Internal Medicine vs. Dermatology? How to choose?

[smiley737]

I'm kind of at a crossroads right now during 3rd year where I need to choose a field so I can start planning my advanced electives and away electives accordingly. I can't decide between dermatology and internal medicine even after doing clerkships in both. I like dermatology b/c you can see the problem in front of you, the lifestyle is supposedly decent, and those in the field I've met seem to be pretty cool people. I like internal medicine b/c you can help in several different ways and the problems you treat may directly benefit the person more. However, I don't like what I see in the busy lifestyles of the residents and attendings stuck in the hospital. Can internists hold pretty laid-back hours? I'd like the opportunity in the future to take short-term trips for medical work in the third world, so I'd like to choose a field that both gives me good training and the flexibility time-wise to contribute to such endeavors. Thus far grades are not a limiting factor for me in either field, so it's strictly a matter of interest. Any advice on how to decide?

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[MagicDrumSticks]

I'm kind of at a crossroads right now during 3rd year where I need to choose a field so I can start planning my advanced electives and away electives accordingly. I can't decide between dermatology and internal medicine even after doing clerkships in both. I like dermatology b/c you can see the problem in front of you, the lifestyle is supposedly decent, and those in the field I've met seem to be pretty cool people. I like internal medicine b/c you can help in several different ways and the problems you treat may directly benefit the person more. However, I don't like what I see in the busy lifestyles of the residents and attendings stuck in the hospital. Can internists hold pretty laid-back hours? I'd like the opportunity in the future to take short-term trips for medical work in the third world, so I'd like to choose a field that both gives me good training and the flexibility time-wise to contribute to such endeavors. Thus far grades are not a limiting factor for me in either field, so it's strictly a matter of interest. Any advice on how to decide?

What did you score on your steps?

 

[coldweatherblue]

if you can match derm I think your future self would thank you for it..

 

[MagicDrumSticks]

if you can match derm I think your future self would thank you for it..

shh... he's competition 😉

 

[njbmd]

I'm kind of at a crossroads right now during 3rd year where I need to choose a field so I can start planning my advanced electives and away electives accordingly. I can't decide between dermatology and internal medicine even after doing clerkships in both. I like dermatology b/c you can see the problem in front of you, the lifestyle is supposedly decent, and those in the field I've met seem to be pretty cool people. I like internal medicine b/c you can help in several different ways and the problems you treat may directly benefit the person more. However, I don't like what I see in the busy lifestyles of the residents and attendings stuck in the hospital. Can internists hold pretty laid-back hours? I'd like the opportunity in the future to take short-term trips for medical work in the third world, so I'd like to choose a field that both gives me good training and the flexibility time-wise to contribute to such endeavors. Thus far grades are not a limiting factor for me in either field, so it's strictly a matter of interest. Any advice on how to decide?

Maybe you need to do a couple of elective in both of these specialties if you can't decide. Seriously, if you say the the derm lifestyle is "supposedly decent" then you haven't spent enough time there to make a decision based on lifestyle. You know what you want so only you can figure this one out.

 

[HTxFrog]

If you are smart enough to match derm, you are probably going to be pretty bored and might feel kind of unfulfilled looking at people's skin the rest of your life. I know some people might take offense to me saying that, but I mean is there really anything to figure out in derm. It seems to me its kind of like well you have a rash, here have some cream. I guess the counter argument would be that you could still have a life outside of work if you did derm and that could leave you feeling more fulfilled. Just my random two cents

 

[sunset823]

If you are smart enough to match derm, you are probably going to be pretty bored and might feel kind of unfulfilled looking at people's skin the rest of your life. I know some people might take offense to me saying that, but I mean is there really anything to figure out in derm. It seems to me its kind of like well you have a rash, here have some cream. I guess the counter argument would be that you could still have a life outside of work if you did derm and that could leave you feeling more fulfilled. Just my random two cents

agreed...I have never understood the fascination with and competitiveness of derm (yeah, money, lifestyle, yadda yadda) - you couldn't pay me to do derm even if I was an AOA contender from JHU or Harvard, I'd get bored out of my mind. The only remotely interesting area of the field to me is burns, which I would get to see anyway if I go into what I want (critical care).

