derm residency experience

[dermyderm]

Hi everyone,
I'm currently a resident (pgy-2) in derm and life sucks. No, this isn't trolling or anything of the sort. I just wanted to rant anonymously about my experience about my program. You may also share the same experience or not about your program. For now, I won't name my program, but this is why it sucks.....

As a med student, I thought it would be cool to be part of a number of hospitals (VA, private, county and university) to get a great number of cases and different environments and payors.
***Reality: it sucks. going from hospital to hospital is a drag. you don't have the best parking. always running late. in extreme weather, it sucks even more

As a med student, I thought it would be cool to be part of a big ass class.
***Reality: it is awesome, then someone or several on vacation.... then you have to cover several ppl's clinic. On dermpath? not a real rotation! you get pulled for county derm clinic duty. On mohs? not a real rotation! get pulled for derm clinic duty.... on elective? not a real rotation!!! on something that we can somehow screw you with..... yea...

As a med student, attendings are so cool, just sitting their doing nothing..... Yes, that's an awesome job. Then as a resident you realize basically you are a scribe to certain attendings that just are either lazy, incompetent in seeing patients, just love making your their bitch or some combo of the 3. I mean seriously... are there any program out there that have the same freaking issue? don't get me wrong, some attendings see patients while you do to when some many are scheduled, but others are just bring on the wtf moments. **** man, some even start blaming residents for being slow..... then don't overbook the ****ing clinic in a place that has the crappiest EMR and expect efficiency and see some patients!!

Worse part is whether it is typing up notes or dictating (which you have to then edit the dictation b/c my mid-freaking0-western american english accent is just not understandable), is staying up doing this till midnight daily, getting called out on dictation when getting co-signed b/c there is ONE or TWO mistakes (then fix it, why make a scene for something so small), and not having any time to study. that inservice is a huge failure on my part for choosing my program that doesn't value studying and care more about RVUs (****ing rvus man! damn them to hell)

There are other crazy ass things about my program that I'll just list as I go along. For now, that is my rant. ... All this happened when we got a new chair. FML.

I know there are other programs like this, feel free to rant too.

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[DermApp13]

Hi everyone,
I'm currently a resident (pgy-2) in derm and life sucks. No, this isn't trolling or anything of the sort. I just wanted to rant anonymously about my experience about my program. You may also share the same experience or not about your program. For now, I won't name my program, but this is why it sucks.....

As a med student, I thought it would be cool to be part of a number of hospitals (VA, private, county and university) to get a great number of cases and different environments and payors.
***Reality: it sucks. going from hospital to hospital is a drag. you don't have the best parking. always running late. in extreme weather, it sucks even more

As a med student, I thought it would be cool to be part of a big ass class.
***Reality: it is awesome, then someone or several on vacation.... then you have to cover several ppl's clinic. On dermpath? not a real rotation! you get pulled for county derm clinic duty. On mohs? not a real rotation! get pulled for derm clinic duty.... on elective? not a real rotation!!! on something that we can somehow screw you with..... yea...

As a med student, attendings are so cool, just sitting their doing nothing..... Yes, that's an awesome job. Then as a resident you realize basically you are a scribe to certain attendings that just are either lazy, incompetent in seeing patients, just love making your their bitch or some combo of the 3. I mean seriously... are there any program out there that have the same freaking issue? don't get me wrong, some attendings see patients while you do to when some many are scheduled, but others are just bring on the wtf moments. **** man, some even start blaming residents for being slow..... then don't overbook the ******* clinic in a place that has the crappiest EMR and expect efficiency and see some patients!!

Worse part is whether it is typing up notes or dictating (which you have to then edit the dictation b/c my mid-freaking0-western american english accent is just not understandable), is staying up doing this till midnight daily, getting called out on dictation when getting co-signed b/c there is ONE or TWO mistakes (then fix it, why make a scene for something so small), and not having any time to study. that inservice is a huge failure on my part for choosing my program that doesn't value studying and care more about RVUs (******* rvus man! damn them to hell)

There are other crazy ass things about my program that I'll just list as I go along. For now, that is my rant. ... All this happened when we got a new chair. FML.

