MD If you could switch into dermatology, would you do it?

[bluetee31]

M1 here. Both of my parents are physicians (dad is in emergency medicine, mom is ophthalmology), and they are both pushing me into dermatology. They have said that if they could spend the rest of their medical careers doing dermatology, they would do it in a heartbeat. According to them, when I'm older, passion for my field won't be as important, and I'll just be grateful to have a high paying job with good hours so I can spend more time with my family, hence the reason why they want me to go into derm. Right now, I find myself drawn to family medicine (oh, the horror!), but I'm wondering if 30+ years from now, I'll be kicking myself in the butt for not having chosen a residency with better pay and hours, assuming of course, that I have the numbers for derm which is a pretty long shot anyway.

So, I wanted to ask the SDN community, if you could go back in time and switch into a dermatology residency and get that laid-back, cushy lifestyle now, would you?

Thanks,
BT

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[gyngyn]

Absolutely no way.

 

[WheezyBaby]

M1 here. Both of my parents are physicians (dad is in emergency medicine, mom is ophthalmology), and they are both pushing me into dermatology. They have said that if they could spend the rest of their medical careers doing dermatology, they would do it in a heartbeat. According to them, when I'm older, passion for my field won't be as important, and I'll just be grateful to have a high paying job with good hours so I can spend more time with my family, hence the reason why they want me to go into derm. Right now, I find myself drawn to family medicine (oh, the horror!), but I'm wondering if 30+ years from now, I'll be kicking myself in the butt for not having chosen a residency with better pay and hours, assuming of course, that I have the numbers for derm which is a pretty long shot anyway.

So, I wanted to ask the SDN community, if you could go back in time and switch into a dermatology residency and get that laid-back, cushy lifestyle now, would you?

Thanks,
BT

The gist of the bolded is probably true for most people (relatively more importance placed on family as opposed to career with age), and for a subset of that group it's true enough that they would trade their career in 'x' for a career in dermatology (or another career with similar perks). It's worth thinking about, but really only you can decide best for yourself. I could've made a competitive application for derm, but it wasn't where my interest was, and I don't regret not pursuing it

 

[Goro]

M1 here. Both of my parents are physicians (dad is in emergency medicine, mom is ophthalmology), and they are both pushing me into dermatology. They have said that if they could spend the rest of their medical careers doing dermatology, they would do it in a heartbeat. According to them, when I'm older, passion for my field won't be as important, and I'll just be grateful to have a high paying job with good hours so I can spend more time with my family, hence the reason why they want me to go into derm. Right now, I find myself drawn to family medicine (oh, the horror!), but I'm wondering if 30+ years from now, I'll be kicking myself in the butt for not having chosen a residency with better pay and hours, assuming of course, that I have the numbers for derm which is a pretty long shot anyway.

So, I wanted to ask the SDN community, if you could go back in time and switch into a dermatology residency and get that laid-back, cushy lifestyle now, would you?

Thanks,
BT

A family friend is a dermatologist. I asked him once what were the most common things he sees. With a sigh of "same old thing", the answered "psoriasis and melanoma". So the grass is always greener on the other side of the fence, I guess.

 

[ortnakas]

Ewww skin no.

I don't have the numbers for derm, but even if I did, I think I'd still want IM (my residency application list would look a little different in that case but c'est la vie).

 

[mw18]

If the numbers weren't so few in a week, I would say I'd rather not do medicine at all than be a dermatologist. But I've worked way more than 35 hours a week at something far less enjoyable, so I could do it and just enjoy the time off. I could probably competitively apply to derm (after a research year most likely), so it's not cognitive dissonance. I just don't think it would be a fun thing to do for me.

 

[JPSmyth]

There's a reason why it is the most competitive speciality, or one of the most. After sacrificing so much of your life to get into med school, do so well in med school, and match residency, don't you want a career with high pay and low hours?

I know I'm not competitive enough for derm but god I would apply in a heartbeat if I get the step score

 

[xffan624]

There's a reason why it is the most competitive speciality, or one of the most. After sacrificing so much of your life to get into med school, do so well in med school, and match residency, don't you want a career that you're satisfied with?

