Introduction: The therapeutic ladder has been well described in literature by many organizations over many years but rarely is the point of entry and the number of steps for the patient examined. It is reported anecdotally that the millennial would rather have a shortened therapeutic ladder.

Materials and Methods: A review of therapeutic ladders across the disease areas of pain management, acne vulgaris, Erectile Dysfunction and benign prostatic hyperplasia and original research of a qualitative phone interview of 24 dermatologists in the UK and Germany.

Results: A shortened therapeutic ladder will create benefits for the patient who wants to return to normal daily activity as soon as possible disease free and it will help in their mental health and quality of life at the same time potentially saving healthcare costs in both time and treatments and probably help the wider economy

Conclusion: Further research is needed into the wider healthcare economics of changing the way we address the therapeutic ladder. Shortening the patient pathway may give great benefits to the healthcare systems, healthcare funders, the wider economy and the patients overall long-term health outcomes.