IM vs Dermatology

[PugsAndHugs]

This has been driving me nuts for some time now and finally decided to get any insight from the SDN community, especially from Hospitalists now working in major cities! Sorry in advance for how long this is but I thought really long and hard about each path since I really do like both of them so much.

Background:
4th year at a lower-tier MD school in NY (Need to stay in NYC for family reasons)
Step 1: 250-255
Step 2CK: Waiting
Rank: 1st or 2nd quartile (Honors in IM)
AOA: No
Research: 1 Dermatology Case Report

• IM (hospitalist)
  • Pros
    • Enjoy diagnosing, “solving the puzzle” aspect of medicine
    • Enjoy working with all organ systems – more variety in pathology
    • Versatile - Have the option to sub-specialize in the future (although hospitalist is most appealing to me at the moment)
    • Goal is very clear - Enjoy treating ONE ACUTE problem (as opposed to many different problems in Primary Care – ex: if you’re treating patient’s acute CHF exacerbation and the patient complains about knee pain or some other vague complaint, we can look into it but for the most part won’t be worked up in this visit, PCP will handle it)
    • Short residency (3yrs)
    • Not a big fan of procedures (except Derm related ones)
  • Cons
    • Low compensation in NYC - put all this time/effort/sacrifice to possibly be under-compensated and maybe feel regret? - One of my main cons for this
    • Uncertainty of Job stability & Future of profession with more midlevel recruitment (Many physicians have said to specialize to avoid this
    • More likely to have patients that may not care about getting better (homeless, chronic CHFs/COPDs that don’t adhere to meds/smoking cessation) vs Dermatology where private practice usually have GREAT adherence
    • Saturated in NYC, finding job might be hard (residents mentioned this)?
    • Hospitalists I've encountered don’t seem happy with their careers
    • Working mainly in hospital – which comes with bureaucracy of administration/pressure to meet certain patient RVUs, patient numbers
    • Won’t get holidays/weekends off (minor reason)

• Dermatology
  • Pros
    • Visual field, enjoy pattern recognition aspect, less reliant on the patient’s HPI and more on your assessment
    • Enjoy treating common chronic diseases (Acne, Eczema, Psoriasis etc)
    • Found myself always disinterested in procedures except for those in Derm. I enjoy all the procedures, including surgical excisions, biopsies, suturing, I&Ds, etc. Basically: I enjoy all procedures involving the skin, but nothing below the skin – main reason why I ruled out surgery
    • Enjoy cancer surveillance with excellent prognosis for majority of the skin cancers.
    • Creative aspect with cosmetics – although I wasn’t a fan of the cosmetic population, especially the ones that were hyper-focused perfection - I can definitely see myself enjoying a few cosmetic patients per day because I enjoy the creative aspect to it and the results are usually very fast
    • Enjoy fast paced environment of clinic as opposed to being with fewer patients for a longer time
    • Private practice - organized office w/ more control as opposed to hospital environment with little control, also 9-5ish, weekends/holidays off (minor
    • Patients are usually healthy, deal with patients of all ages, and usually have great adherence to treatment regimen and follow up
    • Higher Compensation than hospitalist (minor)
  • Cons
    • MAIN CON: Research year!!! and general competitiveness of obtaining dermatology residency – Somewhat intimidating not knowing what state I might match in, especially since I prefer to stay in New York for family reasons. The norm now is to do a research year, however, I am much more a clinical person (love to see and treat patients) as opposed to an academic/research person – may be due to poor research experiences in the past- It’s hard to see myself taking a year off to exclusively do research, even if its clinical, because my experience has been mainly data collection, helping patients answer questionnaires/surveys, etc
    • Less of diagnostic process compared to Internal Medicine – From my experience, many times you can treat something and without knowing what the exact diagnosis is and just calling it “Irritant contact dermatitis”. Diagnostic steps include: biopsy, patch testing, KOH scraping, culturing wound, which can lead to an answer (1 step). If unsure rash/lesion but maybe seems inflammatory? Treat with steroid. If it gets better; great. If it gets worse, may be infectious – try antibacterial/antifungal.- Obviously this is VERY oversimplified but from my experience it's the majority of what goes on
    • Lack of variety? I don't mind the bread and butter cases but worried this may conflict with my personality because I find myself needing to be intellectually stimulated

Any advice/insight/thoughts would be appreciated!

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[FutureEyeGuy]

If you have such a strong geographic requirement (limited to one state), you can't really seriously consider dermatology. IM it is. If you can broaden your geographic preference to, well, anywhere in the United States for dermatology, even then you need a lot more research to bolster you to apply. Consider a research year in that case. Good luck!

 

[puahate]

Do you really want to do IM. Like do you REALLY want to.

 

[mrbreakfast]

You wrote a lot, but in the beginning you wrote "Need to stay in NYC for family reasons." If that is hard-and-fast you're likely looking at IM.

You should consider whether some of your apprehensions about derm (research year, residency length, whether or not you can stay in NY) should determine the course of the next 30 or so years of your career.
If you like derm more, no one is going to tell you not to do it, even if you have to take a research year before you apply.

 

[Splenda88]

If your eyes were set on GI, I would recommend IM. The lifestyle of IM residents is not great. I was told being a hospitalist is just slightly better. Go for derm and call it a day.

 

[afib123]

to me , it seems you like the money in derm and the job of an IM doctor. Either you can start gunning in IM residency to get GI or cards and make money but you won't have lifestyle in cards.
Also, from what I understand, you need to be in academic center for IM to see the really interesting cases. Community IM is probably pretty routine.
Easy route: Derm considering you get in
Hard route: IM then GI for compensation aspect and liking the job aspect