Why do derm? Lifestyle/$ issues

sdnetrocks · Jun 12, 2006

10 chars....

cdql · Jun 13, 2006

1) The salary varies. Obviously if you only work 40 hrs a week for someone, the pay will be greater than average but not great. If you were to work 60 hrs a week and you owned your own practice, I would guess you'd be making a lot more.

2) I'm not sure if you need to be "good"/talented. But to improve, I'm sure you'll need to work hard which means you have to have an interest in derm itself (and not just the lifestyle). It's difficult to drag yourself to work and do well if you hate it!

3) Hmm...I guess this is kind of true. (just an opinion...no flames!) But you can always flash your Rolex at those people which indicates two things. 1) You work from 9-5 and 2) you're very well compensated for your time

4) Another tricky one! You can always wear your sthethoscope around your neck like that doc in Dr. 90210! You'll look both stupid and professional at the same time!

Koil Gugliemi · Jun 13, 2006

sdnetrocks said:
- I really like using a stethoscope...

If this is a deal-breaker for you, you can either give up lifestyle or money. (cards or laid back PCP).

sdnetrocks · Jun 16, 2006

Why did the rest of you go into dermatology?

- Are you really fascinated with diseases of the skin, and would have picked the field anyway regardless of the lifestyle/income?

- Did you select dermatology as your favorite specialty out of the limited selection of radiology, ophthalmology, anesthesiology, dermatology, radiation oncology, and maybe ENT - fields that all come with great lifestyles/incomes?

- Something in between? Or perhaps even further out on the spectrum?

I dunno, maybe this is a sign that this field is not for me, but I just cannot imagine a lot of people picking it if it had the hours and pay of general internal medicine...

P.S. What if I apply to dermatology and an internal medicine internship, and then decide during the internship that I actually want to do internal medicine. Would it be feasible to switch residencies mid-stream (+/- at the same institution) and finish internal medicine in the regular 3 total years?

deleted87716 · Jun 16, 2006

sdnetrocks said:
What if I apply to dermatology and an internal medicine internship, and then decide during the internship that I actually want to do internal medicine. Would it be feasible to switch residencies mid-stream (+/- at the same institution) and finish internal medicine in the regular 3 total years?

You should be able to stay in IM, but whether or not you could stay at the same institution would depend on the availability of a PGY-2 spot. Derm programs usually require either a transitional year or a prelim medicine year. If you're not sure about going into derm, you may want to avoid the transitional year and go for a prelim medicine spot. You'll keep your options open that way.

RaaMD · Jun 16, 2006

lifestyle and money seem meaningless with out some type of passion for dermatology

p53 · Jun 17, 2006

RaaMD said:
lifestyle and money seem meaningless with out some type of passion for dermatology

Spoken just like some idealistic attending with no clue on today's competitive environment.

It is doubtful someone has a "passion" for dermatology as a 3rd year or even as a 4th year student.

cdql · Jun 17, 2006

OK...maybe passion is too strong a word

Let's go with interest. One should at least have some interest in the field of dermatology when applying for such a residency. Lifestyle and salary are great but you can get lifestyle and salary in more fields than just derm. A lil bit of interest in the field will go a long way in making someone happy down the road.

neutropenic · Jun 17, 2006

cdql said:
OK...maybe passion is too strong a word

Let's go with interest. One should at least have some interest in the field of dermatology when applying for such a residency. Lifestyle and salary are great but you can get lifestyle and salary in more fields than just derm. A lil bit of interest in the field will go a long way in making someone happy down the road.

Must like acne and warts.
Should be fascinated with Stevens Johnson, Erythema Multiforme, and TEN.
If male may possibly pop woody with mention of Nikolsky's sign.

sdnetrocks · Jun 17, 2006

I'll be honest - I don't know much about SJ, EM, TEN, etc., though I have picked up that derms use abbreviations (especially 2-letter abreviations) even more than ob/gyns.

But I do like acne, and it seems like freezing off skin lesions (especially with the liquid N2 squirt guns that derms have) is pretty satisfying. I'm pretty ambivalent about shave biopsies, but getting hemostasis with the aluminum chloride, or even the pseudo-bovie, seems satisfying as well. Now excisional biopsies and cutting out various goombas (i.e. cysts) seems like a lot of fun, even though I totally despised general surgery.

As far as more hardcore things, Mohs seems cool, but the whole tissue flap thing that derms do for facial lesions seems beyond my scope of interest.

As far as skin diseases in general, it's really hard to generalize because, as students, we learn so little about them. Learning a brand new field of medicine that I know pretty much nothing about is a bit scary, but also challenging, and when I'll be done, I'll possess a knowledge-base that 99% of other doctors do not. Meanwhile, thanks to internship and Step 3, I'll still be moderately proficient in primary care stuff...

I think I've cooled off a little bit about the whole stethoscope issue - plus, I will have the year of internship to get that, as well as 80-hour weeks / call / float / etc. out of my system.

But my most recent question still stands: if I decide during the prelim medicine year that cards is really where my heart is at (no pun intended), what are my chances of finding a good-enough medicine PGY-2 spot to make for a reasonable cards fellowship application? Do programs reserve extra spots for this kind of thing, or would I basically need a categorical medicine person to quit the program?

RaaMD · Jun 17, 2006

p53 said:
Spoken just like some idealistic attending with no clue on today's competitive environment.

It is doubtful someone has a "passion" for dermatology as a 3rd year or even as a 4th year student.

