Does reputation of residency program matter for Mohs or dermpath fellowship?

Mar 22, 2019
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I was lucky and matched dermatology to a program in my ideal location a couple weeks ago!

However, I do see myself pursuing a Mohs or dermatopathology fellowship in the future. Will going to a lesser well-known program affect my chances of matching to a fellowship? We do not have a home program spot, but do have Mohs surgeons and dermatopathologists on faculty. Also is there any difference between accreditation with ACMS or ACGME? Thanks in advance for any advice.
 

asmallchild

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I was lucky and matched dermatology to a program in my ideal location a couple weeks ago!

However, I do see myself pursuing a Mohs or dermatopathology fellowship in the future. Will going to a lesser well-known program affect my chances of matching to a fellowship? We do not have a home program spot, but do have Mohs surgeons and dermatopathologists on faculty. Also is there any difference between accreditation with ACMS or ACGME? Thanks in advance for any advice.
Congratulations

Matching into fellowship isn't as difficult as matching into derm

At any rate, you've matched where you've matched so all you can do is make the most of it. Figure out what you want to do, see if you can get involved in some research projects with Mohs or dermpath faculty, do away rotations if your residency program allows for it, and apply broadly.

I would check with someone who is more up to date in terms of the accreditation question (I did a Mohs fellowship not so long ago and I still don't understand all the accreditation issues). My program was ACMS accredited and ACGME accredited so ideally, you'd pick a program that has both.
 
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If I am not mistaken dermpath tends to be less competitive these days for a derm resident due to declining reimbursement and job opportunities (i.e. folks may ask why do a fellowship to get paid less or have very limited options for jobs)

It appears that mohs has gotten even more competitive in the past few years. Possibly this is related to derm residents being very procedure oriented.

I think for either fellowship you would greatly benefit from mentors, research, and contacts. I think being at a top program helps with these but matching is still possible from any program, even more so from one with in house fellowships.
 
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asmallchild

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If I am not mistaken dermpath tends to be less competitive these days for a derm resident due to declining reimbursement and job opportunities (i.e. folks may ask why do a fellowship to get paid less or have very limited options for jobs)

It appears that mohs has gotten even more competitive in the past few years. Possibly this is related to derm residents being very procedure oriented.

I think for either fellowship you would greatly benefit from mentors, research, and contacts. I think being at a top program helps with these but matching is still possible from any program, even more so from one with in house fellowships.
I think that's a very valid question.

The same applies for Mohs, not a lot of pure Mohs jobs out there and the ones that exist are typically in less desirable areas. (I have an all Mohs gig, average age of my town is >70). Perhaps the integration of cosmetics into a lot of Mohs fellowships (mine was almost a 50/50 split) has made it more competitive and given residents more cosmetics exposure than they would've had with just residency. Although even then, that's a hard sell to have to do an entire fellowship year just for more cosmetics exposure
 

exeunt

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I think that's a very valid question.

The same applies for Mohs, not a lot of pure Mohs jobs out there and the ones that exist are typically in less desirable areas. (I have an all Mohs gig, average age of my town is >70). Perhaps the integration of cosmetics into a lot of Mohs fellowships (mine was almost a 50/50 split) has made it more competitive and given residents more cosmetics exposure than they would've had with just residency. Although even then, that's a hard sell to have to do an entire fellowship year just for more cosmetics exposure
I have that same question regarding Mohs. If you are willing to go to an underserved area then it makes sense, but I live in a large metropolitan area and don't understand why the competitiveness for Mohs fellowship is increasing instead of going the way of dermpath. It seems that their job prospects (in terms of being able to get a position where they primarily do Mohs or path) are similar. When I ask after they have completed fellowships oftentimes they say they don't know why they did it because they are unable to actually practice Mohs, but for some reason that doesn't seem to be a consideration for residents.

Is it simply because they are unaware of how saturated the market is, or they think that they might luck out and fare better, or ???
 
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I have that same question regarding Mohs. If you are willing to go to an underserved area then it makes sense, but I live in a large metropolitan area and don't understand why the competitiveness for Mohs fellowship is increasing instead of going the way of dermpath. It seems that their job prospects (in terms of being able to get a position where they primarily do Mohs or path) are similar. When I ask after they have completed fellowships oftentimes they say they don't know why they did it because they are unable to actually practice Mohs, but for some reason that doesn't seem to be a consideration for residents.

Is it simply because they are unaware of how saturated the market is, or they think that they might luck out and fare better, or ???
It's because mohs is very cool and people will accept a smaller piece of a great pie. Awesome reconstructions. Also, it seems anecdotally that mohs is doing infinately better than dermpath from a compensation standpoint (dermpath is struggling these days....just a few years ago didnt they cut reimbursements by a third?! Very hard to come back from that).
Ultimately it also has to do with interest. Derm residents really like procedures, more and more.
 
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dermie1985

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Congratulations

Matching into fellowship isn't as difficult as matching into derm

At any rate, you've matched where you've matched so all you can do is make the most of it. Figure out what you want to do, see if you can get involved in some research projects with Mohs or dermpath faculty, do away rotations if your residency program allows for it, and apply broadly.

