Article in NY Times

[Nilf]

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This is an article about how tough dermatology is to match and why.

http://www.nytimes.com/2008/03/19/fashion/19beauty.html?pagewanted=1&ref=health

And here is the highlight:

Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.

 

[docbiohazard]

Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.

Heh, now that's interesting... never heard of it, but just googled it and appears to be a legitimate genetic disorder. Heh.

This, however, is a much more disturbing development:

Title: For Scientists, a Beer Test Shows Results as a Litmus Test
http://www.nytimes.com/2008/03/18/science/18beer.html?_r=1&oref=slogin

From the article: According to the study, published in February in Oikos, a highly respected scientific journal, the more beer a scientist drinks, the less likely the scientist is to publish a paper or to have a paper cited by another researcher, a measure of a paper's quality and importance.

Say it ain't so!!!

BH

 

[Matte Kudesai]

Is a patholgist getting a dermpath fellowship far easier than a medical student matching into dermatology?

 

[LADoc00]

Is a patholgist getting a dermpath fellowship far easier than a medical student matching into dermatology?

Answer: depends. I could have easily easily matched somewhere in derm coming out of my medical school because the school essentially guaranteed a 100% match rate. Dermpath fellowships I needed to apply to 20-30 programs before getting an offer (which I turned down).

 

[schrute]

uncombable hair syndrome sounds rough...but how about Morgellons...anyone ever seen that stuff? Crazy.

 

[paleman]

Is a patholgist getting a dermpath fellowship far easier than a medical student matching into dermatology?

significantly easier to get a dermpath fellowship in my opinion. in order to match in derm you basically need to either (i) be top of the top and publish or (ii) be super hot and flirt with the ol' program director (iii) kiss serious ***. dermpath, on the other hand IMO can be done by just pretending you are very interested in skin and not at all interested in cash (?)

 

[Matte Kudesai]

significantly easier to get a dermpath fellowship in my opinion. in order to match in derm you basically need to either (i) be top of the top and publish or (ii) be super hot and flirt with the ol' program director (iii) kiss serious ***. dermpath, on the other hand IMO can be done by just pretending you are very interested in skin and not at all interested in cash (?)

Thats what I thought.

I just wanted to make sure.... from what I've heard (from dermatologists) dermatopathology is nowhere near as competitive as dermatology and a whole other caliber of individuals do derm residency.

Many dermatopathology jobs stick you in a cubicle and give ya mountains of biopsies at a scope that sometimes becomes like a double barreled shotgun aimed at your head. Is that true?🙂

Dermatologists can do the cool stuff like Moh's and cosmetics. They would never let a dermpath trained pathologist near that stuff right?

I mean comparing dermatopathology to dermatology is like comparing a bus driver to fighter pilot. 🙄 Both have a function... someone brilliant enough to be a fighter pilot can choose to be a bus driver.....just because of sheer humility....😉

 

[paleman]

Thats what I thought.

I just wanted to make sure.... from what I've heard (from dermatologists) dermatopathology is nowhere near as competitive as dermatology and a whole other caliber of individuals do derm residency.

Many dermatopathology jobs stick you in a cubicle and give ya mountains of biopsies at a scope that sometimes becomes like a double barreled shotgun aimed at your head. Is that true?🙂

Dermatologists can do the cool stuff like Moh's and cosmetics. They would never let a dermpath trained pathologist near that stuff right?

I mean comparing dermatopathology to dermatology is like comparing a bus driver to fighter pilot. 🙄 Both have a function... someone brilliant enough to be a fighter pilot can choose to be a bus driver.....just because of sheer humility....😉

oi hold on a minute.. IMHO Moh's and cosmetics = double barreled shotgun to head. cool stuff?? hell no - check it out for yourself. if youre a relaxed kind of person who thinks path is for you but likes a more clinical focus dermpath as a subspecialty cannot be beat. a lot of med students going into derm are obsessive overachieving lemmings who don;t realize how tedious hair nails and spongiotic dermatitis can be.

 

[Matte Kudesai]

if youre a relaxed kind of person who thinks path is for you but likes a more clinical focus dermpath as a subspecialty cannot be beat.

Is this the kind of path resident that does dermpath? I thought dermpath attracted the non relaxed personality and many of the dermpath seekers I have met don't give a crap about anything clinical.....When you are done with your fellowship and are board certified.... how is dermatopathology any more clinically oriented than any other path specialty? I have heard that you rotate through clinic when you are training but how often does a dermatopathologist have time to do anything remotely clinical?

Don't you just do the SK, SK, SK, AK, AK, AK Oh wait melanocytic lesion lets do a mitotic count chching chching chching dance? 😉

Honestly I am asking because I'm not sure what "most" non academic dermatopathologists do. I guessed that they needed to sign out a large number of biopsies to be raking in all that cash. Do they have time to do much else... I mean clinically (you mentioned clinical stuff. Do they biops?... shoot they might because FP docs get to do that as well)? I guess in academics you can be involved in research projects and participate in training dermatology fellows. Don't you get paid less though? Every dermatopatholgist that I have seen or heard of is buried under a mountain of glass. And the glass keeps coming and coming and coming and coming.... 🙁.. I am glad that so many people want to do it but do they know what it really entails? Does the cash numb the pain? I'm messing around a bit but also serious too... Enlighten me please but be gentle🙄

 

[b&ierstiefel]

significantly easier to get a dermpath fellowship in my opinion. in order to match in derm you basically need to either (i) be top of the top and publish or (ii) be super hot and flirt with the ol' program director (iii) kiss serious ***. dermpath, on the other hand IMO can be done by just pretending you are very interested in skin and not at all interested in cash (?)

