IM vs Derm

[swman]

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I have been having a hard time deciding between these 2 specialties. A lot of old threads I searched for contain comments about how passing up Derm would be passing up a once in a lifetime opportunity, but those have all been from the Derm residents.

I would be interested in hearing from internists who passed up Derm for IM and what factored into their decision as well as how satisfied they are with the decision looking back.

Thank you

 

[GiHunter]

that's BS...some of us could have matched in derm...its incredibly boring is why I didn't do it......some of the IM subspecialties can't be beat but I will admit it takes a lot of willpower to go through IM residency and compete for a fellowship rather than match into something straight out of school

 

[Frugal Traveler]

I didn't seriously consider dermatology, but I am sure with my stats (which were similar to those going into derm at my school), I probably could have had a decent probability with the PROD (note: I do not consider anesthesiology anymore as part of the ROAD... so I call it PROD instead of ROAD since plastics fits well now.)


For me, internal medicine is outstanding. From what I hear, it used to be one of the most competitive specialties back in the day given that it is by far one of the most intellectually stimulating specialties. I believe that one day it will return to that status. I think internal medicine provides one of the most diverse experiences possible… you have so many options after you finish residency, and while many are not 9-5 like derm can be, you are taking care of some very sick patients… you know better than almost any other doctor how to tackle a variety of simultaneously difficult problems in a single patient, and you understand a massive body of knowledge while intimately knowing pathophysiology, pharmacology, and social dynamics.

I don't know why more people do not go into internal medicine (my theory is that our generation does not like to work hard... as Tom Brokaw might say... we're not the greatest generation)... people have that conception... but I think derm residents work quite hard. If you enjoy medicine, we gladly welcome you to join us on a hard yet satisfying road! To each, their own… you have to do what you enjoy the most... because things change… and dermatology is not always going to be the best opportunity and make the best money… believe it or not… family doctors can treat acne and psoriasis greater than 10 % of TBSA… and Obama knows that… melanoma is a different story… referral to dermatology for all the fun and liability


All in all, derm is a great field... so is internal medicine or any field you enjoy. I've seen the pros and cons of internal medicine… still heading full throttle… and plan to stay positive and happy whatever happens because my goal is to take care of some really sick people with multiple issues. At the end of the day, I will be satisfied pulling into my driveway.. so use the "driveway" test and not the "money" test... some of my classmates are using the latter... which is fine for now... but you never know what will happen later.

If you're a visual person... would definitely consider dermatology. If you're an MD/Ph.D, many great research opportunities present as well. If you have tons of student debt or would like to work 9-5, then consider dermatology. If you like making people look better and restore their confidence, consider derm. For instance, this can be done with cosmetic procedures or even starting someone on Accutane (which for people with cystic acne can be a life saver and lend them confidence for the rest of their life given that it cured the acne) or even starting someone on a biologic for psoriasis (which has a ton of morbidity for patients with extensive lesions). It's a field with a ton of James Bond lasers, skin biopsies with one of the weirdest and deadliest cancers... and you may make some interesting diagnoses as the skin may be the first organ that manifests (neurocutaneous syndromes). It may seem like a superficial field... but you can do much good with your skills as a future dermatologist.
Other thing I can think of = you deal with both children and adults (in IM, obviously... it's like a NC-17 movie... I am not seeing anyone in my theater under the age of 18).

Bottom line: Pick what you enjoy!!! You're not missing any great opportunity if you enjoy what you are going into... if other influences affect your choice (going into the field just because you have the stats), you have a good chance of failing the driveway test later on.

Good luck in your decision!

 

[dragonfly99]

I agree w/the above post.
However, keep in mind that you will likely be working significant more hours doing IM, definitely during training and very likely during practice as well. So part of this depends on whether you enjoy working long and hard, vs. less hard. Dermatologists are very smart and their specialty requires ability to memorize a lot of stuff, to have good visual skills and be able to do some procedures, but the work hours in IM are definitely more. IM is also an intellectual specialty, which requires ability to memorize and integrate a lot of information. If you do IM you may have to go through the Match again, unless you choose to Short Track into some competitive specialty - I think you should definitely consider that if you want cards or GI because you'd be able to avoid the stress of having to do the Match twice, and avoid the risk (albeit small) of not matching into what you want. If you are a good enough med student to be competitive for derm, you could definitely Short Track into a subspecialty at a good IM program.

