Dermatology Resident: Ask Me Anything

[Rocky and Vohwinkel]

Currently a derm PGY-2. Dermatology is an amazing field, and one that many of you may not get much exposure to during undergrad and even medical school. I remember stressing about the MCAT/applying to medical school back in 2006 or so, and couldn't even imagine where I'd be 7 or 8 years down the line at that point.

I'm happy to answer your questions about the field, about my journey, or anything else! It really is as awesome as advertised.

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[Lya]

Thank you for doing this!

As an introduction, can you briefly describe your journey?
Why derm?
What type of personalities or people in general should consider derm as a potential specialty of interest?
How did you narrow down your specialties of interest?
How did you prepare yourself towards matching into derm?
Since derm is very competitive, did you have any backup plan in case of not getting matched into a desired program?
Any advice you wish you had when you were MS1?

 

[Rocky and Vohwinkel]

Thank you for doing this!

As an introduction, can you briefly describe your journey?
Why derm?
What type of personalities or people in general should consider derm as a potential specialty of interest?
How did you narrow down your specialties of interest?
How did you prepare yourself towards matching into derm?
Since derm is very competitive, did you have any backup plan in case of not getting matched into a desired program?
Any advice you wish you had when you were MS1?

1. Sure. I decided to pursue medical school while in the summer prior to my last year of undergrad. I was in a nontraditional major (econ) so I hadn't taken some of the prerequisites yet. I graduated but still needed a few other prereqs and had to take the MCAT, all of which I did in the year after graduation. Thankfully I had a half dozen or so medical school acceptances, and attended my state medical school.

I began medical school at the age of 25 (so maybe a tad older than some, but not by much). Had no idea what I wanted to do afterwards, and at that point was thinking maybe family medicine (my only real premed exposure) or something surgical. Either way, I figured trying to do my absolute best in medical school would be the way to go, as this would leave as many doors open as possible for me. The first two years of med school were trying, as I put almost all my free time into studying (well, studying and lifting, since I'm big into weightlifting). Eventually it paid off and I entered the clinical years with a solid foundation and essentially all doors still open. I did Surgery first in 3rd year since I was thinking Urology or Ortho, but was turned off by the personalities and the general day to day goings-on in surgical fields, so I started looking elsewhere. I had a friend who was a 4th year who was applying for Derm, and he recommended I shadow the Derm department during some free time, which I did. I loved it and never looked back!

I could go into more details about different steps, if there's anything of particular interest to you.

2. This is the question that everyone will be expected to answer on the interview trail for residency. For me, derm's appeal is its largely cerebral approach to things (don't let anyone ever tell you dermatology is easy), its combination of medical and procedural interventions, and the satisfaction of achieving visually apparent clinical improvement. In addition, the hours (once out of residency) aren't bad either.

3. Derm can theoretically attract all personality types, but it seems that the field is predominantly made of extremely intelligent, hard working individuals who can balance a ridiculous amount of detail/minutiae with the day to day interactions of all types of patients and their own outside non-vocational interests. I've met some of the most interesting people in this field, who are surely much smarter than me, who have achieved amazing things in completely different walks of life (archery champions, recording artists, elite athletes, etc). Simply put, Dermatology is a field for high achievers who are well-rounded and would like to retain these well-rounded interests for life.

4. I touched on this a bit earlier, but I sort of made a list of fields I didn't like as I went, and also noted things I did like (either a specific field, or a specific attribute of several fields such as the ability to perform procedures, the patient population in general, etc). Derm had what I was looking for ultimately, as it allows me to treat all ages, with a variety of medical and surgical interventions. The patients are usually somewhat healthy overall, and often very grateful for my help. This is often not the case in many fields.

5. The best thing you can do to prepare yourself for Derm or any competitive field is to do very well during the first two years of medical school. The P=MD philosophy will almost certainly not get you there. I went to a school with a modified grading system (Honors/High Pass/Pass/Fail, which is about the same as having an A/B/C/D/F and is what most schools do), but I suppose the very few true P/F schools would be an exception to this. You should want to learn any and all things presented to you in medical school, and of course strive for a high Step I score. The reality is that a low Step I score will very likely keep you from matching into Dermatology.

Additionally, being a nice and friendly person will get you very far in the third and fourth years, and this is what will help bolster your application. Doing away rotations is a great way to get to know a program, and to allow a program to get to know you and how awesome you are. They are key in the field of Dermatology, along with SOME kind of research (it doesn't have to be Derm related, although that helps). Those are the main points, and there are other details like trying to get letters of recommendation from well known people in the field that can help you.

Overall, I just tried to be the best at everything I did. That's not to say I WAS, but that kind of attitude is what got me where I am.

