"DermCare" Team

I was convinced of the emerging trend in 2003, long before there was much lip service to the topic -- and the trend was set up long before the explosion of midlevels entering the mix. Around that time there was a massive push for expanding residency slots in dermatology against the backdrop of both rising total derm practitioners as well as dermopulation ratios. A variety of spurious arguments were put forth, ranging from poor data such as surveys and opinion polls to huckster math cherry picking demographic and geographic data. There were only a handful - two or three, really - dermatologists active and vocal enough on the national level pointing this out; they were shouted down as protectionists (way to demonize your opponents, academic ****s) and, as a resident, I was "instructed" to sit down and shut my mouth.

Here's the rub: it's basic math. I don't give two ****s if you are a 27 yo resident or a 60 yo chair, math is math.... and apparently the 27yo resident had a much firmed grasp of the concept of equilibrium dynamics than did the sheltered and insulated referral center chair who had spent 30 years in that practice setting - heh.

Everyone eventually reaps what is sown... and we are no different. Yes, we continue to have it better than the majority of the house of medicine.... and that may continue for some time (well, until FFS is dead and bundled payments are the norm)... but you are deluding yourself in an effort toward intellectual pacification if you believe things are as they were or that we have not lost more than most. If this was not the case one would not see the consolidation and acquisition activity sweeping the country that we do right now; it's not the cardiologist or gastro groups being bought up left and right with PE monies, is it.

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"DermCare" Team