I know I'm not competitive enough for derm but god I would apply in a heartbeat if I get the step score

FTFY. That's really the only metric that matters. A job that sucks can make one eight hour day last 10,000 years. A job you enjoy can make your work day fly and then when you go on vacation you're not dreading your return, but kinda wanting to get back to it. No job is perfect, but enjoying your job as much as humanly possible is paramount over lifestyle or money. You only have one life and the large chunk of time you spend in it working might as well be satisfying and somewhat enjoyable.

For some people, dermatology would never satisfy them, as stated by folks in this thread.

 

[Womb Raider]

M1 here. Both of my parents are physicians (dad is in emergency medicine, mom is ophthalmology), and they are both pushing me into dermatology. They have said that if they could spend the rest of their medical careers doing dermatology, they would do it in a heartbeat. According to them, when I'm older, passion for my field won't be as important, and I'll just be grateful to have a high paying job with good hours so I can spend more time with my family, hence the reason why they want me to go into derm. Right now, I find myself drawn to family medicine (oh, the horror!), but I'm wondering if 30+ years from now, I'll be kicking myself in the butt for not having chosen a residency with better pay and hours, assuming of course, that I have the numbers for derm which is a pretty long shot anyway.

So, I wanted to ask the SDN community, if you could go back in time and switch into a dermatology residency and get that laid-back, cushy lifestyle now, would you?

Thanks,
BT

What does your mom have against ophtho?

 

[bluetee31]

What does your mom have against ophtho?

derm still makes more $ on average and concerns about possible encroachment by optometrists.

The gist of the bolded is probably true for most people (relatively more importance placed on family as opposed to career with age), and for a subset of that group it's true enough that they would trade their career in 'x' for a career in dermatology (or another career with similar perks).

Early on in their careers, I really think that my parents were passionate and excited about their respective fields but then somewhere down the line, they just got ambivalent I guess and really regretted not going into derm. I've been doing some heavy introspection but I just don't know how to discern between true passion for a speciality and a fleeting fascination for the field. I don't want to make the same mistake as my parents and end up regretting my decision.

Edit: once again, just wanted to clarify that I'm a M1 and that I'm aware that there's a high chance that I won't even have the luxury of choosing derm or not.

 

[MilkIsGood]

Absolutely yes. Only 3 weeks into my derm residency, and I wouldn't ever trade it for any other career. Residency is hard work with lots of reading and crazy busy clinics, but the future payoff is great. Definitely working way harder now that my internal medicine intern year but loving every second of it.

 

[FindMeOnTheLinks]

Every time a derm question comes up on uworld, I want to close my laptop. Literally so annoying - "erythematous, pruritic, macular or pustular lesions with blah blah blah blah." Just shoot me in the face. I don't care.

That's how I know I could never do it.

 

[username456789]

A family friend is a dermatologist. I asked him once what were the most common things he sees. With a sigh of "same old thing", the answered "psoriasis and melanoma". So the grass is always greener on the other side of the fence, I guess.

You've told this false story twice now already.

Psoriasis and melanoma are absolutely nowhere near what a dermatologist most commonly sees on a daily basis. IIRC, last time I mentioned this you said something to the effect of "well, uh, I couldn't remember what he said really."

 

[username456789]

By the way, I'm a dermatologist and I would absolutely 100% choose this field again if given the chance.

Any field is going to end up feeling repetitive after many years. Even academics, but possibly to a lesser extent. Obviously don't choose something you absolutely don't enjoy from the beginning, but make sure you talk to all types of other attendings at various stages in their career to gain proper perspective. Odds are most people will be a "generalist" within their chosen field, unless you carve a very specific niche out for yourself, again most likely at a large academic institution. You will focus on the bread and butter, typical cases more often than not. Whether you're dealing with skin, colons, dicks, brains, hearts, or whatever . . . eventually it may lose its luster. When/if it does, consider what you will be left with.

 

[Goro]

You've told this false story twice now already.

Psoriasis and melanoma are absolutely nowhere near what a dermatologist most commonly sees on a daily basis. IIRC, last time I mentioned this you said something to the effect of "well, uh, I couldn't remember what he said really."

