Academic Orthopaedic surgery vs Academic dermatology

[eyepop]

MS3 here. So before you start judging why I am choosing between 2 of the highest paid/most competitive specialties (And I wonder about that myself all the time, too). Here is a little about me:

1) MD/PhD, PhD in bone metabolism. Would love to continue basic science research in some way in the future. But won't die if all I can do is clinical research.
2) Definitely will stay in academia. LOVE teaching, LOVE research, LOVE seeing the most complicated/referral cases. Also LOVE being in a big team.
3) Yes I do care about income. No I am not willing to get paid 80k as an pediatrics attending in NYC (true story heard form friend). And no if ortho pays 120k or something like that I probably won't consider going into it after all the hard work during residency. But both specialties I am interested in are pretty well paid now, even after the pay cut for being in academia. So money is not a factor between the 2 right now.
4) I like visual things, like specialties that treat healthier patients and have good outcomes in general. Like immediate gratification. Like fixable problems (no CHF, CKD, DM for me!!) Maybe this is why I am between derm and ortho
5) Female, definitely interested in MSK disease, but not a bro person, can't lift, and not interested in football at all T_T

About Ortho
Pros: 1) obviously having a PhD and publications in bone and having been to national bone/ortho conference helps with match
2) Dad is orthopod and loves his job, so I kinda have natural affinity for the specialty. Plus me and my dad have very similar personalities, except that I am more of a toned down, feminine, and politically correct version of him lol. (good sign I will be happy in ortho?)
3) surgery is pretty bad ass. Got to do a running sub-cuticular suture on abdomen the other day, and was already too excited to sit down for the next few hours! But I feel this excitement might get old once I do a ton of them during residency?

Cons: 1) lifestyle. Surprisingly I don't find our MS3 surgery Q3 call schedule hard at all, although i know residents work way harder than us. Also getting up early has not been a problem. However, it might be challenging if I have to do it for 5-6 years straight vs 2 months, especially, since I am pretty sure I will want kids before I get too old!
2) culture/personality: Again surprisingly I really loved the surgical personality, i.e. chill, fun, love what they do, no bull****. Heard ortho is even more chill than GS. But then I don't know what to do if my future co-residents start talking about football or strippers on and on and on, which I heard still happens in ortho. T_T

About Derm
Pros: 1) super interesting pathology, at least in the academic setting. Was very surprised at how much I loved it during my derm rotation. Also visually very gratifying specialty.
2) good amount of pathology training (I love looking at pathology slides), good amount of procedures.
3) perfect for research: lots of biopsies for research ^_^, so many diseases that we don't understand the pathophysiology. Chill lifestyle so I can totally image myself running a RO1 funded basic science lab, whereas in ortho running a lab is probably very hard. Also awesome 2+2 research track residencies. Finally my derm attendings are the only ones that cared about pathways, enzymes, genetic syndromes, which I found very impressive and attractive.
4) super chill lifestyle, probably great for family (but I am single right now so probably thinking too much....)

Cons: 1) might miss the OR the rest of my life
2) I have no derm research or publication. Step 1 is good enough for derm but definitely not going to make it to AOA or first quartile. Just overall not as strong of an applicant for derm. Might need a back up plan if I don't match.

Would appreciate any advice on how to approach this problem.

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[massmocha]

MS3 here. So before you start judging why I am choosing between 2 of the highest paid/most competitive specialties (And I wonder about that myself all the time, too). Here is a little about me:

1) MD/PhD, PhD in bone metabolism. Would love to continue basic science research in some way in the future. But won't die if all I can do is clinical research.
2) Definitely will stay in academia. LOVE teaching, LOVE research, LOVE seeing the most complicated/referral cases. Also LOVE being in a big team.
3) Yes I do care about income. No I am not willing to get paid 80k as an pediatrics attending in NYC (true story heard form friend). And no if ortho pays 120k or something like that I probably won't consider going into it after all the hard work during residency. But both specialties I am interested in are pretty well paid now, even after the pay cut for being in academia. So money is not a factor between the 2 right now.
4) I like visual things, like specialties that treat healthier patients and have good outcomes in general. Like immediate gratification. Like fixable problems (no CHF, CKD, DM for me!!) Maybe this is why I am between derm and ortho
5) Female, definitely interested in MSK disease, but not a bro person, can't lift, and not interested in football at all T_T

