Lifestyle during Residency and after

[Anita Shirley]

Everyone says that dermatology is a great field to go into if work-life balance is important to you. Just how much better is it than other fields, though? I'm sure it varies but if you're working in a hospital, for example, what kind of hours can you expect to work? What about as a resident (and does it get better later on in your residency)? Lastly, is dermatology a field in which it is common or "necessary" to do a post-residency fellowship?

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[sore eye asses]

derm residents enjoy normal work hours (45-50 hrs/week). they make up the difference with studying at home. i prefer home study to spending 80 hrs/week in the hospital, so derm is great for me.

if you want to be a true derm hospitalist, you'll probably have pretty rough hours, and be working in an academic medical center. if you go into private practice derm you can make your schedule as you see fit and find commensurate pay.

it's a good lifestyle field because it has good hourly pay, so you can work less and still do well. like 25 hrs a week and still make what a primary care doc does working 40+

as for fellowship, I think it depends on where you train, but it's nothing like rads. i imagine maybe 40-50% of folks do derm fellowships. someone correct me if i'm way off with this estimate.

 

[FixItUp Chappie]

I believe the beauty of a dermatology career is that you can make of it what you like.

If you want to work 3 half-days a week in a practice, you can do that and still make more than the average U.S. household.

If you want to work 6 days a week and make $500,000+ a year, its certainly within reach.

You can have a practice with 2 ancillary staff, or you can have 10+.

You can work in Academic, Multi-Specialty, Large Group, Small Group, Solo, Part Time and Locum practices.

Dermpath, Moh's, Cosmetics all have the ability to impact your income/time away from work in both a negative and positive way. So add/subtract them from your education and/or practice if it makes you happy.

Most Derm's don't take Medicaid right now. You can increase your practice's mission/charitable statement by seeing such patients.

I personally believe that many physicians, dermatologists included, will likely stop taking Medicare in the future. Dumping Medicare patients will likely decrease your 65+ patient population, decrease your headaches/red tape associated with taking medicare patients and potentially decrease your billing of several of the more lucrative codes.

Cash only practices and concierge care are certainly feasible in Dermatology.

Ultimately, Dermatology gives you more choices than most fields in the changing landscape of the American medical system. It's all up to you (and what your definition of successful is) to determine where your priorities are.

 

[reno911]

"true derm hospitalist, you'll probably have pretty rough hours".

Just wanted to comment on this part. I really have no idea what a "true derm hospitalist", but I assume it refers to someone in an academic center who sees a lot of inpatient consults and perhaps admits some patients. Even these people don't have what any reasonable MD would call "pretty rough hours". In fact, I would go as far as to say that no academic dermatologist has "pretty rough hours". Perhaps there are a few exceptions here or there, but I'd like to meet an academic dermatologist that averages 60+ hours/wk in the office/on campus.

All of the dermatologists that I know that work a lot of hours (60+ per week is my arbitrary cut-off for this) are in private practice (normally their own practice) and they only work so much because the choose to. They are very well compensated for the work, and they do have to spend time managing their practices.

All of these people could choose to work far less and still make tremendous amounts of money, they simply choose not to. One of the nice things about derm, as others have mentioned, is that we have that choice.

 

[sore eye asses]

Just wanted to comment on this part. I really have no idea what a "true derm hospitalist", but I assume it refers to someone in an academic center who sees a lot of inpatient consults and perhaps admits some patients. Even these people don't have what any reasonable MD would call "pretty rough hours". In fact, I would go as far as to say that no academic dermatologist has "pretty rough hours". Perhaps there are a few exceptions here or there, but I'd like to meet an academic dermatologist that averages 60+ hours/wk in the office/on campus.

All of the dermatologists that I know that work a lot of hours (60+ per week is my arbitrary cut-off for this) are in private practice (normally their own practice) and they only work so much because the choose to. They are very well compensated for the work, and they do have to spend time managing their practices.

All of these people could choose to work far less and still make tremendous amounts of money, they simply choose not to. One of the nice things about derm, as others have mentioned, is that we have that choice.

by true derm hospitalist, i meant an academic derm who sees strictly inpatient cases. I worked with several of these during medical school and they all averaged at least 60 hrs/week. just a trend I noticed on my travels that seemed salient to the OPs question.