This is what he told me, genius. Maybe it was "skin cancer". So sue me. I stand by the story.

Applying the Ignore function. You'll feel some slight pressure between the eyes.

 

[doctorleospaceman]

Every rash is maculopapular to me so I could never do it.

 

[Smurfette]

Derm is not in the top five (maybe not even top 10) of fields I would consider switching into. It just doesn't appeal to me.

 

[username456789]

This is what he told me, genius. Maybe it was "skin cancer". So sue me. I stand by the story.

Applying the Ignore function. You'll feel some slight pressure between the eyes.

I thought you already had me on ignore when I called you on this last time. Your "pressure between the eyes" line gets very old.

 

[DrfluffyMD]

By the way, I'm a dermatologist and I would absolutely 100% choose this field again if given the chance.

Any field is going to end up feeling repetitive after many years. Even academics, but possibly to a lesser extent. Obviously don't choose something you absolutely don't enjoy from the beginning, but make sure you talk to all types of other attendings at various stages in their career to gain proper perspective. Odds are most people will be a "generalist" within their chosen field, unless you carve a very specific niche out for yourself, again most likely at a large academic institution. You will focus on the bread and butter, typical cases more often than not. Whether you're dealing with skin, colons, dicks, brains, hearts, or whatever . . . eventually it may lose its luster. When/if it does, consider what you will be left with.

How many pts do you see a day? I can't deal with clinic days with more than 20-30 pts a day. I heard most derm see many, many pt with 15 min slots. Just can't deal with that. Rather be doing big cases on a few people.

 

[username456789]

How many pts do you see a day? I can't deal with clinic days with more than 20-30 pts a day. I heard most derm see many, many pt with 15 min slots. Just can't deal with that. Rather be doing big cases on a few people.

I see ~30-35 per day. Some derms see a good bit more. My appointments are every 15 minutes, and I work about 8 hours per day. One day a week I work a half day, so I see 15-16 usually on those days.

 

[username456789]

Every rash is maculopapular to me so I could never do it.

"Maculopapular" should never exist in any healthcare worker's vocabulary.

 

[bannie22]

always listen to your parents.
sometimes we think we are so smart, and know more, but those are wise words from your parents.

at least make sure you consider them.

 

[AcademicNeurosurgery]

Never. It's sometimes an uncommon perspective on this forum but there are many physicians out there who are still truly passionate about their field and are motivated by the cliche things we all write in our med school personal statements (love science, want to help people, yada yada).

That said, it's really a personal decision, do you see medicine as a job or as a passion? If you see it as a job that funds your hobbies/lifestyle, pick a field accordingly. If you see it as a passion, pick a field you love. Regardless of which path you choose though, you better be busting your tail and giving every patient 110% while you're on the job.

I'll give you an example of two EM physicians, one is a guy I shadowed in undergrad and the other is a close friend who is an attending. The guy I shadowed in undergrad would literally delay care because he was screwing around on the job. I can't tell you how many times this dude was napping, making a purchase on Hollister's website (wtf?), talking to his relatives on the phone, etc. while patients were waiting to be seen in the ER. If it wasn't urgent, he didn't budge. Through our conversations, medicine was very clearly a way for him to coast into a comfortable retirement. Nothing wrong with that, but this goal shouldn't have gotten in the way of patient care. My friend, on the other hand, works his rear end off when he's in the ER chasing down consults, labs, etc. If it's slow, he is reading papers to keep up with the newest guidelines to make sure he's an effective "guardian of inpatient medicine". He values his lifestyle and definitely plays hard on his days off, but when he's in the ER there is no doubt he is giving every patient his best.

Basically, it's okay to see medicine as a job. You will have to read outside of work to stay current regardless of specialty and of course some will demand more time outside of work than others. Patient care shouldn't suffer though. I only mention this because you never want to become the doc that's waiting to clock out.

Last point I'll make is to take advice from older physicians with a grain of salt. 55-65 year old physicians saying they wish they would've done derm doesn't really mean much if they just started expressing these sentiments. Chances are, they may not have had these sentiments during the 25-30 years prior while they were enjoying what they did. Now they are older, feel like they've seen enough, and may be ready to step away so it's easy for them to say now that they wish they would've done derm for the last 25-30 years.