 

[GiHunter]

i disagree with the ms4 above...IM residency is a serious pain in the *****.....i can gaurantee that poster will laugh at his post in 1 year....taking care of multiple patients each with very complex issues..hahaha sorry i couldn't resist

 

[Frugal Traveler]

i disagree with the ms4 above...IM residency is a serious pain in the *****.....i can gaurantee that poster will laugh at his post in 1 year....taking care of multiple patients each with very complex issues..hahaha sorry i couldn't resist

People made the same argument about my college major (which is not "fun"). I made similar assertions back then, and I didn't end up laughing at them later. I obviously know what I am getting myself into because I've seen IM at my institution. IM can be rough, but I tend to thrive in complex and difficult situations. It's like that passage in the first chapter of Brave New World:

"[SIZE=-1]Doing repairs on the outside of a rocket in mid-air is a ticklish job. We slacken off the circulation when they're right way up, so that they're half starved, and double the flow of surrogate when they're upside down. They learn to associate topsy-turvydom with well-being; in fact, they're only truly happy when they're standing on their heads. "[/SIZE]

I tend to be truly happy in complex and difficult situations because I find it very stimulating. Other people find other situations stimulating (like visual people might like radiology, pathology, or dermatology).

Therefore, I stand by my comments again. If you want to see the definition of pain, then spend a year in general surgery. Otherwise, I'd suggest being positive... it's free and better than being negative... somewhere along the way our generation has to buck being "the lamest, whiniest generation."

 

[docscience]

If you don't plan on specializing, why not do an FM residency? I hear it is fairly easy and you can find a niche in many areas.

 

[GiHunter]

I tend to be truly happy in complex and difficult situations because I find it very stimulating.

That's cute m8......I know what you are thinking, we have all been there...but there's nothing stimulating about admitting nursing home gomers, figuring out dispo, dealing with drug seekers, the politics.....

Again I know what you are saying..and someone warning you about doing IM is not the same thing as someone warning you about not to do be a biomedical engineer at Hopkins as an undergrad, lol....Just my opinion, I think you will reflect on this post in 1 year's time!

 

[GiHunter]

Actually I won't deny general surgery residency is painful..but atleast they are doing something for their patients...most of the patients you will admit, for whatever reason, the actual cure rate is very low.

 

[asmallchild]

I have been having a hard time deciding between these 2 specialties. A lot of old threads I searched for contain comments about how passing up Derm would be passing up a once in a lifetime opportunity, but those have all been from the Derm residents.

I would be interested in hearing from internists who passed up Derm for IM and what factored into their decision as well as how satisfied they are with the decision looking back.

Thank you

Since a prelim year is mandatory, you could always do a "hardcore" prelim year that will expose you to as much mandatory medicine months as possible with few electives.

If at the end of it you still feel medicine is your true calling, I'm fairly confident the medicine program will be more than happy to keep you aboard for another 2 years, and while your derm program won't be thrilled, they'll find someone to take your spot and probably fairly quickly too.

I'll concede there are days when I walk out of work (I'm an intern right now) feeling medicine is pretty nice. I agree with the comment above that no one else is really equipped or trained to handle patients with extensive problem lists as well as an internist.

That being said, I can't tolerate the work hours (being a good internist really does require a lot out of you) and more importantly, the general lack of respect (some of it comes with being an intern but I'm just really unhappy being in the hospital)

 

[ResidentMD]

I didn’t seriously consider dermatology, but I am sure with my stats (which were similar to those going into derm at my school), I probably could have had a decent probability with the PROD (note: I do not consider anesthesiology anymore as part of the ROAD... so I call it PROD instead of ROAD since plastics fits well now.)


For me, internal medicine is outstanding. From what I hear, it used to be one of the most competitive specialties back in the day given that it is by far one of the most intellectually stimulating specialties. I believe that one day it will return to that status. I think internal medicine provides one of the most diverse experiences possible… you have so many options after you finish residency, and while many are not 9-5 like derm can be, you are taking care of some very sick patients… you know better than almost any other doctor how to tackle a variety of simultaneously difficult problems in a single patient, and you understand a massive body of knowledge while intimately knowing pathophysiology, pharmacology, and social dynamics.

