Derm and EM

[leafy]

I can't decide whether to apply in derm or EM, or both. You might think this represents a serious split personality, but consider this.

Derm: quick exam, a little procedure here and there (not interested in cosmetics), then on to the next patient. Time after work to drink a beer with your buddies.

EM: quick exam, a little procedure here an there, diagnostic tests and imaging (admittedly a much cooler reasoning process than derm), then on to the next patient. Time before work to drink a beer with your buddies (just kidding.)

Problem is, derm being crazy competative, its seems reasonable to apply in both, but if the burly EM docs find out you're also interested in derm, they pound you or burn your application. Do you think it's reasonable to apply in both fields? Even at the same institution?

Also, I'd be curious to hear your thoughts on this choice in general.

peace,

leafy

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[MrBling]

How would EM folks find out you were applying to derm if you didn't say anything? 🙂

although if you have multiple derm research or derm related experiences, they might ask you.. and that can get sticky. (mm.. yea i decided i didn't like derm 🙄)

 

[leafy]

How would EM folks find out you were applying to derm if you didn't say anything? 🙂

although if you have multiple derm research or derm related experiences, they might ask you.. and that can get sticky. (mm.. yea i decided i didn't like derm 🙄)

I guess that's part of the question, do you think that programs would find out? All lot of folks say it's a bad idea to apply in two different fields at the same institution.
-leafy

 

[coharahawk]

There is a chance they would find out. I know that our program coordinator told us that when they see an applicant has applied in a different specialty within our institution, they frown it because it questions your dedication to the field of Emergency Medicine. I see where you are coming from, but I'm just relaying the info that I've heard.

 

[deleted65604]

I can't think of 2 more opposite fields. I can't think of an emergent derm diagnosis that needs to wake up the dermatologist at 3 in the morning for. Derm is mostly clinic work, with a very rare consult in the hospital. The worst derm diagnosis I could think of would be TEN, and that is wound care and supportive treatment.

Emergency medicine, by and large is treating, or at least ruling out emergencies. It is a completely different mindset.

The only common thread is that a lot of times, smart lazy people go into both fields. The difference is that smart lazy people are usually really frustrated by working in the ER (and dermatologists are usually smarter and lazier, and make way more money).

I guess you are concerned that derm is too competitive? If I were you, I would apply to derm and if I failed, I'd scramble into FP. There are some pretty sweet gigs out there for FP. I know a guy who just graduated and he only works 4 days a week from 8-5 (with an hour lunch break). Yes, that is 32 hours a week. 80 percent of FP residencies would kill to have a smart, english-speaking resident who couldn't get into derm. There is a lot of minor procedures (mole removal, circumcisions) in FP that involve the dermis. 😳

 

[Apollyon]

I can't think of 2 more opposite fields.

Path and Family Medicine. I know a guy that did one year of path, then switched into FM.

 

[EC3]

apply derm and then also em as a backup. nobody will find out unless you're overt about it or applying to both programs at the same institution.

derm is a much more academic field. the residency is very reading-based.

if you can do derm, try and go for it. it's a pretty cool field and being a skin expert is actually pretty neat as most people are uncomfortable about derm stuff. also, one of the best things about derm, is that you can have a huge positive impact on someone's quality of life. don't let anyone convice you otherwise. poll dermatologists and ER attendings. i bet the majority would recommend derm if you have a decent shot at landing a spot.

 

[deleted65604]

The problem is that in applying for Emergency Medicine, the things that will look good on your application are lots of ICU months, inpatient rotations, emergency medicine, anesthesiology, etc. I'm ignorant about what would look good on a derm application, but I imagine that it would be rotations like pathology, clinic rotations, (obviously dermatology), and a more heavy emphasis on research. It seems to me that a derm-oriented application wouldn't look good at all to an ER program director. I think you might do yourself a disservice to not make the decision now rather than waiting for the match to make it for you.

 

[roja]

derm is a much more academic field.

if you can do derm, try and go for it. it's a pretty cool field and being a skin expert is actually pretty neat as most people are uncomfortable about derm stuff. also, one of the best things about derm, is that you can have a huge positive impact on someone's quality of life. don't let anyone convice you otherwise. poll dermatologists and ER attendings. i bet the majority would recommend derm if you have a decent shot at landing a spot.