 

[BigRedBeta]

Absolutely not. Couldn't stand clinic as a student or resident, now in a field (PICU) that is entirely inpatient. Anything that is mostly outpatient would never cross my mind as an option.

 

[bluetee31]

"Last point I'll make is to take advice from older physicians with a grain of salt. 55-65 year old physicians saying they wish they would've done derm doesn't really mean much if they just started expressing these sentiments. Chances are, they may not have had these sentiments during the 25-30 years prior while they were enjoying what they did. Now they are older, feel like they've seen enough, and may be ready to step away so it's easy for them to say now that they wish they would've done derm for the last 25-30 years."

Good point.

 

[doctorleospaceman]

"Maculopapular" should never exist in any healthcare worker's vocabulary.

Sounds exactly like something a dermatologist would say...

 

[username456789]

Sounds exactly like something a dermatologist would say...

Indeed.

 

[ERDOC555]

M1 here. Both of my parents are physicians (dad is in emergency medicine, mom is ophthalmology), and they are both pushing me into dermatology. They have said that if they could spend the rest of their medical careers doing dermatology, they would do it in a heartbeat. According to them, when I'm older, passion for my field won't be as important, and I'll just be grateful to have a high paying job with good hours so I can spend more time with my family, hence the reason why they want me to go into derm. Right now, I find myself drawn to family medicine (oh, the horror!), but I'm wondering if 30+ years from now, I'll be kicking myself in the butt for not having chosen a residency with better pay and hours, assuming of course, that I have the numbers for derm which is a pretty long shot anyway.

So, I wanted to ask the SDN community, if you could go back in time and switch into a dermatology residency and get that laid-back, cushy lifestyle now, would you?

Thanks,
BT

These questions drive me up a wall! Not you specifically, but hearing people ask this over and over again annoys me to no end.

Everyone wants to do derm, and (anecdotally) less than a quarter of these people ever even shadowed a dermatologist at all. I'm all for considering lifestyle, compensation, hours, etc, but for the love of god at least make sure you somewhat enjoy the field.

These would be my guidelines for "should I do derm?"

-Do you love derm? Is it your "passion"?
If yes, obviously do derm.

-Do you like derm but also like other specialties equally as well?
If yes, do derm.

-Do you like derm, but love a different specialty?
If yes, don't do derm, pursue the other specialty.

-Do you dislike/feel neutral towards derm?
If yes, don't do derm.

-Do you not like any fields of medicine at all?
Fine, do derm. In this case you'll be miserable regardless, might as well be miserable with fewer hours.

 

[cellsaver]

So, I wanted to ask the SDN community, if you could go back in time and switch into a dermatology residency and get that laid-back, cushy lifestyle now, would you?

Never. Dermatologists and Plastic Surgeons in South Beach are strictly cash basis and filthy rich. yet, their lives are soul-less and their patient demographics are beyond shallow and narcissistic. Difficult specialization especially when they hock personal care products to augment their income

Give me a dirt poor patient who truly needs medical intervention any day over a rich plastic surgery prospective patient, and I would slide my payment scale for the poor while removing any third party payer involvement

Physicians need to take back the physician-patient sacred relationship

 

[username456789]

Never. Dermatologists and Plastic Surgeons in South Beach are strictly cash basis and filthy rich. yet, their lives are soul-less and their patient demographics are beyond shallow and narcissistic. Difficult specialization especially when they hock personal care products to augment their income

Give me a dirt poor patient who truly needs medical intervention any day over a rich plastic surgery prospective patient, and I would slide my payment scale for the poor while removing any third party payer involvement

Physicisns need to take back the physician-patient sacred relationship

You have a very skewed vision of what most dermatologists do.

If I was that misinformed on the topic, I probably wouldn't be very interested either.

 

[ACSurgeon]

derm still makes more $ on average and concerns about possible encroachment by optometrists.



Early on in their careers, I really think that my parents were passionate and excited about their respective fields but then somewhere down the line, they just got ambivalent I guess and really regretted not going into derm. I've been doing some heavy introspection but I just don't know how to discern between true passion for a speciality and a fleeting fascination for the field. I don't want to make the same mistake as my parents and end up regretting my decision.

