I have been in the derm industry a long time. Most derm companies use to be lead by people with both field and derm experience; and as they moved up through the ranks, they developed relationships with key derms, both in private practice and acedemics throughout the country. These were truly leaders in the industry, good team builders, and simply great business man/women. They really grew the derm businesses, and times were pretty good.
Now, most top positions are being filled by the company board of directors with MBA financial warriors that have no sense of the industry, no relationships with the derm community, and little knowledge on how to truly advance the company through this market space. They simply have theories on how to increase the bottom line for any ole' company making widgets; and they feel that they can do this from the confines of a distant ivy tower office and a computer. As their companies lose greater amounts of business under their incompetent execution of textbook theories, they resort to the lamest trick in the book which is cutting expenses everywhere. A company "leader" that goes this route has proven he/she has no vision for the future of a company, and is simply trying to squeeze out a little profit, before the board notices their mistake of putting people like that into key company positions.
Unfortunately, it is a mindset that has been bred into our society over the last decade through our universities. Also, as our companies become owned and centrally managed by European bureaucrats, you can bet, the leadership will not improve, and companies will continue to rot from within, with profits shown from cuts, not growth.