Dermatology vs Ophthalmology

[doctober1]

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[asmallchild]

I would not use that as a deciding factor.

If ophthalmology is anything like dermatology, there will be an immense amount of reading. Pick up a textbook from each subject and see what interests you more. What can you see yourself practicing in 10 years? More short-term, what can you see yourself tolerating/enjoying while reading nightly during your residency?

I have yet to find anyone who can accurately predict the medical landscape, especially if you are projecting 4+ years from today.

 

[vicinihil]

completely agree with the above. Prediction of the medical landscape will lead you down all sorts of dark alley ways. You will not go wrong with either as they are both services that are indispensable and your services irreplaceable.

 

[opthotobe]

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[doctober1]

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???

Thanks to the 2 posts with the advice to choose the most interesting field. However, I have tried the "interest" litmus test and it has been inconclusive. I agree that it is impossible to predict the medical landscape and is unwise to even consider.

Why choose ophtho over derm or vice/versa?

What are the thoughts on leaving it up to the match?

 

[molmol]

Which field will be in the best "shape" when I finish residency?

Plastic Surgery.

 

[drdan766]

Plastics = long, hard residency. And most of their stuff gets NO reimbursement. Unless you do reconstructive.

Plastics = surgical specialty = it better be what you really want!

 

[doctober1]

Plastic Surgery.

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[drdan766]

In derm, i love that my patients are one the same page as i am. I dont have to convince them they have htn and they should take pills that may or may not work but will have side effects. In derm, the first question i always ask is, "does it bother you?" if the answer is no, then we are done, barring a melanoma or stevens johnson, etc. I love that. I do t know about ophtho. . . . but for me, i love the derm exam. It's all visual. Ophtho i think u need slit lamp, etc. Still, you should shadow and publish in each and then pick, if you are really at a loss.

 

[doctober1]

In derm, i love that my patients are one the same page as i am. I dont have to convince them they have htn and they should take pills that may or may not work but will have side effects. In derm, the first question i always ask is, "does it bother you?" if the answer is no, then we are done, barring a melanoma or stevens johnson, etc. I love that. I do t know about ophtho. . . . but for me, i love the derm exam. It's all visual. Ophtho i think u need slit lamp, etc. Still, you should shadow and publish in each and then pick, if you are really at a loss.

Good point.

 

[sawtella]

kind of alluding to what drdan already said but ophthal is a very tech-heavy field. They have a whole bunch of neat toys that they get to play with. Some people love this, others not so much. With the exception of a dermatoscope, which is really just a glorified magnifying glass, most of your physical exam in derm is by visual inspection. Some other questions you might want to be considering:

1) The Anatomy: do you want to be focusing the rest of your career on the eye? some people love the idea of being an expert on a particular (albeit small) area of the body. Others want something more global.

2) What do you like more: diagnostically challenging cases or technically difficult cases? Sure, dermatology has Mohs/lasers but by and large, ophthalmology is a much more surgically-oriented field. Dermatology is more pattern recognition and detective work.

3) Do you like the bread and butter of dermatology or opthal more? you can always specialize but you still need to enjoy or at least be able to tolerate the everyday stuff. If the sole reason you want to dermatology is because of Mohs/procedures, you may want to reconsider your career choice. You have to like medical dermatology too

And finally, I can't fault you for trying to make your career decisions based on financial outlook but like the others have said, it is almost impossible to predict what the future holds. My humble opinion is that the surgical subspecialities, particularly ortho, will have the best outlook because they have such strong lobbying groups.

 

[doctober1]

Thanks sawtella for the response. You made some very good points.

 

[drdan766]

Thanks sawtella for the response. You made some very good points. It is really important that one enjoy both surgical and medical aspect of both fields. It is true that ophth. is highly technical versus the highly visual aspect of derm. However, ophth. has a highly visual component too.

