Dermatology Salary (2026): The $625,000 Median and the Cosmetic vs. Medical Split

The Data Landscape: Why Every Source Shows a Different Number

Before trusting any single dermatology salary figure, understand why the data diverges so dramatically across sources.

According to 86 approved, self-reported salaries on SalaryDr, the median total compensation for dermatology in 2026 is $625,000, with the 25th percentile at $505,000 and the 75th percentile at $700,000; the 10th to 90th percentile range is $445,000 to $984,500. Ninety percent of those reports include bonus or incentive compensation. Among them, the median bonus is $110,000 and the average $120,818, and bonus pay makes up about 19 percent of total compensation. Satisfaction is 4.5 out of 5. Workload is approximately 40 hours per week.

The Doximity 2026 Physician Compensation Report, based on nearly 23,000 surveys of full-time physicians in 2025, puts the dermatology average at $497,509, 17th of the 51 specialties it lists. MGMA's employer-reported survey is the benchmark many employers use in contract talks, but its figures sit behind a paywall. FastRVU, a planning tool that isn't produced by MGMA, uses $426,000 at 7,900 wRVUs as an illustrative dermatology median.

SalaryDr's reports also split pay by setting. Academic dermatologists average $445,000 (18 reports) and hospital-employed dermatologists $585,000 (18 reports). Private practice dermatologists average $730,340 (49 reports), with a median of $690,000 and the middle half between $650,000 and $807,000, depending on procedures, cosmetics, and ancillary services.

Here is what the data gap actually represents:

• The Doximity $497,509 average comes from a large national survey of full-time physicians in every practice model; Doximity doesn't publish how many of its respondents were dermatologists
• The SalaryDr $625,000 median comes from 86 self-reported salaries, more than half of them (49) from private practice, so it captures more partnership income and cosmetic revenue
• The incomes above SalaryDr's 90th percentile of $984,500 generally belong to cosmetic-primary or Mohs-heavy practice owners capturing both professional fees and cash-pay margin

None of these figures is wrong. They are measuring different physician populations in the same specialty. The number that applies to your situation depends entirely on which of these career paths you are evaluating.

The Mechanism: How Medical and Cosmetic Dermatology Generate Revenue Differently

This section explains why the income gap exists — specifically and mechanically — not just that it exists.

Medical Dermatology: The Insurance Reimbursement Architecture

Medical dermatology manages skin disease: acne, psoriasis, atopic dermatitis, rosacea, contact dermatitis, alopecia areata, pemphigus, bullous pemphigoid, inflammatory skin conditions, and the full spectrum of benign and malignant skin growths. Every service is billed to insurance using CPT codes, with reimbursement determined by a negotiated fee schedule that is anchored to the CMS Medicare Physician Fee Schedule.

The efficiency advantage in medical dermatology is real and documented. In FastRVU's worked example, a dermatologist seeing 40 patients per day with a typical procedure mix produces more wRVUs than its 90th percentile; it puts a typical practice at 30 to 35 patients per day and 8,000 to 10,000 wRVUs a year.

Work RVUs and payments from the CMS 2026 physician fee schedule as listed by FastRVU's CPT pages. Medicare rates are national office (non-facility) payments before geographic adjustment.

The daily production model at 35 patients:

A typical high-efficiency medical dermatology day might look like this:

• 20 established patient visits, all coded 99214 (1.92 each): ~38 wRVUs
• 8 biopsies (4 punch at 0.81, 4 tangential at 0.64): ~6 wRVUs
• 4 shave excisions (0.78 to 0.94 each): ~3.5 wRVUs
• 3 destruction procedures (17260, 0.94 each): ~3 wRVUs
• Daily wRVU production: ~50 wRVUs

At 220 clinic days per year: about 11,000 annual wRVUs. At the median rate hospital-employed dermatologists report on SalaryDr, about $68 per wRVU (18 reports): approximately $748,000 in gross wRVU-based compensation. That volume sits between the 9,900-wRVU 75th percentile and the 12,200-wRVU 90th percentile FastRVU uses for dermatology, so treat it as a high-production example, not a typical year.