Edit: once again, just wanted to clarify that I'm a M1 and that I'm aware that there's a high chance that I won't even have the luxury of choosing derm or not.

There's no way for you to be 100% sure which field is right for you. You'll have to chose a field based on what interests you and the pay/hours/other aspects of the job. Keep in mind, in 10 or 20 years, the pay could be very different for different specialties. So, if you're not really interested in a field, don't pick it just for the money. That's the only sure way to regret your decision.

Regarding your parents: life happens and overtime your life outside of work becomes much more important that work. So, that's why they're saying derm, just to say any specialty that pays well per hour and has no nights/weekends/call. I think that's poor reflection on their part, because unless your really excited about it, you'll have a hard time doing all the leg work to get into and through a derm residency.

Finally: if you find yourself equally enjoying two specialties with one have much easier life/better pay, by all means do that. This would be different than disregarding what you're interested in and JUST focusing on what (currently) pays well and affords a good work-life balance.

 

[oncology2020]

I would still do IM

 

[Redpancreas]

No way. I'd rather do IM without fellowship or Family or even Neuro. Derm isn't exactly this amazing field everyone not applying to it thinks it is. You work pretty hard in residency and see patients for 5 minutes as an attending and you're always on your feet. Also, the material itself is piling adjectives on adjectives and then you're giving steroids. The ultimate money and lifestyle combo is derm and there's no field that compares and if that's all you want, then gun.

 

[Stagg737]

Something that hasn't really been brought up is that every field in medicine is high paying. Even the lowest fields (peds, FM) are now averaging over 200k/yr. It might not be derm money, but compared to everyone else in the U.S. (and world), you're still making bank. Since both your parents are physicians, I'm guessing you're not going to be hurting on the debt side of things either. So pick a field where you enjoy the basic stuff and that you enjoy on a day to day basis. If lifestyle is a huge factor, there are plenty of fields other than derm to explore that average 50 hours a week or less.

Every time a derm question comes up on uworld, I want to close my laptop. Literally so annoying - "erythematous, pruritic, macular or pustular lesions with blah blah blah blah." Just shoot me in the face. I don't care.

That's how I know I could never do it.

I'm the same way. I read "A 14 yr old boy comes into your clinic with pruritic, erythematous papules blah blah" and my first thought is "so he's got a rash..."

 

[IlDestriero]

No. Derm sucks. YMMV.


--
Il Destriero

 

[LostinLift]

Lol. No. Maybe if it paid 1 mill without much effort (i.e. just clock in and clock out 40 hrs no dealing with business stuff) then work for a few years and determine if I want to do a second residency in my field or just retire from medicine and do something else.

 

[CherryRedDracul]

Derm's cool but it's just not for me. I'm sticking with radiology.

 

[ActinicKeratosis]

I really don't get why everyone hates on derm. Sure you're not managing high acuity patients but you are still making a big impact on quality of life for your patients. Also, everything will get repetitive after awhile. If it didn't get repetitive then you would not be an expert in your field which would not be good.

 

[username456789]

I really don't get why everyone hates on derm. Sure you're not managing high acuity patients but you are still making a big impact on quality of life for your patients. Also, everything will get repetitive after awhile. If it didn't get repetitive then you would not be an expert in your field which would not be good.

Most people fear what they don't understand. Just read the anecdotes on this thread. Dermatology is consistently the worst taught subject at most medical schools, to the point that most other posters on here (and most non-derm physicians) 1) have no clue what we actually do, and 2) know next to nothing about dermatology.

I don't mind that much, though, because one of the things that drew me to derm was the ability to be an expert in something that most other physicians just don't get. But, because the lifestyle is also very good, there is quite a bit of envy involved, and it's usually communicated in a negative way.

Yes, of course, not everyone will enjoy the subject matter. But there's a lot of overcompensating that goes on when people go out of their way to make it known how yucky/boring/whatever they think it is.

