Has anyone started Derm and wished they did something else?

[Mari78]

---

Members don't see this ad.

I am a first year derm resident and I hate to say it but I don't love it. I am having regrets about not doing IM. Is this crazy? I feel guilty about this because I am lucky to have this opportunity. However, I really miss the acuity of IM patients and the inpatient atmosphere. Has anyone else been through this? Does anyone do IM after finishing derm residency?

 

[newdude2009]

I am a first year derm resident and I hate to say it but I don't love it. I am having regrets about not doing IM. Is this crazy? I feel guilty about this because I am lucky to have this opportunity. However, I really miss the acuity of IM patients and the inpatient atmosphere. Has anyone else been through this? Does anyone do IM after finishing derm residency?

I've never really met a prelim intern going into derm, who by the end of their intern
year was not super excited about going into derm, but there's a first time for anything.

I have seen people finish their internal med residency and then go into derm. One of our faculty in the dermatology department did that and now does a IM/derm conference with the IM residents once a month.

 

[michaelrack]

xxx

 

[ArMed]

You likely spent hundreds of hours working with the underserved as an empathic and passionate medical student. You spent your best years slaving over texts, sacrificing friendships, family, love. You clawed your way to the top of your medical school class as some of the best and brightest minds in the country.
To be honest, I'm shocked more subspecialty residents don't see their path as one that sells out their talent and sacrifice.
Congrats! It's never too late to switch!

 

[DrAwsome]

You likely spent hundreds of hours working with the underserved as an empathic and passionate medical student. You spent your best years slaving over texts, sacrificing friendships, family, love. You clawed your way to the top of your medical school class as some of the best and brightest minds in the country.
To be honest, I'm shocked more subspecialty residents don't see their path as one that sells out their talent and sacrifice.
Congrats! It's never too late to switch!

I think that while the schedule/lifestyle and potential money is very alluring at first in derm, the reality is that derm in most places will be rather basic and can become mindnumbing. The spectacularly fantastic cases that you read about, hear about,etc are usually only at major medical centers. The typical dermie will not be seeing them. Typical derm will be treating acne/psoriasis/removing BCC/SCC's, etc and will refer complex cases to major centers. I won't even go into discussing many of the personality types in derm, which are a big turn off.

I don't think that what the OP is feeling is really all that uncommon.

 

[Phyozo]

You likely spent hundreds of hours working with the underserved as an empathic and passionate medical student. You spent your best years slaving over texts, sacrificing friendships, family, love. You clawed your way to the top of your medical school class as some of the best and brightest minds in the country.
To be honest, I'm shocked more subspecialty residents don't see their path as one that sells out their talent and sacrifice.
Congrats! It's never too late to switch!

👍

Derm needs the best and brightest too. They just don't need that many of them.

 

[username456789]

I am a first year derm resident and I hate to say it but I don't love it. I am having regrets about not doing IM. Is this crazy? I feel guilty about this because I am lucky to have this opportunity. However, I really miss the acuity of IM patients and the inpatient atmosphere. Has anyone else been through this? Does anyone do IM after finishing derm residency?

I interviewed at 3 derm programs that had all had someone switch back to IM (all after PGY2 I believe).

 

[thesauce]

This is not crazy. Most candidates that could get into derm choose to do something else. At some point you have to come to the realization that you could be happy in many specialties. There is not one right answer and any choice you make is going to sacrifice something.

 

[colbgw02]

I think that while the schedule/lifestyle and potential money is very alluring at first in derm, the reality is that derm in most places will be rather basic and can become mindnumbing. The spectacularly fantastic cases that you read about, hear about,etc are usually only at major medical centers. The typical dermie will not be seeing them. Typical derm will be treating acne/psoriasis/removing BCC/SCC's, etc and will refer complex cases to major centers. I won't even go into discussing many of the personality types in derm, which are a big turn off.

I don't think that what the OP is feeling is really all that uncommon.

This is true of pretty much every specialty.

 

[Skinceutical]

I think that while the schedule/lifestyle and potential money is very alluring at first in derm, the reality is that derm in most places will be rather basic and can become mindnumbing. The spectacularly fantastic cases that you read about, hear about,etc are usually only at major medical centers. The typical dermie will not be seeing them. Typical derm will be treating acne/psoriasis/removing BCC/SCC's, etc and will refer complex cases to major centers. I won't even go into discussing many of the personality types in derm, which are a big turn off.

