Nov 17, 2013
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Geez, where do I start.

In med school I was initially thinking of derm, as well as a few other areas. I tanked step 1 and just put derm completely out of mind since my colleagues interested in derm had numbers and such that made me look like a chump. Anyway, I decided to go into IM. After a year of IM I realized it wasn't for me and switched to gen surgery. After a year of that I realized surgery also wasn't for me and went BACK to IM (ridiculous, I know). I knew I still didn't like general IM but at least I would find a specialty that maybe interested me. Unfortunately this has not happened. I have rotated in all of the IM subspecialty areas that I felt I might like and realized I just wouldn't' be happy doing any of them. The only elective that I truly enjoyed was a derm rotation I had this year. I ABSOLUTELY loved it. Hands down there was not a single thing I didn't like about it.

So this is where I am. I am a US state school MD grad, I've switched residencies TWICE, I'm about to graduate from a top NYC IM program, have relatively crummy step scores (220s for step 1, 230s for step2 and barely passing for step3), no derm research and derm has been the only thing that has interested me throughout residency.

I have considered doing a derm research fellowship for a year or two in order to get more exposure, show dedication and publish some papers. However, it would be a significant pay reduction of what I would be earning as a hospitalist next year, so I'm only wanting to do the research if I stand a chance. Do you think I would have any shot to get into a derm program after research or should I just cut my losses and be an internal medicine doc? Please minimize the trolling, this already has me really stressed out.
 

Dral

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Jan 8, 2009
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Pros:
Can probably convincingly discuss why Derm
Medicine residency done (some programs like this)

Cons:
No Derm research or pubs
Lower end Scores
Medicine residency done (funding issues)
Have not stuck to one residency, so need to convince a Derm PD you won't jump ship a third time

That doesn't necessarily say anything, but I just wanted to distill things down.

There are several things to consider:
1. How close are you to the Derm department where you are currently a resident? Who you know is really important in the Derm 'game'.
2. How strong of LoRs can you obtain?
3. What did you think about Allergy/Immunolgy? I know numerous people who have not made it to derm who have gone that route and are very happy.

Nobody will likely tell you NOT to try. However, the cards are stacked against you so to speak.

If I was in your shoes, this is what I would do. You of course have to make your own decision by weighing your wants/desires.

I would do a research fellowship and work my butt off/attend meetings/network like crazy. I would try to land a fellowship dealing with immunology that I could relate to allergy/immunology/IM. I would apply to Derm once (or twice max). If I would get in, great. If not, I would fall back on medicine since I (you) already can be boarded...possibly try to land an allergy/immuno fellowship (although I hear they are getting somewhat competitive now and it might be difficult to convince them that they are not just fall back from not getting a derm spot). The research in derm/immuno would hopefully support this decision as well.

Linking IM and Derm through your research is a great way to highlight your past IM experience while stating your interest in Derm. Some derms love the IM/Derm combo, some think it's a total waste of time, some are in between. It's really hard to predict who will think what, but this has been your path so your only choice is to play it up and go with it.

Best of luck. Again, if it was me, I think I'd give it a shot, but it's easy for me to say that as a Derm resident. Just realize you are facing an uphill battle (you already know this of course).
 
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OP
H
Nov 17, 2013
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Thanks for the quick response!
Unfortunately the only person I know is the outpatient dermatologist I rotated with, who is more of a community dermatologist. However, I need to schedule a meeting with the program director just to ask for his advice.

As for the derm fellowship. Would it be better to try to do research at one of the less competitive programs in NY in hopes that that I could get into that program eventually or would it be better to work at one of the more competitive places since there would be more research opportunities/funding and potentially more influential LoRs?

I see that several places have formal derm fellowships like Columbia, MSK and NYU with stipends in the 40K range. Would you recommend trying one of these fellowships or just working as a hospitalist and trying to independently get in touch with a dermatologist to work on a research project?

Thanks so much!
 

IlDestriero

Ether Man
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Looking at your scores and history, in light of the fact that derm may be the most competitive specialty now, you have no chance. Your best shot was your first shot and you didn't take it. Losing hundreds of thousands of dollars pursuing something with maybe 1% chance of success is foolish. You were a marginal student with worsening exam scores and changed residencies twice already. You're going to be competing with the best and the brightest with all the accolades, not red flag after red flag.
 
