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

[BigRedBeta]

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

Funny, we had a rad onc lecture but no dermatopathology.

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[Mad Jack]

I could suffer through a life of surgery, I could waste far too many hours of my telomeres rounding in IM, but dermatology... I just couldn't. The patient turnover is too fast, the procedures too unrewarding, the work too tedious. If you can do it, good for you, but it's just not a field I could enjoy.

 

[Stagg737]

Funny, we had a rad onc lecture but no dermatopathology.

We had the opposite. a week of derm mixed in with our second MSK section and zero lectures on rad onc.

 

[wegh]

I could suffer through a life of surgery, I could waste far too many hours of my telomeres rounding in IM, but dermatology... I just couldn't. The patient turnover is too fast, the procedures too unrewarding, the work too tedious. If you can do it, good for you, but it's just not a field I could enjoy.

but but but lifestyle! /s

 

[plukfelder2017]

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.

Excellent post. I look forward to seeing midlevels encroach into contemporary dermatology and tilt the pay-scales downwards permanently in that speciality. Here's my rant: If you're in medicine exclusively for lifestyle, prestige, or monetary compensation you are wasting your time and most likely rendering lower quality patient care relative to your peers. Develop a personality and find a way to get a 2-3 year capital markets gig out of undergrad at a bulge bracket, elite boutique, or middle market investment bank. Sacrifice your personal life during this period and work your 80-100 hour weeks because you most likely will not have to later on. Shift into venture capital, hedge funds, or private equity and proceed to make much more than a dermatologist over your lifetime. Your rolodex, annual salary, and general business knowledge/acumen will be greater and your net worth will reflect the corresponding changes. As someone who career switched from i-banking to medicine, it bothers me to speak to a quarter of my classmates who have 0 interest in any field other than derm due to lifestyle and salary. /rant sorry for the paragraph of text here.

 

[FindMeOnTheLinks]

Excellent post. I look forward to seeing midlevels encroach into contemporary dermatology and tilt the pay-scales downwards permanently. Here's my rant: If you're in medicine exclusively for lifestyle, prestige, or monetary compensation you are wasting your time and most likely rendering lower quality patient care relative to your peers. Develop a personality and blah blah blah

As someone who career switched from i-banking to medicine, it bothers me to speak to a quarter of my classmates who have 0 interest in any field other than derm due to lifestyle and salary. /rant sorry for the paragraph of text here.

Hilarious post. You don't have a clue about the realities of medicine.

The naivety of premeds and beginning 1st year med students will never cease to amaze me.

 

[J ROD]

hell no......i rather do path than derm....so boring

 

[BearGrappler]

If you love family medicine but are scared about the lifestyle then you should check out Direct Primary Care. You basically charge a set amount a month (around $50-80) and see about 600 patients a year. www.dpcfrontier.com has a map on it that shows you all the clinics that are practicing this model. You don't take insurance so your overhead is really low and you can spend 30 - 60 mins with each patient. In family medicine you can become a great entrepreneur. In other words if you had a clinic that you built up then you can hire another doctor to take your place and take 20% of the clinic income then start another clinic and do the same thing. Plus you can charge for some derm procedures, laser hair removal, dexa scanning, minor surgeries or even cryo freezing. Plus on top of that you can pull in acupuncture, yoga, add an urgent care, x-rays, lab work, and even distribute your own meds (provided your state allows it). The sky is the limit and I've seen and worked in clinics that have done all of the above.

 

[MSTP18]

No way. Derm is gross.

 

[username456789]

Excellent post. I look forward to seeing midlevels encroach into contemporary dermatology and tilt the pay-scales downwards permanently. Here's my rant: If you're in medicine exclusively for lifestyle, prestige, or monetary compensation you are wasting your time and most likely rendering lower quality patient care relative to your peers. Develop a personality and find a way to get a 2-3 year capital markets gig out of undergrad at a bulge bracket, elite boutique, or middle market investment bank. Sacrifice your personal life during this period and work your 80-100 hour weeks because you most likely will not have to later on. Shift into venture capital, hedge funds, or private equity and proceed to make much more than a dermatologist over your lifetime. Your rolodex, annual salary, and general business knowledge/acumen will be greater and your net worth will reflect the corresponding changes. As someone who career switched from i-banking to medicine, it bothers me to speak to a quarter of my classmates who have 0 interest in any field other than derm due to lifestyle and salary. /rant sorry for the paragraph of text here.

This is such a hilariously idealistic and naive post. And oddly bitter/angry at the same time.

May you never have a seat at the RUC.

 

[ActinicKeratosis]

I think OP should change the title of this thread to, "Let's all hate on dermatology." The number of obnoxious comments from people who haven't clearly spent anytime in the field is staggering. There are things that are good and bad about every single field in medicine. No field is better or worse than any other. We all provide a valuable service.