Most employed dermatology positions pair a base salary with productivity bonuses above a defined wRVU threshold. A physician generating 11,000 wRVUs against a threshold near 7,900 — the illustrative median FastRVU uses — earns substantial bonus income above their base salary. In SalaryDr's dermatology reports, bonus and incentive pay makes up about 19 percent of total compensation, so base salary is typically the other four-fifths. The bonus portion comes from productivity bonuses tied to wRVU thresholds, quality bonuses, and occasionally profit sharing.

The ceiling problem in insurance-based medical dermatology: no matter how efficiently you see patients, the revenue per unit of physician time is capped by the fee schedule. A dermatologist who sees 50 patients per day instead of 35 earns more — but their revenue per patient is fixed regardless of skill, speed, or patient satisfaction. The only ways to increase revenue in an insurance-based model are to see more patients, add procedures, or add ancillary services. None of these are unlimited.

Cosmetic Dermatology: The Cash-Pay Structure That Removes Every Ceiling

Cosmetic dermatology operates in an entirely separate economic framework. Botox injections, hyaluronic acid fillers, laser resurfacing, chemical peels, microneedling, IPL photofacials, body contouring (CoolSculpting, Emsculpt), thread lifts, and cosmetic consultations are not covered by any insurance plan and carry no CPT code reimbursement obligation. The price charged is whatever the market will bear.

The supply cost of cosmetic procedures is fixed and relatively low:

A dermatologist performing 6 filler syringes in a 2-hour cosmetic morning at an average of $1,000 per syringe generates $6,000 in gross revenue in 2 hours. Their supply cost for those 6 syringes at $250 wholesale: $1,500. Gross margin: $4,500 in 2 hours.

For context: 2 hours of insurance-based medical dermatology at 5 patients per hour at an average of $120 per patient generates $1,200 in insurance revenue — before the 30 to 90 day lag before payment arrives and the billing overhead required to collect it.

At a 45 to 50 percent overhead rate for a cosmetic practice — covering staff (aesthetician, medical assistant, front desk, practice manager), equipment leases and depreciation (laser units, cooling devices), supplies, facility, and marketing — physician net income: approximately $1,078,700 to $1,186,600 annually.

Working 4 days per week. No call. No insurance denials. No prior authorizations. Payment collected in full at the time of service.

Treat that as the upper end of what the model can do, not a typical result. SalaryDr's cosmetic dermatologists report a median of $695,000 (17 reports), with the middle half between $680,000 and $700,000, so a practice producing these numbers is well above what most cosmetic dermatologists report. Getting there takes an affluent market, full schedules and years of repeat patients.

The Suburban Location Premium: The Most Underreported Fact in Dermatology

Dermatologists in affluent suburbs can out-earn those in cities because cosmetic demand tracks household income, not population density.

This is one of the most practically useful pieces of information in dermatology career planning, and almost no salary guide addresses it at this specificity.

The mechanism is straightforward. Cosmetic dermatology demand correlates with disposable income. A household with $250,000 in annual income has discretionary spending capacity for $3,000 to $6,000 in annual cosmetic dermatology services. A household with $80,000 in income does not.

The ZIP codes with the highest household income concentrations in the United States are not downtown Manhattan, downtown San Francisco, or the Chicago Loop. They are the affluent suburbs:

• Westchester County, NY (Scarsdale, Greenwich border area): Median household income $100,000+; concentrated physician-patient household density within 20 to 30 minutes of the practice
• The Main Line, Philadelphia (Villanova, Radnor, Wayne): Highly educated, high-income population with strong cosmetic dermatology demand
• Bethesda/McLean/Great Falls, VA/MD: Washington DC professional class, among the highest household incomes in the country
• The North Shore, Chicago (Winnetka, Lake Forest, Glencoe): High household income suburban corridor
• Boca Raton/Palm Beach Gardens, FL: Affluent retiree and professional population with cosmetic and medical dermatology demand
• Scottsdale, AZ: High net-worth retirement and second-home market with strong cosmetic procedure demand
• Newport Beach/Laguna Beach, CA: Concentrated wealth in a geography-constrained market