Anyone care to comment on the lifestyle of ophth. vs derm? Both seem to be very happy with their work, because of rewarding pt encounters and the opportunity to see immediate results. The preceptors I've had enjoy their job and the time for non-medical pursuits. I haven't heard much about residency difficulty...

hey, to be perfectly honest, i don't know what you are fishing for! It is starting to sound like you want an easy ride. . . . .and you can find that in ANY residency that you half ass. lifestyle is what you make of it. I think you have gotten great advice but it sounds like it is all stuff you have already seen first hand. so what is the real question? what are you looking for? because it is offensive that you should think that a difficult residency is what matters more than all we have discussed. I mean, what is your deal?

 

[doctober1]

hey, to be perfectly honest, i don't know what you are fishing for! It is starting to sound like you want an easy ride. . . . .and you can find that in ANY residency that you half ass. lifestyle is what you make of it. I think you have gotten great advice but it sounds like it is all stuff you have already seen first hand. so what is the real question? what are you looking for? because it is offensive that you should think that a difficult residency is what matters more than all we have discussed. I mean, what is your deal?

drdan766: dear sir/madam, I'm not for sure what you are implying...I was simply getting the opinion of future professionals until you replied with some very odd remarks. I hope you get some help and learn to better control your aggression.

Thanks to those who have responded in a courteous manner.

 

[molmol]

hey, to be perfectly honest, i don't know what you are fishing for! It is starting to sound like you want an easy ride. . . . .and you can find that in ANY residency that you half ass. lifestyle is what you make of it. I think you have gotten great advice but it sounds like it is all stuff you have already seen first hand. so what is the real question? what are you looking for? because it is offensive that you should think that a difficult residency is what matters more than all we have discussed. I mean, what is your deal?

haha, dude's on his period.

 

[sjonesy]

Is there much difference in the salary ranges between the two?

I know it's a bit mercenary but if I can't ask it here where can I?

 

[crosseyed]

hey, to be perfectly honest, i don't know what you are fishing for! It is starting to sound like you want an easy ride. . . . .and you can find that in ANY residency that you half ass. lifestyle is what you make of it. I think you have gotten great advice but it sounds like it is all stuff you have already seen first hand. so what is the real question? what are you looking for? because it is offensive that you should think that a difficult residency is what matters more than all we have discussed. I mean, what is your deal?

Guy, you might have an anger management problem. I hope you were joking, because you kinda sounded like a nut-job.

 

[drdan766]

ok, so I was wrong. no need to attack me, but i guess that could have been said about my post. My apologies.

just seemed like every bit of advice was met with the OP saying he was already aware. I made a mistake. hopefully, this is the end of it? back to ophtho vs derm?

 

[sawtella]

Thanks sawtella for the response. You made some very good points.

Hey I know how it is. I was deciding between ENT v. Derm (I even applied for the ENT match last year). What made me ultimately decide derm was the variety between med derm and procedures. After several months of surgical rotations, I realized that I didn't want to be operating all the time and if that's how you feel as well, maybe a surgical subspeciality isn't for you. Some may disagree that ophthalmologists are "surgeons" but they are in the OR quite a bit, especially if you're cornea/retina/oculoplastics. Their residency isn't a walk in the park either. One of my good buddies is an ophthal resident at a very well-known program and he is getting killed. During his PGY-3 year, it got so bad that he was thinking about switching into medicine. Derm residency can be very demanding too, especially at some of the more academic programs. In addition, derm requires TONS of independent study. Still, I would have to say that without question, an ophthal residency is more demanding.

When people say derm is a visual field, they are implying more than just the fact that you're using your eyes for the physical exam. When you see a lesion on the skin, you can immediately start thinking of a differential just based on how it looks but it's the subtle clues on the physical exam that will ultimately clinch your diagnosis. Do the lesions blanch? are the borders well-demarcated or ill-defined? are they serpiginous? do they involve a sanctuary zone? these are all questions that will lead you to one diagnosis over another. Interestingly, a lot of the dermatology attendings I have spoken with have repeatedly said that if they weren't in dermatology, they would do radiology. They go onto say that radiology is probably the closest field to dermatology because it requires a lot of volume and pattern recognition. I say this because one of the reasons I like derm so much is because it's diagnostically challenging. In that sense, I don't think ophthalmology can compare. It doesn't make it any lesser of a field, just different.

