modeled estimate: Owner/Partner Ceiling: $900k - $1.8M+
Path Landscape
Compare all 2 paths
3 of 10 dimensions shown. Premium adds ownership / facility upside, geography flexibility, innovation / industry adjacency, and 4 more.
See plansPath battle card
Compare head-to-head
Dermatology
General Medical / Cosmetic
Really about: high-efficiency skin checks and highly lucrative cash-pay aesthetics
validated confidenceDermatology
Mohs Micrographic Surgery
Really about: high-volume, highly lucrative skin cancer extirpation and reconstruction
validated confidence- 1. Income ceilingedge → Mohs Micrographic Surgery
- Favorable
A very strong ceiling, completely uncapped if your practice is heavily weighted toward cosmetics.
The reality · The signal · The catch · The verdict
The reality: Medical dermatology (acne, skin checks) is strictly volume-driven; cosmetic dermatology is margin-driven.
The signal: Supervising multiple PAs/NPs (mid-level extenders) acts as a massive multiplier on your daily RVU generation.
The catch: Selling proprietary skincare products and owning cash-pay lasers adds highly scalable revenue.
The verdict: The ultimate cash-pay scalable business model for non-surgeons.
- Favorable
One of the absolute highest ceilings in all of clinical medicine.
The reality · The signal · The catch · The verdict
The reality: Mohs surgery billing is incredibly lucrative because you legally bill for both the surgical excision and the pathology reading.
The signal: The throughput is massive; a highly efficient Mohs surgeon does 6-10 cases (often multiple stages each) a day.
The catch: In-house lab ownership acts as a massive multiplier on the professional fees.
The verdict: An absolute money-printing machine, provided the internal referral network is ironclad.
- 2. Lifestyle control
- Favorable
Total, absolute control over your schedule.
The reality · The signal · The catch · The verdict
The reality: The practice is 100% outpatient, 100% scheduled, and entirely elective.
The signal: You can easily work 3 or 4 days a week while still maintaining a top-tier income.
The catch: There are absolutely no hospital consults, no ER add-ons, and no unpredictable surgical delays.
The verdict: Widely considered the absolute gold standard for lifestyle control in clinical medicine.
- Favorable
Exceptional control; highly predictable surgical days.
The reality · The signal · The catch · The verdict
The reality: The practice is 100% outpatient, elective, and scheduled weeks in advance.
The signal: You have immense power to control the pace of your clinic and the number of cases you book.
The catch: There are absolutely no hospital rounds and no emergent surgeries to disrupt your evening.
The verdict: The most lucrative pure-lifestyle surgical specialty available.
- 3. Sleep / call burdeneven
- 4. Ownership / facility upsideeven
- 5. Geography flexibilityedge → General Medical / Cosmetic
- 6. Innovation / industry adjacencyedge → General Medical / Cosmetic
- 7. Training opportunity costedge → General Medical / Cosmetic
- 8. Job-market densityedge → General Medical / Cosmetic
- 9. Malpractice / litigation pressureedge → General Medical / Cosmetic
- 10. Burnout-mismatch riskedge → General Medical / Cosmetic
- 11. What people regret
- • The relentless, exhausting pressure of being an Instagram influencer just to get cosmetic patients in the door.
- • Realizing you hate supervising mid-levels but recognizing your income will plummet without them.
- • The physical toll of standing and operating on 10 skin cancers a day, every day, for decades.
- • Realizing you are entirely dependent on your general dermatology partners for referrals, making practice independence difficult.
- 12. Best-fit archetypes
- Lifestyle-First Clinician, Entrepreneurial Physician
- Procedure-Heavy Wealth Builder, Lifestyle-First Clinician
- 13. Poor-fit archetypes
- Acute-Care Identity Seeker, Prestige-Risk Academic
- Acute-Care Identity Seeker
- 14. Questions to ask mentors / fellowships / jobs
- • What is the required daily patient volume, and do I have highly trained mid-level (PA/NP) support to supervise?
- • How is the cosmetic revenue (injectables/lasers) split between the practice overhead and the provider?
- • Has the practice been acquired by PE, and if so, is there any genuine equity upside left for new partners?
- • Are the general dermatologists in this specific group strictly required to refer all their skin cancers internally to you?
- • Who pays for the histotechs, the lab equipment, and the overhead for the slides?
- • Are you expected to do general dermatology on days when you don't have enough surgical volume?
Premium comparison
Who has the edge on the remaining 8 vectors
Premium adds the claim, the signal, and the limitation behind each edge, for both paths. The edge itself is a modeled score comparison, not a measurement.
Evidence & reveals
Dermatology wealth relies on cash-pay conversions and mid-level leverage.
Why · signal · limit · impact
Why: You cannot reach $1M+ just doing 30 skin checks a day yourself.
Signal: Industry data shows PAs/NPs are the main profit engine for large derm groups.
Caveat: Do not take a private job without a clear path to cosmetic upside or extender supervision.
Impact: Push for ownership.
Mohs surgery leverages the unique ability to bill for both surgery and pathology simultaneously.
Why · signal · limit · impact
Why: This dual-billing model is the engine of Mohs wealth.
Signal: Requires a captive referral base (a large group of general dermatologists).
Caveat: Do not open a solo Mohs practice without a referral network.
Impact: A powerful wealth builder when volume, payer mix, and referrals are there.
Scores are relative, directional signals, not dollars and never a salary claim. Each carries its own why, supporting signal, limitation, and decision impact, and the confidence badge shows how validated each path is.
Field notes
- Dermatology has arguably the strongest non-surgical cash-pay potential (Botox, fillers, lasers) in all of medicine, completely decoupling a massive portion of its income from insurance companies.
Common regret patterns
- Selling to private equity too early and becoming a high-volume, exhausted employee for the rest of your career with no equity.
- Trying to do pure medical dermatology (acne, rashes) and realizing the insurance reimbursement per hour is actually quite low without cosmetics.
Questions to ask
- Where did recent graduates land, and at what real compensation model?
- What's the realistic path to ownership or production upside?
Run your personalized report
Premium turns your target life into a required-income number, then tests it against these paths for salary-only gap, ownership upside, call burden, and geography. Evidence depth and confidence stay visible inside every report.