Ask a Derm Resident Anything...

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Skinceutical

Skinceutical

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In the spirit of the existing EM and general surgery threads, I figured it would be nice to start one up for dermatology as well.

I know this field isn't quite as popular among the pre-med set, but if any of you guys have questions, ask away...
 
I lol'd at it not being popular...
What was your step score and what do you think made you a good candidate for your program.
 
What motivated your decision to go into dermatology? Although it's not a very popular choice with the premed crowd, it's a very competitive speciality, correct?
 
Thanks for starting this thread....

I'm curious, where is the line in derm between the conditions family practitioners can effectively treat, and those that need to be handled by a derm attending?

Also, are you aiming for the cosmetic side or the medical side of derm?

Lastly, how do you see the field evolving over the next ten years.

Thanks again!
 
serenade said:
What was your step score and what do you think made you a good candidate for your program.
Click to expand...
My step I score was in the 250's.

Dermatology is a relatively small field, and is almost exclusively clinic based, so as residents we end up working very closely with everyone in the department. Derm applicants are fairly self-selecting...almost all of them are highly qualified and would be a "good candidate" for any program. Honestly, I think at the end of the day, programs are looking for applicants whose personalities just mesh well with everyone else in the department (assuming everything else in the application is in order).

CDAstudent said:
What motivated your decision to go into dermatology? Although it's not a very popular choice with the premed crowd, it's a very competitive speciality, correct?
Click to expand...
You're correct, derm is one of the more competitive specialties.

I really enjoyed the fact that dermatologic treatments generally provide very visible and tangible results. When I excise a skin cancer, I can see the results of my work immediately. Even if the results aren't immediate, like when we're treating alopecia or psoriasis, our patients can see themselves improving when they look in the mirror. Very rarely do we find ourselves titrating medications just to treat a lab value.

I also really enjoy being able to do small procedures (skin surgeries, laser treatments, etc), and the fact that this is an almost exclusively outpatient clinic based field.
 
I really don't know that much about derm in general can't really imagine either.

When did you decide derm was for you, or start looking into it?

What other areas were you looking at beside derm?

Do you think you'll specialize? (What kind of specialties are there?)

Is there a personality arch-type to derm ya think? you said it was pretty self-selecting, what type of person do you find goes into derm?

Whats an average day look like?

Thank you for your time 🙂
 
Skinceutical said:
In the spirit of the existing EM and general surgery threads, I figured it would be nice to start one up for dermatology as well.

I know this field isn't quite as popular among the pre-med set, but if any of you guys have questions, ask away...
Click to expand...

How much $ are you making?

How much are you expecting for starting salary after residency?

Why are their more women in dermatology?

People say looks is important to get into derm (in addition to good app of course), how true is this?
 
anbuitachi said:
How much $ are you making?

How much are you expecting for starting salary after residency?

Why are their more women in dermatology?

People say looks is important to get into derm (in addition to good app of course), how true is this?
Click to expand...
what I really wanted to ask lol
 
JESSFALLING said:
I'm curious, where is the line in derm between the conditions family practitioners can effectively treat, and those that need to be handled by a derm attending?

Also, are you aiming for the cosmetic side or the medical side of derm?

Lastly, how do you see the field evolving over the next ten years.
Click to expand...
I think the line between what a FP treats what he/she refers to a specialist (in any field, not just derm) largely depends on the comfort level of that individual FP. I think most FPs are comfortable managing basic dermatologic issues - mild eczema/acne, common skin infections, warts...and these issues rarely require a referral to a dermatologist unless the FP's initial treatments fail. I've seen a small handful of FPs in the community who will biopsy lesions that they think are concerning for skin cancer, and only refer to derm if the biopsy is positive. Generally anything more complex than that will result in a referral to a dermatologist.

In practice, most dermatologists see both medical and cosmetic patients...I've read that the average dermatologist spends about 10% of his/her clinical time on cosmetic procedures. Ultimately I'd like my practice to be a combination of both.

To answer your last question, I think the field is moving towards embracing more non-invasive diagnostic and therapeutic interventions. Just within the past month, the FDA approved a new device that's capable of analyzing suspicious moles to screen for melanoma skin cancers. I think we're going to start incorporating similar technology into our practices over the next decade.
 
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Mooglies said:
When did you decide derm was for you, or start looking into it?

What other areas were you looking at beside derm?