 

[drasclepius]

Interestingly, a lot of the dermatology attendings I have spoken with have repeatedly said that if they weren't in dermatology, they would do radiology. They go onto say that radiology is probably the closest field to dermatology because it requires a lot of volume and pattern recognition. I say this because one of the reasons I like derm so much is because it's diagnostically challenging. In that sense, I don't think ophthalmology can compare. It doesn't make it any lesser of a field, just different.

I had never heard the radiology comparison but once mentioned seems obvious. What about Rheumatology? I heard one attending say Rheumatology is a lot like derm but more medicine/less surgery and a "non-healthy" pt population. I am interested in a field with more medicine than dermatology but less surgery than ophthalmology/ENT?

 

[Trefoil]

Hey I know how it is. I was deciding between ENT v. Derm (I even applied for the ENT match last year). What made me ultimately decide derm was the variety between med derm and procedures. After several months of surgical rotations, I realized that I didn't want to be operating all the time and if that's how you feel as well, maybe a surgical subspeciality isn't for you. Some may disagree that ophthalmologists are "surgeons" but they are in the OR quite a bit, especially if you're cornea/retina/oculoplastics. Their residency isn't a walk in the park either. One of my good buddies is an ophthal resident at a very well-known program and he is getting killed. During his PGY-3 year, it got so bad that he was thinking about switching into medicine. Derm residency can be very demanding too, especially at some of the more academic programs. In addition, derm requires TONS of independent study. Still, I would have to say that without question, an ophthal residency is more demanding.

When people say derm is a visual field, they are implying more than just the fact that you're using your eyes for the physical exam. When you see a lesion on the skin, you can immediately start thinking of a differential just based on how it looks but it's the subtle clues on the physical exam that will ultimately clinch your diagnosis. Do the lesions blanch? are the borders well-demarcated or ill-defined? are they serpiginous? do they involve a sanctuary zone? these are all questions that will lead you to one diagnosis over another. Interestingly, a lot of the dermatology attendings I have spoken with have repeatedly said that if they weren't in dermatology, they would do radiology. They go onto say that radiology is probably the closest field to dermatology because it requires a lot of volume and pattern recognition. I say this because one of the reasons I like derm so much is because it's diagnostically challenging. In that sense, I don't think ophthalmology can compare. It doesn't make it any lesser of a field, just different.

Resurrecting a thread that died long ago, I would disagree with ophthalmology not being diagnostically challenging. I actually was drawn to ophthalmology for the diagnostic side. It's easy to simplify any specialty to its bread and butter, cataracts for ophthal and acne for derm, but I think as you dig into a specialty you realize how intricate every system is. I have seen countless patients fall through the cracks in ophthal because someone missed the diagnosis. Often, these patients are zebras that required advanced testing. We get very strange cases of vasculitis, infections, neurological syndromes such as Parinaud's, cranial nerve palsy, optic neuritis, orbital inflammation, trauma, thyroid disease, BRVO, BRAO, diabetes, high blood pressure, strange retinal lesions that are not accessible for biopsy without vitrectomy, and yes cataracts (a broad category for ophthalmologists). I actually think derm and ophthal are very similar. The first thing my attending did when I started her rotation was give me an atlas that was 500 pages long all with different images of eye disease (as a med student btw). This is just a small fraction of what I saw as a med student at a medium sized academic center. I am writing this to help other students understand that ophthalmology is actually primarily a diagnostic field. I've seen all kinds of weird systemic diseases diagnosed through the eye. The variety has been quite striking. We have a broad overlap with rheum, derm, and neuro and a fair amount with general IM. Just my two cents. I think derm is an awesome field and very much like ophthalmology though the similarity would only be obvious after rotating through both.