I know there are other programs like this, feel free to rant too.

Sounds horrible. Sorry to hear you're going through that after surviving such a competative process of obtaining a derm residency spot. Look at it from a positive side, one of the great things about derm is that the training is relatively short 2 more years and you are free.

 

[DermViser]

As a med student, I thought it would be cool to be part of a number of hospitals (VA, private, county and university) to get a great number of cases and different environments and payors. ***Reality: it sucks. going from hospital to hospital is a drag. you don't have the best parking. always running late. in extreme weather, it sucks even more

I think as a medical student things are so much fun bc you're only there for a month. It's when you're a derm resident and have to do the same drudgery day in and day out, which is when things get to be a real drag. This is like this for really any medical specialty, not just dermatology. As far as parking, I think this would describe several medical institutions, regardless of specialty, in which you don't get best dibs at parking even though you are doing most of the grunt work. I don't even know if faculty get that great dibs at parking. The upside is that the variety of derm pathology you see at those 4 places are very different - which will help you immensely on the boards. There is a huge difference between seeing it and just reading about it in Bolognia. There's a reason why certain places are powerhouses when it comes to clinical Dermatology training - i.e. Harvard, Columbia (I think), etc. which cover many locations. The downside of course is having so many places to cover, that you're constantly hurrying from one place to another so you WILL be tired. Hence why having a weekend to recharge is crucial, I think.

As a med student, I thought it would be cool to be part of a big ass class.***Reality: it is awesome, then someone or several on vacation.... then you have to cover several ppl's clinic. On dermpath? not a real rotation! you get pulled for county derm clinic duty. On mohs? not a real rotation! get pulled for derm clinic duty.... on elective? not a real rotation!!! on something that we can somehow screw you with..... yea...

As a med student, attendings are so cool, just sitting their doing nothing..... Yes, that's an awesome job. Then as a resident you realize basically you are a scribe to certain attendings that just are either lazy, incompetent in seeing patients, just love making your their bitch or some combo of the 3. I mean seriously... are there any program out there that have the same freaking issue? don't get me wrong, some attendings see patients while you do to when some many are scheduled, but others are just bring on the wtf moments. **** man, some even start blaming residents for being slow..... then don't overbook the ******* clinic in a place that has the crappiest EMR and expect efficiency and see some patients!!

Worse part is whether it is typing up notes or dictating (which you have to then edit the dictation b/c my mid-freaking-western american english accent is just not understandable), is staying up doing this till midnight daily, getting called out on dictation when getting co-signed b/c there is ONE or TWO mistakes (then fix it, why make a scene for something so small), and not having any time to study. That inservice is a huge failure on my part for choosing my program that doesn't value studying and care more about RVUs (******* rvus man! damn them to hell)

I'm sure you've learned by now, that there are many attendings in Dermatology, who would literally not be able to function without residents. There are many big wigs in Dermatology who have made great names for themselves and travel to posh places to lecture on their topic, who literally would never be able to finish clinic in a normal day, if left on their own. Don't get me wrong, they are prolific in their field, but place them in a morning and afternoon clinic by themselves, and they would self-destruct based on the many things that they need to do. When I rotated as a student at places, there were certain attendings, who literally would not be able to do a simple punch skin biopsy themselves without taking FOREVER, and holding up clinics. Hence, you see the patient, check out to the attending, you do all the scribing, dictating, management and treatment, and any procedures. You literally run the clinic from top to bottom, and the only "job" of the attending is to cosign your note (which should be impeccable of course, after all you're at the top of your medical school class, so your perfectionist and neurotic qualities should be well honed). All of this, by the way, should be done with grace and without looking at all overwhelmed.

The good attendings, are kind, thankful and grateful - I would name an attending here, but I don't want to embarass him/her on a public website, and I think in that instance, you get warm, cuddly feelings and forget about it. I think it starts to become toxic when an attending, by nature, is snappy, mean, ungrateful, is not thankful, and is overall entitled or even worse, starts whispering behind your back to other faculty about your faults.