6. I honestly didn't have a real backup plan besides matching into a Prelim medicine year at an academic institution and then reapplying for derm as an intern. It was definitely a gamble, as it is for anyone applying for derm, and the decision to choose an entirely different backup field is a very personal one and has to be made by that individual. Some people would rather match into a less competitive field and live their life in a different specialty; others prefer to throw caution into the wind and go for broke.

7. As an M1, I wish I had kept a more open mind about all fields. For the majority of the first two years of med school, I was "surgery or bust." Once I got to third year, I realized it wasn't all it's cracked up to be, and wasn't at all what I wanted out of life. Shadowing a variety of fields is probably good advice for anyone, premed or medical students alike.

 

[colbgw02]

What is the airspeed velocity of an unladen swallow?

 

[anon12380]

1. Sure. I decided to pursue medical school while in the summer prior to my last year of undergrad. I was in a nontraditional major (econ) so I hadn't taken some of the prerequisites yet. I graduated but still needed a few other prereqs and had to take the MCAT, all of which I did in the year after graduation. Thankfully I had a half dozen or so medical school acceptances, and attended my state medical school.

I began medical school at the age of 25 (so maybe a tad older than some, but not by much). Had no idea what I wanted to do afterwards, and at that point was thinking maybe family medicine (my only real premed exposure) or something surgical. Either way, I figured trying to do my absolute best in medical school would be the way to go, as this would leave as many doors open as possible for me. The first two years of med school were trying, as I put almost all my free time into studying (well, studying and lifting, since I'm big into weightlifting). Eventually it paid off and I entered the clinical years with a solid foundation and essentially all doors still open. I did Surgery first in 3rd year since I was thinking Urology or Ortho, but was turned off by the personalities and the general day to day goings-on in surgical fields, so I started looking elsewhere. I had a friend who was a 4th year who was applying for Derm, and he recommended I shadow the Derm department during some free time, which I did. I loved it and never looked back!

I could go into more details about different steps, if there's anything of particular interest to you.

2. This is the question that everyone will be expected to answer on the interview trail for residency. For me, derm's appeal is its largely cerebral approach to things (don't let anyone ever tell you dermatology is easy), its combination of medical and procedural interventions, and the satisfaction of achieving visually apparent clinical improvement. In addition, the hours (once out of residency) aren't bad either.

3. Derm can theoretically attract all personality types, but it seems that the field is predominantly made of extremely intelligent, hard working individuals who can balance a ridiculous amount of detail/minutiae with the day to day interactions of all types of patients and their own outside non-vocational interests. I've met some of the most interesting people in this field, who are surely much smarter than me, who have achieved amazing things in completely different walks of life (archery champions, recording artists, elite athletes, etc). Simply put, Dermatology is a field for high achievers who are well-rounded and would like to retain these well-rounded interests for life.

4. I touched on this a bit earlier, but I sort of made a list of fields I didn't like as I went, and also noted things I did like (either a specific field, or a specific attribute of several fields such as the ability to perform procedures, the patient population in general, etc). Derm had what I was looking for ultimately, as it allows me to treat all ages, with a variety of medical and surgical interventions. The patients are usually somewhat healthy overall, and often very grateful for my help. This is often not the case in many fields.

5.

Thanks for doing this!

I was wondering if you could expand upon your negative experiences with your surgery rotations--what exactly turned you off about surgery? In addition, what are the work hours like for derm--I have always been under the impression it is one of the least stressful areas of specialty.

 

[Rocky and Vohwinkel]

What is the airspeed velocity of an unladen swallow?

African or European?

 

[Rocky and Vohwinkel]

Thanks for doing this!

I was wondering if you could expand upon your negative experiences with your surgery rotations--what exactly turned you off about surgery? In addition, what are the work hours like for derm--I have always been under the impression it is one of the least stressful areas of specialty.

It was just the general day to day process. Get up super early as a medical student/resident (and still very early as an attending), round on a bunch of patients very quickly, and then head to the OR for sometimes short and sometimes LOOOOOOOONG surgeries. I guess what bothered me the most was the constant uncertainty. At least as a student, you never knew how long a procedure would last (even some simpler/standard surgeries you figured would be 1-2 hours could often have complications and end up 4-5 hours long). I was a varsity athlete and big into weightlifting/bodybuilding, so never knowing when I was going to get my next meal in, or not knowing when I would be able to make time for the gym was a big detractor, as silly as that sounds. Additionally, although some of the people were truly awesome, there were enough grating personalities that are inherent to the field that it just became a bit tiring to deal with them.

