Don't like procedures

[medstudent7860]

I'm an M3 and in general I hate surgery and don't like procedures. I like the medicine component of derm. I was wondering if someone could explain to me how much surgery/procedures you do as a dermatologist and what kinds. Do you have to go to an OR, gown/drape, suture? Is it possible to be a dermatologist and only do a few biopsies here and there?

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[Dral]

Different Mohs surgeons treat their 'OR's differently. Not many will 'scrub in' the way you have experienced in surgery as an M3.

There are procedures such as liquid nitrogen along with random snips, clips, and other things.

ACGME requires us to log our procedures during residency. So you cannot get through residency without doing them. We need 50 surgeries with complex repairs, 15 or so laser experiences, 3 nail procedures, 15 or so botox, etc. Some of them only need to be observational. The 50 surgeries need to be done by the resident though.

I'd say that I'm doing a biopsy on 1 out of 10 or so patients. So it happens pretty often. Add in other procedures such as LN, and that ratio goes up.

You can probably end up in a derm niche where you don't do biopsies much. However, it's unavoidable in residency. If you really dislike procedures/surgeries, you may consider something else. Maybe Rhuem or Allergy. They have procedures, but not so much of cutting type stuff (like biopsies). However, you will have to do lines and such during most any residency related to medicine.

 

[medstudent7860]

Different Mohs surgeons treat their 'OR's differently. Not many will 'scrub in' the way you have experienced in surgery as an M3.

There are procedures such as liquid nitrogen along with random snips, clips, and other things.

ACGME requires us to log our procedures during residency. So you cannot get through residency without doing them. We need 50 surgeries with complex repairs, 15 or so laser experiences, 3 nail procedures, 15 or so botox, etc. Some of them only need to be observational. The 50 surgeries need to be done by the resident though.

I'd say that I'm doing a biopsy on 1 out of 10 or so patients. So it happens pretty often. Add in other procedures such as LN, and that ratio goes up.

You can probably end up in a derm niche where you don't do biopsies much. However, it's unavoidable in residency. If you really dislike procedures/surgeries, you may consider something else. Maybe Rhuem or Allergy. They have procedures, but not so much of cutting type stuff (like biopsies). However, you will have to do lines and such during most any residency related to medicine.

Thank you! What are the surgeries with complex repairs? Aside from biopsies, what kinds of surgeries are done in derm? And are they done in the office/patient room? Also, what is LN?

 

[Dral]

LN is liquid nitrogen...cryo surgery. It's not really surgery since nothing is really cut with it obviously. It counts as a procedure though.

Other than strictly cosmetic procedures, surgeries are typically to remove skin cancers or benign lesions such as lipomas, cysts, or other things. Xanthelasma removal, keloid excision, ear lobe repairs, scar revisions, nail biopsies. Those are all things I've done during residency. Also, rhinophyma treatment, Keloid injection, injection of alopecia or other inflammatory lesions with intralesional kenalog...just some things off the top of my head.

Let's take a typical cyst surgery: I set up in the clinic room, get consent, etc. I measure and mark out the lesion (mark how I'm going to perform my cut). I present to surgery attending to make sure they agree with orientation of cut, suture choice, etc. Then I numb them up and cut/dissect out the lesion. Cancers are actually easier...draw margin, cut down to fat/Sub cutis, take out, repair. Cysts and lipomas take some dissection work with blunt scissors.

Usually some type of undermining has to be performed to close a wound well. This is what adds 'complexity' to the closure. I usually do a few deep sutures, then stitch up the wound with a running and add in interrupteds where needed.

That's about it. I'll admit it's a little daunting as a first year, but by the time third year rolls around, it's kinda fun (at least that's how it went for me). I sorta gravitate toward procedure type stuff anyway though.

Hope that helps.

 

[asmallchild]

I'm an M3 and in general I hate surgery and don't like procedures. I like the medicine component of derm. I was wondering if someone could explain to me how much surgery/procedures you do as a dermatologist and what kinds. Do you have to go to an OR, gown/drape, suture? Is it possible to be a dermatologist and only do a few biopsies here and there?

I recommend doing a rotation in dermatology before making any decisions. It's hard to convey how procedural dermatology can be via a message board. Most procedures are done in the outpatient venus as a dermatologist. It is certainly possible to shy away from procedures as an attending but as others have mentioned, there is a case minimum for residency. You'll also severely limit your income potential if you don't perform procedures.