{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/dermatologists/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "Dermatologists",
    "soc_code": "29-1213",
    "category": "Healthcare",
    "us_employment": 11370,
    "median_annual_wage": 328730
  },
  "verdict": "SAFE",
  "risk_resistance": 78,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 13,
    "embodiment": 15,
    "liability_shield": 19,
    "trust_premium": 15,
    "judgment_accountability": 16
  },
  "reasoning": {
    "task_resistance": "A 13 rather than 17 reflects that image-based triage of pigmented lesions and teledermatology store-and-forward reads are genuinely contestable by CNNs, while the same day's punch biopsies, Mohs-adjacent excisions, intralesional steroid injections and palpation of scaly plaques for texture and induration have no digital substitute — so roughly a fifth of billable encounters are exposed, not the core.",
    "embodiment": "Full-body skin checks under Wood's lamp, dermoscopy contact plate on the patient's back, liquid nitrogen sprays, shave and punch biopsies with suture closure, and laser and injectable work all happen with gloved hands on a live patient in an exam room — it sits at 15 rather than 19 because the environment is a controlled clinic, not a roadside or a crawl space.",
    "liability_shield": "Prescribing isotretinoin under iPLEDGE, dosing methotrexate and cyclosporine, and signing off on biologics like dupilumab all require an unrestricted state medical licence plus board certification, and the named physician carries the malpractice exposure when a missed melanoma metastasises — 19 rather than 20 only because some cosmetic procedures can be delegated to supervised NPs and PAs.",
    "trust_premium": "Patients undress completely for a stranger and return for years of acne, psoriasis or atopic dermatitis management where adherence depends on whether they believe the person telling them to keep taking the drug — a 15 rather than 19 because much of the volume is one-off lesion checks and referred biopsies where the patient never sees the same dermatologist twice.",
    "judgment_accountability": "Deciding whether an atypical nevus warrants excision with 5 mm margins or annual photography, whether a rash is a drug eruption or early cutaneous lymphoma, and whether to start a systemic immunosuppressant in a patient with latent TB are calls with no protocol that resolves them and real downside either way — 16 rather than 19 because staging and treatment of confirmed melanoma follows NCCN pathways."
  },
  "rationale": "Lesion image classification is the one dermatology task where AI genuinely competes — CNNs already match dermatologists on curated melanoma photo sets — but that is a slice of the job, not the job. The median dermatologist spends the day doing full-body skin exams, dermoscopy, punch and shave biopsies, cryotherapy, excisions, cosmetic injectables and lasers, plus prescribing systemic immunosuppressants and biologics that require a licensed prescriber and personal liability for outcomes. AI will most likely arrive as triage that raises the volume of referred lesions the dermatologist must physically inspect and cut.",
  "outlook": "By 2035 AI screening will push more suspicious-lesion volume into dermatology clinics rather than replacing them, and the earnings center shifts further toward surgical and procedural work while pure visual-diagnosis consults get compressed.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "State medical boards or FDA labeling that explicitly requires a board-certified dermatologist to review and sign every AI-flagged lesion triage output before biopsy or discharge — the pattern already set by FDA's De Novo clearance of DermaSensor and SkinVision-type tools as adjunct-only, plus state teledermatology rules (e.g., Texas, Arkansas) barring store-and-forward diagnosis without a licensed physician of record. Medical malpractice insurers adding riders that void coverage when an AI dermatology triage result is accepted without documented physician review would push the same direction.",
        "plausibility": "already happening",
        "would_add": 1
      },
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift: if AI triage absorbs the routine 'is this benign nevus' read, the residual day is dermoscopy on ambiguous lesions, biopsy technique, immunosuppressant/biologic selection and monitoring, and complex inflammatory and pediatric disease — the tier CNNs on curated photo sets do not touch. Watch for AI-first triage in large dermatology groups (e.g., private-equity-consolidated practices) shifting scheduled slots toward procedures and systemic-therapy management.",
        "plausibility": "plausible",
        "would_add": 3
      },
      {
        "dimension": "embodiment",
        "change": "Volume shift toward procedural work — Mohs surgery, excisions, cryotherapy, laser and injectable cosmetics — if AI triage increases referred-lesion throughput as expected. These are unpredictable-field manual procedures on live tissue with no near-term robotic substitute; a rising procedural share of RVUs would be the observable marker in Medicare billing data.",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "trust_premium",
        "change": "Cosmetic dermatology is cash-pay and already brands on the specific physician; if med-spa AI/device scandals drive state legislation requiring physician (not NP/PA/aesthetician) performance of energy-based procedures — bills of this kind have been introduced in Florida and Nevada — the named-human premium hardens legally as well as commercially.",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "judgment_accountability",
        "change": "Ownership of the biologic and immunosuppressant decision under ambiguity — infection risk, malignancy screening, pregnancy, insurance step-therapy appeals — grows if prior-authorization reform requires a named prescribing specialist to attest to medical necessity rather than a plan algorithm.",
        "plausibility": "plausible",
        "would_add": 1
      }
    ],
    "ceiling_note": "At 78 the headroom is small and mostly in embodiment and task-mix; liability_shield at 19 and judgment_accountability at 16 are already near the practical ceiling for a licensed procedural specialty. The realistic downside risk is not displacement but scope competition from NPs/PAs and AI-assisted primary care handling routine reads, which compresses volume without touching any of these five scores."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2021,
        "emp": 9230,
        "wage": 239200
      },
      {
        "y": 2022,
        "emp": 11640,
        "wage": 239200
      },
      {
        "y": 2023,
        "emp": 12040,
        "wage": 239200
      },
      {
        "y": 2024,
        "emp": 10080,
        "wage": 239200
      },
      {
        "y": 2025,
        "emp": 11370,
        "wage": 328730
      }
    ],
    "from": 2021,
    "to": 2025,
    "change_pct": 23.2,
    "comparable_from": 2021,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}