Nov 12, 2013
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OP, the question is " If you were a PD, would you have taken your application over 100 others with superior grades and better record who haven't jumped around in uncertainty?"
 
Mar 29, 2011
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What about doing a rheumatology fellowship? They're not super competitive, good lifestyle, happy docs. Lots of overlap with derm--it could also potentially help secure a derm spot down the road. I agree with other posts though that there's not much in your file at the moment that would make a PD select you over anyone else. Rheum's awesome anyways! Another pathway I know people have taken is to work private practice as a generalist and just recruit derm patients--for instance, there's a family med physician who works part-time and just does her derm clinic twice a week. Compensation's obviously less, but you get to do what you love.
 
OP
H
Nov 17, 2013
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All very good points. Maybe what I need is a bit of tough love if it is nearly impossible for me to get in. If I still have practically little chance after spending two years in research, then I would rather know that now.

For Allergy and Immuno, I really expected to enjoy this rotation but couldn't wait for it to end. Maybe it was just the office I was in but I didn't feel it was too stimulating. I like doing procedures quite a bit, which is why I spent a short time in surgery. A&I is a cush lifestyle with decent money but essentially no procedures and again, I just didn't feel passionate about it.

Yes, rheum has procedures and I considered it as well. When I did my rotation, it was primarily spent with older patient with OA....not my cup of tea. I realize I shouldn't be too picky though.

I have considered doing a derm clinic, and may have to go that route if I give up on this endeavor. I'm originally from rural Nebraska, which isn't a place a lot of specialists rush to. I'm just not yet convinced I want to live in a rural place that would make a derm clinic a viable option.

We dedicate so much time and money in this profession in part to find a field we are passionate about. I feel I have found one for me but it may not be possible. It's unfortunate that there are so few training spots for derm despite a growing need.
However, the facts are the facts and I would be a candidate with red flags up against pristine applicants.
 

Dral

10+ Year Member
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Well, I stand corrected about nobody telling you not to do it. :unsure:

If you're one of those people who is ok with not knowing what could have been, even if it is not the desired outcome, then maybe move on. If you will question the possibility of what might have been for the rest of your life, then maybe you should try it.

You have some tough decisions to make. I hope we at least helped.
 

doc MD

5+ Year Member
Jul 17, 2009
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Geez, where do I start.

In med school I was initially thinking of derm, as well as a few other areas. I tanked step 1 and just put derm completely out of mind since my colleagues interested in derm had numbers and such that made me look like a chump. Anyway, I decided to go into IM. After a year of IM I realized it wasn't for me and switched to gen surgery. After a year of that I realized surgery also wasn't for me and went BACK to IM (ridiculous, I know). I knew I still didn't like general IM but at least I would find a specialty that maybe interested me. Unfortunately this has not happened. I have rotated in all of the IM subspecialty areas that I felt I might like and realized I just wouldn't' be happy doing any of them. The only elective that I truly enjoyed was a derm rotation I had this year. I ABSOLUTELY loved it. Hands down there was not a single thing I didn't like about it.

So this is where I am. I am a US state school MD grad, I've switched residencies TWICE, I'm about to graduate from a top NYC IM program, have relatively crummy step scores (220s for step 1, 230s for step2 and barely passing for step3), no derm research and derm has been the only thing that has interested me throughout residency.

I have considered doing a derm research fellowship for a year or two in order to get more exposure, show dedication and publish some papers. However, it would be a significant pay reduction of what I would be earning as a hospitalist next year, so I'm only wanting to do the research if I stand a chance. Do you think I would have any shot to get into a derm program after research or should I just cut my losses and be an internal medicine doc? Please minimize the trolling, this already has me really stressed out.
you do have a shot like any other candidate that did not make it the first time, does not have the scores, has no research, no connections and clear hx of indecisiveness. what lucky program wouldn't want such a wonderful candidate in such a competitive field? sorry to stress you out with the blunt truth. and yes, many have done derm research fellowships and not match. Give it a shot and see what happens, no guarantees.