Do you think you'll specialize? (What kind of specialties are there?)
Click to expand...
I came into medical school thinking that I wanted to go into a procedural or surgical field. I was initially thinking about ENT or plastics, but after shadowing as an MS1, I realized that I hated being in the OR. I spent some time in the derm clinic later on that year, pretty much decided it was what I wanted to do.

There are a few specialties out there - pediatric dermatology, dermatopathology, and procedural derm. Peds and dermpath are pretty self explanatory; procedural derm focuses on certain types of specialized dermatologic surgeries and some complex repairs. At this point, I don't think I'm going to subspecialize.

Mooglies said:
Is there a personality arch-type to derm ya think? you said it was pretty self-selecting, what type of person do you find goes into derm?

Whats an average day look like?
Click to expand...
I think the stereotypical derm archetype is someone who is fairly fastidious and detail oriented in their work, but is also social and values the prospect of having a life outside the hospital.

I usually get to work at 8AM and have clinic until 5PM. Our clinic tends to be relatively fast paced, so our attendings will usually have around 30 patients scheduled for the day. After clinic, I'll spend another hour or so finishing up notes and paperwork for the day. If I'm the resident seeing inpatient consults that month, I'll have a lighter clinic load during the day so I can leave and see consults, and will typically round with an attending on our inpatients in the early evening after clinic.

anbuitachi said:
How much $ are you making?

How much are you expecting for starting salary after residency?

Why are their more women in dermatology?

People say looks is important to get into derm (in addition to good app of course), how true is this?
Click to expand...
Residents in all specialties make about $50,000 per year; some hospitals in cities with high cost of living (NYC, SF, etc) pay slightly more.

You can look-up average physician compensation in a variety of specialties here:
http://forums.studentdoctor.net/showthread.php?t=817247

At the risk of sounding slightly sexist, I think a lot of women chose dermatology because it's fairly conducive to striking a balance between work and raising a family...more so than many other fields in medicine.

No unattractive person has ever matched in derm. Ever. All of us moonlight as models. 🙄
 
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1. What did you hate about the OR?

2. Whenever I visit my dermatologist, I get the sense that he's always in a hurry to get to the next patient. Do you ever get tired from the pace of things? I would think that rushing from room to room all day would become a bit tedious after awhile.

3. What are the most common conditions?

4. Do you think that derm could be, somewhat, recession proof? 😳

Thanks in advance! 😀
 
Did you consider any other specialty before Dermatology? Or where you set in going into the field from the start?
 
Skinceutical said:
No unattractive person has ever matched in derm. Ever. All of us moonlight as models. 🙄
Click to expand...

🤣

Would it be beneficial at all to a derm app if a nontrad med student had five or so years as a corporate trainer/ makeup artist for a big name cosmetic company or is it kind of fluffy to mention? The principles between what I did and derm have a lot of parallels

Is it strange the two fields I love are emergency medicine and derm?

Thanks for starting this 🙂
 
American Shero said:
1. What did you hate about the OR?

2. Whenever I visit my dermatologist, I get the sense that he's always in a hurry to get to the next patient. Do you ever get tired from the pace of things? I would think that rushing from room to room all day would become a bit tedious after awhile.

3. What are the most common conditions?

4. Do you think that derm could be, somewhat, recession proof? 😳

Thanks in advance! 😀
Click to expand...
1. As interesting as some of the surgeries were, I simply didn't enjoy standing there for hours on end, swathed from head to toe in a stuffy sterile gown, while living in perpetual fear of moving incorrectly and contaminating myself or the field. I also didn't really enjoy working with the personalities that the OR typically attracts.

2. I think it's a matter of personal preference. I'd rather be running from room to room with quick, problem-focused visits, than sitting with one patient for 45 minutes and trying to figure out why they aren't taking their BP meds, why they need Vicodin for their back pain, and why their big toe hurts every time they sneeze.

3. Our program is affiliated with a major oncology referral center, so a lot of our patient visits focus on screening for, diagnosing, and treating skin cancers and pre-cancerous growths. Other very common conditions include psoriasis, connective tissue disorders and other auto-immune conditions, fungal infections of hair/skin/nails, bad cases of eczema and acne, various forms of alopecia, etc.

4. To a certain extent, yes. This is a fairly small field, so there's always pretty significant demand for our services (especially with an aging population).

BurntFlower said:
Did you consider any other specialty before Dermatology? Or where you set in going into the field from the start?
Click to expand...
I thought about ENT and plastics early on in med school, but I saw the light before the end of my 1st year.
 