Believe me p53, i have have no doubt that there are medical students with a "passion" for dermatology. i know several actually. Whether they actually make it there is one thing, but the strong interest is certainly not questionable. These students were once eczema or psoriasis patients and one had a brother with ichthyosis and so they know what it is like to suffer with a skin disease.

daphilster78 · Jun 18, 2006

sdnetrocks said:
I honestly cannot imagine a better lifestyle in medicine... And it does involve direct patient care (vs. rads/path/?gas?). And there's an opportunity to do procedures, which are simple enough IMHO that even I could be trained to do them, yet seemingly satisfying. So those are all good things.

Derm is probably on average one of the best lifestyles. Here are some other suggestions though that involve DIRECT patient care:

gas, pm&r --> pain management fellowship
interventional radiology
outpatient PM&R (usu 9-5pm clinics)
neurology --> sleep studies, EMGs only
IM --> rheumatology clinics, GI clinics only, allergy outpatient
Urology, ENT, Plastics, Ophtho (shorter cases like Lasiks, breast implants)

so you actually have lots of options. it still thinks its best to be at least moderately to highly interested in your field of study. You'll be happier. Don't be one of those obsessed about $$/work ratios or anything.

cdql · Jun 18, 2006

RaaMD said:
Believe me p53, i have have no doubt that there are medical students with a "passion" for dermatology. i know several actually. Whether they actually make it there is one thing, but the strong interest is certainly not questionable. These students were once eczema or psoriasis patients and one had a brother with ichthyosis and so they know what it is like to suffer with a skin disease.

Good point.

I should warn you though: program directors HATE it when you cite that as a reason for liking derm. "My uncle had psoriasis blah blah blah and now I love derm!"

It's certainly a valid reason but there should be some more concrete evidence to show your commitment to derm.

porokeratosis · Jun 18, 2006

cdql said:
Good point.

I should warn you though: program directors HATE it when you cite that as a reason for liking derm. "My uncle had psoriasis blah blah blah and now I love derm!"

It's certainly a valid reason but there should be some more concrete evidence to show your commitment to derm.

Agreed. If you personally have a skin disease or have a relative with a skin disease and this motivated you to pursue Derm, then you should have evidence of your strong interest and commitment. Evidence of this includes Derm research, publications, Derm electives, and excellent letters of recommendations from Derm attendings. You don't necessarily need all of these factors. But the more "feathers" you have, the stronger your Derm application becomes.

Please remember, the competition in Derm is fierce. If you have mediocre or poor grades and USMLE scores, your chances of matching into Derm will be low. You will still need great grades (Top 15-20% of your class or better) and great USMLE scores (> 230-240) to stand a decent chance.

RaaMD · Jun 18, 2006

porokeratosis said:
Agreed. If you personally have a skin disease or have a relative with a skin disease and this motivated you to pursue Derm, then you should have evidence of your strong interest and commitment. Evidence of this includes Derm research, publications, Derm electives, and excellent letters of recommendations from Derm attendings. You don't necessarily need all of these factors. But the more "feathers" you have, the stronger your Derm application becomes.

Please remember, the competition in Derm is fierce. If you have mediocre or poor grades and USMLE scores, your chances of matching into Derm will be low. You will still need great grades (Top 15-20% of your class or better) and great USMLE scores (> 230-240) to stand a decent chance.

You and cdql raise good points.

bigfrank · Jun 21, 2006

p53 said:
Spoken just like some idealistic attending with no clue on today's competitive environment.

It is doubtful someone has a "passion" for dermatology as a 3rd year or even as a 4th year student.

doclobster · Jun 21, 2006

porokeratosis said:
Agreed. If you personally have a skin disease or have a relative with a skin disease and this motivated you to pursue Derm, then you should have evidence of your strong interest and commitment. Evidence of this includes Derm research, publications, Derm electives, and excellent letters of recommendations from Derm attendings. You don't necessarily need all of these factors. But the more "feathers" you have, the stronger your Derm application becomes.

Please remember, the competition in Derm is fierce. If you have mediocre or poor grades and USMLE scores, your chances of matching into Derm will be low. You will still need great grades (Top 15-20% of your class or better) and great USMLE scores (> 230-240) to stand a decent chance.

i'm a current med student with a strong interest in dermatology. the catch: i go to an unranked, no-name, low-tier school. my school's previous matchlists show 0-2 people matching into derm, usually just 1 or none. this could equivalently refelect a low number of people from my school applying for derm, but that is not clear.

the bottom line: assuming i do well on step 1, get good grades and recs, and take up derm electives, will i match or will my school hold me back? i just can't imagine being that 1 person from my class who matches into derm...it just seems so unlikely. (also, my school does not have a great derm program, so i'd prefer to match to another institution, possibly out-of-state)

thanks for any input, it really means a lot.

RaaMD · Jun 21, 2006

bigfrank said:

once again, i disagree.

IzzyMD09 · Jun 21, 2006

neutropenic said:
Must like acne and warts.
Should be fascinated with Stevens Johnson, Erythema Multiforme, and TEN.
If male may possibly pop woody with mention of Nikolsky's sign.

THATS SO CRASY YOU MENTIONED SJS!!!! I started going on rounds in our hospital (just a first year here) and we had a patient present with SJS to such an advanced degree (TEN) that I was just blown away. I mean this lady was just completely burned from the inside out and she had no idea why, none of the drugs she was taking were contraindicated or anything...god imagine what it would be like if you took a tylenol and then woke up the next day with blisters and burns all over your body....SJS is fricken crazy

porokeratosis · Jun 30, 2006

Derm is the best specialty for me because skin disease affects me...doctor heal thyself!

Everyone has their own reasons for entering a specialty. You must explore each specialty on your own, work in the clinic or surgical suite, and talk to people in the field. After comparing each field you experienced, then you will find the specialty for you. Choosing your specialty is a personal decision you must make on your own.

Good luck :luck:

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