To the OP, I have no advice to you, but to go with your heart, not people telling you derm is more competitive or better paying or whatever. My heart is in love with a field that has crappy hours and low pay, but I feel really fulfilled when I'm in the ICU, and this is coming from a person who's pretty jaded. It seems to me that if you want to do international relief work, you may not have the same mindset as most dermatologists (no offense to those dermatologists who do relief work abroad, but I've never actually met one).

 

[SouthernSurgeon]

If you are smart enough to match derm, you are probably going to be pretty bored and might feel kind of unfulfilled looking at people's skin the rest of your life. I know some people might take offense to me saying that, but I mean is there really anything to figure out in derm. It seems to me its kind of like well you have a rash, here have some cream. I guess the counter argument would be that you could still have a life outside of work if you did derm and that could leave you feeling more fulfilled. Just my random two cents

Derm typically gets a bad rap, but this post goes a bit far even for the usual derm standards.

There is tons of interesting research and work to be done in derm - from the variety of "everyday" skin cancers to the more rare things like cutaneous lymphomas, to mohs surgeries to auto-immune diseases w/ cutaneous manifestations, and on and on. To say that a smart person would be "bored looking at skin" suggests you don't know much about the variety the field has to offer.

 

[MossPoh]

if you can match derm I think your future self would thank you for it..

Maybe not. Derm tends to have some of the most unsatisifed people later on when you look at a few random studies of specialities and satisfcation.

 

[OpalOnyx]

Derm typically gets a bad rap, but this post goes a bit far even for the usual derm standards.

There is tons of interesting research and work to be done in derm - from the variety of "everyday" skin cancers to the more rare things like cutaneous lymphomas, to mohs surgeries to auto-immune diseases w/ cutaneous manifestations, and on and on. To say that a smart person would be "bored looking at skin" suggests you don't know much about the variety the field has to offer.

yea I agree. A guy in my class was making a presentation on the integumentary system with a "what more can be said about just skin" attitude. There is a lot of complexity that may not be immediately visible to some.

 

[smiley737]

Thanks for the input all. I'm going to talk to my advisers and think about it some and then decide what I want to do.

 

[unsung]

I'm kind of at a crossroads right now during 3rd year where I need to choose a field so I can start planning my advanced electives and away electives accordingly. I can't decide between dermatology and internal medicine even after doing clerkships in both. I like dermatology b/c you can see the problem in front of you, the lifestyle is supposedly decent, and those in the field I've met seem to be pretty cool people. I like internal medicine b/c you can help in several different ways and the problems you treat may directly benefit the person more. However, I don't like what I see in the busy lifestyles of the residents and attendings stuck in the hospital. Can internists hold pretty laid-back hours? I'd like the opportunity in the future to take short-term trips for medical work in the third world, so I'd like to choose a field that both gives me good training and the flexibility time-wise to contribute to such endeavors. Thus far grades are not a limiting factor for me in either field, so it's strictly a matter of interest. Any advice on how to decide?

Wow, those are two entirely different fields. Not that I have personal experience yet with any of this, but those two fields are supposed to attract two quite different personality types. Have you taken the specialty aptitude test or whatever that we get to take on the AAMC Careers in Medicine site? That may help somewhat.

A lot of people who would enjoy a hands-on, visual, "there in front of you" field like derm strongly dislike "cerebral" fields like internal med. And vice versa, the "problem solvers" who enjoy the endlessly long differentials, theories of internal med are supposed to dislike the clear cut aspects of derm.

What do I know, but those ARE the stereotypes aren't they? I'd certainly be happy to have someone disprove them in some way... but it just surprises me to hear someone interested in two completely different fields. If it's mostly a matter of lifestyle to you, then go ahead and pick derm.

 

[smiley737]

Wow, those are two entirely different fields. Not that I have personal experience yet with any of this, but those two fields are supposed to attract two quite different personality types. Have you taken the specialty aptitude test or whatever that we get to take on the AAMC Careers in Medicine site? That may help somewhat.

A lot of people who would enjoy a hands-on, visual, "there in front of you" field like derm strongly dislike "cerebral" fields like internal med. And vice versa, the "problem solvers" who enjoy the endlessly long differentials, theories of internal med are supposed to dislike the clear cut aspects of derm.

What do I know, but those ARE the stereotypes aren't they? I'd certainly be happy to have someone disprove them in some way... but it just surprises me to hear someone interested in two completely different fields. If it's mostly a matter of lifestyle to you, then go ahead and pick derm.

