Dermatology residency after practicing as an internal medicine doc?

[jh0276]

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I have been practicing in internal medicine for 4 years now and I want to go back and train in dermatology. I am looking for a little advice...My stats from med school are decent (top 10 med school, mostly honors but no AOA, >235 on boards), my recs from my residency PD at a top 10 IM program and from my boss when I practiced in academics would be outstanding, but currently I don't have any recs from dermatologists. In the years I have been out I have been a clinician educator and have worked in the inner city (no private practice), which is what I want to continue doing except as a dermatologist, which is actually true. Should I even try applying this year or would I not even get interviews because of no derm recs? If I were able to do a 2 week rotation with a derm program (using my vacation time from work), is it rude to ask for a letter of rec after only 2 weeks? Any help appreciated.

 

[tripleJ]

I don't blame you!

 

[FacDerm]

You have a challenge ahead of you, but it's possible. There is a sense that there aren't enough students and residents interested in "medical derm," so your IM background may actually be seen as an advantage at some programs. You will need to sell yourself as interested in the medical aspects and probably academically-oriented. I would not suggest applying without derm recommendations. If you have a derm dept/division at your institution, go to them first. Try to get involved in projects or at least case reports/posters/etc. By all means, find someone in academic dermatology close to home who can give you guidance. You may have trouble finding institutions that will host you for rotations due to liability issues (it's much easier to host students, who still have to have some liability coverage through their home institutions). You could also consider a clinical fellowship -- there are lots available -- but you'll be looking at a big cut in pay for that year. Good luck.

 

[asmallchild]

There were a couple of programs I saw on the trail that seemed to really relish those who trained in other fields before going to dermatology so I'd say it's possible. That being said, those applicants usually had to go through research fellowships especially those without extensive prior experience in dermatology.

 

[DermMatch]

In the application game, always put yourself in the other person's shoes. Would you write a letter of recommendation for someone after knowing them for two weeks?

Asking for a letter of rec in derm is the same as in any other endeavor. Two weeks is insufficient.

 

[Dermguy]

In the application game, always put yourself in the other person's shoes. Would you write a letter of recommendation for someone after knowing them for two weeks?

Asking for a letter of rec in derm is the same as in any other endeavor. Two weeks is insufficient.

I think it is insufficient too, but what is someone supposed to do when they have limited time and contact with academic dermatologists? Maybe asking after two weeks is the ONLY option?

 

[DermMatch]

If an applicant has limited time, but is dying to get into derm, then to be competitive that applicant should seriously consider making some sacrifices such as giving up his/her current practice and doing a pre-derm research fellowship. Otherwise, you just look like a dabbler who wants to make more money in a shorter work week than you currently have.

 

[Dermguy]

pre-derm research fellowship

Ouch! (but probably right)

 

[paintballdoc]

Hi jh,

You definitely should go for derm if you are not interested in any medical subspecialties. Bear in mind I am not in derm, but was interested in it at one time. I too completed internal medicine and looked into different avenues. You have better stats than I did, and if I had your scores, I would have pursued every option.

Here is what I learned.
1. You would definitely be very competitive at the larger programs. I have talked to a Mohs surgeon who trained at Emory and a dermpath who did his derm and dermpath at Mayo in MN. Both of their programs were large enough to not be too dependent on medicare dollars. They would value having an internist-trained dermatologist.

2. You would definitely need a strong rec from a dermatologist. The derm community is tightly-knit (due to its size). I personally would not ask a dermatologist after 2 weeks of work.

3. Consider a derm research elective for a year. You may even have to commit 2 years--Emory seemed to like you to do 2 years. Many programs have a good track record for taking their research fellows. No guarantee, but what is guaranteed. Look at the programs and their track records for matching. My understanding is some PD may not "bat" for you very much even after having worked for them. Avoid these programs at all costs. It seemed Emory, Mayo, Wake Forest, and Utah seemed to have good track records in mathcing their candidates at their respective programs or somewhere else.


I hope this helped somewhat. Granted, my research was done a few years ago, but I doubt much has changed.

I say go for it. Best of luck.

 

[asmallchild]

SLU is another program that has a good track record for taking their own research fellows. I believe it's a 2 year track but well worth it if you get in.

I believe a couple of years ago their program consisted almost entirely of residents who were double-boarded with only one resident taking the traditional pathway of medical school -> derm residency.

 

[dragonfly99]

I agree with doing a 1 or 2 year derm fellowship or just derm research in a prominent dermatologist's lab. You could still moonlight during that to avoid being totally poor. I think with >230 USMLE's you would then have a shot.
You can still do your 2 week derm rotation during your vacation, though...it helps to have connections. I have seen a derm fellowship @Georgetown advertised, but don't know if it's currently open.