I don't think that what the OP is feeling is really all that uncommon.

That kind of reductionist philosophy can be applied to every single specialty. The rare, fantastic zebras almost always get referred to academic centers, while community practitioners largely settle into a rut of "routine" cases.

One could just as easily argue that the average community internist spends his/her time titrating BP meds and insulin regimens for questionably compliant patients. That the typical emergency physician spends most of their time providing primary care services to the uninsured. That your average community general surgeon is far more likely to be doing lap choleys and appys than Whipples and esophagectomies. That's just the reality of life in private practice.

To the OP: derm isn't for everyone, and luckily, chances are you're a competitive applicant for just about every other specialty out there. That said, I'd think long and hard before making the decision to go back to IM. What attracted you to derm in the first place?

 

[reno911]

I am a first year derm resident and I hate to say it but I don't love it. I am having regrets about not doing IM. Is this crazy? I feel guilty about this because I am lucky to have this opportunity. However, I really miss the acuity of IM patients and the inpatient atmosphere. Has anyone else been through this? Does anyone do IM after finishing derm residency?

I missed it just a little, but I got over it. You probably will too.

There's no reason you can't do IM after derm residency, and that's probably the smart thing to do if you're conflicted (i.e, don't leave derm now). If you leave derm now, coming back will be next to impossible (it has been done, but it's very hard)

I've never met anyone who did this except for a foreign grad (i.e., did derm in home country, then did IM here), but I suppose that doesn't really count.

 

[Mari78]

Thank you all for responding. A few of you have articulated well many of my thoughts over the last few months. I chose derm for many reasons: because I loved the idea that one could make a diagnosis about what is going on on the inside based on the cutaneous manifestation and that dermatologists have to have a firm understanding of internal disease I. I like the amount of procedures (this is lacking in IM, aside from a few subspecialties). I love the variety in patients and the flexibility and hours if I have a family some day. Probably some of these thoughts were naive, as every specialty has its warts or diabetics who won't take their meds properly.
I find myself frustrated by Grand Rounds when we spend 20 minutes arguing about etiologies or treatments of diseases that ultimately do not affect the morbidity of patients. I struggle to enjoy journal articles about rosacea. I did not realize that so many of the interesting or serious dermatologic diseases are so uncommon. And it seems as if when derm disease gets interesting, the patient is no longer managed by dermatology but by IM, heme onc, etc.
But I absolutely acknowledge that the field of dermatology is important and that often dermatologic diseases are the most distressing to patients. Clearly one cannot have everything, no matter what specialty. In retrospect, I probably would have applied to a combined Med/Derm residency.
I really appreciate all of your advice. I hope I have not offended anyone. It is a lot to think over but I will probably stick with it and try to make my career to encompass both if I can.

 

[Fah-Q]

There is plenty of honor in dermatology. Every specialty takes care of life-threatening conditions and non-threatening conditions. The satisfaction you get from your job is mostly derived from your patients' appreciation of you. For example, I'm an ENT and some of my most thankful patients are those that come into my office unable to hear until I clean the earwax out of their ears. I get lots of thanks and hugs. Earwax is not why I went into medicine. Helping the patient with earwax is what is important. You don't have to be fascinated by rosacea but you will help a great many people live better lives with your knowledge. Their appreciation of you is what will keep you coming to work everyday.

 

[Skinceutical]

Clearly one cannot have everything, no matter what specialty. In retrospect, I probably would have applied to a combined Med/Derm residency.
I really appreciate all of your advice. I hope I have not offended anyone. It is a lot to think over but I will probably stick with it and try to make my career to encompass both if I can.

I think this is a wise decision.

PGY-II IM positions aren't terribly hard to come by, and I think you would likely be able to find one after finishing derm. When I was finishing up my prelim year, my PD told me to consider becoming double-boarded, and offered to let me come back after my derm residency to finish IM. Perhaps you could see if the IM program at your current institution (or your prelim program) would be willing to let you work out something similar.

 

[nitemagi]

That kind of reductionist philosophy can be applied to every single specialty. The rare, fantastic zebras almost always get referred to academic centers, while community practitioners largely settle into a rut of "routine" cases.

One could just as easily argue that the average community internist spends his/her time titrating BP meds and insulin regimens for questionably compliant patients. That the typical emergency physician spends most of their time providing primary care services to the uninsured. That your average community general surgeon is far more likely to be doing lap choleys and appys than Whipples and esophagectomies. That's just the reality of life in private practice.

