Transition to Derm

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

dermwisher

Membership Revoked
Removed
7+ Year Member
Joined
Jun 2, 2015
Messages
6
Reaction score
0
Hey forum,

I am in a bit of a bind, so I hope you all can provide me with some good information. A little about me:

I am beginning my intern year at an internal med shop soon. I also matched in a strong ophthalmology program. Over the past couple of weeks, I have been diagnosed with an eye condition myself that may preclude me from being able to do ophthalmology. Therefore, I am coming to you all for advice for how to handle this situation.

I considered derm before deciding on ophtho, and I have always been interested in cancer (particularly procedural work with cancer), so derm is a great field for me IMO.

I am a relatively strong applicant. Good state school, 248 Step 1, 251 Step 2, HP in all but 3 rotations which were P (we have a hard grading scale), tons of research (mostly in ophtho), quite a bit of extracurriculars.

So- assuming that I need to drop ophtho and will try to do derm- what can I do to try to get a derm spot. And how hard will this road be?

Members don't see this ad.
 
You probably do not want to share specifics, but visual acuity is very important in Derm. If nothing else, one needs to be able to reliably diagnose things under the scope to get through residency.
 
I couldn't agree with Dral more so. If this is simply something associated with one eye then you can still swing monocular, like a pirate (but no MOHs for you, and a life of dermpath would probably drive you crazy). If it has absolutely nothing to do with acuity then you might be ok. Heck, old books had us learning Derm in BW, lol. To reiterate what Dral said, keep the specifics to yourself.

Otherwise, I'd steer clear of Derm, Radiology, Path, and procedural heavy fields in general...

You placed into Ophtho, you know the difficulty already.
 
Members don't see this ad :)
Thanks for the input guys. I guess I should have mentioned, that my vision problem is not with VA, it is not degenerative or anything. It is due to a lack of fine stereopsis which hinders my ability to do microscopic surgery without contrast cues (i.e. in a strict microscopic setting). I have fine binocular vision and do fine in gross and fine motor skills. So I don't think it would stop me from doing dermatology or any other field that doesn't require excellent microscopic stereovision. I may even be able to do ophthalmology, as I never had any issues with my vision beforehand (it was incidentally found on a recent eye exam)- but I am at the mercy of my PD on that front.

Assuming that I can do it visually (and I believe I can, with no problem), what are my options for maneuvering towards dermatology at this point?
 
Any thoughts, y'all? I just want to get a sense for what my path could look like, if I need to switch into derm
 
Any thoughts, y'all? I just want to get a sense for what my path could look like, if I need to switch into derm

Maybe I'm not totally understanding the extent of your vision problem as I don't know much about optho. Have you ever assisted with microscopic surgeries? Did you really have any issues? Are there optho's in practice who don't perform microscopic surgery? Would a deficiency in fine stereopsis bare you from board certification in optho?

It seems a little strange that you would abandon your chosen career in medicine and start looking into switching into dermatology because an eye exam revealed an incidental deficiency which had never impacted you before. I would try and talk to people in your field (someone who you trust to keep things confidential) to get a better sense of how this could impact your career before you start window shopping for paths into other specialties. Also, maybe just spend an afternoon under the microscope. I'm sure there are simulation trainings for these kinds of surgeries you could practice with and see if there's any major issues.
 
Good point. I am mostly hoping to formulate a contingency plan, if ophtho doesn't work.

I will certainly do my due diligence to see if I can still do ophtho, but I want to have a plan of action in case I can't. The scary thing is that we don't operate intraocularly until 3rd year, so I wouldn't have a good sense for whether I could do it until then. I could do non-microscopic surgery, including oculoplastics. But I'd rather not blind anyone on the way, so I'm checking my options.

Essentially (assuming I don't do ophtho), I am thinking that I could apply for a Pgy2 spot in dermatology this year with low chances of acceptance. Then I can apply for a research year with plans of doing that for a year, then reapplying (would I be applying for pgy2 spots or would I need to go through the regular match).

See, I just don't know how it would work...
 
Good point. I am mostly hoping to formulate a contingency plan, if ophtho doesn't work.

I will certainly do my due diligence to see if I can still do ophtho, but I want to have a plan of action in case I can't. The scary thing is that we don't operate intraocularly until 3rd year, so I wouldn't have a good sense for whether I could do it until then. I could do non-microscopic surgery, including oculoplastics. But I'd rather not blind anyone on the way, so I'm checking my options.