As a derm resident, my clinic hours are 9-5, Mon-Friday (but one half day is reserved for reading/studying), with didactics every morning from 7:30-9. However, the amount of reading outside of clinic is mind-boggling. There's a reason Derm has such high Step I/II cutoffs: the board exam is an absurd exercise in minutiae. 99.9% of what you learn in dermatology residency is completely new to you, and it's like being a first/second year medical student all over again, but with no time to study during the day because you're in clinic seeing patients. The first 6 months especially is an extremely steep learning curve.

That said, it's still better than being stuck in the hospital rounding forever. And the more advanced you get in your training, the better it is since you obviously know a lot more.

As an attending, your schedule can be what you want to make it, and it'll vary a bit between academics and private practice. Our attendings have 1-2 "academic" days where they can do research or get caught up on work, have 1-2 days of their own patients in clinic, and then 1-2 days of precepting residents in clinic. Many private practitioners will work some variation of an 8-4 or 9-5 schedule M-F, but you're often able to work a bit less if you'd like (3.5-4 day a week, with salary scaled accordingly).

 

[NontradCA]

What is so special about Derm that it needs the best and brightest in its numbers? I am asking from a place of ignorance honestly; I tend to think that Derm is one of those specialties that the layman has very little knowledge of what actually goes down.

 

[Rocky and Vohwinkel]

What is so special about Derm that it needs the best and brightest in its numbers? I am asking from a place of ignorance honestly; I tend to think that Derm is one of those specialties that the layman has very little knowledge of what actually goes down.

Honestly part of it is the fact that the body of knowledge required for passing the board exam after "only" 3 years of residency/study is pretty ridiculous. And that's somewhat self-imposed by the field itself, but you'd be surprised how maybe 5-10% of what you'll actually see in practice consists of literally thousands of bizarre and esoteric genetic and otherwise rare conditions/syndromes. Imagine slogging through 4 years of medical school and a year of internship, then showing up and realizing you pretty much know NOTHING required for your chosen field. This occurs with some other very specialized fields like Ophtho as well.

Other than that, sure Dermatology is actually a very complex field (there are mucocutaneous findings associated with nearly every disease known to man it seems, and often we can be one of the first people to help make a diagnosis of a more extensive systemic condition). Much of what we do may be pattern recognition, but there is a very large component of critical thinking inherent to any field of medicine.

 

[TheWeeIceMan]

How does it feel to have reached the holy grail of medical specialties?

Off topic, but I just looked a the Medscape survey for derm and it shows that only 37% of dermatologists would choose medicine again. What's up with that? I would think derm would have a pretty high job satisfaction rate.

 

[NontradCA]

Honestly part of it is the fact that the body of knowledge required for passing the board exam after "only" 3 years of residency/study is pretty ridiculous. And that's somewhat self-imposed by the field itself, but you'd be surprised how maybe 5-10% of what you'll actually see in practice consists of literally thousands of bizarre and esoteric genetic and otherwise rare conditions/syndromes. Imagine slogging through 4 years of medical school and a year of internship, then showing up and realizing you pretty much know NOTHING required for your chosen field. This occurs with some other very specialized fields like Ophtho as well.

Other than that, sure Dermatology is actually a very complex field (there are mucocutaneous findings associated with nearly every disease known to man it seems, and often we can be one of the first people to help make a diagnosis of a more extensive systemic condition). Much of what we do may be pattern recognition, but there is a very large component of critical thinking inherent to any field of medicine.

Gotcha. Thanks for answering and for the thread.

 

[Rocky and Vohwinkel]

How does it feel to have reached the holy grail of medical specialties?

Off topic, but I just looked a the Medscape survey for derm and it shows that only 37% of dermatologists would choose medicine again. What's up with that? I would think derm would have a pretty high job satisfaction rate.

Haha, I don't know about "holy grail", but I certainly consider it to be the best field.

Those surveys are silly and have a low response rate. The one from the year prior showed that 52% would choose medicine again, and the year before that 76% in 2011. The truth is surely somewhere in the middle, and I doubt even with the most recent reforms in healthcare that there has been a drastic decrease in satisfaction within 2 years. All the attendings I work with love their jobs and consider themselves extremely fortunate to be in the field.

 

[Bruits]

Do you think the prestige of your medical school played any role in your eventual residency match? Thanks for answering our questions.

 

[Rocky and Vohwinkel]

Do you think the prestige of your medical school played any role in your eventual residency match? Thanks for answering our questions.

I went to a good but not great state medical school (as far as national reputations go). It's certainly possible that a more "prestigious" med school may have opened a few more doors as far as residencies at the premier research-driven dermatology residency programs, but much more so I think it's related to your own achievements. Performing well in school and on board exams, and involving yourself in research is going to be the way to get into Derm, regardless of where you go to school. I ended up with 16 derm residency interviews, which is more than I ever hoped for. The high profile "research heavy" programs like MGH, NYU, and UCSF didn't offer me an interview, but I don't think I'd be happy there either.

