Dermatopath

[pollyanna]

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Can a dermatopathologist enter the clinical field of dermatology after residency, possibly specializing in cutaneous oncology? Could they do MOHS surgery if they became certified?

 

[LADoc00]

Can a dermatopathologist enter the clinical field of dermatology after residency, possibly specializing in cutaneous oncology? Could they do MOHS surgery if they became certified?

You can enter any field you want and you dont need residency. Read the business practice and professional codes of the state you want to practice in.

>>>Did you know the most prolific interventional cardiologist in the whole state of California until recently never even did a residency? He did his internship at an Army base and his medical school in Mexico. Before he was busted on billing fraud, he practiced for the better part of 15 years based on weekend clinical seminars he took and made millions.
Interesting little factoid.

If you are asking whether a pathologist who is subspecialized in derm will GET PAID by someone to do MOHS, the answer is no.

So yes you CAN theoretically do anything you want. Can I do a pathology residency and practice in vitro? Yes I can, heck I would love to do that (pure $$$), the problem is no one would pay me to do so.

 

[ny skindoc]

The focus of a dermpath fellowship is on becoming an expert on the histopathology of the skin.There is minimal direct patient contact.Someone who enters this field through a pathology residency is not trained to practice clinical dermatology.As stated above you can do whatever you want,if you feel competent and can obtain appropriate liability coverage.MOHS is a fellowship in itself with a derm residency as a prerequisite.It is of course possible for a pathologist who has completed a dermpath fellowship to enter a derm residency,but I have rarely seen this done.

 

[LADoc00]

The focus of a dermpath fellowship is on becoming an expert on the histopathology of the skin.There is minimal direct patient contact.Someone who enters this field through a pathology residency is not trained to practice clinical dermatology.Dermatlogists who complete dermpath fellowship may combine both.MOHS is a fellowship in itself with a derm residency as a prerequisite.It is of course possible for a pathologist who has completed a dermpath fellowship to enter a derm residency,but I have rarely seen this done.

That statement is actually quite false. See the ABP guidelines on becoming board certified in DP. AP/CP pathologists are required to have significant patient contact and clinic responsibilities. You WILL see MOHS in a DP fellow as a pathologist there is no question of that. The question is whether you will be considered competent to perform MOHS after. My opinion if you work at it, spend time learning it, you sure as heck should be able to do it! Why not?

Let me give you a five second rant: Derm is easy, heck its beyond easy, lets not kid ourselves, almost anyone can work through the algorithmic approach taught in derm programs to get to the right steriod treatment, this isnt the resection of acoustic neuroma or diagnosing metastatic carcinoma on frozen section-level of medical care. NP and PAs can do, almost anyone can. Therein lies the "derm dilemmia."

 

[ny skindoc]

That statement is actually quite false. See the ABP guidelines on becoming board certified in DP. AP/CP pathologists are required to have significant patient contact and clinic responsibilities. You WILL see MOHS in a DP fellow as a pathologist there is no question of that. The question is whether you will be considered competent to perform MOHS after. My opinion if you work at it, spend time learning it, you sure as heck should be able to do it! Why not?

Let me give you a five second rant: Derm is easy, heck its beyond easy, lets not kid ourselves, almost anyone can work through the algorithmic approach taught in derm programs to get to the right steriod treatment, this isnt the resection of acoustic neuroma or diagnosing metastatic carcinoma on frozen section-level of medical care. NP and PAs can do, almost anyone can. Therein lies the "derm dilemmia."

I was attempting to respond to the ambiguous question posed here,which I understood to be would a dermatopathologist be able to practice as a clinical specialist in "cutaneous oncology" or possibly"MOHS surgery" by virtue of this fellowship.My answer was accurate.Dermpath fellows spend some time in derm clinics but this is not the focus or purpose of their training, if they had such an interest they could no doubt arrange things to learn much clinical dermatology and practice however they chose.If they want to promote themselves as experts in treating patients needing such attention is a question I'll leave to them and their lawyers.

 

[yaah]

I had heard, and correct me if I'm wrong, that pathologists who undertake a dermpath fellowship must do significant derm clinical work as a component - like up to 6 months! If you come at it from a derm background, you don't need to do all this clinical time because you've already done it.

 

[pollyanna]

Thanks everyone for their input, albeit a little controversial. 🙄 I have heard that the above post is true.

 

[tsj]

You can enter any field you want and you dont need residency. Read the business practice and professional codes of the state you want to practice in.

>>>Did you know the most prolific interventional cardiologist in the whole state of California until recently never even did a residency? He did his internship at an Army base and his medical school in Mexico. Before he was busted on billing fraud, he practiced for the better part of 15 years based on weekend clinical seminars he took and made millions.
Interesting little factoid.

If you are asking whether a pathologist who is subspecialized in derm will GET PAID by someone to do MOHS, the answer is no.

So yes you CAN theoretically do anything you want. Can I do a pathology residency and practice in vitro? Yes I can, heck I would love to do that (pure $$$), the problem is no one would pay me to do so.

If you would love to do that, why didn't you go into it instead of path? Or radiology, you seem quite fond of that also.

 

[yaah]

Why would anyone want to see patients if they didn't have to? They whine, complain, and only thank you half the time. Your derm path "patient" is often seen, treated, and diagnosed in 30 seconds (and that includes dictating the diagnosis).

There are plenty of "doctors" in other countries who practice medicine without real licenses (or counterfeit licenses). They give saline injections as miracle cures or something.

Sort of kidding...I know some people like treating patients. I liked some of them too, but I prefer where I am now more.

 

[ny skindoc]

Why would anyone want to see patients if they didn't have to? They whine, complain, and only thank you half the time. Your derm path "patient" is often seen, treated, and diagnosed in 30 seconds (and that includes dictating the diagnosis).

