Neither lifestyle nor pay were reasons I chose derm, but welcome bonuses for doing something I love. When choosing my specialty, I considered what I'm good at, what I'm interested in, what the patients are like, what my colleagues would be like, and the day-to-day activities. I'm a highly visual and hands-on person, so surgical/procedural specialties were always at the top of my list. I like making diagnoses that emphasize knowledge, experience, and physical exam without relying on lab tests or other doctors' interpretations all the time. In medicine, I felt like I was treating numbers and not a patient. In terms of patients, I wanted to work with all ages and all walks of life. People care a lot about their skin and are generally happy and compliant. The selling point for me was the people I met in derm, who were universally friendly, eager to teach, and ridiculously smart yet humble. I could go on and on, but this is just an overview.
Just like any field of medicine, there's a spectrum of disease. Simple atopic dermatitis (eczema), acne, and rashes can be treated by a PCP, however patients with more extensive or severe cases can be refractory to many treatments and require specialized knowledge of treatments beyond simple topical steroids. In addition, there is a ton of dermatoses, autoimmune and rheumatological conditions, drug reactions, malignancies, and more that most doctors have never even heard of. Sadly, I have seen cases where patients have been misdiagnosed by their PCP and were on incorrect medications for years before seeing a dermatologist and having their condition properly identified.
