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Mohs fellowship

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asmallchild

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    So it's safe to assume that if one is not picky, getting a spot shouldn't be difficult?

    Yes, but you should be. I think the best advice in the thread above is to figure out why you want to do a fellowship and is it worth the opportunity cost
     
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    ark205

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      I think it is a reasonable question to revisit from time to time as things change. The conversation in the link is from 2010. That being said the number of Mohs applicants is steadily increasing as are the number of people who go unmatched. The competition pales in comparison to applying to derm. Also, while many spots still go outside the match this practice is decreasing with time.
       

      asmallchild

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        I think it is a reasonable question to revisit from time to time as things change. The conversation in the link is from 2010. That being said the number of Mohs applicants is steadily increasing as are the number of people who go unmatched. The competition pales in comparison to applying to derm. Also, while many spots still go outside the match this practice is decreasing with time.

        The competitiveness of Mohs fellowships waxes and wanes but in general, if someone really wants to be a Mohs surgeon and is willing to apply broadly (short of any significant character flaws), I haven't heard of people really struggling to match.

        There is an outstanding fallback plan for Mohs applicants and that is to go on and be a dermatologist so I find residents tend to be more selective when applying which explains the higher numbers of those who go unmatched.

        There are certainly very competitive and very attractive programs that residents flock to. If you solely apply to those, again, the chance of not matching increases. There are still a few programs that will go outside the match (or subject their potential fellows to research years before agreeing to take them in the match)
         

        reno911

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          I know plenty of people that went unmatched the first time through, but all but one eventually secured a Mohs fellowship. I can think of only one person that I know of who wanted to get a fellowship that didn't. That person's problem is that they applied to an extremely small number of programs (<5).

          Getting a Mohs fellowship is an order of magnitude easier than getting a derm spot.
           

          Dogginit

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            PGY-1 here, matched derm this year. Thought I remembered several derm residents stating that this year's Mohs match had the lowest match rate in some time...around 50%?

            I found data on the SF match site under the "statistics" tab for Mohs, which seems to reflect that 104 applied and 52 were matched for 53 available positions.
             
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            Tamahawk

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              I've not posted in awhile but I feel compelled to regarding this topic.

              The degree of difficulty in matching in Mohs now is FAR greater than it was even 5 years ago when I applied. Part of this is due to the fact that Dermpath has become less attractive due to reimbursement cuts to groups (more specifically, for the technical component), which in turn has led to fewer groups yearning for an in-house Dermatopathologist and lab. Many of these highly qualified, would-be dermpath applicants are now applying to Mohs instead. This is because some percentage of each derm class has people that like general derm but also don't want to be doing ONLY General derm.

              Over the past 2 years, I personally know of 7 people who applied broadly and were not social misfits who failed to match. 3 of these people subsequently found an out of match spot or re-applied successfully. The rest did not.

              I am not writing this to be a Debbie downer but just wanted to alert current residents of the difficulties in matching in Mohs in the current landscape.
               
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              Sophia88

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                I'd like to second what Tomahawk said. Mohs and procedural fellowships have gotten much more competitive in the last few years and I know at least 3 very well qualified applicants from top programs last year who applied broadly and did not match. From what I've heard this year there was a big jump in number of applicants so will be likely be even more competitive. I don't fully understand the trend..possibly less residents are getting hands on exposure to Mohs during residency coupled with less interest in dermpath as mentioned before. As stated above by asmallchild, very much agree that one needs to evaluate how much a fellowship would add to your training and if it is worth the opportunity cost.
                 

                Gracile

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                  If one gets a lot of Mohs training in residency and only wants to perform part time, is it possible to do Mohs without fellowship? Also is reimbursement different if one is not fellowship trained?

                  Thanks!
                   

                  asmallchild

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                    If one gets a lot of Mohs training in residency and only wants to perform part time, is it possible to do Mohs without fellowship? Also is reimbursement different if one is not fellowship trained?

                    Thanks!

                    You can do Mohs without a fellowship, those surgeons often belong to the ASMS (American Society of Mohs Surgery) instead of the ACMS (American College of Mohs Surgery)

                    Regarding reimbursement, this will vary but in general, it's the same. That being said, I've worked in regions where certain insurances will reimburse at lower rates for non-fellowship trained Mohs surgeons.
                     
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                    MOHS_01

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                      Current applicant here. Anyone else applying this season? I am nervous :(
                      Think you're nervous now, wait until you start looking for a job - heh. ;)

                      As for the question on reimbursement: most states have laws that prevent distinction based on training, etc, as licensure for the practice of medicine does not delve into the arena of scope of practice. In other words, a credentialed MD can generally contract at similar rates irrespective of specialty, and Medicare would pay the forensic psychiatrist the same, to the penny, as the Zitelli trained stud/ette.
                       

                      reno911

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                        If one gets a lot of Mohs training in residency and only wants to perform part time, is it possible to do Mohs without fellowship? Also is reimbursement different if one is not fellowship trained?

                        Thanks!

                        I hate to break it to you, but nobody gets "a lot of Mohs training" in residency. I understand where you are coming from, because I thought I did when I was a resident. However, compared to what you will get in a good fellowship it is almost nothing.

                        In fact, most residents get so little training and exposure to Mohs that they don't truly have a good sense of what a great, good, or bad Mohs surgeon is.

                        But if you want to do Mohs with no fellowship, as long as your patients are willing, no one will stop you. And you will get paid the same.
                         
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                        MOHS_01

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                          I hate to break it to you, but nobody gets "a lot of Mohs training" in residency. I understand where you are coming from, because I thought I did when I was a resident. However, compared to what you will get in a good fellowship it is almost nothing.

                          In fact, most residents get so little training and exposure to Mohs that they don't truly have a good sense of what a great, good, or bad Mohs surgeon is.

                          But if you want to do Mohs with no fellowship, as long as your patients are willing, no one will stop you. And you will get paid the same.

                          Word... although you would likely upset a bunch of society guys with that reality drop. Over and over again, it seems, the bigger problem with knowledge is not what people actually know or not, but what they falsely believe they do. You don’t get to be good merely by doing something 1500 times in a year (although that helps); you get to be good by doing 1500 cases under the critique and supervision of a mentor who has done 15-20,000+ cases - and doing it in a condensed time period.

                          While I have never really been a fan of the society, I similarly don’t believe that a fellowship is an absolute requirement to responsibly perform MMS for select cases. Let’s face it, the 1cm nBCC on the buccal cheek generally does not represent a Herculean task... but again, in my experience it is in the recognition of difficulty that the judgment defect lies. Well, there’s that... and it still pisses me off that people do the easy ones that take no effort or time themselves, getting paid the same for it, and refer anything difficult (or that they’ve already managed to screw up).

                          Perhaps there should be some kind of severity scoring for the purpose of pay differential.
                           
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