Probably most people aren't one-dimensional, and within every field everyone has things they like and dislike about it. I have several friends who had a tough choice between surgery and medicine, let alone derm and medicine. And what I like about derm is the cutaneous manifestations of systemic disease, immunology, and infectious disease. These are pretty intertwined w/IM. That's also why I'm interested in how derm may present itself in the third world. I have much less interest in cosmetic dermatology or acne.

 

[Pianoman32]

Maybe not. Derm tends to have some of the most unsatisifed people later on when you look at a few random studies of specialities and satisfcation.

http://www.sacbee.com/296/story/2348681.html

Do you have any links? This is the only satisfaction survey I've ever seen and it showed some of the highest satisfaction among dermatologists.

 

[futureres]

Probably most people aren't one-dimensional, and within every field everyone has things they like and dislike about it. I have several friends who had a tough choice between surgery and medicine, let alone derm and medicine. And what I like about derm is the cutaneous manifestations of systemic disease, immunology, and infectious disease. These are pretty intertwined w/IM. That's also why I'm interested in how derm may present itself in the third world. I have much less interest in cosmetic dermatology or acne.

Perfect interview answer. 🙂 I'm not doubting your sincerity, but most people I know matching into derm only want to do it for $$/lifestyle reasons. Someone posted their interest in burns--interestingly it's difficult to find enough residents who want to specialize in that, despite the high need for it.

I tried to make myself like derm...for the reasons stated above. I couldn't take it-most of what I was seeing had no real impact on quality of life. There are some dermatologic diseases that really have an impact on a patient's life, and in some cases, are life-threatening. The problem is that many dermatologists focus on private practice/cosmetic derm.

I'm not sure if a Med-Derm program is worth your while, but it may be something to consider if you are intellectually stimulated by both and want more flexibility career-wise, esp. in academic medicine.

 

[deuce924]

Wow, those are two entirely different fields. Not that I have personal experience yet with any of this, but those two fields are supposed to attract two quite different personality types. Have you taken the specialty aptitude test or whatever that we get to take on the AAMC Careers in Medicine site? That may help somewhat.

A lot of people who would enjoy a hands-on, visual, "there in front of you" field like derm strongly dislike "cerebral" fields like internal med. And vice versa, the "problem solvers" who enjoy the endlessly long differentials, theories of internal med are supposed to dislike the clear cut aspects of derm.

What do I know, but those ARE the stereotypes aren't they? I'd certainly be happy to have someone disprove them in some way... but it just surprises me to hear someone interested in two completely different fields. If it's mostly a matter of lifestyle to you, then go ahead and pick derm.

Although Derm cases are visual when it comes to the disease manifestations, it is still very "cerebral" when trying to figure out the cause of the "rash". Many diseases present similarly and Dermatologists have to come up with a Differential based on Symptoms and figure out if this is a localized or systemic problem. So I don't think that Derm and IM are that far apart as you may think.

 

[basupran]

http://1.bp.blogspot.com/_5qp51IdWOV8/SASZ8VkhyEI/AAAAAAAAAwA/scD2146tuUs/s1600-h/dermatologist.jpg

 

[smiley737]

I'm not sure if a Med-Derm program is worth your while, but it may be something to consider if you are intellectually stimulated by both and want more flexibility career-wise, esp. in academic medicine.

Actually, that does strike my interest. Did you have any resources in mind that I could look into?

 

[OpalOnyx]

What do I know, but those ARE the stereotypes aren't they? I'd certainly be happy to have someone disprove them in some way... but it just surprises me to hear someone interested in two completely different fields. If it's mostly a matter of lifestyle to you, then go ahead and pick derm.

My opinion regarding specialty + personality type is that anyone can go into any field... AS long as the person is flexible and willing to learn and adapt and place themselves out of their comfort zone. Maybe the speciality doesn't have to fit like a glove, perhaps some people can instead mould themselves to embrace what interests them most. We are not all magically good at what interests us, some of us have to work at it.