I don’t know why more people do not go into internal medicine (my theory is that our generation does not like to work hard... as Tom Brokaw might say... we're not the greatest generation)... people have that conception... but I think derm residents work quite hard. If you enjoy medicine, we gladly welcome you to join us on a hard yet satisfying road! To each, their own… you have to do what you enjoy the most... because things change… and dermatology is not always going to be the best opportunity and make the best money… believe it or not… family doctors can treat acne and psoriasis greater than 10 % of TBSA… and Obama knows that… melanoma is a different story… referral to dermatology for all the fun and liability


All in all, derm is a great field... so is internal medicine or any field you enjoy. I’ve seen the pros and cons of internal medicine… still heading full throttle… and plan to stay positive and happy whatever happens because my goal is to take care of some really sick people with multiple issues. At the end of the day, I will be satisfied pulling into my driveway.. so use the "driveway" test and not the "money" test... some of my classmates are using the latter... which is fine for now... but you never know what will happen later.

If you're a visual person... would definitely consider dermatology. If you're an MD/Ph.D, many great research opportunities present as well. If you have tons of student debt or would like to work 9-5, then consider dermatology. If you like making people look better and restore their confidence, consider derm. For instance, this can be done with cosmetic procedures or even starting someone on Accutane (which for people with cystic acne can be a life saver and lend them confidence for the rest of their life given that it cured the acne) or even starting someone on a biologic for psoriasis (which has a ton of morbidity for patients with extensive lesions). It's a field with a ton of James Bond lasers, skin biopsies with one of the weirdest and deadliest cancers... and you may make some interesting diagnoses as the skin may be the first organ that manifests (neurocutaneous syndromes). It may seem like a superficial field... but you can do much good with your skills as a future dermatologist.
Other thing I can think of = you deal with both children and adults (in IM, obviously... it's like a NC-17 movie... I am not seeing anyone in my theater under the age of 18).

Bottom line: Pick what you enjoy!!! You're not missing any great opportunity if you enjoy what you are going into... if other influences affect your choice (going into the field just because you have the stats), you have a good chance of failing the driveway test later on.

Good luck in your decision!

Completely agree. Love the driveway test concept.

Btw, if this is what you post on a forum, your personal statement must be killer👍!

Few points - instead of calling it PROD - you could call it DROP 😉. Ways to deflate a person's ego...What are you applying for? Plastics. Yeah, thats a DROP specialty 😉..sorry, I have a weird sense of humor.

I tend to be truly happy in complex and difficult situations because I find it very stimulating.

That's cute m8......I know what you are thinking, we have all been there...but there's nothing stimulating about admitting nursing home gomers, figuring out dispo, dealing with drug seekers, the politics.....

Again I know what you are saying..and someone warning you about doing IM is not the same thing as someone warning you about not to do be a biomedical engineer at Hopkins as an undergrad, lol....Just my opinion, I think you will reflect on this post in 1 year's time!

I will have to back up Frugal on this one. I picked IM for the same reason I picked medicine..which were similar to Frugal's. I couldve picked Derm (not in United States, but in my home country - paradoxically, Derm is lesser competitive than IM there - ROTFL!), but I didnt want to - same reasons. And the only reason I am here is for Internal Medicine, and for the reasons mentioned above. And how do you know his degree at Hopkins was biomedical engineering?

Actually I won't deny general surgery residency is painful..but atleast they are doing something for their patients...most of the patients you will admit, for whatever reason, the actual cure rate is very low.

Surgery troll. Tell me the last time you cured the metastatic pancreatic Ca case my friend. Dont want to pick a fight...but there is a reason people choose to become internists and intensivists....and there isnt really a direct correlation with the cure rate. There is something more to that. Dont throw this argument in an intensivists' face, when they are taking on a subspecialty with > 40% mortality. There is a reason they do so.

 

[Ariee]

I completely agree with RMD and Frugal.
OP- you MUST draw up a list. Try this: On the x axis put Derm and IM. On the y axis put things that matter to you. Please don't include things like money or prestige b/c that really makes me want to vomit. IM has a comparable salary if not better to Derm anyways. I would suggest putting things like: intellectual stimulation, satisfaction, your goals, your personality attributes, etc and see which you feel better with anyways. Also, if Derm wasn't such a competetive specialty would you go for it? I know there is a hollywood effect in medicine that some of my classmates seem to have got lost in.