Realize that Dermatology is filled with these personality types, and your program definitely is not alone. There are many faculty who are leaders in the field of derm, well-liked by outside dermatology colleagues, and when back home, treat their residents like pure crap (and of course, have a different face with patients). I have known residents that literally go home and cry due to being berated by certain notorious attendings.

Part of the problem is that Dermatology is not a "revenue-maker" for the hospital. People think that Dermatology connivingly doesn't want to increase residency spots, but the truth is that hospitals are reluctant to "waste" a residency spot in Derm, when they could get an Ortho resident, who brings in more money to the hospital. Hence, Dermatology at some places, is relegated to seeing more patients, in a shorter period time --- that means scheduling patients every 10-15 minutes, even when a patient may require a biopsy. This same reason is why many hospitals are reluctant to renovate for Derm - i.e. better rooms, better EMR, better dictation service, etc. Dermatology, as a specialty, is very much dependent on RVUs, it's not even funny. Historically, there were some programs that did Saturday clinics (Yes, I said Saturday), due to having to make up RVUs. At the expense of this, of course is PROTECTED study time during the week. I'm assuming you at least get your weekends off, so really that's when your hardcore studying for the inservice should take place. You won't be able to study for expansive periods of time during the week, so I would say 1-2 hours everyday with something light, depending on what time you get home.

 

[Medicine123abc]

I appreciate the OP's honest assessment of his/her residency field, it highlights the incredible difficulty in accurately assessing residency programs in dermatology. I am a candidate this year fortunate to receive many interviews and will match, but I look back and believe the selection process for derm (and probably all other competitive specialities) needs reform. It was a disillusioning experience.

Ss an applicant, the single thing I want to highlight is a culture of fear. I was afraid at every dinner to upset any resident at any time. During the tour, I felt the need to be ultra-engaged even when it was often times critical to respond to invitation emails within 5-7 minutes to get a specific date to minimize scheduling conflicts. Lunch was similar. Ultimately, I realized it just wasn't worth it to ask real questions (how much real cosmetics? how much real Mohs? Are you just a scribe?) Yes, maybe I'm paranoid. But when PDs and other residents confirm that "Yes, we are watching you. Yes, attendings tell us to report which applicants look bored or distracted", I believe I was in the right. And yes, yes I want to be an academic dermatologist and do research. It certainly doesn't feel like you can be yourself and ask real questions. Matching derm doesn't feel like a great field selecting great candidates--to me it felt like who can fake it long enough to slip through all the filters for programs to disqualify you.

Medical training is brutal. Are we taking the best and brightest out of medical school classes, running them through this gauntlet and then effectively killing whatever optimism and energy they have left?

 

[Dral]

Sorry things are going a little rough for you. I'm in a program that has a bunch of different sites too. It's tough for sure. But as you alluded to, you get to see different populations which benefits your educational experience. I think most derm clinics are booked like crazy. I think that pushes people to learn how to be efficient, which is critical for many dermatologists in practice.

My program pulls people from consult service to cover clinics, but that's it. Thankfully, Mohs, Dermpath, and electives are totally protected time and people are never pulled as far as I can tell. There are always going to be rough times in residency, but one just has to do the best with it.

Yes, there are times when I (all of us) feel frustrated about how things work. However, I feel lucky in that I really like my program, and I'm glad I ended up where I did. Give your program some time. Maybe you'll start to enjoy it more as time goes on and you advance to pgy 3 and 4.

 

[DermViser]

I appreciate the OP's honest assessment of his/her residency field, it highlights the incredible difficulty in accurately assessing residency programs in dermatology. I am a candidate this year fortunate to receive many interviews and will match, but I look back and believe the selection process for derm (and probably all other competitive specialities) needs reform. It was a disillusioning experience.

