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Primary care dermatology

Discussion in 'Dermatology' started by Doku, Jan 7, 2009.

  1. Doku

    Doku New Member
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    Anyone thinks it is reasonable to focus at primary care dermatology after IM residency. Do you know of any IM doc practising as a dermatologist?
     
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  3. bananamed

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    Yes. My family doctor practices as a dermatologist on the weekdays and as a neurosurgeon on the weekends. This is after an internal medicine residency. I mean, it's all medicine. Right?

    .....
     
  4. 238950

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    No need to be sarcastic...

    The original poster's question is actually valid. So, to answer his/her question --- Yes, there are a lot of primary care doctors (IM, Family Medicine, and yes, even OB-GYN) who focus their practice on dermatology. They take CME courses here and there, and try to see a lot of patients with skin disorders, making them known in the community as "skin experts."

    The way dermatology limits its number of residency slots is a double-edged sword. It is good because it makes the specialty very competitive and creates a low supply : demand ratio, making jobs very easy to come by. But then, when you fail to supply a service, other people will start doing it to meet the demand. And this is what primary care doctors are doing --- they mostly deal with cosmetics but in a dermatopathology practice for example, you will see a good number of biopsies (including punches) coming from non-dermatologists.

    I personally would not do it if I were a non-dermatologist. I might do the cosmetics part (botox, restylane, etc.) but I would leave medical dermatology to the experts. Getting sued for missing a melanoma is just not worth it.
     
  5. tripleJ

    tripleJ Member
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    You mean like any of these:
    www.westdermatology.com


    Very, Very common. And they vary from being up front about not being a derm to outright lying.
     
  6. DermMatch

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    I don't get the reference to West Dermatology--the majority of the MDs on their list seem to be dermatologists.
     
  7. oracle07

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    The problems are multiple.

    We've seen family practice docs, OBGYN's, IM docs who do laser procedures, cause significant scarring/complications, and then expect the derm to handle their complications. If you're going to do these procedures, you should be able to handle your own complications. We've recently been refusing to manage complications from non-derms who are practicing outside of their scope of training.

    I too once thought that cosmetics was an easy way to make a quick buck. After seeing what some true cosmetics experts can do, there is a huge difference in the types of results they give their patients compared to people who attend a weekend course and dabble in cosmetics in between hypertension followups.

    Yes you can dilute your botox to make it shorter lasting and increase your profits. But is this ethical?

    Yes you can inject small amount of fillers and get OK results... but the patient might be better served going to someone who can manage their expectations appropriately and give great results.

    You also better know what to do if you occlude a facial artery or cause granulomatous reactions or use the wrong filler for the treatment area.

    All I can say is practicing outside your scope of training is risky. Have a good lawyer. Your affluent cosmetics patient will.
     
  8. tripleJ

    tripleJ Member
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    Exactly- the OP can finish his primary care residency, and if he has "an interest" in dermatology can be one of the "minority" of MDs on that list and can be a provider in a "Dermatology" practice.
     
  9. DermMatch

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    The issue with cosmetics training in a regular derm residency is that it's nearly nonexistent in at least mine, as well as a lot of other places I know.

    So to graduate and start a derm practice with barely any hands-on training in cosmetics seems like a pitfall even newly minted dermies may run into.

    And then? Fellowship for everyone?

    What constitutes a cosmetics expert? Someone with the good luck to land in a program who'll give you lots of experience? Because I'm not one of those, and I want to be able to provide good results to my pts.

    Cosmetics are something that many of our patients request in going to us. To be able to provide that to them is going to be important, but we sure as heck aren't learning it well.

    Would you only go to a cosmetic fellowship-trained dermie? There aren't even a lot out there.
     
  10. cancerman51

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    I agree. When i finish with my current dermatology residency I would consider myself incompetent to do cosmetic procedures due to insufficient training. Perhaps when I'm no longer a resident, i will be able to enter the training sessions at AAD and learn there.
     
  11. bigblue007

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    An internists scope of practice (as well as Family Practice) does include basic dermatologic procedures such as shave and punch biopsies, for which they receive training for during residency. When something is found on a biopsy that is out of the scope of training, the patients are referred to dermatology. As far as the cosmetics go, it's not just Primary care specialties who are trying to get their hand in, but other medical specialties such as dentistry, general surgery, general practice, etc. It is just more lucrative than seeing your run of the mill medical problem, and people become "certified" after a weekend course.
     

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