I actually think even more than considering a med school's reputation for residency matching, you should consider whether your medical school has that particular residency program. In a field like Derm, which is certainly not present at all schools, that can matter, as your access to research and faculty in the field will be limited if you don't have a home derm program.

 

[Jimsy]

What do you think was the key to your success in medical school? Any advice for incoming medical students?

 

[Distinct]

What was your Step 1 score? Did you enter medical school directly after undergrad or did you take some time off to pursue a master's degree or something?

 

[Rocky and Vohwinkel]

What do you think was the key to your success in medical school? Any advice for incoming medical students?

I found out early what worked for me studying-wise, and stuck with it. Unfortunately, what works for me is basically re-writing all the notes we were given in order to make one unifying notebook (or series of binders) with the relevant information I needed to study for exams. This is VERY time consuming and probably not for everyone. But the two years of doing this was absolutely worth it in the end.

My advice is to hit the ground running, and realize that everyone learns differently and has a different background. For me, as an Econ major, I took no biochemistry courses and when we got to the biochem/genetics portion of first year of med school, I realized I needed to not only study what they gave us, but brush up a bit on more basic stuff at an undergrad level. REALIZING YOUR WEAKNESSES is key, but it's what you do about that that matters most. I absolutely hated biochem/genetics/molecular bio in medical school because it scared me, so instead I went and dominated it to make it a strength instead of a weakness. I felt like I worked extra long hours during that block, but it helped me tremendously.

 

[Jimsy]

Which was the harder test for you: mcat or step 1?

Did you do any research in medical school?

 

[Rocky and Vohwinkel]

What was your Step 1 score? Did you enter medical school directly after undergrad or did you take some time off to pursue a master's degree or something?

262.

Took two years off mostly just because I decided late on applying to medical school and had to still take prereqs after graduating. I worked at Pep Boys during those two years, believe it or not.

 

[Rocky and Vohwinkel]

Which was the harder test for you: mcat or step 1?

Did you do any research in medical school?

Step I tests infinitely more volume, but the curriculum is fairly standardized among most medical schools so I knew I was going to be prepared. For the MCAT, I sort of took the prereqs at different times (by the time I took the MCAT, my bio classes were ~5 years behind me) so a lot of it was studying on my own after already out of undergrad, trying to figure out what I needed to know. I used ExamKrackers (audio and books) and had SDN help guide me, but there was still a lot of uncertainty for me while studying for that.

I will say, though, that at least with the MCAT you know you can retake. With Step I, as long as you pass, you're stuck with that score and it may help or hurt your chances at your future profession.

 

[Acosi]

Thank you very much for doing this.

I believe you mentioned you had half a dozen acceptances - what do you wish you considered more when you chose which school to attend? What advice would you give someone trying to match into a competitive specialty like derm who is considering a less prestigious state school (still top 50 US News) and much more prestigious private schools? Is there a "line" that separates when prestige should start to matter more in your decision (ie think carefully about attending a school known for being less prestigious)?

Currently a derm PGY-2. Dermatology is an amazing field, and one that many of you may not get much exposure to during undergrad and even medical school. I remember stressing about the MCAT/applying to medical school back in 2006 or so, and couldn't even imagine where I'd be 7 or 8 years down the line at that point.

I'm happy to answer your questions about the field, about my journey, or anything else! It really is as awesome as advertised.

 

[karayaa]

2. This is the question that everyone will be expected to answer on the interview trail for residency. For me, derm's appeal is its largely cerebral approach to things (don't let anyone ever tell you dermatology is easy), its combination of medical and procedural interventions, and the satisfaction of achieving visually apparent clinical improvement. In addition, the hours (once out of residency) aren't bad either.

3. Derm can theoretically attract all personality types, but it seems that the field is predominantly made of extremely intelligent, hard working individuals who can balance a ridiculous amount of detail/minutiae with the day to day interactions of all types of patients and their own outside non-vocational interests. I've met some of the most interesting people in this field, who are surely much smarter than me, who have achieved amazing things in completely different walks of life (archery champions, recording artists, elite athletes, etc). Simply put, Dermatology is a field for high achievers who are well-rounded and would like to retain these well-rounded interests for life.

a. How is derm different than gyn (@gyngyn?) or urology or other med/surg specialities?
b. Is derm cerebral in the same way as ID or hematology? Would you call it a "cognitive" speciality?
c. Where do you see yourself practicing in the future (academic vs private practice vs HMO vs doctor's groups)?
d. Do most dermatologists go into cosmetics (maybe even cash-only)? Why do you think that is? Does it falsely inflate the average incomes?

Thanks for doing this!

 

[Fedxup]

When did you do research in med school? For how long? How many pubs?