Ss an applicant, the single thing I want to highlight is a culture of fear. I was afraid at every dinner to upset any resident at any time. During the tour, I felt the need to be ultra-engaged even when it was often times critical to respond to invitation emails within 5-7 minutes to get a specific date to minimize scheduling conflicts. Lunch was similar. Ultimately, I realized it just wasn't worth it to ask real questions (how much real cosmetics? how much real Mohs? Are you just a scribe?) Yes, maybe I'm paranoid. But when PDs and other residents confirm that "Yes, we are watching you. Yes, attendings tell us to report which applicants look bored or distracted", I believe I was in the right. And yes, yes I want to be an academic dermatologist and do research. It certainly doesn't feel like you can be yourself and ask real questions. Matching derm doesn't feel like a great field selecting great candidates--to me it felt like who can fake it long enough to slip through all the filters for programs to disqualify you.

Medical training is brutal. Are we taking the best and brightest out of medical school classes, running them through this gauntlet and then effectively killing whatever optimism and energy they have left?

This is very much true. At a derm interview, you can't really ask "real" questions in Derm, that you can ask with no hesitation in other fields. I attribute this however, to the competitiveness of the field. They know no matter what, they will not be kicked off your rank list. They will only be changing positions on your list.

The prevailing belief is that you should be so thankful to even be getting a Derm interview in the first place, that any questions inquiring about supposed flaws shows that you're an ingrate.

Asking "real" questions can give the perception that you're lazy, too whiny, etc. Nothing positive can really come out of it, bc derm residents are more than willing to run to faculty and tell them how they can't believe an applicant asked that question to them - and off the rank list you go.

 

[asmallchild]

Hi everyone,
I'm currently a resident (pgy-2) in derm and life sucks. No, this isn't trolling or anything of the sort. I just wanted to rant anonymously about my experience about my program. You may also share the same experience or not about your program. For now, I won't name my program, but this is why it sucks.....

As a med student, I thought it would be cool to be part of a number of hospitals (VA, private, county and university) to get a great number of cases and different environments and payors.
***Reality: it sucks. going from hospital to hospital is a drag. you don't have the best parking. always running late. in extreme weather, it sucks even more

As a med student, I thought it would be cool to be part of a big ass class.
***Reality: it is awesome, then someone or several on vacation.... then you have to cover several ppl's clinic. On dermpath? not a real rotation! you get pulled for county derm clinic duty. On mohs? not a real rotation! get pulled for derm clinic duty.... on elective? not a real rotation!!! on something that we can somehow screw you with..... yea...

As a med student, attendings are so cool, just sitting their doing nothing..... Yes, that's an awesome job. Then as a resident you realize basically you are a scribe to certain attendings that just are either lazy, incompetent in seeing patients, just love making your their bitch or some combo of the 3. I mean seriously... are there any program out there that have the same freaking issue? don't get me wrong, some attendings see patients while you do to when some many are scheduled, but others are just bring on the wtf moments. **** man, some even start blaming residents for being slow..... then don't overbook the ******* clinic in a place that has the crappiest EMR and expect efficiency and see some patients!!

Worse part is whether it is typing up notes or dictating (which you have to then edit the dictation b/c my mid-freaking0-western american english accent is just not understandable), is staying up doing this till midnight daily, getting called out on dictation when getting co-signed b/c there is ONE or TWO mistakes (then fix it, why make a scene for something so small), and not having any time to study. that inservice is a huge failure on my part for choosing my program that doesn't value studying and care more about RVUs (******* rvus man! damn them to hell)

There are other crazy ass things about my program that I'll just list as I go along. For now, that is my rant. ... All this happened when we got a new chair. FML.

I know there are other programs like this, feel free to rant too.

Agree with all the above posters. Sorry to hear about your experience thus far, my only advice is to quietly grind through (surely it can't be bad enough to leave your highly coveted position)

A couple of pointers for medical students evaluating programs:

- I've always been a fan of programs with fewer sites. I do agree there is benefit in seeing varied pathology but in going to a residency that operated primarily out of one site, I didn't find it to be a crippling disadvantage

- Class size is important and a personal fit. Programs with larger classes tend to rely heavily on residents as the workhorses which means you will be pulled if others are sick/on vacation. I've had friends who were very happy at small programs, but I probably would not have been a fan of a program where I was the only resident in the class.

