Answer: Yes. In fact, it would be more competitive.
Explanation: You ask a stupid question, you get a stupid answer. Would any job maintain its allure if it paid less, required more work, and required a tougher path to attain the position?
I understand (and expected) but disagree with your response. Since the vast majority of people who go to medical school DO work long residency hours, have lots of call, and work more hours when practicing as physicians, clearly adjusting these variables alone does not make something not competitive. And since a very large number of medical students still go into family practice and general internist jobs, the average physician salary is not tremendously higher than what I stated--though it of course would be with most specialization.
Another case in point....consider orthopaedic versus thoracic surgery. Both are among the highest paid specialties, both require very long residencies (especially if one subspecializes in ortho, where some of the biggest money is earned), and neither are exactly "cush" jobs when it comes to working hours (i.e. both have call, have avg hours worked exceeding 50 hrs/week, etc.). Yet it is nowhere near as competitive today to do general surgery followed by a thoracic fellowship as it is to get into spine ortho surgery, for instance. And thoracic back in the 70s was one of the most competitive subspecialties, so I've been told.
So what I'm asking kind of boils down to....the "lifestyle" aspects aside....do such a large number (compared to spots available) of medical students really develop a passion for "the skin" and all its maladies? Or do you think there are a good number of students who are mostly attracted to the lifestyle, the competitiveness of the field, etc.--in the same way many argue that many students go into medicine itself MORE for the money, prestige of "getting that spot" in med school (akin to getting derm) versus the true nature of the job.
Again, I mean no offense. I've just thought it's an interesting situation with dermatology. And I always feel a little bad for those "average" med students that go into medical school with a real passion for derm (maybe due to diseases they experienced as a kid, burns, etc.) only to find out that you have to be uber-competitive to even think of the specialty--most likely (in my opinion) due to too few residency spots given the demand (most cities have very long waits to see derms, it seems) and (most importantly) the fact that many students become attracted to derm AFTER entering med school and realizing maybe they don't really want to be on call all the time and work 55+ hrs/wk after all.
Continuing the "no offense" warning...as a naive first-year, there just doesn't seem to be anything innate about the field of derm beyond supply and demand (which is not to be discounted, of course) that would necessitate having 245+ Step 1, AOA, etc. anymore than OBGYN, oncology, anesthesiology, or any other less competitive specialty. So it is likely quite a shock to the student who assumes derm will be of standard competitiveness given the nature of the field once they get out and realize it requires one to be among the "best and the brightest" typically!
Another way of asking this that's less hypothetical....Do you find once out in the residency and practicing that there are many derms out there who don't truly have a passion for "the skin" and begin to second guess their decision once they get used to the fact that they're working 8-5 and/or are no longer reminded of how coveted derm spots are among students?
And finally...note that I said "at all competitive" and NOT "as competitive." Of course I would imagine if you changed the variables discussed above, derm wouldn't be one of THE most competitive spots for residency as it currently is. But how much appeal would it have if those variables WERE changed a bit? The hours not quite so good, the pay a bit less. But everything else equal. Where would it fall in the grand scheme of things based on interest in treating skin disease and the nature of the work alone? Would it be like family practice, where essentially anyone can get into it? Or would it be more like EM or anesthesiology, for instance, where it might take a bit of work but is defintiely doable?