To the OP: derm isn't for everyone, and luckily, chances are you're a competitive applicant for just about every other specialty out there. That said, I'd think long and hard before making the decision to go back to IM. What attracted you to derm in the first place?

Y'know I used to believe this, and to an extent I actually believe it has some truth. But moreso I believe the zebras come into community clinics all the time, it's just missed by many because they aren't looking for it, or more commonly don't have the resources to fully evaluate it. Community clinics often can't do sophisticated labs, get specialist evals, etc. But if you aren't looking for it you definitely won't find it.

 

[colbgw02]

That kind of reductionist philosophy can be applied to every single specialty. The rare, fantastic zebras almost always get referred to academic centers, while community practitioners largely settle into a rut of "routine" cases.

Y'know I used to believe this, and to an extent I actually believe it has some truth. But moreso I believe the zebras come into community clinics all the time, it's just missed by many because they aren't looking for it, or more commonly don't have the resources to fully evaluate it. Community clinics often can't do sophisticated labs, get specialist evals, etc. But if you aren't looking for it you definitely won't find it.

Ummm...who, exactly, did you think was doing all of the referring to academic centers to which Skinceutical referred?

The salient point remains that interesting or rare processes will largely get referred out. Whether the zebra is recognized early, late, or not at all is not particularly germaine.

 

[nitemagi]

The salient point remains that interesting or rare processes will largely get referred out. Whether the zebra is recognized early, late, or not at all is not particularly germaine.

That depends. Recognizing that the zebras exist in the community first before referral out is contradictory to the idea that there are no zebras in the community and thus community treatment is boring and routine. Those that buy into that myth of the academic centers being the only way to catch zebras, then IMO can become intellectually lazy in their scrutiny of cases, and not pick up on the zebras in the first place when working in the community.

 

[colbgw02]

That depends. Recognizing that the zebras exist in the community first before referral out is contradictory to the idea that there are no zebras in the community and thus community treatment is boring and routine. Those that buy into that myth of the academic centers being the only way to catch zebras, then IMO can become intellectually lazy in their scrutiny of cases, and not pick up on the zebras in the first place when working in the community.

The problem here is that no one has said that there are no zebras in the community, nor has anyone said that only academic centers will catch zebras. You're refuting claims that no one on this thread have made.

Again, the point is that those zebras - once caught at the community center - will promptly be packaged up and sent to a referral center for the complete work-up and treatment. That leaves the community physician an abundance of time to handle the routine and mundane.

 

[nitemagi]

The problem here is that no one has said that there are no zebras in the community, nor has anyone said that only academic centers will catch zebras. You're refuting claims that no one on this thread have made.

Again, the point is that those zebras - once caught at the community center - will promptly be packaged up and sent to a referral center for the complete work-up and treatment. That leaves the community physician an abundance of time to handle the routine and mundane.

Fair point. I misread the original post regarding the community docs settling into the rut of routine cases referring to the concept of only routine cases coming into community clinics, which I've seen some people maintain (obviously not in this thread, my mistake).

 

[PharmaTope]

There is plenty of honor in dermatology. Every specialty takes care of life-threatening conditions and non-threatening conditions. The satisfaction you get from your job is mostly derived from your patients' appreciation of you. For example, I'm an ENT and some of my most thankful patients are those that come into my office unable to hear until I clean the earwax out of their ears. I get lots of thanks and hugs. Earwax is not why I went into medicine. Helping the patient with earwax is what is important. You don't have to be fascinated by rosacea but you will help a great many people live better lives with your knowledge. Their appreciation of you is what will keep you coming to work everyday.

this is a solid post. realizing what makes YOU happy. then map out a way that will help you find your happiness

 

[Groove]

I am a first year derm resident and I hate to say it but I don't love it. I am having regrets about not doing IM. Is this crazy? I feel guilty about this because I am lucky to have this opportunity. However, I really miss the acuity of IM patients and the inpatient atmosphere. Has anyone else been through this? Does anyone do IM after finishing derm residency?

I think many interns switch specialties during their intern year prematurely. Internship gives you no great insight into your choice of specialty and career options whatsoever. Internship sucks for everyone, regardless of the specialty, yet most interns think this is a factor that correlates directly to their choice in specialties and don't realize that it's a ubiquitous feeling and universal aspect of residency in general. Quitting anything during your first year is always a bad idea in my opinion. Let's say you feel the same way by year 2 or 3, well... by then it almost makes more sense to finish your training and then pursue something else if you so choose.

