Moh's interest

[unsurem4]

Hey Guys

I'm an M4 currently doing a dermatology rotation and am really loving doing Moh's surgery. I think the general derm stuff is interesting but not amazing. Anyway, do you think it's worth doing derm so I can eventually end up in Moh's or is this a poor idea? The guy I am with seems to only like doing Moh's and actually isn't that excited when regular derm stuff shows up .

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[asmallchild]

Hey Guys

I'm an M4 currently doing a dermatology rotation and am really loving doing Moh's surgery. I think the general derm stuff is interesting but not amazing. Anyway, do you think it's worth doing derm so I can eventually end up in Moh's or is this a poor idea? The guy I am with seems to only like doing Moh's and actually isn't that excited when regular derm stuff shows up .

As long as you find general derm interesting, I don't think it's unreasonable to pursue dermatology with the goal of doing MOHS eventually (I say you need to find general derm at least a tad interesting as not everyone gets a MOHS fellowship)

That being said, I would not be so bold as to announce this on the interview trail. Fair or not, it's not looked upon favorably (at least at the places I've rotated at/interviewed at) to be solely interested in MOHS.

 

[N-Surge]

Consider plastics instead. Or maybe better yet, ENT w/ a facial plastics fellowship.

 

[unsurem4]

Thanks guys, I appreciate the input. Not to be completely naive but I didn't realize Moh's was frowned upon - I mean I can understand that cosmetic stuff - lasers, botox would be frowned upon. That's actually what I like about this guy I am working with now, he's not interested in crazy cosmetics. He doesn't enjoy the patients that throw a wad of cash on the table and say "how much botox can you put in my face?". I think he is really helping tons of patients and they all love him for it.

I have thought about ENT but I did a rotation and the guy I was with did tubes/tonsils all day long and I really wanted to shoot myself. I was too concerned that if I don't like the bread and butter of ENT, then it's not worth going through the residency to try do facial plastics. I realize that ENT does a bunch more than this and not trying to put them down at all (they're awesome) but I liked general derm better.

I also thought about plastics but never got good exposure to it and to be entirely honest, the 6/7yrs of surgery scares me because I have a family with a significant other already in medicine. Maybe I should take a better look at plastics...

I like general derm but we don't have a residency where I am so I really see limited private practice derm which, at least here, is lots of acne, skin cancer checks, inclusion cyst procedures and occasionally psoriasis but no crazy rashes or skin conditions.

 

[asmallchild]

N-Surge brings up a good point too about pursuing a surgical subspecialty.

If you enjoy MOHS a lot and don't really enjoy derm, you may find derm residency to be a real drag. (Similar to your thoughts on not enjoying the bread and butter of ENT and not being able to make it to a facial plastics fellowship)

I'm sure an ENT residency or a plastics residency isn't a cakewalk but you may find it's a sacrifice you're willing to make if it means significantly more OR time.

Thanks guys, I appreciate the input. Not to be completely naive but I didn't realize Moh's was frowned upon - I mean I can understand that cosmetic stuff - lasers, botox would be frowned upon. That's actually what I like about this guy I am working with now, he's not interested in crazy cosmetics. He doesn't enjoy the patients that throw a wad of cash on the table and say "how much botox can you put in my face?". I think he is really helping tons of patients and they all love him for it.

I have thought about ENT but I did a rotation and the guy I was with did tubes/tonsils all day long and I really wanted to shoot myself. I was too concerned that if I don't like the bread and butter of ENT, then it's not worth going through the residency to try do facial plastics. I realize that ENT does a bunch more than this and not trying to put them down at all (they're awesome) but I liked general derm better.

I also thought about plastics but never got good exposure to it and to be entirely honest, the 6/7yrs of surgery scares me because I have a family with a significant other already in medicine. Maybe I should take a better look at plastics...

I like general derm but we don't have a residency where I am so I really see limited private practice derm which, at least here, is lots of acne, skin cancer checks, inclusion cyst procedures and occasionally psoriasis but no crazy rashes or skin conditions.

 

[Long Dong]

There is a Mohs attending who sometimes post on here (Mohs1 i think). In one of his/her post about the slashing of mohs reimbursement he said if he had to do it over again, he'd done plastics. You might want to PM him/her about your questions.

 

[scumbagderm]

longdong--(or others who might know).

Do I have to kill step 3 to get into mohs (or dermpath)? I'm just not feeling up to studying big time for step 3 during internship. Somebody (upperlevel-ish) told me I had to do well (comparable to step1/2 scores) and this shocked me because I thought that is would depend mostly on preformance in residency.

 

[asmallchild]

longdong--(or others who might know).

Do I have to kill step 3 to get into mohs (or dermpath)? I'm just not feeling up to studying big time for step 3 during internship. Somebody (upperlevel-ish) told me I had to do well (comparable to step1/2 scores) and this shocked me because I thought that is would depend mostly on preformance in residency.

I was told much of was based on how you performed in residency and who you knew. But then again, what do I know? I'm the in process of slacking off, err, studying for Step 3 myself.

 

[MOHS_01]

Echo what everyone has said.

I only did dermatology to ultimately do MMS. The specialty and practice of MMS is great; the logistics and outlook are increasingly problematic. There are what I would consider strong headwinds for the specialty, with both internal (pertaining to the house of medicine) and external pressures (in the world of healthcare financing) on the practice of MMS.

If you don't enjoy general derm, I would be very hesitant in recommending going down the derm road for the sole purpose of MMS; we are in a very vulnerable position. I did it, but many personal factors played into my decision that are not applicable across the board and I did so without the benefit of experience or insight. At the very least I would gain some exposure to the alternative specialties that would afford you similar work conditions.

Feel free to PM with any specific q's.