 

[jh0276]

I can't start a fellowship until July 2010 (personal commitments). Do you think I should apply this year with no derm recs or do you think that if I don't match this year that it would hurt my chances for matching next year after I get recs from the derm fellowship because I didn't match initially?

 

[DermMatch]

I never understood those people who rush to apply to the US's most competitive specialty without the best application they can possibly assemble.

You will look like damaged goods on rematch.

 

[jh0276]

I never understood those people who rush to apply to the US's most competitive specialty without the best application they can possibly assemble.

You will look like damaged goods on rematch.

That was a bit hostile...I am just looking for advice since I am a few years out, I am older and am trying to balance happiness in my career (going for derm) vs my family responsibilities (not only money but time). I was pretty sure that I needed to do a research fellowship before applying but I just thought this would be a good forum to make sure my thoughts were correct. It is just a little daunting to think that I won't be able to start a derm residency (if I am even successful in matching) for another 3 years not to mention the 2 years of clinical research.

 

[238950]

i was wondering --- do you practice general IM? so you just did 3 years of residency and no fellowship?

what about the daily IM practice do you not like?

 

[DermMatch]

Not being hostile -- just being honest. The fact is that you WILL look like damaged goods if you have to rematch.

Stats bear it out: For rematchers,

- fewer interview offers
- lower percentage ultimately match.

You have to go to bat with the best application you can assemble instead of hobbling yourself from the get-go with a letter of rec after 2 weeks of shadowing and no research.

Oh, and also:

Because you've done IM, *much* fewer programs will even want to invite you from the start because of the intricacies of fed funding. So you're already starting out behind.

I'm not telling you NOT to go for derm. I'm telling you that if you want to go for derm, you have to have the best application humanly possible.

 

[asmallchild]

That was a bit hostile...I am just looking for advice since I am a few years out, I am older and am trying to balance happiness in my career (going for derm) vs my family responsibilities (not only money but time). I was pretty sure that I needed to do a research fellowship before applying but I just thought this would be a good forum to make sure my thoughts were correct. It is just a little daunting to think that I won't be able to start a derm residency (if I am even successful in matching) for another 3 years not to mention the 2 years of clinical research.

I'm sure there are exceptions but virtually everyone I've met who transitioned into dermatology from another residency needed to put in research time.

 

[MedDerm]

I can only share from my experience. I matched into derm in my last year of IM residency training. I do feel there is a difference (and have been told by other dermatologists this is true) in someone applying while in another residency vs someone who has been out in practice for a period of time. Whether right or wrong, they are put in different categories when applying. So, that being said, my situation was different from that of the OP. However, funding was a big issue I encountered with many programs. For me, the hard part was getting interviews. Many programs excluded me because I had been through a prior residency (If you contact programs, they will be honest about this). Once I got interviews, each program expressed that my IM background was a big asset and thought I would add a unique perspective to their program. I received interviews at top tier and community based, smaller programs. I did absolutely no research (and had no pubs in IM either). However, I had some unique life experiences and had competitive board score (250+ Step 1). I also had to ask for LOR after only 2-3 weeks of working with academic dermatologist. This was all I was able to do. Of course, the question you will get asked is why dermatology after having completed IM, so have good answers for that. Anyway, this was my experience. This might not be the normal experience, but I wanted to share what I went through a few years ago. I knew there was a chance I would not match, but I was older and was not willing to go through a fellowship given my family situation. I still liked IM and saw derm as an extension of IM just like allergy or ID or rheum. I was content that if I didn't match, I could be happy in life and already had a pretty good job. I know our situations are a little different but I hope this might help in some way.

 

[drvechman]

jh
the only good advice you will get on this board is... Don't listen to anyone on this board. For the most part (except the nice guy/girl above me who posted his/her success story) no one on this board has any real perspective. It is a bunch of scarred medical students who put the field of dermatology on a pedestal and don't have any real chance of matching because, despite board scores in the 300s and publications in the NEJM, they are too awkward to carry on a conversation with anyone. You already have many successes. You are a graduate of a well regarded medicine program. Seek advice from people in the know, state your objectives clearly in your interviews, be likable and follow your common sense. Disregard the ney-sayers on this forum. Good luck.
V

 

[asmallchild]

jh
the only good advice you will get on this board is... Don't listen to anyone on this board. For the most part (except the nice guy/girl above me who posted his/her success story) no one on this board has any real perspective. It is a bunch of scarred medical students who put the field of dermatology on a pedestal and don't have any real chance of matching because, despite board scores in the 300s and publications in the NEJM, they are too awkward to carry on a conversation with anyone. You already have many successes. You are a graduate of a well regarded medicine program. Seek advice from people in the know, state your objectives clearly in your interviews, be likable and follow your common sense. Disregard the ney-sayers on this forum. Good luck.
V

I disagree. Nobody is saying "no". We're all saying it would be prudent to prepare the best possible application before going for it. Your 1st shot is your best shot.