 

[bannie22]

Id find it difficult because I dont have the personality, skin quality, nor interest in the field.
I think the money is hard to turn down, but without the above 3, I think making that sort of big bucks would be more challenging than anticipated.

 

[WingedOx]

Nah.

 

[bluetee31]

Since both your parents are physicians, I'm guessing you're not going to be hurting on the debt side of things either. So pick a field where you enjoy the basic stuff and that you enjoy on a day to day basis.

I probably should've mentioned this in my initial post, but my parents are not paying for any of my undergraduate or medical school education. They believe that my brothers and I will value our education more if we have to pay for it ourselves. They did buy me a decent used car right before I started medical school though

You work pretty hard in residency and see patients for 5 minutes as an attending and you're always on your feet.

Is this really true or just an exaggeration? I don't think I would be happy with spending only 5 minutes per patient.

@ActinicKeratosis @username456789 This might sound like a troll question, but do you feel pressured by your colleagues or patients to have clear, flawless skin all the time? Just wondering because, despite numerous creams and scrubs and what have you, I have had persistent acne problems, even to this day.

 

[raiderette]

I would rather see my chosen specialty have better malpractice rates.

 

[OrthoTraumaMD]

Wouldn't switch, rashes freak me out.

 

[Logic Inc]

Bluetee's derm interview:

Derm MD: "why derm?"
BT: "both of my parents are physicians and they told me to go into derm bc hrs are short and you get to make bank"
Derm MD: "perfect! You will fit right in"

 

[evilbooyaa]

Most people fear what they don't understand. Just read the anecdotes on this thread. Dermatology is consistently the worst taught subject at most medical schools, to the point that most other posters on here (and most non-derm physicians) 1) have no clue what we actually do, and 2) know next to nothing about dermatology.

I don't mind that much, though, because one of the things that drew me to derm was the ability to be an expert in something that most other physicians just don't get. But, because the lifestyle is also very good, there is quite a bit of envy involved, and it's usually communicated in a negative way.

Yes, of course, not everyone will enjoy the subject matter. But there's a lot of overcompensating that goes on when people go out of their way to make it known how yucky/boring/whatever they think it is.

I think Rad Onc definitely takes the cake in terms of your bolded line.

I at least had a dermatopathology lecture set in MS2. Granted, I slept through most of it, but it was there.

 

[wegh]

Not a chance. I could have gone into finance and made 5x as much but no way I was going to do that either.

 

[wegh]

Yes, of course, not everyone will enjoy the subject matter. But there's a lot of overcompensating that goes on when people go out of their way to make it known how yucky/boring/whatever they think it is.

The reality is that derm is only coveted because it's hard to get and that's because they purposely keep the residency spots low. Once you see through that, there are other specialities with good lifestyle and more than livable wages out there that are nowhere near as competitive as derm. I think that's another reason why derm gets a lot of crap. Neurosurgeons I respect because they slave over their work and despite being competitive it's still a very self-selected group of people. Start adding more derm spots, the number of dermatologists goes up, the pays go down, and then everyone remembers that it really should only be for people truly fascinated with skin pathology.

Im half asleep so apologies for the incoherent rant

 

[droliver]

One thing to remember about contemporary dermatology, aside from the MOHS surgeons, is that it's a field with a low barrier to being disrupted by NP/PA's. It's also squarely in the sites of CMS for reimbursement adjustments downwards as procedural dermatology on medical patients has skyrocketed in #'s for no good reason. I say that to emphasize that the financial attraction to the field might not be a durable thing down the road.

I also would go crazy doing do the 50-75+ patient clinic days that many dermatologists (and opthamologists for that matter) do 4-5 days a week to churn the revenue wheel. It's a miserable and soul sucking way to practice.

 

[neoevolution]

I think Rad Onc definitely takes the cake in terms of your bolded line.

I at least had a dermatopathology lecture set in MS2. Granted, I slept through most of it, but it was there.

I remember having literally a single 1hr lecture for rad onc during our onc block. Derm actually got its own 3 week block, and the derm attendings complained a little bit during the intro lectures that they felt they needed more time. I think the 3 weeks was proportional to how much derm shows up on Step 1 though too, I don't think I've ever seen a question that required knowledge on what rad onc does