I would check with someone who is more up to date in terms of the accreditation question (I did a Mohs fellowship not so long ago and I still don't understand all the accreditation issues). My program was ACMS accredited and ACGME accredited so ideally, you'd pick a program that has both.
I might slightly disagree....Mohs is pretty competitive, just because so many residents are interested in going into it and applications have increased considerably despite a lack of increase (or need for increase) in training spots. I think there are a subset of applicants who apply who haven't really prepared appropriately, but I think the match rate is more around 50-60% given the limited number of spots.

I would say the biggest factor for getting an advantage in the process is having a home program fellowship option. Many Mohs programs are simply more comfortable taking a candidate they've known (and trained) for 3 years than an outsider.

I'm sure going to a top program with an excellent fellowship program will afford you networking and research opportunities that may not be available elsewhere...but I think other factors may be more important. I personally know 2 people from a "Top 10" programs who didn't match, and lots of people from "lesser known" programs that did. Just plan early and make the appropriate connections / mentorship relationships / doing some aways if you have a geographic preference.
 
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asmallchild

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I might slightly disagree....Mohs is pretty competitive, just because so many residents are interested in going into it and applications have increased considerably despite a lack of increase (or need for increase) in training spots. I think there are a subset of applicants who apply who haven't really prepared appropriately, but I think the match rate is more around 50-60% given the limited number of spots.

I would say the biggest factor for getting an advantage in the process is having a home program fellowship option. Many Mohs programs are simply more comfortable taking a candidate they've known (and trained) for 3 years than an outsider.

I'm sure going to a top program with an excellent fellowship program will afford you networking and research opportunities that may not be available elsewhere...but I think other factors may be more important. I personally know 2 people from a "Top 10" programs who didn't match, and lots of people from "lesser known" programs that did. Just plan early and make the appropriate connections / mentorship relationships / doing some aways if you have a geographic preference.
This is probably true, the landscape has probably changed significantly when I applied

I came from a "lesser known" program and ended up matching at an excellent fellowship program having no connections at that program. Sometimes it really is luck and "clicking" with the staff at a particular program on interview day.

I didn't have a home fellowship program either. Having a good mentor relationship and being willing to apply broadly probably worked in my favor despite not having any other + factors on my application profile.
 
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I might slightly disagree....Mohs is pretty competitive, just because so many residents are interested in going into it and applications have increased considerably despite a lack of increase (or need for increase) in training spots. I think there are a subset of applicants who apply who haven't really prepared appropriately, but I think the match rate is more around 50-60% given the limited number of spots.

I would say the biggest factor for getting an advantage in the process is having a home program fellowship option. Many Mohs programs are simply more comfortable taking a candidate they've known (and trained) for 3 years than an outsider.

I'm sure going to a top program with an excellent fellowship program will afford you networking and research opportunities that may not be available elsewhere...but I think other factors may be more important. I personally know 2 people from a "Top 10" programs who didn't match, and lots of people from "lesser known" programs that did. Just plan early and make the appropriate connections / mentorship relationships / doing some aways if you have a geographic preference.
Any thoughts on dermpath?
 
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Thanks everyone for the input.

@dermie1985: For the people who did not match, is the "backup" to do general dermatology (either private practice or academics)? What does the fellowship / job hunting timeline (private practice or academics) overlap look like?

@asmallchild When you say "excellent" fellowship, what do you mean by that? How does one gauge whether fellowship programs are "worth it" / "excellent" (not sure if these are two different questions)?
 

asmallchild

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Thanks everyone for the input.

@dermie1985: For the people who did not match, is the "backup" to do general dermatology (either private practice or academics)? What does the fellowship / job hunting timeline (private practice or academics) overlap look like?

@asmallchild When you say "excellent" fellowship, what do you mean by that? How does one gauge whether fellowship programs are "worth it" / "excellent" (not sure if these are two different questions)?
That's for you to decide. Do you want a program where you will be more hands-on? Do you want a program where you will be observing an expert? Are you more surgically inclined? Cosmetically inclined? What are your career goals? Do you want to be in academics? Publish? Be comfortable with enormous cases? Be proficient so you can churn out as many cases as possible in private practice?
 
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reno911

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@asmallchild When you say "excellent" fellowship, what do you mean by that? How does one gauge whether fellowship programs are "worth it" / "excellent" (not sure if these are two different questions)?
This wasn't for me, but I'll take a stab at it.

To be honest, as a resident you have almost no way of gauging whether a fellowship is good or not. Virtually none. You get a one day interview and you'll have the opinions of your own surgical faculty and all the biases therein.

Now that I've been in the field for a while, I have a vastly different perspective. I know a lot of fellowship directors well, I've seen many talks they've given and read papers they've published. Also, now I too am an expert so I can much better judge pretty good from great. I could tell you which I think is the best, but I'm sure that others may disagree. Also there is the issue of fitting your interests. The best fellowship for you may not be the best fellowship for someone with different interests.

When I look back at how I ranked the programs I interviewed at, I can tell you the order was somewhat different from how I would rank them today. The way I ranked them was not crazy, but it is different from what I would do with the knowledge I have now.

One fact you can take comfort in is that there are very few bad fellowships. Most are good enough. The will give the foundation you need to develop your skillset. What you do with that foundation will determine how good you end up being.
 
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Speaking of dermpath, I dont know if you all read on the path forum how bcbs anthem announced cutting path codes to a fraction of what medicare pays. This seems like a very serious threat, but admittedly I cant conclude what this means for dermpath.