- Teaching attendings come in all shapes, sizes, and forms. There certainly are a fair number that will basically sit and just sign the chart (and then somehow find a way to criticize your effort, your dictation, your notes, your procedural technique, etc.) In general, I find that programs who hire full-time academic attendings tend to offer better teaching experiences (obviously not true for all attendings. I've had plenty of part-time attendings who have their own private clinic and yet are very enthusiastic about teaching residents)

 

[dermyderm]

Thanks everyone for the advice and comments! Going to see it through and hope for the best!

 

[Substance]

Reading this thread makes derm residents seem pretty catty.

One of the reasons people are attracted to derm, besides the pay/hour ratio and the lifestyle, is the chill personalities involved with the field. At my school, the derm docs were all happy, reasonable, and very intelligent professionals.

If these catsos you're describing are the next gen of derm, I can see the whole professional vibe going out the door. "OMG my shoelace iz untyd I wunt get a interviewz OMFG kill me now plz" thinks the derm student as the staff is thinking to herself "His shoelace is untied; what a loser".

 

[Substance]

Reading this thread makes derm residents seem pretty catty.

One of the reasons people are attracted to derm, besides the pay/hour ratio and the lifestyle, is the chill personalities involved with the field. At my school, the derm docs were all happy, reasonable, and very intelligent professionals.

If these catsos you're describing are the next gen of derm, I can see the whole professional vibe going out the door. "OMG my shoelace iz untyd I wunt get a interviewz OMFG kill me now plz" thinks the derm student as the staff is thinking to herself "His shoelace is untied; what a loser".

Makes me think of that Donna Magid Hopkins radiology thing.

 

[DermViser]

Reading this thread makes derm residents seem pretty catty.

One of the reasons people are attracted to derm, besides the pay/hour ratio and the lifestyle, is the chill personalities involved with the field. At my school, the derm docs were all happy, reasonable, and very intelligent professionals.

If these catsos you're describing are the next gen of derm, I can see the whole professional vibe going out the door. "OMG my shoelace iz untyd I wunt get a interviewz OMFG kill me now plz" thinks the derm student as the staff is thinking to herself "His shoelace is untied; what a loser".

This highly depends on the program. There are dermatology programs with very chill and nice faculty, who are great mentors to residents. There are dermatology programs with very catty and abrasive faculty, in which as the resident your job is to crank out RVUs. A lot depends on the ability of the applicant to be able to read between the lines on interview day, bc at least on SDN, no one in their right mind will "out" a program.

While I don't think one will be blackballed for having an untied shoelace, you are expected to dress the part as a dermatology resident - esp. since unlike Internal Medicine or Surgery, you get enough sleep every night and get your weekends off. I think faculty expect a certain level of attention to detail by derm residents.

 

[dermathalon]

There are nice programs and not so nice programs. This is why I tell people to really listen to their gut when they make a decision and speak to as many people as you can when making that final rank list to get as much of a full and honest picture as you can. Sometimes, you'll match where you are going to match but good to go in with your eyes wide open.

I think it's a little ridiculous to pick out small things and make a big deal out of it (for the faculty). There are a lot of fragile egos in medicine but you'll find a lot more in derm when a lot is made out of test outcomes to a neurotic degree. A major flaw that we need to change from the inside....easier said than done.

 

[Transformers]

Just resurrecting this thread...starting to see some more factors to consider in derm...little things that matter to residents, but most of us as applicants don't consider since we just want to match: number of services covered (hence running around to different hospitals), consult vs. Clinic time, available study time, didactics, cases covered, autonomy, required research (probably at bigger institutions) have I hit them all?..I mean at the end of the day, derm is derm and matching in itself is a blessing and the residency is far more cush than other specialties.