A dermatologist who opens a cosmetic and Mohs surgery practice in Scarsdale, New York faces lower competition than one in Manhattan, charges comparable prices, and draws from a household income pool that supports premium cosmetic pricing. A cosmetic dermatologist in Scottsdale charges $12 to $18 per unit of Botox to patients who drive 15 minutes from multi-million dollar homes and book quarterly appointments without price sensitivity.

The urban versus suburban comparison in practice economics: a dermatologist in Manhattan competes with hundreds of other dermatologists, aesthetic physicians, and medical spas for cosmetic patients who are price-conscious and comparison-shopping. A dermatologist in an affluent suburb competes with two or three practices for patients who have chosen their physician based on reputation and convenience and are not switching for a $50 difference in filler pricing.

Salary surveys don't split dermatology pay by suburb and city, so treat the suburban premium as a pricing and competition argument rather than a measured number. It is still directly actionable for dermatologists planning their practice location.

Mohs Surgery: The Income-Maximizing Path Within Insurance-Based Dermatology

Mohs surgery is the main procedural subspecialty inside insurance-based dermatology, and in the survey data it pays somewhat more than the specialty as a whole.

Mohs surgeons on SalaryDr report a median of $680,000 (15 reports), with the middle half between $530,000 and $750,000 and a 10th to 90th percentile range of $450,000 to $920,000. The median for all dermatologists, Mohs surgeons included, is $625,000.

Mohs micrographic surgery is the staged excision of non-melanoma skin cancers — primarily basal cell carcinoma and squamous cell carcinoma — using real-time frozen-section histologic margin control. The Mohs surgeon acts simultaneously as surgeon, histotechnician supervisor, and pathologist — excising the tumor, processing the tissue into frozen sections, reading the slides, and reoperating on any positive margins, all within a single clinical visit. The result is the highest cure rate of any skin cancer treatment modality with the smallest tissue sacrifice.

The procedure generates substantial wRVU production because each stage — the initial excision plus each additional margin-clearing stage — is separately billable. A Mohs case requiring 2 stages and complex reconstruction generates:

• 17311 (first stage): 6.05 wRVUs → $667.02 Medicare
• 17312 (additional stage): 3.22 wRVUs → $402.81 Medicare
• 14060 (local flap reconstruction): 9.00 wRVUs → $771.89 Medicare
• Total for one case: 18.27 wRVUs → $1,841.72 in Medicare reimbursement (2026 national office rates)

At commercial insurance rates of 150 to 200 percent of Medicare: approximately $2,763 to $3,683 per complex Mohs case. A Mohs surgeon performing 8 cases per day, averaging 1.8 stages and moderate reconstruction complexity:

• Daily wRVU production: approximately 100 to 130 wRVUs
• At 220 operating days: 22,000 to 28,600 annual wRVUs
• At $55 to $65 per wRVU: $1,210,000 to $1,859,000 in gross professional fee revenue

After practice overhead of about 55 percent for a Mohs practice (higher than general dermatology due to histology lab equipment, histotechnician salary, and OR facility costs): net physician income of roughly $545,000 to $837,000 from Mohs alone. That is an illustrative model, and it lands inside the range SalaryDr's Mohs surgeons actually report.

Add cosmetic services alongside Mohs surgery — which the reconstructive surgical skills of a Mohs surgeon make a natural addition — and the hybrid practice draws on a second, cash-pay income stream. SalaryDr doesn't break out hybrid practices, so there is no survey figure for what that combination adds.

The Mohs Fellowship Decision

Mohs fellowships (formally, Micrographic Surgery and Dermatologic Oncology) last one to two years after the four-year dermatology residency. U.S. programs are accredited by the ACGME, and the American College of Mohs Surgery describes the selection process as extremely competitive — most successful applicants have strong research records, dermatology residency leadership experience, and often prior exposure to Mohs surgery during residency.

