Compensation models in academic cosmetic dermatology

Abstract

Compensation models for cosmetic procedures in academic dermatology vary widely across institutions, reflecting differences in pricing strategies, revenue distribution, and physician incentives. To better understand current practices, the Association of Academic Cosmetic Dermatology (AACD) conducted a survey of AACD members, who were academic dermatology faculty responsible for resident education and patient care in cosmetic dermatology. A total of 52 dermatologists from 24 US states responded. Most respondents (88.5%) practiced exclusively in an academic setting. Pricing for cosmetic procedures was commonly benchmarked against local competitors (82.7%), with less frequent use of institutional financial teams (50%) or regional cost-of-living data (25%). Of respondents with facility fees, more than half reported that the degree of direct and indirect support provided was at least partially determined by institutional financial or administrative teams. Compensation models also varied: 65.4% of respondents reported hybrid salary and productivity-based models, while 17.3% each received either fixed salary or productivity-only compensation. Among productivity-based systems, 46.5% used work Relative Value Units (wRVUs), 41.9% used percent collections, and 9.3% used both. Respondent comments highlighted shared challenges, including limited pricing flexibility due to electronic medical record constraints, unclear or evolving funds flow systems, and barriers to implementing pricing changes. Many respondents emphasized the importance of exceeding revenue thresholds to trigger productivity bonuses and noted that facility fees often dilute direct compensation to physicians. Despite institutional variation, several participants reported satisfaction with their compensation structures. These results may assist faculty in negotiating more transparent, equitable, and sustainable compensation models in academic cosmetic dermatology.