Lastly- I went to an IV today with an Anesthesiology troll/douche-bag pre-lim resident and I gotta tell y'all one thing...I couldn't be happier with my choice. My personality JUST FITS with IM, other fields definitely have a personality/immaturity/lack of inhibition/obnoxiousity that I just can't stand being around...

In medicine, you should compete with yourself, not others...if this was the case, we wouldn't have PROD/DROP/ROAD/poo-poo...

G'luck,
A

P.S. Where is JDH??? Dude, you coming back or what?! I need my Official IM Questions thread answered!

Completely agree. Love the driveway test concept.

Btw, if this is what you post on a forum, your personal statement must be killer👍!

Few points - instead of calling it PROD - you could call it DROP 😉. Ways to deflate a person's ego...What are you applying for? Plastics. Yeah, thats a DROP specialty 😉..sorry, I have a weird sense of humor.



I will have to back up Frugal on this one. I picked IM for the same reason I picked medicine..which were similar to Frugal's. I couldve picked Derm (not in United States, but in my home country - paradoxically, Derm is lesser competitive than IM there - ROTFL!), but I didnt want to - same reasons. And the only reason I am here is for Internal Medicine, and for the reasons mentioned above. And how do you know his degree at Hopkins was biomedical engineering?



Surgery troll. Tell me the last time you cured the metastatic pancreatic Ca case my friend. Dont want to pick a fight...but there is a reason people choose to become internists and intensivists....and there isnt really a direct correlation with the cure rate. There is something more to that. Dont throw this argument in an intensivists' face, when they are taking on a subspecialty with > 40% mortality. There is a reason they do so.

 

[GiHunter]

lol..i know your types...i'm thankful everyday there will be internists like you

 

[Ariee]

lol..i know your types...i'm thankful everyday there will be internists like you

lol...i know your type...:troll:

 

[MedicalDoctorV]

Yeah pick what you like - not what you think will give you a better life or what matches your "stats."

I actually thought I liked ophthalmology, but i had a great time my intern year in a hardcore prelim program in nyc.

Now my first year after internship i am miserable in ophtho and am looking for a way back into medicine.

What do i miss?
- Actually applying SOMEthing/ANYthing of what i learned during medical school and internship
- Being someone's doctor and not a consultant
- Working in a hospital: clinic 24-7 gets boring
- Variety: don't let anyone tell you that in ophtho/derm/anything else you get to see systemic diseases manifested in X body system. You do, but the "real" docs take care of the systemic disease. YOU end up seeing the same 5 disease processes over and over and over again.

Completely agree. Love the driveway test concept.

Btw, if this is what you post on a forum, your personal statement must be killer👍!

Few points - instead of calling it PROD - you could call it DROP 😉. Ways to deflate a person's ego...What are you applying for? Plastics. Yeah, thats a DROP specialty 😉..sorry, I have a weird sense of humor.



I will have to back up Frugal on this one. I picked IM for the same reason I picked medicine..which were similar to Frugal's. I couldve picked Derm (not in United States, but in my home country - paradoxically, Derm is lesser competitive than IM there - ROTFL!), but I didnt want to - same reasons. And the only reason I am here is for Internal Medicine, and for the reasons mentioned above. And how do you know his degree at Hopkins was biomedical engineering?



Surgery troll. Tell me the last time you cured the metastatic pancreatic Ca case my friend. Dont want to pick a fight...but there is a reason people choose to become internists and intensivists....and there isnt really a direct correlation with the cure rate. There is something more to that. Dont throw this argument in an intensivists' face, when they are taking on a subspecialty with > 40% mortality. There is a reason they do so.

 

[asmallchild]

- Actually applying SOMEthing/ANYthing of what i learned during medical school and internship

This is actually something I've heard echoes across multiple fields (not just derm and ophtho)

It can be a crushing feeling to move on from a prelim year to something completely new. In some ways, it's akin to feeling like an intern all over again. Especially as a lot of your friends are moving on to a 2nd year where they are starting to gain more responsibility/autonomy and have the opportunity to build on their prior base of knowledge and experience both from med school and internship.