I wouldn't do derm if the most awesome cushiest nicest spot had landed in my lap. I had one colleague who was AOA, 2nd in a class of 210 set to go into derm and ended up really disliking it. went FP (ie followed her heart) and is very happy.

None of this implies that derm doesn't impact peoples lives. It absolutely does. As do EP's and almost every other specialty. Every field has an academic core, including EM.

The problem is that in applying for Emergency Medicine, the things that will look good on your application are lots of ICU months, inpatient rotations, emergency medicine, anesthesiology, etc. I'm ignorant about what would look good on a derm application, but I imagine that it would be rotations like pathology, clinic rotations, (obviously dermatology), and a more heavy emphasis on research. It seems to me that a derm-oriented application wouldn't look good at all to an ER program director. I think you might do yourself a disservice to not make the decision now rather than waiting for the match to make it for you.

Well put. Not to mention these fields are incredibly disparate in terms of what you do, style, etc.

 

[leafy]

The only common thread is that a lot of times, smart lazy people go into both fields. The difference is that smart lazy people are usually really frustrated by working in the ER (and dermatologists are usually smarter and lazier, and make way more money).

Do you think such folks are frustrated by the ED because they are lazy, or because they are smart? 😀 Respectfully though, I find the ED fascinating, but am told that after a time, it becomes formulaic.

Staying in academics is a way around this, and when you are teaching and doing research, the job of the derm or ED attending starts to look more similar, no? Same salary too in academia.

-leafy

 

[AmoryBlaine]

if you can do derm, try and go for it. it's a pretty cool field and being a skin expert is actually pretty neat as most people are uncomfortable about derm stuff. also, one of the best things about derm, is that you can have a huge positive impact on someone's quality of life. don't let anyone convice you otherwise. poll dermatologists and ER attendings. i bet the majority would recommend derm if you have a decent shot at landing a spot.

This is my essential feeling. I mean we all like emergency medicine but the field has some very large and well-described down sides. Derm does too but it is also much more highly compensated and much lower stress.

If you can be satisfied and happy doing a 9-5 clinic job and making $250+ (possibly ++++) after a benign residency then why would you go into emergency medicine?

 

[roja]

I know this answer might surprise some people 😉 but I would go into Emergency again and again, because I love it.

To assume the only reason everyone isn't running around being a skin doctor is because we weren't competitive enough is skirting very close to an offensive line. 🙂

 

[EC3]

I know this answer might surprise some people 😉 but I would go into Emergency again and again, because I love it.

To assume the only reason everyone isn't running around being a skin doctor is because we weren't competitive enough is skirting very close to an offensive line. 🙂

Dermatology is a great field with some of the best hours and best pay per hour. There should be nothing offensive about the notion that more people would prefer to practice a specialty that afforded them this type of lifestyle. EM is a good field but it's not for everyone and it certainly doesn't favor an older practitioner over more sedate specialties like Derm.

Also, it's not an assumption or an insult to comment that most EM folks couldn't become dermatologists even if they wanted to. Statistically speaking it is a fact. Only the top 5-10% of EM applicants would even have a realistic chance of matching Derm. Think about it.. something like 1/3 of those with 240+ did not match and almost 1/5 of those with over 260+ did not match... that's unbelievable.

 

[jbar]

Also, it's not an assumption or an insult to comment that most EM folks couldn't become dermatologists even if they wanted to. Statistically speaking it is a fact. Only the top 5-10% of EM applicants would even have a realistic chance of matching Derm. Think about it.. something like 1/3 of those with 240+ did not match and almost 1/5 of those with over 260+ did not match... that's unbelievable.

There is a bit of a chicken and the egg thing though. The people who come into med school thinking they want to do derm do a lot more work trying to get all honors, getting that top Step 1 score etc. If I was thinking derm I would have studied for step one for 6 months instead of six weeks, but you don't need a 270 for EM so why kill yourself trying to ace the test. So it isn't really fair to say that people in field X couldn't have matched in field Y, because they would have had very different looking applications and scores if they had had their sights set on a super competitive field.

 

[vtucci]

Personally, I could not imagine a more boring field of medicine. I do not care if it pays 800K a year--dealing with zits, moles and cancer on a regular basis is not my idea of a good time.

