Derm vs. Path

[deleted967776]

Interested in dermpath. I enjoy general surg path/cyto more than derm clinic, but I don't mind clinic. I have no interest in CP or autopsy/forensics. I have enough of a base to put myself into the conversation for derm (top quartile class rank, top quartile step 2, did a post-sophomore fellowship at a T10 path program, personally know some academic dermpaths with some connections). However, I would have to go hard from a research/extracurricular standpoint to really be competitive; I would almost certainly try to take a research year. I could choose a path residency with an inhouse dermpath fellowship and make that my stated goal from day one, but I consistently hear there is an advantage to the derm --> dermpath route in terms of logistically landing a spot. I would be interested in doing specifically as much dermpath signout as possible even if I went the derm route because that's what I really enjoy. I do have some hesitations about the path job market, but it's hard to tell what's real and what's ball busting/shooting the crap. It also seems to be the consensus that going the derm route provides more flexibility both geographically and lifestyle wise, which is something I'm interested in. Essentially, does derm really provide as much of an advantage over path for matching dermpath, flexibility, autonony as is generally advertised? Trying to determine if it's worth grinding hard for another few years to open the door to going that route.

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[caffeinegirl]

Derm-dermpath candidates are highly regarded in the fellowship market. There are several derms I know who remained in academia with a strong research career - and some have ended up chair of their department. I know derms in private practice who primarily do dermpath, with maybe a half day of clinic.
I would not do path - it looks like you're interested in an AP/DP route. That will pigeon-hole you into academics and not private practice.
My advice - derm all the way, and go to a program with a strong dermpath department.

 

[KeratinPearls]

Interested in dermpath. I enjoy general surg path/cyto more than derm clinic, but I don't mind clinic. I have no interest in CP or autopsy/forensics. I have enough of a base to put myself into the conversation for derm (top quartile class rank, top quartile step 2, did a post-sophomore fellowship at a T10 path program, personally know some academic dermpaths with some connections). However, I would have to go hard from a research/extracurricular standpoint to really be competitive; I would almost certainly try to take a research year. I could choose a path residency with an inhouse dermpath fellowship and make that my stated goal from day one, but I consistently hear there is an advantage to the derm --> dermpath route in terms of logistically landing a spot. I would be interested in doing specifically as much dermpath signout as possible even if I went the derm route because that's what I really enjoy. I do have some hesitations about the path job market, but it's hard to tell what's real and what's ball busting/shooting the crap. It also seems to be the consensus that going the derm route provides more flexibility both geographically and lifestyle wise, which is something I'm interested in. Essentially, does derm really provide as much of an advantage over path for matching dermpath, flexibility, autonony as is generally advertised? Trying to determine if it's worth grinding hard for another few years to open the door to going that route.

Derm-Ferrari
Path-Honda Accord

You’d be stupid to choose path over derm if you can get into derm. Path is full of rejects, some of whom couldn’t even get into an internal medicine residency. Add on the fact there are limited jobs in tight markets. You will have to fight for a job.

Put all your hard work into good use. If you think you can match derm, go derm. If not then do path and just hope for the best. Be realistic though.

There are derms working 3-4 days a week making great money.

You deserve better if you are indeed qualified to match derm.

 

[Dave CX]

The ONLY negative about derm is the year of internal medicine. Too many negatives about pathology to list.

 

[HeyDalaron]

No brainer. Derm.

 

[SunBakedTrash]

If your main or only interest is skin, do derm. It’s a safer bet financially and strategically as mentioned above.

If things fall through and derm is never a sure bet, path is a good backup. There is truth in some of the nonstop bleating, but the sky is not really falling for most well-adjusted, competent trainees who trained at good places and are willing to be flexible on location and job description. if you end up in path, i would highly advise you to include CP. it’s paid vacation in residency and chances are you’ll never use it except in locking down a PP dermpath position.

 

[KeratinPearls]

If your main or only interest is skin, do derm. It’s a safer bet financially and strategically as mentioned above.

If things fall through and derm is never a sure bet, path is a good backup. There is truth in some of the nonstop bleating, but the sky is not really falling for most well-adjusted, competent trainees who trained at good places and are willing to be flexible on location and job description. if you end up in path, i would highly advise you to include CP. it’s paid vacation in residency and chances are you’ll never use it except in locking down a PP dermpath position.

I don’t know about you but I’d like to live where I want after being in training for 6 years. I would not want to pick up and move my family to live where I don’t want to just to secure a job.

I don’t know of any other field in medicine where you have to be “geographically flexible” to secure a job. Maybe rads onc?

 

[SunBakedTrash]

I don’t know about you but I’d like to live where I want after being in training for 6 years. I would not want to pick up and move my family to live where I don’t want to just to secure a job.

I don’t know of any other field in medicine where you have to be “geographically flexible” to secure a job. Maybe rads onc?

It’s obviously more restricted in small highly specialized fields like path, RO or NSG where a hospital needs very few of these types to function. It should be common sense for applicants to know this before they match. Even if 90% of pathologists retired or died today, Methville, Oklahoma, population 2k isn’t going to need its own pathologist.

You can find discussions of geographic restriction in almost every forum including anesthesia and EM, where I’ve heard Columbus, Ohio and Dallas, TX as “tight markets.” If you couldn’t even secure desirable employment in Ohio in EM, wouldn’t you rather do pathology and move? I would.

 

[KeratinPearls]

It’s obviously more restricted in small highly specialized fields like path, RO or NSG where a hospital needs very few of these types to function. It should be common sense for applicants to know this before they match. Even if 90% of pathologists retired or died today, Methville, Oklahoma, population 2k isn’t going to need its own pathologist.

You can find discussions of geographic restriction in almost every forum including anesthesia and EM, where I’ve heard Columbus, Ohio and Dallas, TX as “tight markets.” If you couldn’t even secure desirable employment in Ohio in EM, wouldn’t you rather do pathology and move? I would.

Anesthesiology job market is GREAT near where I live (large metropolitan city). There are TONS of jobs. Path jobs maybe 10, some with lowball offers. There are more trainees graduating and looking for jobs than there are jobs.

I’d do derm hands down if I was the original poster.

Ability to work anywhere in the country and still command a good to great salary even if you live in a major city. No need to move for jobs.

 

[WEBB PINKERTON]

I would choose derm too BUT derm is being taken over by private equity firms faster than any specialty I have seen. Literally overnight all the derm around me sold out. I have heard horror stories about the effect this is having.

 

[Dral]

I was exactly in your shoes back in the day. I liked both derm and path. Over time, I realized I liked the scope more than the clinic, so I mostly do dermpath now. If your end goal is mostly dermpath, I'd go derm. It may take a bit of searching, but you should be able to find a job that gives you that. While my impression is that the path job market isn't that awful anymore, you are more marketable currently to land a job where you are doing clinic and dermpath, hopefully increasing your dermpath over time. At the very least, as a derm/dp you are marketable to a derm practice that is associated with a lab due to the 'eat what you kill' concept.

 

[KeratinPearls]

I would choose derm too BUT derm is being taken over by private equity firms faster than any specialty I have seen. Literally overnight all the derm around me sold out. I have heard horror stories about the effect this is having.

As long as the Derm society protects and limits the numbers of derms graduating each year (demand>supply), then they won’t get exploited and still command high salaries….unlike Pathology.

 

[WEBB PINKERTON]

As long as the Derm society protects and limits the numbers of derms graduating each year (demand>supply), then they won’t get exploited and still command high salaries….unlike Pathology.

And you can go ANYWHERE you want and have plenty of business. Just stay away from all the PE practices dominating the landscape.