It is amazing that your hours are pretty much set for your resident years :O

 

[SunsFun]

When did you do research in med school? For how long? How many pubs?

It is amazing that your hours are pretty much set for your resident years :O

I also wanna ask about research. Did you do any research before medical school? What was it about? Was your research in medical school derm-related? What do you think premeds need to know about research to have an opportunity to match into competitive specialty?

 

[SunsFun]

How is the job market for new derm attending?

It you wanna be in a big city (NYC, LA, Chicago, SF) what opportunities are available? Can you easily find a private practice to join? Are hospital jobs available? How easy would it be to start your own practice? What salary would someone be looking at realistically?

How about smaller cities like Boston, Philly, Vegas, Phoenix, Dallas, Houston?

Thanks for doing this.

 

[Rocky and Vohwinkel]

Thank you very much for doing this.

I believe you mentioned you had half a dozen acceptances - what do you wish you considered more when you chose which school to attend? What advice would you give someone trying to match into a competitive specialty like derm who is considering a less prestigious state school (still top 50 US News) and much more prestigious private schools? Is there a "line" that separates when prestige should start to matter more in your decision (ie think carefully about attending a school known for being less prestigious)?

I think it can be difficult to answer this because everyone's idea of "prestige" differs a bit. The US News rankings are largely based on research funding and such, although there are general trends that would be consistent regardless of most definitions of "prestige." As a premedical student, had I applied to/been accepted to a school like Harvard, I may have gone simply due to the name; however, looking back, it was much more important that I found a school that had a schedule that allowed me to study on my own (no mandatory class attendance), supplied online videotaped lectures, and afforded students opportunities to get involved with research without shoving research down our throats.

Aside from all that, cost should definitely be a consideration. The difference between graduating with $100k of debt and graduating with $350k of debt is huge!

 

[The Buff OP]

I was a varsity athlete and big into weightlifting/bodybuilding, so never knowing when I was going to get my next meal in, or not knowing when I would be able to make time for the gym was a big detractor, as silly as that sounds.

I know that feeling.

 

[csx]

I know that feeling.

couldn't tell

 

[Rocky and Vohwinkel]

a. How is derm different than gyn (@gyngyn?) or urology or other med/surg specialities?
b. Is derm cerebral in the same way as ID or hematology? Would you call it a "cognitive" speciality?
c. Where do you see yourself practicing in the future (academic vs private practice vs HMO vs doctor's groups)?
d. Do most dermatologists go into cosmetics (maybe even cash-only)? Why do you think that is? Does it falsely inflate the average incomes?

Thanks for doing this!

1. They are extremely different! All of the med/surg subspecialties tend to involve dedicated OR time/days (and some are predominantly OR). OB/Gyn does mix medicine and surgery, but the patient population is VERY different and extremely specific. The personalities in that field tend to be a turn off to me too, but that's of course a personal opinion. The other specialties like Urology are hospital/OR-based specialties mostly, and your clinic days are mostly seeing post-op patients or drumming up future operating cases. In Derm, the procedures are usually less extensive (unless you're a Mohs surgeon) and you can go from one room where you diagnose and treat a complex medical/derm condition like systemic lupus erythematosus to the very next room where you perform an excisional biopsy on a suspected melanoma.

2. I guess using terms like "cerebral" and "cognitive" to differentiate specialties is a bit disingenuous. All fields of medicine/surgery are very cerebral. What I think tends to be unique to Dermatology (but likely has analogs in other fields) is the sort of detective work that often goes into diagnosing patients. Aside from biopsies/pathology reports, there are very few lab studies or tests that we heavily rely on to make a diagnosis. Much of it is very thorough clinical examination, and piecing together the various subtle clues (almost imperceptible pitting of the nails, buccal mucosa cobblestoning) to formulate a diagnosis that fits with the various puzzle pieces. It's extremely rewarding.

3. At this time, I plan on doing academics, but that may change.

4. Most dermatologists do not "go into cosmetics", but many end up incorporating a little bit (maybe 5-20% of total patients) into regular practice. You almost have to; patients will come to see you with the expectation that you can provide that service.

 

[Rocky and Vohwinkel]

When did you do research in med school? For how long? How many pubs?

It is amazing that your hours are pretty much set for your resident years :O

I did research the summer between M1/M2 and got two pubs out of it. Did a little derm research at the end of M3 but no pubs there.

Many people do more research than I did, though.

 

[Rocky and Vohwinkel]

I also wanna ask about research. Did you do any research before medical school? What was it about? Was your research in medical school derm-related? What do you think premeds need to know about research to have an opportunity to match into competitive specialty?

I actually had zero research before medical school. My medical school research was mostly non-derm related, but I got two pubs from it and derm programs liked that I had produced.

