A doctor for skin, hair and nails. Very well paid, and one of the hardest residencies to get.
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Pay, the path, pros and cons and the facts on one printable page. Good for a wall or a guidance counsellor.
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What you earn and what it costs to get there.
Median
$328,730
Bottom tenth
$102,810
Top tenth
$578,560
The national median is $328,730 a year, and the top tenth reach $578,560. One caution: the federal survey counts physicians who are employed and paid a wage. Dermatologists who own or part-own a practice are not in it, and the bottom tenth mostly reflects part-time and academic work rather than a normal full-time job.
About $70,000 to $95,000 a year
Resident salary, rising with each year of residency
You are paid from the day after medical school, but that is four years of hospital training on a fixed salary while your student loan interest keeps running.
$578,560 at the top tenth
Practice owners and surgeons who remove skin cancers
Insurance pays for medical dermatology. Cosmetic treatments are paid for directly by patients, with no insurer deciding the price, which is a large part of why the top of this field earns what it does.
Tuition, fees, exams and kit. Not rent, food or travel
The low end is a community college transfer into an in-state public bachelor's degree, then an in-state public medical school, plus the MCAT (Medical College Admission Test), applications and the licensing exam steps. The high end is full price public undergraduate tuition followed by a private medical school, with board certification fees at the end. Residency, which is another four years, is paid work, so it adds no tuition of its own. Graduates commonly finish owing around $200,000, so apply for the admission test fee assistance program before you spend anything on testing, and fill in the FAFSA (Free Application for Federal Student Aid) every year.
Medical school graduates commonly finish owing around $200,000. Fill in the FAFSA (Free Application for Federal Student Aid) every year, and apply for the fee assistance program before you spend money on the admission test.
Employed salary
A base from a hospital or large group, plus a bonus tied to how many patients you see.
Practice ownership
You keep the profits of the clinic. The highest ceiling and invisible in government wage data.
Procedure income
Biopsies, excisions and skin cancer surgery pay far better per hour than talking.
Cosmetic services
Paid directly by patients. Steady, predictable, and not dependent on any insurer.
The exact path from high school to qualified.
Twelve years after high school, and the competition is fierce the entire way.
Bachelor's degree
4 years
Any major, but finish the pre-medicine sciences with a very high grade average and sit the admission test.
Medical school
4 years
An MD (doctor of medicine) or DO (doctor of osteopathic medicine) degree, with clinical rotations in the last two years.
Intern year
1 year
A general year of hospital medicine or surgery before dermatology training starts.
Dermatology residency
3 years
Skin clinic, dermatopathology under the microscope, and surgery. Paid, and very hard to get into.
Board certification and license
After training
Certify with the American Board of Dermatology and hold a license from your state medical board.
Biology and chemistry
Required for every pre-medicine track.
Physics
On the medical school admission exam, and it explains how lasers and light treatments work.
Statistics
Reading studies is a daily part of medicine, and studies are statistics.
Art
Dermatology is pattern recognition by eye. Being able to describe exactly what you see is the core skill.
Each state licenses physicians through its own medical board, so there is no single national license. The examination is national: three steps of the United States Medical Licensing Examination, or the osteopathic equivalent. After residency you certify with the American Board of Dermatology, one of the twenty four member boards of the American Board of Medical Specialties. Certification is not the same thing as a license, but hospitals and insurers expect both.
There are only a few hundred dermatology residency places in the country each year, and far more applicants than that. Programs look at exam scores, research output, the reputation of your medical school and who wrote your letters. Students who want this typically take a research year to strengthen an application, and many strong candidates still do not match. If you are planning for it, build a backup specialty you would genuinely be happy in.
Things you don't need, but that help.
Micrographic dermatologic surgery
One to two more years. Removing skin cancer layer by layer, checking each one under the microscope while the patient waits.
Dermatopathology
One more year. Reading skin biopsies under a microscope all day, with no clinic.
Pediatric dermatology
One more year. Birthmarks, eczema and genetic skin conditions in children.
Cosmetic and laser dermatology
Learned mostly through courses and practice rather than a formal fellowship.
Research
It carries more weight in this specialty than almost any other. Start early and stick with one project.
A very high grade average
There is no gentle route into dermatology. The filtering starts in your first year of college.
Shadowing
Spend a day in a skin clinic and a day in a surgery suite. They are very different jobs.
A backup you would enjoy
Most pre-medicine students never reach medical school, and most medical students never match into dermatology.
Dermatology is famous among medical students for a reason that has nothing to do with skin. Clinic hours are predictable, almost nobody is admitted to hospital overnight, and true emergencies are rare. That combination of high pay and a schedule you can plan a life around is what turns it into one of the hardest specialties to enter. Be honest with yourself about whether you want the field or the schedule.
Day to day, pros and cons, where you'd work.
Clinic from eight, often 30 or more patients in a day, many of them short. Full skin checks looking for anything that has changed, acne in teenagers, eczema, psoriasis, rashes nobody else could name. Several biopsies, done in a few minutes each. One afternoon a week might be surgery, removing skin cancers and closing the wound. Then reading pathology reports and calling the patients whose results were not what anyone hoped. Home by six.
The good
The hard parts
Things people don't tell you.
More Americans are diagnosed with skin cancer each year than with all other cancers combined. Most of it is found by a dermatologist looking at a spot the patient had stopped noticing.
In micrographic surgery, the surgeon removes a thin layer, freezes and examines it under a microscope in the next room, and goes back for more only where cancer still shows at the edge. The patient sits in the waiting room between rounds. It takes hours and spares as much healthy skin as possible.
An adult's skin covers roughly 20 square feet and weighs more than the brain and liver. It is also the only organ a doctor can examine completely without any equipment at all.
Dermatology is the one field of medicine where a clear photograph is often enough to make a diagnosis. That has made virtual consultations genuinely useful here, and it is how many rural patients now reach a skin doctor at all.
Last checked September 2026. Pay figures are typical full-time annual amounts in United States dollars, based on Bureau of Labor Statistics wage data and published pay scales. They vary by state, employer and experience. Tuition is for in-state students at public schools unless the card says otherwise.