Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why is it hard to find a good dermatologist in a competitive market?

Dina D. Strachan, MD
Physician
May 30, 2020
Share
Tweet
Share

We’ve all heard the phrase, “survival of the fittest.” It suggests that in the competitive, “free market” world, it is the “best” who survives and it’s “the cream” that rises to the top.  But is that true for doctors?  Do patients get better care when competition rules the health care marketplace?

A few years ago, a doctor from a large primary care group contacted me to give a talk to the staff and to potentially become part of their referral network.  “It’s so hard to find a good dermatologist in New York!” the doctor complained.

“Really?”  I thought to myself.  In New York?

New York City has the highest concentration of dermatologists in the nation—if not the world.  Whereas in many parts of the country, there are indeed “dermatology deserts” where people wait 4 to 6 months, and/or have to drive two hours, to see a board-certified dermatologist, in Manhattan, patients can often find a specialist to see them the same day.  In the Big Apple, if patients cannot get in within a couple of weeks, they can go somewhere else.  As a doctor, you are never too popular to get no shows if people have to schedule appointments too far out.  They don’t have to wait.  I once found skin allergy patches on the back of a new patient who had come in for a second opinion.  He had scheduled the same day and had just seen another dermatologist … a few hours prior.

Sometimes patients complained that it was hard to find a good dermatologist — but I figured it was because they didn’t work in health care.  But still, the statement seemed dissonant.  I had excellent, young colleagues leave New York because they couldn’t fill their schedules.  Why then were patients who complained they couldn’t find a good doctor not flocking to their offices? How were patients, and even referring doctors, perceiving such scarcity in what felt like a saturated market? Here are some possibilities:

1. Blocking doctors. Sometimes health care systems refuse to make patients aware of all their options. Years ago, an internist who used to send a significant number of patients to my office suddenly stopped.  We had always received great feedback. Shortly after, I met her at a social event and pulled me aside.  “I’m so sorry I had to stop referring to you,” she said, blushing. “The hospital administrators got upset with me and said that I was only allowed to refer to the doctors at our hospital,” she whispered.  Sometimes systems don’t let new board-certified doctors join, yet, midlevel providers with a fraction of the training are instead available.

2. Marketing. In a competitive market, marketing becomes more significant.  Marketing is simply making the public aware of your service.  Many think of marketing as unethical.  If you think your service benefits the public, however, one could argue it’s unethical not to market.  The problem is that when the choice of doctors is driven by marketing, it can ironically make it harder to find the good doctor, or a doctor at all, versus the good marketer.  Anyone can market.  Not just anyone is a good doctor.  With marketing, a patient has to be savvy.  Does the patient know the difference between someone marketed as a board-certified dermatologist (a physician who has accredited training) versus a “dermatologist” who may, or may not be, board-certified in some other specialty but want to practice dermatology?  Does the patient know the difference between board-certified doctors and mid-level providers who may have had only two years of school and no accredited training?  Sometimes we perceive that there is no “good” board-certified dermatologist although they are there because of all the noise.

3. “Dermatologists don’t take insurance.” For some reason, there is a popular myth that “no dermatologists take insurance.” If you look at most insurance directories, however, that is clearly not true.  Yes, of course, some don’t.  Even then, sometimes, the cash fees are affordable.  Get the facts.  And by the way, even when a doctor participates in your health insurance, cosmetic procedures are not covered.

4. Valuing perceived convenience over expertise. Shortly before the coronavirus pandemic, a long-time patient started her visit with the comment, “you’re gonna be mad at me.” I asked her why. A month prior, she had had a flare-up of a condition I had diagnosed and treated years ago.  Instead of coming to me, or another dermatologist, to manage it had she gone to a nearby walk-in clinic.  “There were no appointments here,” she defended. That wasn’t true.  “What happened?” I asked.  They said they didn’t know what she had.  This was not a surprise as it was a specialist level problem.  She was not, however, referred to a board-certified dermatologist.  She was instead given multiple prescriptions.  She didn’t get better.  She sought help, again, this time at a dermatology office — but one staffed by a physician assistant.  “It was so convenient,” she defended.  There she got a diagnosis, but it was incorrect.  Even if it had been the right one, the dosing of the medication was off.  There was no improvement, so she came back to see me.  She had always had access to expertise — but it was out marketed by perceived convenience.  But, in fact, it was less convenient and more expensive.  Treatment was delayed.  There was a convenience fee.  She paid extra copays for visits and prescriptions.  It exposed her to potential medication side effects.  “It’s not that I should be mad at you,” I said to her.  “You should be mad at you.”  We laughed although it really wasn’t funny.  It’s a shame that in “free market medicine” that patients have to be such savvy “consumers,” even when they do have access to good care.

One expects it to be hard to find a “good doctor” where there are few.  But, ironically, in competitive markets it can be hard to access one even where there are many.

Dina Strachan is a dermatologist and author of Moxie Mindset: Secrets of Building a Profitable, Independent Physicians Practice in a Competitive Market.  She can be reached at her self-titled site, Dr. Dina Strachan, and on Twitter @drdinamd.

Image credit: Shutterstock.com

Prev

The mindset of an entrepreneur: Why failure is an option

May 30, 2020 Kevin 0
…
Next

Remember the real heroes in our COVID war

May 30, 2020 Kevin 0
…

ADVERTISEMENT

Tagged as: Dermatology, Practice Management

Post navigation

< Previous Post
The mindset of an entrepreneur: Why failure is an option
Next Post >
Remember the real heroes in our COVID war

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Dina D. Strachan, MD

  • Alexithymia: patient satisfaction, doctor burnout and health care costs

    Dina D. Strachan, MD
  • I don’t apologize for being a fast doctor

    Dina D. Strachan, MD

Related Posts

  • Market-based approaches solving the opioid epidemic

    Julie Craig, MD
  • Black market pharmaceuticals target immigrants

    John M. Glionna
  • The problem with the free market in health care

    Roy Benaroch, MD
  • What matters in an optimal consumer health care market

    Richard Reece, MD
  • Can the Maternal CARE Act fail moms? 

    Sonal Patel, MD
  • Medical error disclosure programs: Old habits die hard

    Gail Handley

More in Physician

  • The broken health care system doesn’t have to break you

    Jessie Mahoney, MD
  • How a $75 million jet brought down America’s boldest doctor

    Arthur Lazarus, MD, MBA
  • The dreaded question: Do you have boys or girls?

    Pamela Adelstein, MD
  • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

    Muhamad Aly Rifai, MD
  • How grief transformed a psychiatrist’s approach to patient care

    Devina Maya Wadhwa, MD
  • Fear of other people’s opinions nearly killed me. Here’s what freed me.

    Jillian Rigert, MD, DMD
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Why great patient outcomes don’t protect female doctors from burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why ADHD in women is finally getting the attention it deserves

      Arti Lal, MD | Conditions
    • How a $75 million jet brought down America’s boldest doctor

      Arthur Lazarus, MD, MBA | Physician
    • Why ruling out sepsis in emergency departments can be lifesaving

      Claude M. D'Antonio, Jr., MD | Conditions
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Why great patient outcomes don’t protect female doctors from burnout [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why ADHD in women is finally getting the attention it deserves

      Arti Lal, MD | Conditions
    • How a $75 million jet brought down America’s boldest doctor

      Arthur Lazarus, MD, MBA | Physician
    • Why ruling out sepsis in emergency departments can be lifesaving

      Claude M. D'Antonio, Jr., MD | Conditions
    • The hidden cost of delaying back surgery

      Gbolahan Okubadejo, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why is it hard to find a good dermatologist in a competitive market?
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...