Oh it’s definitely easier to open a new general dermatology office than many specialty practices, no doubt. You can do it on a 500k line of credit and people can self refer themselves to you... and the demand is not nearly as restricted as it is for, say, rad onc services. The same cannot be said as easily for the Mohs or path guys, but probably still better than it is for many specialties. My point is the rapidity and degree of change over time, though; 15 years ago, in derm, you could easily have set up an office in practically anywhere, America and have a full schedule before opening the doors. Since that time the market has been flooded with providers (residency slots have doubled since my graduation), folks are working longer, midlevels exploded, and, most precipitously perhaps, insurer consolidation and MC Advantage expansion have narrowed panels and decimated reimbursements.
It’s a very toxic environment for small, subspecialty private practice right now. I think that is about the most ubiquitous thing in all of it.