Deciding where to practice? Ask yourself these questions

Neal Bhatia, M.D.Deciding where to practice and spend your foreseeable future is a big deal for young dermatologists. A few key questions can help you determine the practice destination that’s right for you.

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As a rule of thumb, dermatologist Neal Bhatia, M.D., advises new dermatologists to first consider what’s important to them for the next five to 10 years.

“For many younger derms, the first job is not their last,” says Dr. Bhatia, director of clinical dermatology at Therapeutics Clinical Research, in San Diego, Calif. “What’s important? And what are you willing to trade off?”

Thinking five to 10 years out, these key considerations can help dermatologists choose their perfect practice location.

What is my focus? General? Cosmetic? Cancer?

Many dermatologists focus on where they want to live, not on what they want to practice. But type of practice and location often go hand in hand, according to Dr. Bhatia.

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Dermatologists should do research on the market before they open a practice of their choice, to help ensure demand.

“New residents in training want to open these big cosmetic practices in big cities, where there’s no demand [because the market is saturated]. They want to go to places that are more where they want to live, rather than where they want to work,” Dr. Bhatia says.

Dermatologists who want to open cosmetic practices in Beverly Hills, Calif., where there is a dermatologist on every corner, according to Dr. Bhatia, are going to be fighting for patients against dermatologists who either already have an established base or an established legacy.

“Why would you want to set yourself up for failure? Or are you prepared to go the long run in an environment that you may not make overhead for some time?” Dr. Bhatia asks.

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Dermatologists who want to practice medical dermatology generally have their pick of locations, according to Dr. Bhatia.

“If you want to start on your own in medical dermatology, the real trick is, where can you really handle living? Because the need for medical dermatology is nationwide, and you can go almost anywhere in the rural part of the country and not only make a decent income but have a really solid practice. It’s a little bit of a risk, and it takes courage to make that decision,” Dr. Bhatia says.

NEXT: Where are you in your life?

Where are you in your life? 

Going home is a strong preference for many dermatologists after their residencies, according to Dr. Bhatia. Home tends to be where friends and family are. It might also be where dermatologists have built-in referral bases or community ties that lead to patients.

Sometimes, ‘home’ is where dermatologists trained. After completing Accreditation Council for Graduate Medical Education- (ACGME-) accredited programs, 47.8% of physicians stayed or returned to the state where they completed their most recent graduate medical education, according to the Association of Medical Colleges 2011 State Physician Workforce Data Book.

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But going home isn’t the best idea if you think you can rely on the patronage of friends, family and contacts. Dr. Bhatia says he went back home to Milwaukee and started a dermatology practice with the advice of friends (including friends he trained with in internal medicine), as well as family.

“I opened in an area where there wasn’t a dermatologist for a couple of miles. I was near the hospital. On paper, it made a lot of sense that this would be a good fit. What I didn’t know is that the market was in evolution and, within a few years, I lost half of my referral base because of the consolidation going on. I also had trouble maintaining status quo because of the way insurances were changing,” Dr. Bhatia says. “Milwaukee wasn’t a big vanity market at the time. One of the mistakes I made early was buying a laser … and the laser just ended up sitting.”

NEXT: What is your professional bliss?

What is your professional bliss?

Lauren Eckert Ploch, M.D., M.Ed.Some go for the big job offer, which, according to Dr. Bhatia, usually has to be really good for someone to think about moving to a brand new location.

Yet another preference is to go where you’re needed, to serve communities in need of dermatologists, or to go where you can learn from the best-to an academic hub, for example.

“If you’re from Southern California, there has to be a real draw for you to want to go to North Dakota. But if there’s big demand in North Dakota and the job is really good, someone might consider it,” Dr. Bhatia says.

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Dermatologist Lauren Eckert Ploch, M.D., M.Ed., says she and her husband, a radiologist, received an offer in Aiken, S.C., that the couple couldn't refuse.

“I'm actually going to be practicing primarily in Augusta, Georgia, but will be living in Aiken. Both Aiken and Augusta are relatively underserved areas,” Dr. Ploch says, adding that she thinks that “a big challenge facing dermatologists is whether to join a large group [or] hospital vs. a small group vs. solo practice. Most dermatologists my age are intimidated by the administrative demands of private practice, so they prefer to join a larger organization straight out of residency. This may lead younger dermatologists to settle in cities where these larger hospitals are located, leaving rural areas and smaller towns underserved. It seems like many people choose jobs based on opportunity vs. what will make them happy in the future.”

NEXT: What do you want in a location?

What do you want in a location?

Moving to a destination for its lifestyle isn’t much fun if you’re working nonstop to start a new practice, according to Dr. Bhatia.