FoxyMD30 said:
🤣

Would it be beneficial at all to a derm app if a nontrad med student had five or so years as a corporate trainer/ makeup artist for a big name cosmetic company or is it kind of fluffy to mention? The principles between what I did and derm have a lot of parallels

Is it strange the two fields I love are emergency medicine and derm?

Thanks for starting this 🙂
Click to expand...
Drawing parallels between working as a makeup artist and clinical dermatology on your application or in an interview (for residency, or for med school for that matter) is an excellent way to ensure that your application ends up in the recycling bin.
 
Is this the real life?

Is this just fantasy?

2vA1a.png
 
Skinceutical said:
No unattractive person has ever matched in derm. Ever. All of us moonlight as models. 🙄
Click to expand...

pics or you didn't happen.
stethoscope on head and sign that says hi sdn with the date.

in any case, your signing up for sdn less than a week ago makes me somewhat suspicious of your claim to be a derm resident.
 
As a resident, are you ever grossed out by some skin conditions?

In terms of cosmetics, how do you view what you do? As boosting people's self-esteem or something along those lines? How do you see the field evolving in this area? Do you think there will be truly effective treatments for common cosmetic problems, such as acne and baldness? How attractive do you have to be to go into derm (only semi-joking)?
 
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MS1 here. Is AOA a requirement for even being offered a residency interview? I've heard things ranging from "all you have to do is pass preclinicals then rock Step 1 and the clerkships" to "everything matters". Don't get me wrong. I enjoy doing well in the basic science courses, but I'd like to know if I need to consistently score in the 90s on exams.
 
1) What specialty would you have gone into if you hadn't scored as well on Step 1?

2) Are you planning on specializing in dermpath, pediatric derm, etc? Do many derm residents specialize?

3) Do you know if you want to do private practice or academic medicine? How much of a paycut do academic dermatologists suffer compared to private practice?

4) Roughly what % of derm residents truly have a passion for the field? (that is to say, how many of them would still do it if it had the hours and salary of primary care?)

Thanks!
 
tiedyeddog said:
If skin is dry, do you think it's a good idea to recommend wetting it?

What do you do if it's too wet? 😱
Click to expand...

Mean and uncalled for. A little funny though.
 
tiedyeddog said:
I'm just kidding. We all know if it's too wet you dry it. 😎
Click to expand...

Somebody is taking time from their day that is undoubtedly more busy then both of ours, just to help us out, be appreciative.
 
.
 
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This is one of the most useful threads I have read in a long time. Thank you!
 
tap5103 said:
Somebody is taking time from their day that is undoubtedly more busy then both of ours, just to help us out, be appreciative.
Click to expand...
Ok, I am really just kidding this time. I thought people would get more of a laugh out of it. I guess not.
 
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Skinceutical said:
I think the line between what a FP treats what he/she refers to a specialist (in any field, not just derm) largely depends on the comfort level of that individual FP. I think most FPs are comfortable managing basic dermatologic issues - mild eczema/acne, common skin infections, warts...and these issues rarely require a referral to a dermatologist unless the FP's initial treatments fail. I've seen a small handful of FPs in the community who will biopsy lesions that they think are concerning for skin cancer, and only refer to derm if the biopsy is positive. Generally anything more complex than that will result in a referral to a dermatologist.

In practice, most dermatologists see both medical and cosmetic patients...I've read that the average dermatologist spends about 10% of his/her clinical time on cosmetic procedures. Ultimately I'd like my practice to be a combination of both.

To answer your last question, I think the field is moving towards embracing more non-invasive diagnostic and therapeutic interventions. Just within the past month, the FDA approved a new device that's capable of analyzing suspicious moles to screen for melanoma skin cancers. I think we're going to start incorporating similar technology into our practices over the next decade.
Click to expand...

Thanks! 🙂
 
nygiants fan said:
MS1 here. Is AOA a requirement for even being offered a residency interview? I've heard things ranging from "all you have to do is pass preclinicals then rock Step 1 and the clerkships" to "everything matters". Don't get me wrong. I enjoy doing well in the basic science courses, but I'd like to know if I need to consistently score in the 90s on exams.
Click to expand...
Impressive, man! nygiants fan, you sound like a very studious and sharp-witted guy.
 
flatearth22 said:
1) What specialty would you have gone into if you hadn't scored as well on Step 1?

2) Are you planning on specializing in dermpath, pediatric derm, etc? Do many derm residents specialize?

3) Do you know if you want to do private practice or academic medicine? How much of a paycut do academic dermatologists suffer compared to private practice?