 

[reno911]

by true derm hospitalist, i meant an academic derm who sees strictly inpatient cases. I worked with several of these during medical school and they all averaged at least 60 hrs/week. just a trend I noticed on my travels that seemed salient to the OPs question.

I find it hard to believe that there are many such individuals. I have, both in the course of my training and afterwards, worked at many very large academic teaching hospitals. Even if a single dermatologist was assigned to do all of the consultative work and inpatient work themselves it would be very difficult for them to come up with 60 hours of work a week. When you consider the fact that residents do much of grunt work and the faculty is mostly just there to be the "brain", 60 hours of work a week would be tough to find. I suppose they might have some sort of research that they could be working on as well, but 60 hours is still a lot. That would be a schedule of working from 7 AM to 7 PM, Monday through Friday. I'm not saying it's impossible, but it would be very, very rare.

 

[sore eye asses]

I find it hard to believe that there are many such individuals. I have, both in the course of my training and afterwards, worked at many very large academic teaching hospitals. Even if a single dermatologist was assigned to do all of the consultative work and inpatient work themselves it would be very difficult for them to come up with 60 hours of work a week. When you consider the fact that residents do much of grunt work and the faculty is mostly just there to be the "brain", 60 hours of work a week would be tough to find. I suppose they might have some sort of research that they could be working on as well, but 60 hours is still a lot. That would be a schedule of working from 7 AM to 7 PM, Monday through Friday. I'm not saying it's impossible, but it would be very, very rare.

it was the norm for the few that i worked with. that's all I can say. i can't comment on the extent to which their research projects contributed to their overall hours worked, but I know they were involved in projects.

 

[dermathalon]

There are quite a few academic dermatologists that work in excess of 60 hours a week, especially when you take into account the time needed to write papers, grants (especially time consuming), set up clinical trials, etc...in addition to seeing patient in clinic. Frequently they take this work home with them and it's not work on campus or in the clinic. They will not make nearly as much as the private practitioners as mentioned before (unless you are an uber-consultant and participate in many expert consultation cases...I know these people exist as I know some of them but they are quite rare). And you have certain dermpath faculty that can work pretty long hours, pretty close to 60 hours a week when they are on service...but that depends on the volume that comes through and the number of dermpath faculty present.

The sky is the limit with derm in terms of the possibilities! It's got flexibility on so many angles but I think this has been discussed in detail here in the previous posts.

 

[reno911]

Frequently they take this work home with them and it's not work on campus or in the clinic.

I was not counting (most) work at home. If you choose to count this stuff, then you can certainly get a higher number of hours. There are many reasons I have for not counting this stuff, but detailing them would require a longer post than I'm inclined to make right now. Maybe later.

However, I hope that we can all agree that an academic dermatologist that works > 60 hours per week (at the office) is rare. I was in academia myself for some time, and when I think of all of the academic dermatologists that I have known well from med school onwards, I cannot think of a single one that works >60 hours a week on average (though several complained about their workloads as if they did).

 

[dermathalon]

Can't disagree with you that most academic derms don't work more than 60 hours at the workplace. I do know a few that put in that sort of time when you include labwork but they are on the path to tenure and not there yet...it's tough work. But, for sure, the majority are not working those hours. For that matter, I think you could make that statement in general for derm. Suffice it to say that the "rough hours" are for those who choose it and no one is forced into frequent overnight call and emergency situations/surgeries.

I think it's a beautiful thing when you work because you want to instead of because you have to...we're all pretty lucky in derm.

 

[Anita Shirley]

Wow, thanks for all the helpful input guys!

Some follow up questions:

1. It seems that schedules are pretty flexible once you're working, and you can pretty much work as little or as much as you want. This seems to suggest that most dermatologists work as private practioners. Would this be an accurate statement? And if so, are they normally working in small group practices, solo? I'm sure it varies considerably, but can any sort of generalizations be made, esp for large cities?

2. Although it seems that lifestyle is very flexible once you're actually working, what is residency like? What kind of hours do you work and does it improve as you get to years 3/4? Is it possible/common to start a family, for example, during that time?

3. Fellowships--for people who choose to do them, what are the most common ones in, and how long to they typically last (1 year? 2 years?)

Sorry for all the questions, but I really appreciate the help!