“That’s a driver that needs to be tempered with some reality. I think a reality that a lot of new derms miss out on is, where is the best opportunity to develop a practice and grow?” Dr. Bhatia says.

Nevertheless, you have to like where you are. Definitely, spend time in the location before moving there, Dr. Bhatia says.

“Some places sound great until you actually visit and spend time,” Dr. Bhatia says.

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Dr. Ploch says the perks of a place aren’t always evident until you become more intimate with a location. For example, although Dr. Ploch’s pay is similar in Aiken to what it was in New Orleans, where she used to practice, the dollar goes a lot further in Aiken.

“The gas is cheaper, and real estate in some areas is less expensive. Stretching your dollar makes it much easier to travel, retire or purchase a home. It's also better for work-life balance for us. We're much closer to hiking and biking trails. It's a golfer's paradise, if you like to golf. It's also much easier to travel from here…,” Dr. Ploch says. “We're only 2.5 hours from the Atlantic coast (Charleston), three hours from Atlanta, and two hours from Charlotte. New Orleans is pretty geographically isolated (six hours from Houston and six to seven hours from Atlanta), so weekend trips were difficult unless we wanted to fly somewhere.”

NEXT: What is your target market's derm saturation?

What is your target market’s derm saturation?

One way to find out how many dermatologists are in your immediate area is to search your zip code, city or town for how many dermatologists are around.

Another tip, according to Dr. Bhatia, is to look at where the recruiters are doing their recruiting.

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“If you see recruiting ads for certain states or areas, it’s either saying there’s a shortage or it’s not a desirable location. That can either be a good thing or a bad thing,” Dr. Bhatia says.

Dr. Bhatia notes that especially aspiring cosmetic dermatologists should consider looking beyond dermatologists as potential competition. Medical spas, for example, offer esthetic services, including those traditionally offered by dermatologists and cosmetic surgeons, in some states.

What do the experts say?

Bert Sperling, founder of Sperling’s Best places and www.bestplaces.netBert Sperling, founder of Sperling’s Best places and www.bestplaces.net, makes his living helping people find their best places to live, work and retire.  

He shares some of his tips for professionals with Dermatology Times:

Quality of life is high the Pacific Northwest.

“People are making the choice to maybe not be in Boston or some other recognized center for practice because they want to have a ‘better’ lifestyle,” Sperling says.

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Some of the really hot cities for quality of life: Portland, Oregon, seems to be on everybody’s short list, according to Sperling. Others are Asheville, N.C., and Austin, Texas. Interestingly, Pittsburgh is very affordable and seems to be trending. The City is coming back strong after a 100 years of decline, according to Sperling.

Minnesota is “hot” for a state, according to Sperling, because it’s striving to be a destination state for new residents. Minneapolis is regularly included as one of the top five livable cities in the U.S. 

Urban living is trending.

“People seem to want to live more in, towards the city and enjoy more city living as opposed to living in the suburbs, like they used to 20 years ago. It seems like everybody wants to move in towards the city, where things are happening,” he says.

NEXT: Where are the worst places and derm-dense areas?

As for worst places?

Sperling says that it’s his feeling that there are no worst places to live.

“There are places that are struggling. There are places that are challenging. Cleveland, Detroit, Syracuse, places like that are having a tough time. They’re all tremendously affordable. As a result, the housing stock is really inexpensive. For young people and for anyone willing to take a chance (people with more energy than money), those places present an opportunity to do urban pioneering or urban homesteading. You can stake a claim for not much money and help the city recover,” Sperling says.

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Sperling adds that “I was talking to the Mayor of Rockford, Ill. Rockford is a place that has been struggling to remake itself after being home to manufacturing and industrial businesses-many of which have moved off shore. He returned to his hometown and became mayor in his mid-thirties. He says he could have stayed in Chicago and just been working with everybody else there, but by coming back to Rockford, he’s making a real difference in what’s happening in the community.”

What are the least and most derm-dense areas?

Researchers published a study in 2010 in the Archives of Dermatology that looked at areas in the U.S. with the highest and lowest concentrations of dermatologists per capita.¹

According to the study, the areas with the highest derm density per 100,000 population are number one Downtown Boston, Mass., followed by Palo Alto, Calif., Manhattan, N.Y., and Santa Monica, Calif.

Among the least derm-dense areas: Trenton, N.J., Lexington, Kentucky, Mansfield, Ohio, and Chattanooga, Tenn.

Resources:

1.      Yoo JY, Rigel DS. Trends in dermatology: geographic density of US dermatologists. Arch Dermatol. 2010 Jul;146(7):779. http://archderm.jamanetwork.com/article.aspx?articleid=421611