It happens.

 

[exPCM]

I followed the AP/CP/DP fellowship route.

The # of applicants to # of positions ratio for derm residency is about 1.7:1.
see:
http://www.nrmp.org/data/matchoutcomes2006.pdf

The applicant to position ratio for DP fellowship based on my crude analysis of the numbers is about 3:1.

 

[docbiohazard]

uncombable hair syndrome sounds rough...but how about Morgellons...anyone ever seen that stuff? Crazy.

Yes.... dellusional parasitosis by any other name... 😀

BH

 

[mlw03]

i do think some things are being done to make primary care more attractive, namely the switch to careers focusing mainly on EITHER inpatient or outpatient care, rather than the older model of round on patients in hospital in early morning then go see patients all day in clinic then go home and be on call all night. i see very little of that, and in that vain, internal med becomes more pleasant a career when you're doing only shift-type work either inpatient or outpatient. this seems to hold true in internal med and gen pediatrics, to say nothing of the fact that in big cities family practice is pretty much entirely outpatient adult patients. so my point is that primary care fields are becoming more attractive career options because the practice model seems to be changing to emulate the more desirable specialties that involve fewer work and call hours. i don't know as much about ob-gyn, but i've also heard this specialty is even beginning to follow the outpatient-hospitalist model in some practice groups. as i've said in prior posts, i think this huge shift in practice model should eventually lead to a massive alteration in graduate medical education, namely different residencies for inpatient versus outpatient tracks in adult and/or pediatric medicine. no need for the outpatient doc to learn the intricacies of inpatient management of DKA and also no need for the hospitalist to learn the fine details of metabolic syndrome management. let each branch focus most of their training on what they'll be doing day in and day out.

i agree this is a great discussion to be having and am glad that it's receiving press in major media outlets like the NY Times. this is a topic that needs discussing by medical and non-medical persons together.

 

[Nilf]

👍

Absolutely. The most important poignant conclusion of the article is the sad reality that these 'Keynesian' tactics of fixing the problem of low number of medical students entering primary care and other not-so-competitive specialties WILL NEVER BE WORK UNLESS THE WORKING CONDITIONS AND REIMBURSEMENT IMPROVE. My medschool was pushing primary care big time... free lunches, conferences, speakers, etc... And guess what? People flocked into GAS.

I was surprised to see a liberal behemoth like NY Times to write about this subject, expecially that they did not implicate that socialized healthcare will somehow solve the problem. I think it's an encouraging sign that media start to dig deeper into the complexities of medical training and how it affects the way healthcare is delivered.

 

[Matte Kudesai]

👍Absolutely. The most important poignant conclusion of the article is the sad reality that these 'Keynesian' tactics of fixing the problem of low number of medical students entering primary care and other not-so-competitive specialties WILL NEVER BE WORK UNLESS THE WORKING CONDITIONS AND REIMBURSEMENT IMPROVE.

A factor that drives competition in derm, plastics, optho, is the percentage of cash generated that is unrelated to reimbursement.

People are more likely to pay cash (or go into credit card debt) for botox, LASIK, breast implants, dermabrasion, rhinoplasty, hair removal, hair transplant, and liposuction.



These subspecialties have a the possibility of a cash/credit up front business model.

Primary care will manage the 10 million baby boomers with Alzheimers, the millions with heart disease, diabetes, urinary incontinence, depression, and dementia. You know all that mundane stuff. 🙁


A few rich boomers will pay for "TOTAL BODY MAKEOVERS".


Lets figure out how to convince people to pay for healthcare that has nothing to with what is "skin deep". Unfortunately a cultural shift may be necessary.


When an MBA from a decent program can earn ya at least 125,000... why do a specialty that makes about the same doing DRE's and ENT checks? Who knows what drives people to do medicine. Uber-desirable medical specialties reflect themes prevalent in culture.

Specialties that remind us of our mortality will likely never be as popular as those that follow Juan Ponce de Leon.

 

[coroner]

Essentially, this achieves their goal of more primary care docs. By increasing the number of medical students and thus graduates (the AMA already proposed a 10% increase in medical school admission slots a year or two ago and many schools have done this or are in the process of doing so), and not increasing the number of residency positions available; this creates a trickle effect where more people will be competeing for the 'glam' specialties forcing more to accept what they may not have wanted i.e. primary care. Although the argument could be made that it will make people "settle" for GAS instead of Derm. The ultimate equalizer would be to have a more compatible number of total residency slots nationwide with graduates, but that brings up a separate discussion of postions for DO's, IMGs, US grads who took research time/sabbaticals, etc. which is a whole other ball of wax.

i do think some things are being done to make primary care more attractive, namely the switch to careers focusing mainly on EITHER inpatient or outpatient care, rather than the older model of round on patients in hospital in early morning then go see patients all day in clinic then go home and be on call all night.

Or skip the rhetoric as some medical schools across the country are doing and give cash bonuses b/w 10-50K to seniors going into family or internal med (one of our residents graduated from one of these schools and considered going into primary care to get these 'grants')