How dermatology became the 'it' job in medicine

Tried getting an appointment in Denmark. “We don’t take any new patients”. A familiar story when trying to reach many specialists in European countries (Germany, Belgium). Except I doubt they’re getting 500k.

Guessing you also need a referral to see a specialist in Denmark?

In USA, with PPO insurance, you can see specialists without a referral. Direct specialist appointments without seeing your primary doctor for a referral.

https://www.sundhed.dk/borger/guides/find-behandler/ tells you waiting times at specialist doctors

No, it's not a matter of referral.

It's a matter of "current patients have filled the schedule indefinitely."

At least in Switzerland it's like this: if you call directly the dermatologist (or just any medical specialist), they offer you a slot in 6 months. If you go over your house doctor (whatever the term is in your country) you get it in 1-2 weeks. If you are already known patient to said dermatologist, maybe even earlier. Thus: how about you try your house doctor?

That's pretty crazy considering Denmark is touted as a socialist utopia where the taxes are high but it's worth it because the government supposedly takes care of everything for you. I'd expect them to have figured out the doctors' shortage but this problem seems endemic in every country.

Anecdotal, but I'm in the North East US and I called, and I'm not joking, nine primary care offices. Eight of them said they couldn't take anymore patients, and one said I could get an appointment six months later.

I hadn't needed to go to a primary care doctor in my adult life, but it was mind blowing that this was the case. Many friends of mine have had the same experience.

Had the same thing in the Midwest about 8 months ago. Had to call a half dozen offices before one would take me and appointments had to be scheduled long in advance. I had not been to the doctor as an adult either and was quickly surprised by how frustrating healthcare is.

In EU, there is a severe shortage of MDs. Part of the problem is that the number of students is not sufficient to satisfy MD demand. In some countries, this is a deliberate policy imposed by MD lobbies, who act like a cartel. In other countries, the job is simply not attractive due to relatively low salaries and high workload. So students choose other degrees, or they immigrate after graduation. Furthermore, an aged population and lack of adequate policy planning does not help.

I had this experience when shopping for a highly rated doctor. Luckily I was able to get in on a great doctor after a few weeks of casually calling around, and now can get appointments no problem.

When I was younger on crap insurance, I was able to quickly find one by having no standards other than "be a medical physician". And the doctor I went to was definitely lower rung.

Same, had to call around a lot to find primary care, and was being given multi-month waitlist estimates for seeing an ENT specialist. I've had more luck recently as I was able to get into see an ENT in less than 30 days. It's also crazy how much everyone tries to upsell you. It' hard to tell what tests or procedures I really need.

I laugh to myself whenever I read some disclaimer that says “ask your doctor” because… how? I’m supposed to call the office, wait six to nine months, and then ask about a mild health concern I had that’s long past?

In mid-2023 I decided it would be good to have a primary care doctor since I was 74 years old at the time and hadn't been to a doctor in decades.

Full disclosure: I am a retired board-certified anesthesiologist.

I asked around town (Charlottesville, Virginia) and got two names from doctors I trust.

The first was not taking new patients; the second was, so I made an appointment: first available appointment was January 2025 (i.e., in 18 months). I happily took it.

I figured maybe this was a way of triaging old people like myself: if we're forced to wait long enough before being seen, maybe we'll die in the meantime so slots will open up.

At least in my area, huge medical groups or insurance companies have bought nearly all primary care practices. They’ve cut costs and raised prices and it’s virtually impossible to see an MD for an acute medical condition. All procedures need to be scheduled out months now.

It reminds me of what some Canadian friends described their healthcare system being like 20 years ago. If we’re paying more and getting the same service, I’m not sure there’s much reason not to socialize healthcare now (health care, not insurance).

While getting less service, as a marketplace insurance purchaser my premiums are doubling next year. It’s still “cheap”, but that would be a significant shock for most families.

Primary care has the opposite problem right now. Practices are closing faster than new ones are opening, and doctors are leaving the profession faster than new doctors are joining. There is an actual shortage of primary care docs.