 

[N-Surge]

jh
the only good advice you will get on this board is... Don't listen to anyone on this board. For the most part (except the nice guy/girl above me who posted his/her success story) no one on this board has any real perspective. It is a bunch of scarred medical students who put the field of dermatology on a pedestal and don't have any real chance of matching because, despite board scores in the 300s and publications in the NEJM, they are too awkward to carry on a conversation with anyone. You already have many successes. You are a graduate of a well regarded medicine program. Seek advice from people in the know, state your objectives clearly in your interviews, be likable and follow your common sense. Disregard the ney-sayers on this forum. Good luck.
V

🙄

The people here are not in any way nay-sayers... I have met many wonderful people who have been a great source of inspiration on this board, some whom I have been conversing with and getting great input from since M3 through this years Match. The PM conversations I have had have been great!

These people ARE in the know... You might want to check on the credentials of others who are posting here as well, i.e. NOT scarred med students (and a 300 STEP score is impossible...). Some of these folks are current residents in the field and others have recently Matched. Who better to ask the nature of the interview/Match trail than those FRESH from the craziness? Seriously...

To the OP, imo try to land a research fellowship and then go for it! 🙂

 

[Dermguy]

jh
the only good advice you will get on this board is... Don't listen to anyone on this board. For the most part (except the nice guy/girl above me who posted his/her success story) no one on this board has any real perspective. It is a bunch of scarred medical students who put the field of dermatology on a pedestal and don't have any real chance of matching because, despite board scores in the 300s and publications in the NEJM, they are too awkward to carry on a conversation with anyone. You already have many successes. You are a graduate of a well regarded medicine program. Seek advice from people in the know, state your objectives clearly in your interviews, be likable and follow your common sense. Disregard the ney-sayers on this forum. Good luck.
V

Don't act like you know any of us. You don't.

What you say sounds like sour grapes, and apparently you are the one who has problems relating to people. I'm all for diversity of scores/schools/applicant types, and all are welcome to post on this board to help those applicants who want some advice. Who do you think you are to pass judgment on whose advice is worthy and whose is not?

 

[Iwy Em Hotep]

Once I got interviews, each program expressed that my IM background was a big asset and thought I would add a unique perspective to their program.

This is the impression that I also got after talking with faculty from different institutions. All other factors equal, an IM background may reduce the number of interviews you receive, but may improve your chances at each interview.

 

[pooch21]

*

 

[TeamDerm95]

I can only share from my experience. I matched into derm in my last year of IM residency training. I do feel there is a difference (and have been told by other dermatologists this is true) in someone applying while in another residency vs someone who has been out in practice for a period of time. Whether right or wrong, they are put in different categories when applying. So, that being said, my situation was different from that of the OP. However, funding was a big issue I encountered with many programs. For me, the hard part was getting interviews. Many programs excluded me because I had been through a prior residency (If you contact programs, they will be honest about this). Once I got interviews, each program expressed that my IM background was a big asset and thought I would add a unique perspective to their program. I received interviews at top tier and community based, smaller programs. I did absolutely no research (and had no pubs in IM either). However, I had some unique life experiences and had competitive board score (250+ Step 1). I also had to ask for LOR after only 2-3 weeks of working with academic dermatologist. This was all I was able to do. Of course, the question you will get asked is why dermatology after having completed IM, so have good answers for that. Anyway, this was my experience. This might not be the normal experience, but I wanted to share what I went through a few years ago. I knew there was a chance I would not match, but I was older and was not willing to go through a fellowship given my family situation. I still liked IM and saw derm as an extension of IM just like allergy or ID or rheum. I was content that if I didn't match, I could be happy in life and already had a pretty good job. I know our situations are a little different but I hope this might help in some way.

Hey so are you saying IM residency helped you get into a dermatology residency or are you saying the excluded you because you had done a residency before?

 

[username456789]

Hey so are you saying IM residency helped you get into a dermatology residency or are you saying the excluded you because you had done a residency before?

Not sure about that poster's experience, but I know that some programs flat out want interview if you're doing another residency already. Some seem to prefer these types.