I thin premeds need to realize that they don't NEED research for many fields, but for many of the more competitive fields is almost necessary, and for less competitive fields it can still make you a more attractive candidate. Also, it doesn't need to be in your chosen field, although that never hurts.

 

[Rocky and Vohwinkel]

How is the job market for new derm attending?

It you wanna be in a big city (NYC, LA, Chicago, SF) what opportunities are available? Can you easily find a private practice to join? Are hospital jobs available? How easy would it be to start your own practice? What salary would someone be looking at realistically?

How about smaller cities like Boston, Philly, Vegas, Phoenix, Dallas, Houston?

Thanks for doing this.

The job market is pretty good in most regions, from what I know. I could answer this better as a PGY-4 I'm sure. The opportunities for private practice are more abundant than academic, just based on sheer availability. Compensation is anywhere from 20-40% better in private practice, depending on your source. Even as a PGY-2, I occasionally get emails about job listings for dermatologists in various areas for anywhere from $280k/year to $430k/year. There are lots of variables involved, like built in incentives, area of the country, etc. Just like any field, it's very difficult these days to start your own practice from the ground up.

As with any specialty, demand and salary will decrease in large cities that are saturated. Many smaller cities too. This is probably less of problem with Derm than some other specialties that train a higher number of people yearly, but it's still an issue.

 

[karayaa]

1. They are extremely different! All of the med/surg subspecialties tend to involve dedicated OR time/days (and some are predominantly OR). OB/Gyn does mix medicine and surgery, but the patient population is VERY different and extremely specific. The personalities in that field tend to be a turn off to me too, but that's of course a personal opinion. The other specialties like Urology are hospital/OR-based specialties mostly, and your clinic days are mostly seeing post-op patients or drumming up future operating cases. In Derm, the procedures are usually less extensive (unless you're a Mohs surgeon) and you can go from one room where you diagnose and treat a complex medical/derm condition like systemic lupus erythematosus to the very next room where you perform an excisional biopsy on a suspected melanoma.

2. I guess using terms like "cerebral" and "cognitive" to differentiate specialties is a bit disingenuous. All fields of medicine/surgery are very cerebral. What I think tends to be unique to Dermatology (but likely has analogs in other fields) is the sort of detective work that often goes into diagnosing patients. Aside from biopsies/pathology reports, there are very few lab studies or tests that we heavily rely on to make a diagnosis. Much of it is very thorough clinical examination, and piecing together the various subtle clues (almost imperceptible pitting of the nails, buccal mucosa cobblestoning) to formulate a diagnosis that fits with the various puzzle pieces. It's extremely rewarding.

3. At this time, I plan on doing academics, but that may change.

4. Most dermatologists do not "go into cosmetics", but many end up incorporating a little bit (maybe 5-20% of total patients) into regular practice. You almost have to; patients will come to see you with the expectation that you can provide that service.

Thanks! This thread is super informative. Like you said, derm is not as well known as other specialities.

Do patients seem vain or impossible to please/unrealistic expectations? Does that bother you? How do you deal with it?

 

[Rocky and Vohwinkel]

Thanks! This thread is super informative. Like you said, derm is not as well known as other specialities.

Do patients seem vain or impossible to please/unrealistic expectations? Does that bother you? How do you deal with it?

Man it varies so wildly. I am resident in a large urban tertiary care center, so many of my patients have complex disease with significant quality of life issues. Working wih those patients make the job extremely rewarding. We have a suburban satellite office I staff once a week, and the patients are a mix of the aforementioned complicated medical derm patients and people whose two acneiform papules or chin wrinkles are absolutely RUINING their lives. Those encounters can sometimes be challenging. Yesterday I had a 36 year old woman whose mother accompanied her to the visit "for moral support" (her words, not mine) because of a small solar lentigo (sun spot) on her left cheek that is a cosmetic nightmare for her.

Sure it can be bothersome, but I just try to keep things in perspective and realize that everyone is affected differently by certain things, and one person's values may differ greatly from mine. I just feel fortunate that I am in the position to be able to educate and treat these patients, and hopefully have a very positive impact on their quality of life and their health/well-being.

 

[Elevencents]

Are you required to be involved in a lot of research in residency and beyond?

Love seeing these specialty threads. Thank you.

 

[SN12357]

Thanks for answering these questions! Very interesting AMA. My question: In my city (and I know this is not unique) there is often a 6 month waiting list for a standard, non-emergency derm appointment. I find this to be completely ridiculous--yes, many derm problems are not emergencies, but that doesn't mean they can or should go 6 months before treatment. And, from what I can tell, the private practice dermatologists seem to have really cushy hours that leave a lot of need unmet.