4) Roughly what % of derm residents truly have a passion for the field? (that is to say, how many of them would still do it if it had the hours and salary of primary care?)
Click to expand...
1. I didn't really have a contingency plan at the time. In retrospect, I might have done anesthesia (also procedural, tend to be the most pleasant people in the OR).

2. I'm not planning on subspecializing. Most derm residents don't do a fellowship. We receive training in peds, surgery, and dermpath during residency, so most residents leave training feeling comfortable seeing pediatric patients, doing basic excisions, and interpreting at least basic dermpath. The people who subspecialize plan on making those fields the exclusive focus of their practice.

3. Ideally private practice with some sort of an academic affiliation. I'd like to be involved with teaching students & residents, but don't particularly care for research. I haven't started looking for jobs at this point so I can't really comment on salary differences. I've heard (and could very well be wrong) that in general, going into academics entails a 20-25% pay cut.

4. I can't speak for the entire field, but I know that most of the people I know went into derm because they genuinely enjoy the field...the lifestyle certainly is a perk, but isn't our only consideration. I will also point out that if your only consideration is a nice lifestyle, then you're going into the wrong specialty. Radiation oncology is slightly easier to match into, has similar hours, and significantly out-earns dermatology.

Also, that last question is about as ridiculous as asking someone in IM/FP/peds what percentage of their colleagues "were truly passionate" about primary care and didn't just do it because they couldn't match into anything more competitive.
 
sibitrum said:
As a resident, are you ever grossed out by some skin conditions?

In terms of cosmetics, how do you view what you do? As boosting people's self-esteem or something along those lines? How do you see the field evolving in this area? Do you think there will be truly effective treatments for common cosmetic problems, such as acne and baldness? How attractive do you have to be to go into derm (only semi-joking)?
Click to expand...
I think necrotic, infected foot and leg ulcers are pretty disgusting, but we don't deal with them very often.

First of all, I think the role played by cosmetics in the overall practice of dermatology is over-hyped by people outside of the field. However, if a patient is distressed by some aspect of their appearance, and a small cosmetic procedure could take care of that issue, then I'm happy to help. That said, I've also spent a lot of time with patients trying to convince them that not every one of their moles is a blemish that needs to be excised.

We already have very effective treatments for acne (I take it you've never needed Accutane). Obviously, I think the field will continue to evolve, just like the rest of medicine.

Being attractive is not a requirement for matching in derm.

nygiants fan said:
MS1 here. Is AOA a requirement for even being offered a residency interview? I've heard things ranging from "all you have to do is pass preclinicals then rock Step 1 and the clerkships" to "everything matters". Don't get me wrong. I enjoy doing well in the basic science courses, but I'd like to know if I need to consistently score in the 90s on exams.
Click to expand...
If you look at the statistics, only about 50% of successful applicants are AOA - that's a higher percentage than in just about any other specialty, but still not a majority. Some programs do use AOA status as a screening criterion for interviews, but I think they're in the minority. I have a couple of friends who successfully matched on their first try without being AOA - but they all still had excellent grades and board scores. That said, if you're serious about going into dermatology, I'd still do my best to get in.
 
tiedyeddog said:
Ok, I am really just kidding this time. I thought people would get more of a laugh out of it. I guess not.
Click to expand...


I don't think the pre-meds are aware of the general ribbing that goes on between medical specialties.

For those who thought tiedyeddog was just being a jackass, there's an old adage about derm:

If it's wet, make it dry. If it's dry, make it wet. For all else, topical steroids.
 
1) What was your MCAT?

2) How did you prep for such an amazing step score?
 
Bl4ckout said:
1) What was your MCAT?

2) How did you prep for such an amazing step score?
Click to expand...
1. I scored a 36 on the MCAT.

2. I've never taken a prep course for any standardized test. I spent about 6 weeks preparing. I purchased a set of Kaplan review books from a friend and read through them, cover to cover, during the first 4 weeks. I spent the last 2 doing review questions online from the Kaplan Q-Bank, as well as NBME practice tests.

sibitrum said:
Have you ever seen a vaccinia infection?
Click to expand...
No. Vaccinia infections are exceptionally rare, reportable occurrences.
 
What school did you go for undergrad/medical school?

Do you think they made a difference in your residency matching, considering dermatology is a notoriously competitive specialty?
 
sparklingwater said:
What school did you go for undergrad/medical school?

