SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 286 COMPELLING COMMENTS An Exciting, Innovative, and Compelling Dermatology Subspecialty Worthy of Continued Consideration among Dermatology Residents Robert T. Brodell, MD1, Tammie Ferringer, MD2 1Department of Dermatology, University of Mississippi Medical Center, Jackson, MS 2Department of Pathology, Geisinger Medical Center, Danville, PA In 1974, the American Board of Dermatology and the American Board of Pathology came together to offer certification for special competence in dermatopathology.1 The first accredited dermatopathology fellowships began in 1976.1 Attention was focused on this field which provides a scientific basis for the diagnosis of over 1500 disorders. This political victory led pathologists and dermatologists to agree on a training program which produced excellent dermatopathologists from dermatology- trained and pathology-trained physician pools. It has broken down silos and enriched the specialty. In January 2013, the field of pathology was rocked by a 52% decrease in Medicare (Center for Medicare Services-CMS) payment for the technical component (88305 code) and a smaller cut in professional fees.2 This led to a number of problems beyond financial exigencies. Jobs dried up for new graduates of dermatopathology programs as laboratories froze hiring to help maintain salaries of their physicians and staff. Dermatology residents had choices with regard to other subspecialties or general dermatology. This led to a gradual downturn in applications for dermatopathology fellowship positions from dermatologists. Though the number of fellowships has declined, pathology residents have continued to apply for dermatopathology fellowships at a strong rate. (See Table 1) To paraphrase Samuel Clemens, “Reports of the death of dermatopathology are greatly exaggerated.” In 2018, incomes for dermatopathologists held strong ($431,000† for academic and $480,000†† for private practice).3 Furthermore, dermatopathologists LOVE what they do. The attraction that many dermatopathologists find for the field are summarized in Table 2. Though salaries in dermatopathology remain high, the richness of our field is rooted in much more than monetary gain for the physician. We hope to play a role in increasing the trickle of applicants from clinical dermatology to a flood. This is critical to maintain the diversity that has been a key strength of dermatopathology and insure continued gains in patient care, education and research. † MGMA Academic Total Compensation †† MGMA Private Practitioner Total Compensation SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 287 Table 1: Dermatology-trained and Pathology-trained Fellows (1975-present) Year Total Candidates Total ABD Total ABP 1974 204 119 85 1975 177 141 36 1976 111 55 56 1977 123 68 55 1978 123 60 63 1979 116 57 59 1980 117 53 64 1981 125 66 59 1982 108 50 58 1983 60 31 29 1984 55 30 25 1985 35 8 27 1986 27 14 13 1987 29 13 16 1988 26 11 15 1989 26 10 16 1990 28 12 16 1991 44 21 23 1992 No Exam Given 1993 80 41 39 1994 No Exam Given 1995 97 39 58 1996 No Exam Given 1997 110 36 74 1998 55 14 41 1999 58 12 46 2000 66 12 54 2001 61 10 51 2002 87 15 72 2003 80 15 65 2004 84 17 67 SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 288 2005 93 28 65 2006 99 34 65 2007 88 29 59 2008 87 28 59 2009 95 30 65 2010 104 42 62 2011 91 34 57 2012 96 42 54 2013 91 39 52 2014 86 34 52 2015 75 35 40 2016 85 25 60 2017 70 27 43 Totals 3472 1457 2015 SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 289 Table 2: Reasons Dermatopathologists Love their Work. 1) Visual aspect of dermatopathology: This aligns itself well with clinical dermatology. If you like dermatology, you will love dermatopathology. 2) Basic science: Many physicians went to medical school because they like “science.” Pathology has a clear link to the basic science of our field. 3) Peace. The slides do not talk back. We love our patients, but there is serenity engendered by work at a microscope. 4) Second opinions for difficult cases. It is comforting to know that help is around the corner (Digital dermatopathology or snail mailing slides) when needed without shipping the entire patient to another office for a second opinion. 5) Collegial associations: Dermatopathologists develop unique relationships (team-based care) with clinical dermatologists, general pathologists, primary care physicians, and specialists. These relationships have social and educational value to the physician. 6) Variety…. the spice of life. Clinical dermatologists enrich their lives by spending time each day in other pursuits such as dermatopathology. In addition, the dermatopathologist sees the most interesting patients from many clinical dermatologists. 7) Teaching opportunities. Dermatopathologists establish contacts that lead to teaching opportunities in many venues. 8) Less pressure to keep to a schedule. Sometimes extra time is required to research the clinical history and literature in complicated dermatopathology cases. This does not result in a waiting room overflowing with restless patients. 9) Flexibility. The day’s start and end can be adjusted to optimize biorhythms and re-arranged with little notice to accommodate family and personal needs. 10) Minimization of administrative hassles. Dermatopathologists do not have patient calls, incomplete medical records, and a pile of prior authorizations for expensive medications waiting to be completed at the end of the day. SKIN July 2019 Volume 3 Issue 4 Copyright 2019 The National Society for Cutaneous Medicine 290 Conflict of Interest Disclosures: Robert T. Brodell, M.D., discloses the following potential conflicts of interest: Multicenter Clinical Trials: Galderma Laboratories, L.P.; Novartis Principal Investigator; and, Glaxo Smith Kline. There are no conflicts of interest related to employment, stock ownership, expert testimony, grants, patents filed, received, pending, or in preparation, or royalties. Tammie Ferringer, MD: None Funding: None. Corresponding Author: Robert T. Brodell, MD and Tammie Ferringer, MD References: 1. Bernhardt MS. The History of Dermatopathology. JAMA Dermatol. 2013;149(10):1140. doi:10.1001/jamadermatol.2013.5622 2. Klipp J. ed. Laboratory Economics. (7) November 2012: 1. 3. 2018 MGMA DataDive® Provider Compensation, based on 2017 data. Used with permission from MGMA, 104 Inverness Terrace East, Englewood, Colorado