With that in mind, I'm just curious about lifestyle and hours across programs. My best friend matched into a top 5 rigorous program this year (minus the cush TY) but he's one of the guys who wants to put in the extra hours/see the rare zebras to get the best training/maybe do academics- and this program notoriously has that reputation. I'm in the other boat....just wanna match at a place, work hard enough to pass the derm boards and become a good outpatient dermatologist (like most residents)...So really my question is (and sorry its very slacker-ish and lazy)

Do all top tier programs (UCSF Penn Yale Michigan NYU Harvard) have the toughest, most brutal hours (medicine-like)? I'm think short and long term in terms of considering an away at a top 10 reach derm program, possibly getting an interview, and ranking it very high but I want to be sure it's something that fits my long term goals

 

[spartan564]

Just resurrecting this thread...starting to see some more factors to consider in derm...little things that matter to residents, but most of us as applicants don't consider since we just want to match: number of services covered (hence running around to different hospitals), consult vs. Clinic time, available study time, didactics, cases covered, autonomy, required research (probably at bigger institutions) have I hit them all?..I mean at the end of the day, derm is derm and matching in itself is a blessing and the residency is far more cush than other specialties.

With that in mind, I'm just curious about lifestyle and hours across programs. My best friend matched into a top 5 rigorous program this year (minus the cush TY) but he's one of the guys who wants to put in the extra hours/see the rare zebras to get the best training/maybe do academics- and this program notoriously has that reputation. I'm in the other boat....just wanna match at a place, work hard enough to pass the derm boards and become a good outpatient dermatologist (like most residents)...So really my question is (and sorry its very slacker-ish and lazy)

Do all top tier programs (UCSF Penn Yale Michigan NYU Harvard) have the toughest, most brutal hours (medicine-like)? I'm think short and long term in terms of considering an away at a top 10 reach derm program, possibly getting an interview, and ranking it very high but I want to be sure it's something that fits my long term goals

Bump. I would like some opinions on this too please.

 

[asmallchild]

Bump. I would like some opinions on this too please.

It's only a problem for a very select few. If everything in your application profile is perfect, you may be the rare person in position to dictate where you want to go. If you want an "easier" experience, by all means rank the "lower tier" programs higher. The level of training is likely to be just as good. And I guarantee you there will be no shortage of people behind you for the "top tier" programs.

For the vast majority of us, we go where we are lucky enough to match.

 

[doctalaughs]

Just resurrecting this thread...starting to see some mor

Do all top tier programs (UCSF Penn Yale Michigan NYU Harvard) have the toughest, most brutal hours (medicine-like)? I'm think short and long term in terms of considering an away at a top 10 reach derm program, possibly getting an interview, and ranking it very high but I want to be sure it's something that fits my long term goals

I cant speak for all these programs but in general that is true. Having gone through one of the "tougher" programs above I can say the clinical hours are not what people expect for "derm" but they aren't so bad (think 55-75) - so kinda "medicine" hours but not nearly so bad as some residencies like surgery.

Also, keep in mind this is only 3 years of your life and you are probably going to practice 30 years while you draw on your training. Some "non-top-tier" programs will just make you spend those extra hours reading (useless) stuff too. Think of it like this- would you rather spend an extra 20 hours a week reading/memorizing useless facts about basement membrane proteins in rare forms of pemphigus, or would you actually rather see and learn how to manage these types of patients (just to give one example).

 

[spartan564]

how much do you all think that residency name matters when trying to get a private practice job? Additionally, while I agree with your point doctalaughs about rather be doing than reading, I understand that knowing minutia about basement membrane proteins is important for the inservice/ board exams so I would like some time to read as well.

 

[doctalaughs]

how much do you all think that residency name matters when trying to get a private practice job? Additionally, while I agree with your point doctalaughs about rather be doing than reading, I understand that knowing minutia about basement membrane proteins is important for the inservice/ board exams so I would like some time to read as well.

I agree name wont matter (much) for getting a private practice job. However, being a good doctor should matter for something (not to say you cant be a good doctor at a non-name program but richness of your clinical experience does matter).

With regards to boards I wouldn't worry too much. Programs that emphasize getting super high scores ITE are ridiculous and most everyone passes - you are smart enough to memorize those useless facts in the last 2 months (which you'll forget within a year anyway)