Why is this? Do you think there is a solution for it? In my less generous moments I think that the solution would be to compensate dermatologists less so that they would have to work more...but I am open to the idea there is something in the system I am not seeing.

 

[Lucca]

Thanks for contributing!

Although I've rotated through a hospital I've never had the opportunity to shadow a derm, so I'm learning a lot here.

@Rocky and Vohwinkel

What types of fellowships and career paths are open to derms? I'm not asking about academic vs. private really but I'm more wondering as to how derms further specialize down the road or what kind of environments they can work in.

 

[mybubbles627]

Thanks for the information! This is super helpful.

You mentioned getting a 262 on Step I which is AMAZING! What scores are expected to have a realistic change at a dermatology residency?
Also, you said they do a lot of procedures. The only procedures I can think of are biopsies. Can you elaborate what else is done?

Thanks again!

 

[Rocky and Vohwinkel]

Are you required to be involved in a lot of research in residency and beyond?

Love seeing these specialty threads. Thank you.

You're generally expected to participate in some research in residency, and the amount and intensity will vary from program to program. If you go into academics, research will be a part of your job for sure, but not a requirement for private practice.

 

[Rocky and Vohwinkel]

Thanks for answering these questions! Very interesting AMA. My question: In my city (and I know this is not unique) there is often a 6 month waiting list for a standard, non-emergency derm appointment. I find this to be completely ridiculous--yes, many derm problems are not emergencies, but that doesn't mean they can or should go 6 months before treatment. And, from what I can tell, the private practice dermatologists seem to have really cushy hours that leave a lot of need unmet.

Why is this? Do you think there is a solution for it? In my less generous moments I think that the solution would be to compensate dermatologists less so that they would have to work more...but I am open to the idea there is something in the system I am not seeing.

To be fair, private practice dermatologist hours are usually not that different than other outpatient specialties. The main difference in lifestyle lies in the fewer emergent conditions you will be contacted about after hours. Some dermatologists do choose to work fewer than 5 days a week, and their pay is decreased accordingly; this is true in many other fields as well.

I think compensating anyone less with the expectation that they would have to "work more" is a terrible solution to any problem, regardless of the field. A true solution would be to significantly increase the number of dermatologists trained each year to increase the number of available dermatologists, but that seems unlikely anytime soon.

Medicine (as a profession en masse) suffers from the silly idea that we physicians should be devoting our every waking hour to our profession. The solution shouldn't be to make anyone's lives more difficult, but rather to improve the quality of life for our other colleagues. I think family practitioners should be paid more than they often are, but not at the expense of other physicians' salaries.

Anyway, I'm getting off course. It's a supply and demand issue, and the "cushy schedule" isn't really to blame. Much of the "cushiness" lies in the fact that a Dermatologist is more likely to be able to enjoy his or her life away from the office, but the hours spent in the office often do not differ significantly from other fields.

 

[Rocky and Vohwinkel]

Thanks for contributing!

Although I've rotated through a hospital I've never had the opportunity to shadow a derm, so I'm learning a lot here.

@Rocky and Vohwinkel

What types of fellowships and career paths are open to derms? I'm not asking about academic vs. private really but I'm more wondering as to how derms further specialize down the road or what kind of environments they can work in.

There are 3 board certified types of fellowships available: Mohs Surgery, Dermatopathology, and Pediatric Dermatology. There are 1 year fellowships.

There are other non-boarding fellowships in areas like Rheum-Derm, Lasers/Phototherapy, Complex Medical Derm, etc.

Mohs surgeons can work in an academic or private practice setting. Same for Dermpath. Pediatric dermatologists most often work in academic centers.

 

[Rocky and Vohwinkel]

Thanks for the information! This is super helpful.

You mentioned getting a 262 on Step I which is AMAZING! What scores are expected to have a realistic change at a dermatology residency?
Also, you said they do a lot of procedures. The only procedures I can think of are biopsies. Can you elaborate what else is done?

Thanks again!

Thanks, a lot of hard hard work went into that score.

The general gestalt among derm applicants is that a 240+ should put you in the running for most programs. That's not to say you can't get in with something lower, but as your score decreases, your insane awesomeness elsewhere better be increasing. Often times the people who match with scores in the 220-230 range tend to have extenuating circumstances elsewhere (year-long research fellowship at the program where they the matched, significant research elsewhere/a PhD, amazing back story, etc).

I'd generally shoot for >240. I heard of one program in California that recently decided to screen using 260(!) as a cutoff, just because they can.

As far as procedures go, there are a variety of skin biopsy types (shave/punch/excisional), but that's not all we do. Nail biopsies, actual excisions of skin cancer (BCC, SCC, melanoma, various rare tumors), cyst or lipoma excisions, botox injections for axillary or palmoplantar hyperhidrosis, electrodessication and curettage for superficial skin cancers, are just some of the other things I do on a weekly basis. We also can perform cosmetic procedures like botox injections for rhytides, hair transplants, fillers, chemical peels, venous sclerotherapy, and we can play with lasers.

