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You can find the original Washington Street Journal article here. I applied for a dermatology residency in 2003. Even at that time, with fewer than 300 residency spots in the country, it was one of the top three most competitive fields. The number of training spots has now grown to above 500, but the increase in applicants has far outpaced this growth.
An amazing aspect of dermatology is that the skin is the largest organ in the body. It’s how people present themselves to society, making it incredibly important to their confidence, quality of life, and mental health. And yes, we are facing a mental health epidemic in the U.S., made worse by corporate social media platforms.
The skin also provides a window into the body’s systemic functions. You can surmise what’s happening internally based on what we see externally.
Not to mention, non-melanoma skin cancer is the most common skin cancer in the world. We diagnose and treat it every day, and it has an incredible impact on our patients' morbidity, mortality, and quality of life.
My favorite part of practicing dermatology is the patient relationships. We get to know our patients and their families over the years. I learn so much from them, it’s truly a privilege.
Another trend that dermatologists have been able to sidestep is the corporatization of healthcare, which is driving doctors away from patient care and into chart administration. Dermatologists are proceduralists: hands-on professionals performing treatments that help patients with both medical and cosmetic needs. We deliver healthcare as service workers, true laborers. This allows us to avoid becoming cogs in the insurance system “cartels,” protecting both our emotional well-being and job satisfaction.
The reason our income is higher is due to the free-market value of cosmetics (aka capitalism), not insurance reimbursements (which I consider racketeering). Reimbursements have been decreasing for years, as recent news has highlighted premiums being diverted from healthcare to insurance bureaucracy, the so-called “cartels.” After the tragic and intolerable murder of United Healthcare executive Brian Thompson by Luigi Mangione, a flurry of articles has emerged highlighting the deep frustrations of physicians across the nation with an untenable healthcare system. Thompson’s life, tragically cut short, also brings attention to the immense profits accrued by insurance executives; Thompson himself earned millions annually while overseeing a system that many physicians find oppressive.
New York Magazine
Financial Times
Physicians were suffering in this oppressive system in relative silence while trying to deliver patient care, as they are deeply vested in the system given the years of training and amount of loans. As all fields of medicine have been negatively affected, dermatology has had the cosmetic free marker “escape valve.” There’s demand and relief from the system with cosmetics and purely “concierge” practices, and many dermatologists have pulled the lever.
If the new administration and DOJ want to help healthcare by breaking up this racketeering, I suggest two steps:
Apply the Medical Loss Ratio (MLR) to all insurance companies, not just those in the Affordable Care Act (ACA). The MLR requires insurers to spend at least 80-85% of premiums on medical care. If they fail to meet this requirement, they must provide rebates to the policy holders. I strongly suspect an audit (Use the Internal Revenue Service (IRS) ) all carriers owe their participants rebates.
Allow younger people to buy into Medicare on a sliding scale now. Their health will balance out and help fund the system. Not Medicare for all, but Medicare for all who want to pay into it earlier for benefits.
Thank you so much for your time,
Saryna Young, MD, FAAD
Board-Certified Dermatologist
Small Business Owner and Founder, Young Skin Dermatology
Stamford, CT