There are plenty of "doctors" in other countries who practice medicine without real licenses (or counterfeit licenses). They give saline injections as miracle cures or something.

Sort of kidding...I know some people like treating patients. I liked some of them too, but I prefer where I am now more.

I'd have to agree with this! With all the hassels of direct patient management(regardless of the specialty) if one had the opportunity to do dermpath full time I'd run with it and not think twice.

 

[LADoc00]

If you would love to do that, why didn't you go into it instead of path? Or radiology, you seem quite fond of that also.

I explained why...damn, are you sure you dont get to med school on the short bus?

 

[pathdawg]

Let me give you a five second rant: Derm is easy, heck its beyond easy, lets not kid ourselves, almost anyone can work through the algorithmic approach taught in derm programs to get to the right steriod treatment, this isnt the resection of acoustic neuroma or diagnosing metastatic carcinoma on frozen section-level of medical care. NP and PAs can do, almost anyone can. Therein lies the "derm dilemmia."

That is unbelievably ignorant. Its amazing that the less you know about a subject, the easier it is.
Believe it or not, clinical dermatology is more than "if its wet make it dry; if its dry make it wet".

 

[LADoc00]

That is unbelievably ignorant. Its amazing that the less you know about a subject, the easier it is.
Believe it or not, clinical dermatology is more than "if its wet make it dry; if its dry make it wet".

I did around 3 months of derm, not a ton, a little Mohs, a lot of inner city clinic stuff, albiet in clerkship mode. The ease of a job is completely relative. Derm is much harder than say being a third grade teacher, but comparatively less difficult than orthopedic trauma. In the grand scheme of all the occupations in for MDs, I would definitely put it in lower 50% of complexity, I think nearly all MDs would agree.

 

[yaah]

I did around 3 months of derm, not a ton, a little Mohs, a lot of inner city clinic stuff, albiet in clerkship mode. The ease of a job is completely relative. Derm is much harder than say being a third grade teacher, but comparatively less difficult than orthopedic trauma. In the grand scheme of all the occupations in for MDs, I would definitely put it in lower 50% of complexity, I think nearly all MDs would agree.

I would agree. There is complexity - lots of treatments related to immunomodulation, light therapy. A lot of the difficulty is experience though - once you figure out what a basal cell looks like, and how to spot a melanoma, a lot of the difficulty goes away. A lot of complexity also is in the terminology - numerous diseases, eponyms, syndromes. But there is only so much. The challenges still exist with cutaneous lymphoma and certain autoimmune diseases. I would also put derm in the lower tier in terms of stress.

 

[pathdawg]

I did around 3 months of derm, not a ton, a little Mohs, a lot of inner city clinic stuff, albiet in clerkship mode. The ease of a job is completely relative. Derm is much harder than say being a third grade teacher, but comparatively less difficult than orthopedic trauma. In the grand scheme of all the occupations in for MDs, I would definitely put it in lower 50% of complexity, I think nearly all MDs would agree.

I might agree that on the medical student level, derm is not as complicated as some other fields. The thing is, medical students are completely clueless. You really have no idea how easy or hard a field is based on medical student experience.
I thought I understood what internal medicine was like after my sub-I month. Then I did a medicine internship for a year. Believe me when I say that I had no clue what medicine was like as a medical student.
Being a student is like watching an NFL game on tv. Actually being trained in a field of study to the level of expertise is like playing in that game. Its just completely different.

 

[PathOne]

I've done clinical derm as part of my dermpath training. Apart from the shock of meeting patients (real live ones! ugh...) I'd say that personally I find it quite interesting, but I can also see why an experienced derm would look at most patients in seconds rather than minutes. Of course there's the occational really difficult case, just like there is in path or in any other specialty, but I'd have to agree that it should be placed fairly low on the complexity scale. Generally a pretty nice bunch, tho'.

 

[AnnaLee]

Hi everyone, sorry to jump in....
Do most dermatopath fellows come from derm or path? Do you tend to be more competitive coming from one specialty or the other? Thanks!

 

[PathOne]

In terms of numbers, most come from path, which makes it somewhat easier for derms to get in. But a lot of the time it's really dependent on the PD. Some definitely has a bias towards path-trained, other towards derm-trained.

And by the way, on the training issue: If you come from path you do up to six months of clinical derm, while a derm-trained has to do up to six months of surgical path. Obviously, that doesn't make you an expert in the other field, but it does give you a better idea of the job than most other people.

Next question would probably be which background is best for dermpath. My answer would be, that it really depends on the individual. Generally speaking, the derm would know more about the clinical correlations, and the path more about the pathology of the slide (and other factors, such as nasty little lymphomas etc.). So both have weak sides and strong sides.

 

[yaah]

To echo the above point - it does depend on the makeup of the PD and the staff. Here, for example, most of the dermpath folks have dermatology backgrounds, and they are planning on starting up a fellowship. Most of the residents here seem to think they will be taking derm residents as a priority, but that might just be gossip.

In general, people with derm backgrounds are competitive individuals, and if they have done research or published, it is often in derm. With a path background, this isn't necessarily true because your residency includes only a couple of months of dermpath over the 4 years. So derm people probably have a bit of an "in" because of that. I am not sure though, because I don't know where more applicants come from.

 

[PathOne]

It's true that the average derm - all other things being equal - are more competitive than the average path. Simply because in recent years derm residencies has been so much more competitive than path residencies.

HOWEVER the pathologists I've seen and met who got a dermpath fellowship was exactly as competitive as the derms in the program. So the morale, if there is one, would be that you'd have to be a very competitive path to get a dermpath fellowship.