The income premium in the survey data is modest: SalaryDr's Mohs median of $680,000 is $55,000 above the $625,000 median for dermatology overall. Fellows earn roughly $70,000 to $95,000 a year, according to SalaryDr, so a year or two of forgone attending income takes years, not months, to earn back. The case for the fellowship rests as much on wanting the procedural work as on the money.

The Private Equity Dimension: A New Variable in Dermatology Economics

A development that has reshaped dermatology practice economics over the past decade is the private equity acquisition of dermatology practices — and understanding it changes how dermatologists should evaluate practice ownership.

PE firms have been aggressively acquiring dermatology practices because the specialty's combination of high EBITDA margins, recurring patient demand, scalable procedure revenue, and limited physician supply creates an attractive consolidation target. A well-run dermatology practice with $800,000 in EBITDA might sell to a PE-backed dermatology platform at a 7 to 10 times EBITDA multiple — a transaction value of $5,600,000 to $8,000,000 for a single-physician practice.

The physician in that transaction typically receives:

• An immediate cash payment for a majority stake (typically 60 to 80 percent of the practice value)
• A retained equity stake (typically 20 to 40 percent) that they cash out at the platform's exit event — typically a second sale or IPO in 3 to 7 years
• An ongoing employment agreement with a guaranteed salary and productivity bonus

The financial impact of a PE transaction for a practice owner: a physician who built a $800,000 EBITDA practice and sells 70 percent to PE at 8x EBITDA receives $4,480,000 at closing. They continue working as an employed physician earning $500,000 to $650,000 annually. Their retained 30 percent equity — if the platform exits at 12x EBITDA in 5 years — is worth about $2,880,000 at the exit event if the practice's EBITDA holds steady, and more if it grows.

Total economic value from a single PE transaction for a dermatologist who built a practice over 10 years: $4,480,000 at close plus $500,000 to $650,000 annual salary for 5 years plus about $2,880,000 at exit = roughly $9,860,000 to $10,610,000 in total economic value.

None of that shows up in salary surveys. SalaryDr's figures cover base salary, bonuses and incentives, so a practice sale's proceeds sit on top of the incomes quoted elsewhere in this guide.

The PE transaction is not the right choice for every practice owner — the loss of clinical autonomy, the production pressure of the platform model, and the variability of exit multiples create genuine risks alongside the extraordinary upside. But understanding that this option exists, and what it requires to position a practice for it, changes how dermatologists should think about building a practice from day one.

Dermatology by Career Stage: The Income Trajectory Over Time

Related reading: See where dermatology ranks in physician wealth in our Physician Net Worth by Specialty rankings.

Residency (PGY-1 through PGY-4)

SalaryDr's small sample of dermatology residents (6 reports) puts the median at $70,000 a year. Dermatology residency matches are among the most competitive in medicine — board scores, research, away rotations, and letters of recommendation all weigh heavily. Four years of training (an intern year plus three years of dermatology) at resident income before the income transition.

Fellowship

One to two additional years (if pursuing Mohs or dermatopathology) at roughly $70,000 to $95,000, per SalaryDr. As the Mohs section above shows, the survey premium for Mohs surgeons is modest enough that the fellowship's lost income takes years to recover.

The attending figures below are SalaryDr's average total compensation by years of experience for dermatologists as a whole, across every practice setting.

New Attending (Years 0 to 2)

$410,000 on average (6 reports). Employed positions pay from day one, while private practice partners and cosmetic dermatologists spend the early years building patient volume, procedure efficiency and the repeat cosmetic appointments that produce the higher figures later.

Mid-Career (Years 3 to 10)

$535,000 on average for years 3 to 5 (15 reports) and $605,000 for years 6 to 10 (18 reports). This is the stretch where private practice dermatologists build procedure volume and cosmetic patient panels, and where Mohs surgeons build their referral base.