All that being said, I think everyone becomes a bit burnt out and jaded during residency and has 2nd thought sometimes but I think that largely is due to the workload. Once you're out and have more free time, you're likely to regain your passion, enjoyment and interest. I'm in EM and after a really arduous string of shifts or month, I feel jaded and cynical. Give me 3 days off and I'm itching to get back into the ED and am completely revitalized. Being overworked, which just goes along with residency, can drastically change the way you feel about being at work, regardless of anything. My 2 cents.

 

[pupster]

Thank you all for responding. A few of you have articulated well many of my thoughts over the last few months. I chose derm for many reasons: because I loved the idea that one could make a diagnosis about what is going on on the inside based on the cutaneous manifestation and that dermatologists have to have a firm understanding of internal disease I. I like the amount of procedures (this is lacking in IM, aside from a few subspecialties). I love the variety in patients and the flexibility and hours if I have a family some day. Probably some of these thoughts were naive, as every specialty has its warts or diabetics who won't take their meds properly.
I find myself frustrated by Grand Rounds when we spend 20 minutes arguing about etiologies or treatments of diseases that ultimately do not affect the morbidity of patients. I struggle to enjoy journal articles about rosacea. I did not realize that so many of the interesting or serious dermatologic diseases are so uncommon. And it seems as if when derm disease gets interesting, the patient is no longer managed by dermatology but by IM, heme onc, etc.
But I absolutely acknowledge that the field of dermatology is important and that often dermatologic diseases are the most distressing to patients. Clearly one cannot have everything, no matter what specialty. In retrospect, I probably would have applied to a combined Med/Derm residency.
I really appreciate all of your advice. I hope I have not offended anyone. It is a lot to think over but I will probably stick with it and try to make my career to encompass both if I can.

You should perhaps wait until after residency and then take a job at an academic center where you can do medical dermatology.

 

[RadOncDoc21]

I think many interns switch specialties during their intern year prematurely. Internship gives you no great insight into your choice of specialty and career options whatsoever. Internship sucks for everyone, regardless of the specialty, yet most interns think this is a factor that correlates directly to their choice in specialties and don't realize that it's a ubiquitous feeling and universal aspect of residency in general. Quitting anything during your first year is always a bad idea in my opinion. Let's say you feel the same way by year 2 or 3, well... by then it almost makes more sense to finish your training and then pursue something else if you so choose.

All that being said, I think everyone becomes a bit burnt out and jaded during residency and has 2nd thought sometimes but I think that largely is due to the workload. Once you're out and have more free time, you're likely to regain your passion, enjoyment and interest. I'm in EM and after a really arduous string of shifts or month, I feel jaded and cynical. Give me 3 days off and I'm itching to get back into the ED and am completely revitalized. Being overworked, which just goes along with residency, can drastically change the way you feel about being at work, regardless of anything. My 2 cents.

Very good advice and so true.

-R

 

[WholeLottaGame7]

How have we made it this far into a dermatology thread with no Seinfeld references?

 

[deleted103644]

How have we made it this far into a dermatology thread with no Seinfeld references?

I'm a rabid anti-Dentite.

 

[mlw03]

How have we made it this far into a dermatology thread with no Seinfeld references?

If someone wants to be Pimple Popper, MD, that's their choice. But don't expect a date with Jerry.

 

[Buzz Me]

How have we made it this far into a dermatology thread with no Seinfeld references?

Because, sadly enough, some of these premeds and med students weren't old enough to be watching those kinds of shows back then (almost 15 years ago).

 

[pupster]

If someone wants to be Pimple Popper, MD, that's their choice. But don't expect a date with Jerry.

Ehh? I prefer Grey's Anatomy...

 

[Mattchiavelli]

OP, I am confident you can make a good practice for yourself doing consultations for inpatient medicine patients- skin findings are very hard to differentiate sometimes and it is extremely useful to have someone that's had a long training seeing a lot of very bad vs not very bad skin findings. For me, getting derm consults inpatient is tough b/c the majority of residents that I interact with are the opposite of you in regards to career focus. If that has correlation to private practice world you could sweep up I think... the chair of the derm dept at my med school referred to himself as a "skinternist" as he had done a full IM training and practiced a few years after, maybe you're another one