I want to make a real contribution to society and the dramatic save as rare as it may be in real EM (as opposed to the daily ones we see on TV) is priceless. Sometimes being the safety net for an entire community of people who do not have health insurance and primary care providers can also be rewarding.

I understand that the dermatologist might be able to diagnose skin cancer and some other rather unfortunate conditions but a lot of the practice is dedicated to more superficial concerns (acne), not that these cannot have a significant psychological impact on the patient. I like my practice to be more varied, in terms of patient population and complaints. How many dermatologists take patients without insurance (no matter how bad their skin is)?

 

[AmoryBlaine]

Personally, I could not imagine a more boring field of medicine. I do not care if it pays 800K a year--dealing with zits, moles and cancer on a regular basis is not my idea of a good time.

I want to make a real contribution to society and the dramatic save as rare as it may be in real EM (as opposed to the daily ones we see on TV) is priceless. Sometimes being the safety net for an entire community of people who do not have health insurance and primary care providers can also be rewarding.

I understand that the dermatologist might be able to diagnose skin cancer and some other rather unfortunate conditions but a lot of the practice is dedicated to more superficial concerns (acne), not that these cannot have a significant psychological impact on the patient. I like my practice to be more varied, in terms of patient population and complaints. How many dermatologists take patients without insurance (no matter how bad their skin is)?

If someone had made similar statements about EM on any SDN forum the EM people would be baying for blood.

How is your personal opinion of derm at all relevant to the disucssion at hand?

I was not suggesting that I found derm to be an exciting or appealing field, merely that if someone likes it and EM equally well why would they not go for the lower stress, higher paying field with an easier residency?

 

[roja]

There is a bit of a chicken and the egg thing though. The people who come into med school thinking they want to do derm do a lot more work trying to get all honors, getting that top Step 1 score etc. If I was thinking derm I would have studied for step one for 6 months instead of six weeks, but you don't need a 270 for EM so why kill yourself trying to ace the test. So it isn't really fair to say that people in field X couldn't have matched in field Y, because they would have had very different looking applications and scores if they had had their sights set on a super competitive field.

Exactly. I *knew* I was going into peds (aka much less competitive) so I didn't kill myself in medical school. I think the many of people in medical school could do well enough to get into medical school and many don't want to.

 

[Substance]

As for doing rotations in both derm and ER - 12-15% of all ER visits are for a derm related complaint. So keep this in mind when you're challenged about it...

 

[SoCuteMD]

There is a bit of a chicken and the egg thing though. The people who come into med school thinking they want to do derm do a lot more work trying to get all honors, getting that top Step 1 score etc. If I was thinking derm I would have studied for step one for 6 months instead of six weeks, but you don't need a 270 for EM so why kill yourself trying to ace the test. So it isn't really fair to say that people in field X couldn't have matched in field Y, because they would have had very different looking applications and scores if they had had their sights set on a super competitive field.

I don't know that I've met anybody who came into med school wanting to go into derm.

On the other hand, I know a number of EM candidates with derm-level qualifications.

 

[leafy]

Thanks for the response, some very interesting viewpoints, to be sure. One thing I'm wondering about, is how this plays out 15-20 years from now. EM residency actually seems way more fun to me than a derm res, but to get to the point, I've talked to EP in their 50s (and much earlier in two cases), who seem frustrated by the system, and urged me to specialize (in anything!)

I'm sure there are a number of docs here who have been in EM long enough to foresee their role after 20 years of experience. How does it compare to being an expert in one particular field?

leafy

 

[roja]

You should search this. EM doctors are specialist. They specialize in Emergency medicine. there are several threads, I believe, that adress this point.

EP's specialize in "the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department."

You will find MD's in every field who will say this. (my dad is an ortho and told me EM was definately a wise choice). Do what you love. There are plenty of people >20 years out who still love working in the ED.

 

[jbar]

I don't know that I've met anybody who came into med school wanting to go into derm.

On the other hand, I know a number of EM candidates with derm-level qualifications.

I can only speak from my n=1 experience. Maybe not so much wanting derm on day one but quite a number of people in my class knew by the start of second year that they wanted to go into derm or plastics or neurosurge and started studying for the boards with a 250-260 goal. They were thinking "lifestyle" early on and knew they wanted a field that would probably be a competitive match.