Senior Physician (Years 11+)

$689,657 on average for years 11 to 15 (35 reports) and $770,000 after 16 or more years (12 reports). SalaryDr's academic dermatologists average $445,000 across all experience levels. The income ceiling for dermatology keeps rising for practice owners because the patient panel grows, cosmetic patients return quarterly, and the referral network deepens. Unlike surgical specialties where physical capacity eventually limits volume, dermatology cosmetic and medical services can be partially delegated to mid-level providers — extending the physician's effective reach.

Geographic Salary Data: The After-Tax Analysis That Changes Rankings

State-level dermatology pay data is thin, and the after-tax picture can change the order once state income tax is applied.

Among states with at least three approved reports, the highest dermatology medians on SalaryDr are in Arizona ($780,000, 6 reports), California ($680,000, 22 reports) and Florida ($660,000, 7 reports). State medians built from a handful of reports can move as new reports arrive, and SalaryDr doesn't publish a Texas dermatology figure.

Nominal salary comparisons without tax adjustment are misleading for a specialty where the income level creates substantial state income tax exposure:

Tax impact: at those medians, each extra dollar of pay costs 11.3 cents in California state tax, 6.85 cents in New York, 5 cents in Massachusetts and 2.5 cents in Arizona, and nothing in Florida or Texas.

Florida's $660,000 median is $20,000 below California's $680,000, but by our estimate from the 2026 brackets, a single California filer taking the standard deduction would owe roughly $64,000 in state income tax on $680,000. The Florida dermatologist would owe none, which more than closes the gap. Use the Calculate Take Home Pay tool near the top of this guide to run your own numbers, including federal tax.

The geographic decision for a cosmetic dermatology practice involves one additional variable that salary surveys do not capture: cosmetic pricing power by market. What a practice can charge per filler syringe varies from market to market. The pricing power difference reflects the local patient population's income level and competing practice density — and it is the variable that drives cosmetic practice revenue as much as the physician's skill or patient volume.

A cosmetic dermatologist earning $800,000 net income in Palm Beach, Florida — no state income tax, high cosmetic pricing power, aging affluent population — and one earning $850,000 in San Francisco — a 12.3 percent state bracket at that income for a single filer, high cost of living, intense cosmetic competition — have very different actual financial positions despite the similar gross revenue.

The Employed vs. Private Practice Decision: What the Numbers Actually Require

Every dermatology resident approaching graduation faces this decision. The financial difference is documented. The risk difference is equally real.

Employed Medical Dermatology

Provides guaranteed income from day one, employer-paid malpractice, employer retirement contributions, no personal capital required, and no business management responsibility. In SalaryDr's reports, hospital-employed dermatologists average $585,000 (18 reports) and academic dermatologists $445,000 (18 reports), with productivity bonuses doing much of the work above base salary.

Private Practice

Requires startup capital, business management responsibilities, staff hiring and management, payer contracting, and in cosmetic-heavy practices, patient acquisition marketing. The payoff shows up in the survey data: SalaryDr's private practice dermatologists average $730,340 (49 reports), with a median of $690,000 and the middle half between $650,000 and $807,000. The early years, while the practice builds, are usually leaner than that.

The Inflection Point

Across SalaryDr's reports, the gap between the private practice average ($730,340) and the hospital-employed average ($585,000) is about $145,000 a year — the premium that has to justify the earlier risk and capital investment. The employed dermatologist who reaches year 10 has earned predictably and comfortably. The private practice owner who reaches year 10 has also built an asset — the practice itself — whose equity value sits on top of their annual income.

The Partnership Path

Some hospital-employed dermatologists eventually access profit-sharing or partnership arrangements — particularly in multi-specialty groups or in employed positions at practices where the employer offers a path to equity. These arrangements are relatively uncommon in pure hospital employment but more frequent in large multi-dermatologist employed groups that offer equity participation after defined performance periods.