 

[sunset823]

Actually, that does strike my interest. Did you have any resources in mind that I could look into?

there are only a handful of combined programs in this (literally, 5 according to NRMP), but if you have the grades and the interest, it's worth a shot. Definitely seems it could fulfill you more than the traditional derm track. From my cursory google search:

UPenn: http://www.uphs.upenn.edu/medicine/education/resAppInfo/sponsor/med-derm.html
Washington Hospital (DC): http://www.whcenter.org/body.cfm?id=556308
University of Wisconsin: http://www2.medicine.wisc.edu/home/housestaff/hsmeddermmain
Northwestern (Chicago): http://www.feinberg.northwestern.ed...ation/residents/combined_med_derm_program.htm
University of Minnesota: http://www.med.umn.edu/derm/education/medderm/home.html

 

[Dermatologist india]

I'm kind of at a crossroads right now during 3rd year where I need to choose a field so I can start planning my advanced electives and away electives accordingly. I can't decide between dermatology and internal medicine even after doing clerkships in both. I like dermatology b/c you can see the problem in front of you, the lifestyle is supposedly decent, and those in the field I've met seem to be pretty cool people. I like internal medicine b/c you can help in several different ways and the problems you treat may directly benefit the person more. However, I don't like what I see in the busy lifestyles of the residents and attendings stuck in the hospital. Can internists hold pretty laid-back hours? I'd like the opportunity in the future to take short-term trips for medical work in the third world, so I'd like to choose a field that both gives me good training and the flexibility time-wise to contribute to such endeavors. Thus far grades are not a limiting factor for me in either field, so it's strictly a matter of interest. Any advice on how to decide?

Hi Smiley 737!
I read about your confusion between derm and Int med today after almost 5 years of you posting it. I am at this crossroads of confusion today and I think exactly like you for both derm and med. It would be really nice if you could help me take this decision, I am curious to know what did you do with your career and how are you liking it?

Thanks in advance. Waiting for your reply.

 

[username456789]

OP pls respond.

In all seriousness, I'm glad to see the OP made the right choice.

 

[PhillyMed777]

How about...a combined internal medicine/dermatology program?!?! There are only a few, but they exist.

Edit - looks like someone above mentioned already. thought i was special.

https://services.aamc.org/eras/erasstats/par/display8.cfm?NAV_ROW=PAR&SPEC_CD=785

 

[FiveOClock]

If you are smart enough to match derm, you are probably going to be pretty bored and might feel kind of unfulfilled looking at people's skin the rest of your life. I know some people might take offense to me saying that, but I mean is there really anything to figure out in derm. It seems to me its kind of like well you have a rash, here have some cream. I guess the counter argument would be that you could still have a life outside of work if you did derm and that could leave you feeling more fulfilled. Just my random two cents

I would argue that derm can be one of the most cerebral and intellectually challenging fields in medicine. While many cases may be straightforward and "just require a cream," many cases will also be complex manifestations of systemic problems. The idea that derms just treat acne and do biopsies all day is simply wrong. Consider a pt presenting with something that "appears" to be acanthosis nigricans. It sure looks a lot like it, but the pt reports absolutely no other systemic problems. At the same time, the pt doesn't regularly see a primary care doc and keeps few formal checks on their health. Compound this with a multitude of other risk factors of your choice. Well what do you do?

I think you see my point.

 

[username456789]

I would argue that derm can be one of the most cerebral and intellectually challenging fields in medicine. While many cases may be straightforward and "just require a cream," many cases will also be complex manifestations of systemic problems. The idea that derms just treat acne and do biopsies all day is simply wrong. Consider a pt presenting with something that "appears" to be acanthosis nigricans. It sure looks a lot like it, but the pt reports absolutely no other systemic problems. At the same time, the pt doesn't regularly see a primary care doc and keeps few formal checks on their health. Compound this with a multitude of other risk factors of your choice. Well what do you do?

Look at their palms.

 

[Kaustikos]

I would argue that derm can be one of the most cerebral and intellectually challenging fields in medicine. While many cases may be straightforward and "just require a cream," many cases will also be complex manifestations of systemic problems. The idea that derms just treat acne and do biopsies all day is simply wrong. Consider a pt presenting with something that "appears" to be acanthosis nigricans. It sure looks a lot like it, but the pt reports absolutely no other systemic problems. At the same time, the pt doesn't regularly see a primary care doc and keeps few formal checks on their health. Compound this with a multitude of other risk factors of your choice. Well what do you do?

I think you see my point.

You're basically saying you'd have to actually accept the consult and get an actual workup involving talking and examining the patient.
God. You guys have it so much worse than other fields

 

[FiveOClock]

You're basically saying you'd have to actually accept the consult and get an actual workup involving talking and examining the patient.
God. You guys have it so much worse than other fields

To be clear, I am not in the field. I'm a med student too. I'm sure an actual derm could give you a much better example.