Do you think they made a difference in your residency matching, considering dermatology is a notoriously competitive specialty?
Click to expand...
I attended an Ivy League college, and went to med school at a well regarded (but certainly not Harvard/Hopkins/WashU caliber) school.

Although I value my college experience immensely, I don't think my undergraduate institution played a role in matching. I think my medical school, on the other hand, might have played a small role - if you look at data from the match, roughly 45% of successful derm applicants come from NIH top 40 med schools. Conversely, only 25% of unsuccessful applicants come from those schools.
 
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Do you have a family?

If so, when did you decide to have kids? What were some things that helped you and your significant other pull through the demanding moments.

If you don't have kids, when do you think is the most feasible time to start that chapter of your life as a physician? (So that one may maximaze the time spent with family.)
 
Does rad-onc really earn more than derm?
 
Slowpoke said:
Do you have a family?

If so, when did you decide to have kids? What were some things that helped you and your significant other pull through the demanding moments.

If you don't have kids, when do you think is the most feasible time to start that chapter of your life as a physician? (So that one may maximaze the time spent with family.)
Click to expand...
I'm single.

Taking all factors into consideration, personally I think the best time to have your first kid would be during your first year or two out of residency. You'll have more free time and far more disposable income than at any time during residency. My sister (who is an attending in a different specialty), did something similar - she got married shortly after finishing her intern year, but waited till the year after she finished residency to start a family.

ReptarBar said:
Does rad-onc really earn more than derm?
Click to expand...
Yes. If you look at AMGA data, radiation oncologists earn about $75,000 more, on average, than dermatologists. They also work very similar hours.

http://www.cejkasearch.com/view-compensation-data/physician-compensation-data/#
TheProwler said:
Do you moonlight? how well does that pay?
Click to expand...
I don't, and I actually don't think any of my co-resident do either (at least that I know of).
 
Do you need to have like perfect skin to get the residency spot? If not does having perfect skin increase your chances?
 
Do you think the literature really supports the idea that we should wear sunscreen whenever we are exposed to the sun, 365 days a year?

And do you wear sunscreen every day? Do you prefer organic or mineral blocks?
 
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ZsaZsaM said:
Do you think the literature really supports the idea that we should wear sunscreen whenever we are exposed to the sun, 365 days a year?

And do you wear sunscreen every day? Do you prefer organic or mineral blocks?
Click to expand...
There is ample evidence in the literature to show that nonmelanoma skin cancers and their precursor lesions are directly linked to UV-exposure, and that regular sunscreen use significantly decreases their incidence. The evidence isn't as strong for melanoma skin cancers (which, with a few exceptions, aren't as closely lined with UV-exposure). Overall, we generally do recommend daily sunscreen use for all of our patients.

I have seen some people raise concerns about hypovitaminosis D (because sunscreen theoretically interferes with the production of vitamin D3 in the body), but I personally haven't seen anything in the literature demonstrating higher incidence of vitamin D deficiencies in patients who use sunscreen regularly. That said, we do periodically check vitamin D levels in some of our patients who are fair skinned and use sunscreen religiously - most of them still have adequate vitamin D levels. That's not surprising, given the fact that only a few minutes of sun exposure each day is sufficient for adequate vitamin D production.

I use a chemical sunscreen daily. Personally, I'm not a fan of the mineral-based, physical sunscreens - they tend to leave a grey-white residue on the skin. I only recommend them to people with sensitive skin and patients who need the added protection of a physical barrier because they're exquisitely sensitive to light (patients with lupus, photodermatitis, etc).
 
Skinceutical said:
I'm single.

Taking all factors into consideration, personally I think the best time to have your first kid would be during your first year or two out of residency. You'll have more free time and far more disposable income than at any time during residency. My sister (who is an attending in a different specialty), did something similar - she got married shortly after finishing her intern year, but waited till the year after she finished residency to start a family.


Yes. If you look at AMGA data, radiation oncologists earn about $75,000 more, on average, than dermatologists. They also work very similar hours.

http://www.cejkasearch.com/view-compensation-data/physician-compensation-data/#

I don't, and I actually don't think any of my co-resident do either (at least that I know of).
Click to expand...

What about during med school?
 
Skinceutical said:
1. As interesting as some of the surgeries were, I simply didn't enjoy standing there for hours on end, swathed from head to toe in a stuffy sterile gown, while living in perpetual fear of moving incorrectly and contaminating myself or the field. I also didn't really enjoy working with the personalities that the OR typically attracts.
Click to expand...

Amen
 
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