Tungsten5

5+ Year Member
Feb 7, 2014
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Current derm resident at a great program. I'm in a very competitive major metro area.

I really enjoy skin surgery, especially reconstructions, but not to the level of "can't imagine doing anything but Mohs". In fact, my dream practice would be like 2-3 days of Mohs, and 1-2 days of general derm with cosmetics mixed in - I really crave variety. My nightmare scenario would be doing FBSE day after day.

Do you think I should pursue, or is it really a waste of an attending year's salary given my geographic location (want to be here in long run and start a private practice, regardless of how hard) and lack of desire to do it 4+ days a week?
 
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sore eye asses

10+ Year Member
Aug 14, 2009
597
170
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  1. Attending Physician
Rules are changing with mohs certification. I don’t know all the details or terminology as I’m not mohs. You probably could do mohs without fellowship. Even with fellowship, if you’re starting your own shop in major metro area, the likelihood of you doing 2-3 days of mohs per week will likely take you 5-10 years to build.
 
Jan 8, 2009
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1,131
Dermatomicroscope
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  1. Attending Physician
If you like mohs, it wouldn't hurt to do a fellowship for sure. I don't like to think of 'year of salary lost', as you will more than make it up within a few years of doing predominantly mohs work (once you're up to speed).

I like variety, but have drifted toward more and more dermpath over clinic. My guess is you might do the same with Mohs (Mohs folks seem to in general want to mainly just do Mohs and not clinic).

Worst case scenario, you get a locums gig doing mohs (which seems to work more in large metro markets)
 
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Jun 1, 2013
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I think it might be helpful to talk to a Mohs surgeon in your individual market to gauge job prospects. Some major markets on the coasts are so saturated that local fellowship programs specifically aim to train Mohs fellows who do not intend to practice in that area. It definitely will be to your advantage to be flexible on general dermatology (e.i. accept 2 days of Mohs and 2 days of gen derm). Gen derm is really the most flexible as those are the most desired / understaffed need in medicine.

I'd also personally reflect on why you want to do Mohs. You can do cosmetics without a Mohs fellowships. You can do excisions of benign / malignant lesions without a Mohs fellowships. You just can't do Mohs (at least in a major market ) - and/or more complex surgeries.

I wouldn't think of a Mohs fellowships as "waste", even if you only practice it 1 day/week. It's actually a very small investment given a physician career may be 30-50 years. It's better to get the training and do what you love, rather than jump quickly into something you don't love and be *less* happy for 30-50 years. If you're someone who likes variety, the skill investment may provide better flexibility for diversity in your practice for the long-term.
 

MOHS_01

audemus jura nostra defendere
Oct 2, 2005
12,001
7,839
the old rickhouse
Status
  1. Attending Physician
I think it might be helpful to talk to a Mohs surgeon in your individual market to gauge job prospects. Some major markets on the coasts are so saturated that local fellowship programs specifically aim to train Mohs fellows who do not intend to practice in that area. It definitely will be to your advantage to be flexible on general dermatology (e.i. accept 2 days of Mohs and 2 days of gen derm). Gen derm is really the most flexible as those are the most desired / understaffed need in medicine.

I'd also personally reflect on why you want to do Mohs. You can do cosmetics without a Mohs fellowships. You can do excisions of benign / malignant lesions without a Mohs fellowships. You just can't do Mohs (at least in a major market ) - and/or more complex surgeries.

I wouldn't think of a Mohs fellowships as "waste", even if you only practice it 1 day/week. It's actually a very small investment given a physician career may be 30-50 years. It's better to get the training and do what you love, rather than jump quickly into something you don't love and be *less* happy for 30-50 years. If you're someone who likes variety, the skill investment may provide better flexibility for diversity in your practice for the long-term.
Fellowships in the central portion of the country have quietly chosen to not train their competition of decades, not that anyone cared particularly as the population centers of desire were elsewhere anyway. Now even these are saturated, people are looking out for their own, and, if we're being honest, we've overtrained our subspecialty positions to a large degree over the past 20 years and now not even the midlevel explosion is enough to offset it. The system has not been in a stable equilibrium since the very early 2000's, eventually someone will be forced to reckon with that observable and irrefutable fact.
 
Jun 1, 2013
265
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Fellowships in the central portion of the country have quietly chosen to not train their competition of decades, not that anyone cared particularly as the population centers of desire were elsewhere anyway. Now even these are saturated, people are looking out for their own, and, if we're being honest, we've overtrained our subspecialty positions to a large degree over the past 20 years and now not even the midlevel explosion is enough to offset it. The system has not been in a stable equilibrium since the very early 2000's, eventually someone will be forced to reckon with that observable and irrefutable fact.

Agreed. We honestly train too many Mohs surgeons. There just isn't demand for it, especially for full-time positions. Also too many cosmetic dermatologists. On the other end, we have a shortage of medical / general dermatologists, which at least makes the job market for gen derm quite lovely.
 

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