About Ortho
Pros: 1) obviously having a PhD and publications in bone and having been to national bone/ortho conference helps with match
2) Dad is orthopod and loves his job, so I kinda have natural affinity for the specialty. Plus me and my dad have very similar personalities, except that I am more of a toned down, feminine, and politically correct version of him lol. (good sign I will be happy in ortho?)
3) surgery is pretty bad ass. Got to do a running sub-cuticular suture on abdomen the other day, and was already too excited to sit down for the next few hours! But I feel this excitement might get old once I do a ton of them during residency?

Cons: 1) lifestyle. Surprisingly I don't find our MS3 surgery Q3 call schedule hard at all, although i know residents work way harder than us. Also getting up early has not been a problem. However, it might be challenging if I have to do it for 5-6 years straight vs 2 months, especially, since I am pretty sure I will want kids before I get too old!
2) culture/personality: Again surprisingly I really loved the surgical personality, i.e. chill, fun, love what they do, no bull****. Heard ortho is even more chill than GS. But then I don't know what to do if my future co-residents start talking about football or strippers on and on and on, which I heard still happens in ortho. T_T

About Derm
Pros: 1) super interesting pathology, at least in the academic setting. Was very surprised at how much I loved it during my derm rotation. Also visually very gratifying specialty.
2) good amount of pathology training (I love looking at pathology slides), good amount of procedures.
3) perfect for research: lots of biopsies for research ^_^, so many diseases that we don't understand the pathophysiology. Chill lifestyle so I can totally image myself running a RO1 funded basic science lab, whereas in ortho running a lab is probably very hard. Also awesome 2+2 research track residencies. Finally my derm attendings are the only ones that cared about pathways, enzymes, genetic syndromes, which I found very impressive and attractive.
4) super chill lifestyle, probably great for family (but I am single right now so probably thinking too much....)

Cons: 1) might miss the OR the rest of my life
2) I have no derm research or publication. Step 1 is good enough for derm but definitely not going to make it to AOA or first quartile. Just overall not as strong of an applicant for derm. Might need a back up plan if I don't match.

Would appreciate any advice on how to approach this problem.

Do derm. If you miss the OR you can do Moh's surgery

 

[KinasePro]

Do derm. If you miss the OR you can do Moh's surgery

Agreed. Doesn't matter that you don't have derm specific research, You've demonstrated that you can deliver on research projects, which is all that most PD's care about in most fields.

Also, hate to say it but bro culture is part of ortho. If you're already annoyed by it, you'll be fighting an uphill battle in residency.

 

[orthojuniorfaculty]

An important consideration for you is, how much research do you want to do? More specifically, how many days a week do you want dedicated to research? While you might think that research can be done in the mornings, nights and weekends, that is a strategy that works less and less well as your career progresses and likely as you have a family/kids/etc. Even in academic orthopaedics, it is rare to have more than one day dedicated to research each week, and in many departments and subspecialties there might not even be that. Look around at mentors or others in your departments of dermatology and orthopaedics - how much protected research time do they have? My bet is, many of the orthopaedists spend their research day (if they have them) still looking for an OR, or are bogged down with administrative responsibilities and catching up with clinical activities. That's what I saw in residency, with few exceptions. Those who do research 'on the side' can sometimes be successful through shear force of effort to the neglect of other activities, but most successful researchers find a way to make their research time truly that - an attribute not many people have mastered. And even one protected day of research makes running your own lab a challenge. Within orthopaedics, too, some subspecialties are more likely to be amenable to significant lab time than others.

In contrast, in other non-operative fields it is not uncommon for academic providers to have two (40% FTE) days a week for research, or even be in a practice where they do one week of clinic and then one week of research. In dermatology, being mostly clinic-based with few emergencies, I suspect you will have far more flexibility to have more time dedicated to research, if that is what you want. The reason for this difference is simple: orthopaedic surgeons make money for their departments by operating. They make money for their medical centers, for the dean, for the university, etc by operating.