 

[Med student 18]

nope. too mundane.

 

[wegh]

Hilarious post. You don't have a clue about the realities of medicine.

The naivety of premeds and beginning 1st year med students will never cease to amaze me.

I'm not a premed or 1st year and I agree with him for the most part.

 

[wegh]

I think OP should change the title of this thread to, "Let's all hate on dermatology." The number of obnoxious comments from people who haven't clearly spent anytime in the field is staggering. There are things that are good and bad about every single field in medicine. No field is better or worse than any other. We all provide a valuable service.

I don't think anyone claimed that dermatology wasn't a valuable service

 

[wegh]

This is such a hilariously idealistic and naive post. And oddly bitter/angry at the same time.

May you never have a seat at the RUC.

Not sure how you got bitter out of that post. Projecting?

 

[username456789]

Not sure how you got bitter out of that post. Projecting?

Not in the least.

 

[evilbooyaa]

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

That is true. Got sick of maculopapular and then looking a histology slide, with the answer choices being a treatment option.

 

[Brahnold Bloodaxe]

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

Damn, you're really making me want to do plastics or derm with that post. I've been in the ramen-eating stage long enough, and since I'm not Mother Theresa, the "strictly cash basis and filthy rich" stage sure sounds appealing.

Also, I'll be much happier treating rich patients than poor patients. Outside of medicine, I much prefer interacting with white collar workers than with drug addled street people, and I'm sure the same will hold within medicine.

With that said, I'm not very hot on derm because of the threat of midlevel encroachment and the lack of locums opportunities. If by the time I'm an MS4 I decide EM job market is on the downswing and have the package to land an elite tier specialty, I'll rather use it on something more future-proof like ortho or ENT, or even plastics.

 

[Anicetus]

Half of you on this thread are Bernie Sanders cultists. Be real with thyself.

 

[cellsaver]

Half of you on this thread are Bernie Sanders cultists. Be real with thyself.

No one has mentioned the US health care industry reform that is taking place. It tells me most are clueless and just talking yada yada yada. Good luck with that

 

[zurc2014]

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

I am only a incoming MS1 but... I came into school with about 5 pubs in derm and super strong connections from derm PDs. I have forced myself to like the specialty and shadowed extensively (also worked as a MA for a private practice derm clinic). I can honestly say that I have been bored out of my eyes (no offence to derm people) and cannot do it. The money is just not enough to freeze off AKs and deal with biologics for psoriasis for a living. I was legit unhappy in that field.

 

[jhamaican]

I would do Derm if I wasn't doing GI. Actually considered doing derm after my IM residency but too far deep. Both procedural, less patient BS.

Much the same as derm, I think GI has a great future with cash procedures minimally invasive weight loss is the future. Cash procedures for hemorrhoids. Just wait these are growing fields.

I wasn't prepared to put up the fight necessary to match into derm coming straight from undergrad (never took any time off, graduated undergrad in 3 years while working)

 

[wegh]

Half of you on this thread are Bernie Sanders cultists. Be real with thyself.

What

 

[IlDestriero]

I would do Derm if I wasn't doing GI. Actually considered doing derm after my IM residency but too far deep. Both procedural, less patient BS.

Much the same as derm, I think GI has a great future with cash procedures minimally invasive weight loss is the future. Cash procedures for hemorrhoids. Just wait these are growing fields.

I wasn't prepared to put up the fight necessary to match into derm coming straight from undergrad (never took any time off, graduated undergrad in 3 years while working)

I use minimally invasive weight loss now. It's not the future, it's the current. It's called Eat Less and Move More. The ELMM (TM) program works wonders for people. It's not well known because the pharmaceutical companies don't run ads on late night TV for it.


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Il Destriero

 

[VA Hopeful Dr]

I would not. Spending all day with a single organ just isn't my idea of a good time.

That said, I don't dislike dermatologists (well, I dislike cosmetic cash-only ones but everyone else is OK in my book). The skin can be tricky at times and they do good work. Plus I don't want to be on the hook for melanoma anything.

 

[jhamaican]

I use minimally invasive weight loss now. It's not the future, it's the current. It's called Eat Less and Move More. The ELMM (TM) program works wonders for people. It's not well known because the pharmaceutical companies don't run ads on late night TV for it.


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Il Destriero

Bro, that is free and totally not the American way.

Why put in the work when there is an easy out?

No one makes money off of that strategy, Unamerican!

 

[LoGo]

Anyone who is trashing derm due to boredom is spending too long with each patient and missing out on the glory that is the 5 minute derm appointment.

 

[ActinicKeratosis]

Anyone who is trashing derm due to boredom is spending too long with each patient and missing out on the glory that is the 5 minute derm appointment.

Yes I agree. It sure beats Eternal Medicine rounding.