Signing Bonuses and Contract Terms for Dermatologists

Dermatology-specific signing bonus data is thin. Across all specialties, AMN Healthcare's 2026 Review of Physician and Advanced Practitioner Recruiting Incentives (September 16, 2026) found signing bonuses in 87 percent of its search engagements, averaging $49,306 for physicians. Relocation assistance and a CME allowance are also common parts of the package.

Mohs surgeons in markets short on fellowship-trained surgeons have more leverage on signing bonuses and other incentives, so ask for them explicitly.

What to Negotiate in a Dermatology Contract

• Productivity Threshold AlignmentThe most financially consequential negotiation for an employed dermatologist is ensuring the wRVU threshold is set at or below the 50th percentile for the specialty in whichever survey the employer uses (often MGMA, whose figures are paywalled). For a rough reference, FastRVU, a planning tool that isn't produced by MGMA, uses 7,900 wRVUs as an illustrative dermatology median. A threshold set at the 75th percentile means you begin earning bonus only when you outperform three-quarters of your specialty peers. A threshold at the 50th percentile pays bonus for any above-average production.
• Cosmetic Revenue SharingFor employed positions where the employer expects or encourages cosmetic services, negotiate explicitly how cosmetic revenue is treated. If you are generating $200,000 in cosmetic cash-pay revenue for an employer, your compensation arrangement should reflect that contribution — either through a direct share of cosmetic revenue or through an adjusted wRVU rate that accounts for the non-billable clinical time cosmetic services consume.
• Non-Compete for Mohs SurgeonsA Mohs surgeon who builds a patient referral panel of 20 to 30 dermatologists and primary care physicians feeding their Mohs schedule has built professional relationships that have genuine market value. A non-compete that prevents practice within 15 miles of an employer could effectively prevent practice in an entire metropolitan area where the employer operates multiple locations. Push for the smallest defensible radius and always negotiate the without-cause carveout. For the complete non-compete strategy, see our Trapped by a Physician Non-Compete guide.
• Partnership Track SpecificsFor any employed position offering a "path to partnership," the specific terms — timeline, criteria, buy-in formula, what partnership actually conveys — must be in the signed contract before you start. Verbal partnership promises in dermatology are a source of documented disputes between dermatologists and employers. See our Medical Practice Partnership Buy-In guide for how to evaluate whether a buy-in offer is fair.

For the complete physician contract negotiation framework including how to benchmark wRVU thresholds, negotiate signing bonuses, and protect yourself on non-compete terms, see our Physician Contract Negotiation guide and use our Contract Analyzer to model your total compensation under different production scenarios.

Dermatology vs. Other Specialties: The Complete Financial Comparison

In SalaryDr's reports, general surgeons have a $515,000 median (136 reports) on 55-hour weeks with trauma call. Dermatologists report $625,000 on 40-hour weeks, with little or no call, in an office-based setting. The Doximity 2026 averages put the two nearly level ($501,003 for general surgery, $497,509 for dermatology), so the income edge depends on the source; the lifestyle edge doesn't. Against internal medicine, dermatology's SalaryDr median is $297,000 above the internist median of $328,000, a premium of about 91 percent; on Doximity's 2026 averages the gap is $158,235, about 47 percent.

The financial comparison extends beyond annual income when lifestyle is factored in:

At about $300 per hour at the SalaryDr median, dermatology has the highest income per hour in this table, ahead of orthopedic surgery and neurosurgery despite their much larger annual pay, and cosmetic-heavy practices can do better still. For the per-hour ranking across more specialties, see our Highest-Paying Medical Specialties guide.

The satisfaction data confirms what the financial comparison implies. In SalaryDr's reports, dermatologists rate their jobs 4.5 out of 5, and 94 percent of the 86 who answered say they would choose the specialty again. The combination of a top-tier income, one of the best work-life balances of any physician specialty, intellectual engagement across medical, surgical, and cosmetic dimensions, and the genuine possibility of building a business that generates wealth independent of clinical hours makes dermatology the specialty that most consistently delivers on every promise its applicants are chasing.