This is new since Covid era. You used to be able to get an appointment for a physical just a few weeks out, and it was easy to find a new doctor if you needed to.

Sounds like it's a problem in most of the developed world.

This has been developing for a very long time. The two major medical school systems, MDs and DOs have kept supply of medical school graduates below the demand. This has kept the market rate for fees up but has created market inefficiencies. There is an under supply of general practice doctors. And it will be hard to reverse as the internships and residencies are usually in hospitals and large medical centers and there is little room to expand the incoming DR supply.

Given the rise of Physican Assistants and Nurse Practitioners and their expanding scope of (even independent) practice across various states, specifically to address this growing shortage of primary care physicians (PCPs), it almost becomes a self-fulfilling prophecy that fewer potential physicians choose family medicine as that's the first specialty that seems most likely to be addressed by PAs and NPs.

As a medical professional, do you think yearly checkups are useful or necessary for healthy individuals in their 20s and 30s? It seems like you've done well for yourself without the need of one due so long.

A. This is exactly what is to be expected.

If high-skill jobs are compensated (relatively) less, workers are less incentivized to pursue those jobs, or they move to other markets.

B. Capitalist countries like the U.S. are not completely immune to his phenomenon either.

Are doctors in USA emigrating to other countries? Or do you mean across state lines?

This is for "new patients" though, once you're in it's generally fine. It's a back-pressure mechanism for them to not sign up too many new people.

Yep, with our current system we have evolved it into a monstrous and inefficient hybrid that contains most of the downsides of a socialized system with most of the downsides of a free market system. It's utterly insane what we're doing, and there seems to be very little interest in fundamental change.

I'm not a medical professional, but I have a close friend who is. Most of the time, no you don't need yearly checkups. But if you develop something like diabetes, a thyroid condition, or some types of cancer, it might save your life.

If you're going to do it, I would recommend having a bunch of labs done so you can at least know how you're doing. For example might as well test A1C, Vitamin D, Iron, Thyroid, Testosterone and many other hormones and vitamin levels to get a good picture of your nutrition. If you're low/high in many of these things a simple supplementation can radically improve your life, but not if you don't know about it. A friend of mine recently found his Testosterone levels were really low, and after starting TRT he feels way, way better. It improved depression levels and many other things, with a bonus that now when he goes to the gym it's actually possible to get some results.

Worth pointing out is that you can have (most) of these labs done without a doctor. There are websites you can buy kits, and you can sometimes just go in-person to Labcorp offices and they'll run stuff for you.

Anyway, just something to consider.

It regionally-dependent though. On average, if we need to see a doctor, we can get an appointment in a day or two. For a routine physical, it might be two weeks, three at most.

We decided to look for a new primary care doctor in Washington. I was amazed when I read my wife's email to the effect that our physicals were booked for 11/25. Then I understood that this was next year, not next week.

Sorry, I mean that USA has doctor (particularly specialists) shortages as well.

It sounds like it, but no evidence has been provided.

I suppose that's why medical tourism has become a thing. For a few euros you could fly out here to South Africa or other places in the world and get any first world grade medical assistance immediately (as long as you can pay, of course).

This is the thing, even in the US with salaries 2/3/4x those in Europe, people in much of the country can get appointments for the better part of a year.

in case of Belgium

https://www.salaryexpert.com/salary/job/dermatologist/belgiu...

> The average dermatologist gross salary in Belgium is 215.909 € or an equivalent hourly rate of 104 €. In addition, they earn an average bonus of 13.041 €. Salary estimates based on salary survey data collected directly from employers and anonymous employees in Belgium. An entry level dermatologist (1-3 years of experience) earns an average salary of 143.218 €. On the other end, a senior level dermatologist (8+ years of experience) earns an average salary of 286.875 €.

that is... out of the box, a very very nice salary to start your career with. OMG. Top IT jobs in Belgium are at 130k or so (none management)

My wife is a medical professional and it is in your best interest to get yearly checkups if only for a regular lab report history.