Large group practice (16+ practitioners)

Large group practice overview

A large group dermatology practice is typically a multi-site, high-volume clinical organization owned by private equity firms, hospital systems, or corporate entities. These practices often consolidate smaller groups and solo clinicians into centralized systems, offering dermatologists a salaried position with administrative support.

Why dermatologists choose this

• Immediate, stable salary post-residency.

• Reduced administrative and business responsibilities.

• Established brand and built-in patient base.

• Operational support from billing, HR, and IT departments.

• Career options with defined schedules and fewer startup risks.

How this model works

Employment and structure

Dermatologists are employed by a corporation or holding group that owns multiple dermatology clinics. Employment is typically at-will or contract-based, with compensation models tied to productivity, seniority, or revenue targets. These entities often target established practices for acquisition, allowing older dermatologists to monetize their business.

Patient care model

Dermatologists provide care in well-equipped clinical settings with a steady stream of patients. Care may be protocol-driven, focused on efficiency, and supported by ancillary providers like PAs and NPs. Cosmetic, medical, and surgical dermatology are often all offered, maximizing service variety and revenue.

Administrative support

All non-clinical operations including payroll, scheduling, credentialing, compliance, marketing are handled by centralized teams. EHR systems are standardized across locations. This setup reduces administrative burden but may reduce autonomy in vendor or system choices.

Compensation and incentives

Salaries are generally competitive and stable but may grow incrementally. Incentives are often tied to RVU-based productivity or financial performance. Benefits can include health insurance, malpractice coverage, CME stipends, and 401(k) plans. Equity or bonus structures may exist in some organizations but are less common.

Technology and operations

Large groups invest heavily in technology, often using enterprise-level EHRs, teledermatology platforms, patient portals, and data analytics systems. Standardized protocols help ensure compliance, quality reporting, and operational efficiency across multiple sites. Centralized scheduling, inventory, and performance tracking are common, reducing variation but limiting local autonomy. It's important to understand how decisions are made and communicated, especially when it comes to requests for supplies or equipment that affect clinical care.

Career growth

Career progression is structured and may involve leadership roles such as regional medical director or clinical advisor. Advancement is based on tenure, productivity, and operational contributions rather than research or teaching. Opportunities for ownership or equity are rare and often reserved for early investors or founders.

When this model makes sense

• For dermatologists seeking financial stability and lower risk post-residency.

• When you prefer clinical work without business management duties.

• For those drawn to predictable schedules, strong HR support, and established systems.

• Ideal for early-career physicians with student debt or those seeking work-life balance.

Success factors

• Evaluate contract terms carefully, especially around non-competes and productivity benchmarks.

• Understand how compensation is structured, such as salary versus productivity incentives.

• Clarify expectations for patient volume, administrative duties, and time off.

• Engage with the organization to influence care standards and workflow.

• Stay flexible as policies, leadership, and ownership structures can change with private equity involvement.

Potential challenges

• Limited autonomy in decision-making, schedules, and clinical operations.

• Reimbursement tied to Medicare rates, with many payers now paying below that level.

• Less control over work environment, staffing, and supply choices.

• Incremental salary growth and fewer long-term wealth-building opportunities.

• Risk of organizational restructuring or resale by private equity owners.

Real-world example

Brett Coldiron, MD, FAAD, founder of The Skin Cancer Center, observed a significant rise in large group dermatology acquisitions in recent years. Many private equity firms are purchasing older practices, providing a way for retiring dermatologists to monetize their businesses. While these large groups offer appealing benefits such as stable income, administrative support, and reputation, Dr. Coldiron notes they often come with trade-offs in autonomy and long-term financial upside.

Early career advice

• Understand how private equity ownership may affect long-term goals.

• Read your employment contract thoroughly, especially clauses on buyouts, termination, and productivity metrics.

• Ask about administrative support, technology systems, and patient load expectations.

• Make sure the practice’s culture and values align with your own.

• Consider this model as a steppingstone if you’re focused on financial security early in your career.

Related AAD resources

• Practice types: See our full menu of resources on practice types, from solo to institutional.

• Get started: Access our guide to getting started in practice, with resources on practice types and policies and procedures.

• Employment guide: See all our resources on contracts, questions for employers, and more.

This content was created with the particular needs of early-career dermatologists in mind. See the rest of our Career Launch resources for young physicians.