Moh’s surgeons typically focus their careers on removal of cancers on the skin. They are dermatologists by training, but have completed a fellowship (often lasting one year) on microscopic removal of cancerous lesions. The Moh’s fellowship society tends to limit the number of trainees in their field for various reasons, so availability is scarce. Competition into the field is fierce, since there are already a limited number of dermatology spots and only a handful of Moh’s fellowship positions yearly.
Full-time clinical Moh’s surgeons are either in the office or in the procedure room on most days. Clinical days are spent seeing referrals for skin lesion removals. Most of these referrals come from dermatologists or internists. I would say that a high number of referrals end up requiring surgery. The clinical volume of a Moh’s surgeon runs around 20+ patients a day. This is significantly less than what a general dermatologist will see.
Surgery days (or half days) are spent removing skin lesions, waiting for histology to assess clean margins (if possible), and closing up the skin lesions. These procedures are tedious, but the RVUs generated are very high. Very busy Moh’s surgeons can have 8-10 procedures a day.
The overall lifestyle of this profession is relatively good. There are very few emergencies. Most of the procedures are planned. Many Moh’s surgeons can structure a 4-day workweek, simply because there are sometimes limited number of cases that need to be performed and revenue rate per procedure is very high. Some Moh’s surgeons starting out in their practice will also see general dermatological cases.
Many starting salaries for Moh’s surgeons being around $300,000. I’ve seen salaries around $250,000 in highly competitive markets. A well-established Moh’s surgeon who also owns a histology department can earn serious amounts of money. I once met a Moh’s surgeon who worked 4 days a week and took 2 months of vacation per year tell me that she made approximately $1.5 million (pretax)!
The ability of a Moh’s surgeon to generate high income comes from multiple revenue sources. The professional fees for the surgery itself are relatively high given the complexity of the procedure. However, I would estimate that the revenue stream coming from a histology lab (charges insurance for analysis) would more than double the income of an efficient surgeon.
Sounds great being a Moh’s surgeon, right? The truth is that there are still stresses with the job. You are mostly dealing with cancer. There is limited room for mistakes given that clinical management will change depending on surgical outcome.
Would you want to be a Moh’s surgeon?
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