Essentially (assuming I don't do ophtho), I am thinking that I could apply for a Pgy2 spot in dermatology this year with low chances of acceptance. Then I can apply for a research year with plans of doing that for a year, then reapplying (would I be applying for pgy2 spots or would I need to go through the regular match).

See, I just don't know how it would work...

I would seriously talk to a optho attending that knows you well (maybe one of your letter writers) and explain the situation. If your home school has a residency program, I'm sure they have simulation-based training equipment that you could practice on with an attending and see if you have any trouble. They'll also have a better sense of whether this is a real (or just perceived) problem as an aspiring ophthalmologist.

If you're having second doubts about whether optho was the right career pick for you and just want to switch into dermatology that's another story. But, I'd definitely pursue Step A before even thinking about Steps C and D. You need to make the decision as to whether optho is a viable career option. Assuming you find it isn't... you'd also have to do a lot of logistical work to make this possible. Withdrawing from a matched PGY-2 spot in optho is possible but not simple. It means (1) deciding optho is not the career for you (2) formally letting the SF Match and your matched program know (3) having that program sign-off on your withdrawal from that program (you need permission to break a match agreement). You would be putting yourself in a lot of ethical trouble if you were to apply for a PGY-2 derm position in the NRMP match before doing this. So, this would have to be done NOW if you're thinking about applying to a PGY-2 derm spot in September.
 
I will definitely pursue my options with ophtho strongly.

If I am unable to continue with ophtho, then I will still go through with my intern year. Also, I would discuss all this with my matched ophtho program PD. I am not trying to pull a quick one...I just got stuck in a potentially awful position.

If I am not able to match this year- into a pgy2 spot, then what would be my options?
 
I will definitely pursue my options with ophtho strongly.

If I am unable to continue with ophtho, then I will still go through with my intern year. Also, I would discuss all this with my matched ophtho program PD. I am not trying to pull a quick one...I just got stuck in a potentially awful position.

If I am not able to match this year- into a pgy2 spot, then what would be my options?

There's a really nice stickied thread at the top of the forum about how to land and what to look for in a research fellowship program. There are also spots that open up outside the match, but since these are usually by word of mouth, it could be difficult for you to know about them unless you have an academic dermatologist who is trying to help you find something.
 
I will definitely pursue my options with ophtho strongly.

If I am unable to continue with ophtho, then I will still go through with my intern year. Also, I would discuss all this with my matched ophtho program PD. I am not trying to pull a quick one...I just got stuck in a potentially awful position.

If I am not able to match this year- into a pgy2 spot, then what would be my options?

I definitely think that your #1 priority should be figuring out your career in optho (not derm).

If you want to apply this upcoming cycle starting in September, you'll have to get permission for release of your commitment from your PGY-2 optho match, put together a set of strong recommendation letters that includes about 3 academic or clinical dermatologists, and write a strong personal statement that really justifies this specialty switch. ERAS open day is only 3 months away (that actually isn't very far away). If you don't have any prior derm research experience or mentorship relationships, it might be an uphill battle to do this in 3 months...especially in the midst of starting your intern year. Having gone through the match, a lot of dermatology is based on "connections" and "who you know". Furthermore, many of the immediate-start PGY-2 spots (of which there aren't too many) end up going to internal research fellows. Plus, you'll be competing against other candidates who've completed a PGY-1 year already and may have already taken a year to conduct derm research. You definitely want to go into the derm match with as strong of an application as you possible can.

Your alternative would to be to apply for both PGY-2 (immediate start) and advanced PGY-2 positions (i.e. July 2017 start) along with a research fellowship to do in between if you don't get an immediate start position. With this approach, you could technically do anything with that "free" gap year, but derm research might help your career in the long term.

Assuming you don't match into any position this upcoming cycle, you could do a derm research fellowship and re-apply to either (again) immediate start PGY-2 or traditional advanced PGY-2 spots (i.e. July 2018 start). The latter would require you to take a 2-year research fellowship (and/or do something else for that extra gap year).
 
very, very helpful dermie! I was thinking that the road would look something like that, but I wasn't entirely sure. Looonnnnggg road, if that is the case. I hope that ophtho works out (whether it does is likely up to the opinion of the PD), but it is nice to know the roadmap for another great speciality.
 
Top