There's also Mohs surgery, which is a whole different entity itself.

 

[karayaa]

Any thoughts on how the ACA will affect derm?

 

[SN12357]

To be fair, private practice dermatologist hours are usually not that different than other outpatient specialties. The main difference in lifestyle lies in the fewer emergent conditions you will be contacted about after hours. Some dermatologists do choose to work fewer than 5 days a week, and their pay is decreased accordingly; this is true in many other fields as well.

I think compensating anyone less with the expectation that they would have to "work more" is a terrible solution to any problem, regardless of the field. A true solution would be to significantly increase the number of dermatologists trained each year to increase the number of available dermatologists, but that seems unlikely anytime soon.

Medicine (as a profession en masse) suffers from the silly idea that we physicians should be devoting our every waking hour to our profession. The solution shouldn't be to make anyone's lives more difficult, but rather to improve the quality of life for our other colleagues. I think family practitioners should be paid more than they often are, but not at the expense of other physicians' salaries.

Anyway, I'm getting off course. It's a supply and demand issue, and the "cushy schedule" isn't really to blame. Much of the "cushiness" lies in the fact that a Dermatologist is more likely to be able to enjoy his or her life away from the office, but the hours spent in the office often do not differ significantly from other fields.

So if the issue is that there just aren't enough dermatologists, is there a solution to the shortage of supply given that residency slots aren't going to be increasing anytime soon? Is there a large enough portion of what you do that could be taken over by midlevels, with MDs just concentrating on rarer/more complicated things?

 

[Aromatic N]

Thank you for hosting this AMA

What are the prospects for pursuing dermatology for someone who is colorblind? I have a moderate form of protanomaly and am unsure of how this would impair my ability to practice in the field, or if it is looked down upon/expected to be disclosed.

 

[TheWeeIceMan]

Even though derm has a reputation for having some of the better residency hours, I've heard you guys have a pretty intense expectation of outside studying. How many hours a week would you say you spend studying outside of your normal work hours?

Also, any plans for a fun purchase when you get that first attending paycheck?

 

[Rocky and Vohwinkel]

Any thoughts on how the ACA will affect derm?

Like all specialties, it will require us to work harder for less compensation. Independent of ACA specifically, reimbursements for lots of things are being slashed, not just in Dermatology though. I honestly am unsure at this point how badly we will be affected versus most other specialties.

 

[Rocky and Vohwinkel]

So if the issue is that there just aren't enough dermatologists, is there a solution to the shortage of supply given that residency slots aren't going to be increasing anytime soon? Is there a large enough portion of what you do that could be taken over by midlevels, with MDs just concentrating on rarer/more complicated things?

Tough to say, really. A lot of Dermatologists do employ PA/NPs with them to help lighten the load (especially for the yearly skin checks for low risk people who never had a skin cancer). To what degree this can alleviate the access issues - and how likely or unlikely Dermatologists as a group will allow this to occur - is difficult for me to predict. Sorry.

 

[Rocky and Vohwinkel]

Thank you for hosting this AMA

What are the prospects for pursuing dermatology for someone who is colorblind? I have a moderate form of protanomaly and am unsure of how this would impair my ability to practice in the field, or if it is looked down upon/expected to be disclosed.

The biggest hurdle for a colorblind person in dermatology is probably reading pathology slides and learning dermpath. The degree to which your colorblindness affects you clinically is hard to say. For many conditions, differentiating/discerning color can help but is not absolutely necessary for diagnosis; some conditions will likely require this ability, however.

I do not know of anyone in derm who is colorblind, but I imagine you wouldn't be the first. It may be a bit of an uphill battle, though.

 

[Rocky and Vohwinkel]

Even though derm has a reputation for having some of the better residency hours, I've heard you guys have a pretty intense expectation of outside studying. How many hours a week would you say you spend studying outside of your normal work hours?

Also, any plans for a fun purchase when you get that first attending paycheck?

For me, it's kind of like being a medical student again. I get home from clinic and after a short period of down time, I hit the books until I go to bed more or less (with a break for dinner, or the gym). There's also lots of outside work preparing presentations for grand rounds and doing research stuff on top of all that. My weekends are usually filled with studying, although I do occasionally get to watch a football game or two while making flash cards or something, and often get to the gym once or twice on the weekend.

If I had to estimate, I'd say close to 40 hours per week outside of work that I am studying/reading/doing work.

That first attending paycheck (and many of the subsequent ones) is gonna go straight towards paying off my loans. I'm sure I'll come up with something more frivolous as well.