The Dermatology Rate & Negotiation Toolkit

What's Inside

Not "a PDF." Six specific tools:

1. Rate Benchmark Database

   Dermatology rates by state and setting — urban clinic/hospital and rural/community practice — at the 25th, 50th, 75th, and 90th percentile. Fifty states. The number you need before you call the recruiter back.

2. Recruiter Call Scripts

   Word-for-word. The exact sentences:

   • The opening anchor when you've received a below-market offer
   • The counter when they say "this is our standard rate"
   • The Mohs differentiation script — fellowship training commands a separate rate tier, not a general derm rate
   • The patient volume cap script — confirm the daily ceiling before accepting any clinic assignment
   • The dermpath read responsibility script — confirm who reads the pathology before committing
3. Dermatology Leverage Points

   The specific credentials and coverage capabilities that justify a higher rate:

   • Mohs fellowship training commands 30–50% above general dermatology rates at high-volume skin cancer clinics — it is a distinct credentialing category and should always be priced as a separate billing tier
   • Daily patient volume cap is the most important quality-of-life clause in any derm locum contract — a 60-patient day at $250/hr generates $4 per patient to the physician; a 40-patient day at $300/hr generates $7.50. Volume determines effective hourly rate, not the stated rate. Confirm and cap at 40–45 patients per day
   • Teledermatology hybrid arrangements (remote reads plus quarterly in-person procedural coverage) are the new standard at rural sites and can be structured as recurring quarterly arrangements
   • Dermpath read responsibility must be clarified before accepting — some contracts assign pathology reading to the covering physician without separate compensation
4. Contract Red Flag Checklist

   Daily patient volume cap, Mohs rate separate from general derm, dermpath read responsibility, cosmetic procedure scope, and malpractice tail. One page, annotated. Open it while reviewing any contract.

5. Agency Markup Framework

   The math behind what the practice or hospital actually pays for your coverage. High-volume derm clinics generate substantial revenue through procedure billing — the physician hourly rate is a fraction of the revenue generated per clinic day. When you know the approximate bill rate, "that's our maximum" means something different.

6. Locum Tax Framework

   The 1099 math most dermatologists undercount: the S-corp threshold, the Solo 401(k) gap, and the minimum premium required to break even against a W-2 production-model rate.

What It Looks Like on the Call

When a recruiter quotes $295/hr for a high-volume dermatology clinic assignment covering Mohs surgery, this is the sentence from Section 2:

"The market median for general dermatology in this region is $335/hr. Given my Mohs fellowship training, I'd expect to be priced in the $400–450 range for Mohs coverage — that's the standard premium for fellowship-trained Mohs at skin cancer clinics. I'd also want to confirm the daily patient volume cap before we discuss scheduling. Can we structure it that way?"

You change the numbers to match your state. You say it. That is the product.

Who Built This

For years I took every rate I was offered without pushing back. Not because I was naive. I didn't have the data to know whether I should. Neither did anyone I trained with. I built this because the information existed in federal wage surveys, peer-reviewed research, and 50 years of negotiation science, and it wasn't assembled anywhere a physician could use it before calling a recruiter back.

I started with surgery. Then I built the same data model and negotiation framework for the 22 specialties with the highest locum demand. The leverage points in each toolkit come from specialty-specific research. The scripts and the data are the same framework I use myself.

The agency has this organized. Now you do too.

— General Surgery MD

Verify the Premise Before You Buy

Ask the recruiter whether Mohs fellowship training changes the offered rate and what the daily patient volume cap is. Write down what they say.

That is the problem this PDF solves.

The Research Behind It

The economic analysis in this toolkit is grounded in Nobel Prize-winning research:

• Akerlof (1970, Nobel 2001): In markets where one side has better information, the uninformed party is systematically underpriced, not because they're naive, but because the market is structured that way.
• Spence (1973, Nobel 2001): Credentials only move your rate when the agency prices them. This toolkit shows you how to make that happen.
• Nash (1950, Nobel 1994): The fair split in any negotiation assumes equal information and equal skill. Neither assumption holds on a recruiter call.

The negotiation psychology section cites 17 peer-reviewed sources. This is not a blog post formatted as a PDF.

What It Costs in Context

• Consulting an attorney to review your locum contract: $350–$500/hr.
• Hiring a negotiation consultant: $3,000–$5,000.
• This toolkit: $99. One successful negotiation adds $13,000+ annually.

One Honest Limitation

This will not help you if you are already negotiating above the 75th percentile for your specialty and state. If you don't know what percentile your current rate is, that is the problem this solves.

About the Data

Sourced from BLS OEWS public data and CMS geographic adjustment factors, processed through a locum-adjusted model. Not derived from agency-reported data.