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[Dare2Dream]

I started out with derm as a top choice, stayed that way a long time, then spent time in the clinic. Seeing one type or another type of rash one after another took the luster away. Perhaps there are derms who work on more complex and varied cases but seems like by and large it is simple and very repetitive with less variation from case to case than other fields. Make sure to spend time in the clinic, ideally a whole day, not just a few cases, so you get a good idea of what the day looks like. Of course, it is entirely possible that after getting beaten down in another field for a decade, you may wish for these very things that derm offers.

 

[Methodnike]

I'm a family doctor
My hours are great, I make a very good income, and i love my job.
I actually do a lot of dermatology in my practice including cyst removals, lipoma removals, skin biopsies, etc...
Yes, the horror

You're an M1. Think about learning medicine for now. You will see what you like during your third year rotation. Don't choose a specialty just for the " hours". You can build your own practice/schedule in many specialties

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

 

[zurc2014]

Anyone who is trashing derm because of boredom needs to realize that most americans are bored with their job but don't have the privelege of working 40 hours a week and making amazing salaries. Also probably the one's talking about the job being boring are probably boring people without much going on besides their job. It's not only about what happens at work (bored or not), but also what happens after work and a lot of other specialties don't have a lot of after work going on.

I don't bash derm especially since my closest mentor was a derm (hence why I was drawn that way). I have been fully integrated in derm for years before even applying to medical school (academic, private practice, wrote 2 book chapters in derm and published 5 papers). For some of us it is just... not exciting. Not gonna lie, I was mostly doing it for the lifestyle but after seeing the same biopsies, cryosurgery, prescribing Accutane and giving Stelara injections...I can honestly say that I will pass. I respect derms to the fullest but the 9-5 days in clinic feels longer than 11 hour days in surgery to me.

 

[hurtem&healem]

You're an M1. Think about learning medicine for now. You will see what you like during your third year rotation.

Maybe this is the the SDN crazy talking, but isn't 3rd year a bit late to decide on a field as competitive as derm? Common wisdom around here would be that you should be doing derm research by the summer between M1 and M2.

 

[Redpancreas]

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.

Lay off Goro man. He goes out of his scope (simultaneously trying to advise undergraduates, medical students, and apparently speak about residency requires immense -just go try to Pre-Allo and see if your advice means anything anymore post 2015 mcat, etc) but he's always trying to help. I get that he has wrong info sometimes but just tell him and it's a quick fix, don't mock him. I think most MD Allo posters on here know he's reaching and he needs to do a better job explaining that at times.

This isn't meant to be a challenge, but I want your opinion because it sounds like you're either in Derm residency or further so you've done very well and know how Derm is practiced. Please explain how Dermatology is taught poorly to medical students and how that differs from the actual resident/attending material. Conventional SDN wisdom echoes the points I summarize earlier in this thread which you obviously disagree with. Below are points I've heard in defense of Derm (that it's not lifestyle and steroids) and I write my commentary.

1. Dermatology is important because of sentinel signs that can detect systemic disease or immune compromise.

Agreed, but how often does a dermatologist examine the whole body like the stomach and spend more than 15 minutes in a room, or remember/know past medical history (they can look it up but connection comes faster when they know the patient). They carry such a high patient volume and seem to just hyperfocus on the skin lesion of chief complaint that I dont feel this happens.

2. The material is diverse and incredibly detailed.

I'm sure this is true but how often are all these variants change management/treatment? With my field, the material is actually incredibly complex but it gets swept under the rug because 1) our day-to-day focused on things like social work, etc. 2) none of us are sure how much theroretical knowledge about fluids and cardiorenal interaction is mental masturbation vs. something that will influence care.
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3. " Eczema" is not really that simple.

Do all the bread and butter cases like eczema (fillagrin defect-thingy), atopic dermatitis (type 2), and contact dermatitis (type 4 HS) have different subtypes and different managements and is this something running through your head and will it affect management for each patient? Is that what you're thinking of with patient's often or is it just:

If eczema --> how severe? --> refer to steroid strength chart you see in most offices.

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Lastly, IM residents know they suck at rashes. What can future IM physicians learn to do to make your job easier? Do you want us to learn to diagnose more atopic dermatitis/eczema disease and a manage it so you receive the more interesting pathology or do you want IM physicians to just refer to you at all times because that rash may just be cancerous? I'd imagine you'd want Cardiologists to understand venous stasis/etc. but beyond the basics?

 

[IslandStyle808]

Maybe this is the the SDN crazy talking, but isn't 3rd year a bit late to decide on a field as competitive as derm? Common wisdom around here would be that you should be doing derm research by the summer between M1 and M2.

Correct. If you are in this boat of deciding derm is for you in 3rd year. Then the only measure you can take to successfully match is a research gap year.