You already know the downside of dermatology - the privilege of being in the OR, of getting to operate on patients, and applying your knowledge of anatomy, mechanics, and simple ingenuity is fantastic. MOHS is a procedure, and while cool, is not like nailing a femur, replacing a knee, or even doing a carpal tunnel release.

Strange comment warning: someone once advised me to read obituaries or biographies, to see how others spent their life and career to see what I wanted for myself. Reading history in orthopaedics (I've put some recommendations on this in other posts) and learning about current/prior people in the field may help you decide if there are people you'd want to emulate, and same with dermatology. It is an important choice - good luck!

 

[tartrate]

You and I have something very much in common - I hate when people talk about football. I too had the assumption that ortho would have a very 'bro' culture (i.e., independent of football). Surprisingly, I found that I haven't seen much of either with the orthopods I've worked with (attendings and residents in both academic and private settings). Most are pretty easy to get along with, and I even met with a few that could be described more as modest/soft-spoken.

Lifestyle is definitely a consideration but I would pursue whatever is most interesting to you, both conceptually and in terms of practice. This just makes everything else (getting up early, doing research, studying, etc.) that much easier. And regarding procedures - any procedure if done enough becomes "routine."

 

[eyepop]

Thank you all for the response! I spent the last few months doing a lot of soul searching. Pretty much decided on derm as now. A lot of it might have to do with my very biased exposure to both fields at my own school (top 6 academic dermatology department with tons of research vs middle of the road ortho program with almost no basic science research). I also feel my personality fit better with other dermatologists. There are a lot of mentors in dermatology that are already doing exactly what I want to do i.e. Seeing patient 1-2 days per week, at least 1 of the clinic days is their own specialty clinic where people from all over the country fly in just to see them, and spend at least 3 days per week doing research. I have not yet found an ortho person who can pull off this arrangement (at least in my school). Will I miss/regret not going to ortho? I think almost definitely (not to mention my dad still hasn't given up on trying to talk me into ortho yet! lol). But as massmocha mentioned, I can always do mohs if I miss OR. I am also working on a review/letter to editor that connects the similarities between skin and bone, so I am super excited about being able to connect my PhD expertise to what I will do in the future. Also a nerdy observation: do you all know skin and bone research belongs to the same NIH funding institution (National institute for arthritis and musculoskeletal and skin disease)? Apparently I am not the only crazy person out there who like both!

Again thanks a lot for you all's comments. Really appreciate it!

 

[username456789]

Thank you all for the response! I spent the last few months doing a lot of soul searching. Pretty much decided on derm as now. A lot of it might have to do with my very biased exposure to both fields at my own school (top 6 academic dermatology department with tons of research vs middle of the road ortho program with almost no basic science research). I also feel my personality fit better with other dermatologists. There are a lot of mentors in dermatology that are already doing exactly what I want to do i.e. Seeing patient 1-2 days per week, at least 1 of the clinic days is their own specialty clinic where people from all over the country fly in just to see them, and spend at least 3 days per week doing research. I have not yet found an ortho person who can pull off this arrangement (at least in my school). Will I miss/regret not going to ortho? I think almost definitely (not to mention my dad still hasn't given up on trying to talk me into ortho yet! lol). But as massmocha mentioned, I can always do mohs if I miss OR. I am also working on a review/letter to editor that connects the similarities between skin and bone, so I am super excited about being able to connect my PhD expertise to what I will do in the future. Also a nerdy observation: do you all know skin and bone research belongs to the same NIH funding institution (National institute for arthritis and musculoskeletal and skin disease)? Apparently I am not the only crazy person out there who like both!

Again thanks a lot for you all's comments. Really appreciate it!

Interestingly, I am coming across your post now as a newly minted dermatology attending looking back at my decision process. I had been thinking ortho since starting medical school, and gradually went through many of the same thought processes as you. Ultimately, although I do somewhat miss the idea of doing ortho (as evidenced by my perusing this forum randomly), being in the OR all/most days didn't end up appealing to me like I thought it would.

I love my chosen field, and I agree that it's one of the specialties that still maintains very close ties with biochem, genetics, etc. of for no other reason than because that stuff is heavily tested on our boards.

Both are fantastic fields, but obviously very different day to day. Good luck!