reapplicant ophtho vs derm

[pgy100]

Need some help deciding what to do with the rest of my life. A little about myself. Top third of class, no aoa, but 259 step 1. Applied but didn't match derm this year. Going to do an intern year soon in a couple months. However, I did do a 2 week elective in ophthalmology, liked it and I am considering it at the moment.

I liked that in ophtho there are a lot of tools and lasers (I'm a bit of a techie). Plus the idea of giving back the gift of sight is pretty awesome. I also like the fact that surgeries are quick for the most part. Looking at my hobbies, a lot of them involve using my hands (ie art, carpentry) which would be more suited for a surgical specialty.

That being said, I also enjoy derm as it is a visual specialty with lots of procedures (bx, minor surgeries) with the option to do Mohs. I also find pathology and histology interesting and this is actually a key part of derm practice (not so sure how it is in ophtho)

While lifestyle is indeed important, I don't care about money. I think I would be happy with either it's just that I feel like my derm research would go to waste if I went with ophtho.

I talked with ophtho faculty and they would strongly support my application but I need to decide soon whether or not the commit to ophtho so that I can schedule an away elective during intern year (unfortunately need to the use the rest of MS4 for required rotations so no time for an ophtho elective). Derm faculty say I have a shot at matching during intern year but a two year research fellowship will probably be needed.

I understand both are very competitive specialties, though my understanding is that derm is more so. Do I continue to chase derm or switch over ophtho?

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[Chickenandwaffles]

Need some help deciding what to do with the rest of my life. A little about myself. Top third of class, no aoa, but 259 step 1. Applied but didn't match derm this year. Going to do an intern year soon in a couple months. However, I did do a 2 week elective in ophthalmology, liked it and I am considering it at the moment.

I liked that in ophtho there are a lot of tools and lasers (I'm a bit of a techie). Plus the idea of giving back the gift of sight is pretty awesome. I also like the fact that surgeries are quick for the most part. Looking at my hobbies, a lot of them involve using my hands (ie art, carpentry) which would be more suited for a surgical specialty.

That being said, I also enjoy derm as it is a visual specialty with lots of procedures (bx, minor surgeries) with the option to do Mohs. I also find pathology and histology interesting and this is actually a key part of derm practice (not so sure how it is in ophtho)

While lifestyle is indeed important, I don't care about money. I think I would be happy with either it's just that I feel like my derm research would go to waste if I went with ophtho.

I talked with ophtho faculty and they would strongly support my application but I need to decide soon whether or not the commit to ophtho so that I can schedule an away elective during intern year (unfortunately need to the use the rest of MS4 for required rotations so no time for an ophtho elective). Derm faculty say I have a shot at matching during intern year but a two year research fellowship will probably be needed.

Well, derm is very tough to match into, period. You know that. Are you willing to do a 2 year fellowship? In the past, fellowships had more security. These days, most are indentured servant type situations with little guarantee. You can always reapply for derm, but as you know, each year you are less competitive.

Ophtho is also competitive, but I agree it's less so. However, it's not easy to match into, and it's likely that people who have shown a long term interest in the specialty would match vs. someone who found the specialty late in the game. You have good scores it seems, so awsome, but I would assume research is lack in ophtho.

If I were you, I'd personally apply to 3 things - derm, ophtho, and back up. Derm will be tough unless you can make some new connections. Ophtho will also be tough, but if people are willing to go to bat for you then it may be different.

I understand both are very competitive specialties, though my understanding is that derm is more so. Do I continue to chase derm or switch over ophtho?

 

[rokshana]

i find it a bit interesting that you are trying to decide between 2 of the highest paying specialties out there. You voice an interest in pathology but that doesn't seem to be an option (mind you one that would be way easier to get).

 

[shiftingmirage]

Do you know why derm didn't work out this year? Is it something you can fix when you reapply?

 

[pgy100]

i find it a bit interesting that you are trying to decide between 2 of the highest paying specialties out there. You voice an interest in pathology but that doesn't seem to be an option (mind you one that would be way easier to get).

Pathology could be an option with a fellowship into dermatopathology. I'd have to give up clinical medicine however.

 

[pgy100]

Do you know why derm didn't work out this year? Is it something you can fix when you reapply?

From what I've been told, it appears to be lack of aoa and possibly letters (though good content not from well-known senior faculty) leading to not enough invites. I could have also prepared a bit better for interviews tbh.

 

[DermViser]

i find it a bit interesting that you are trying to decide between 2 of the highest paying specialties out there. You voice an interest in pathology but that doesn't seem to be an option (mind you one that would be way easier to get).

Maybe bc of the difficulty in landing a job after Pathology if you go to the Pathology forums. My guess is the OP would want to pursue Dermpath if he went the Pathology route.

 

[Chickenandwaffles]

i find it a bit interesting that you are trying to decide between 2 of the highest paying specialties out there. You voice an interest in pathology but that doesn't seem to be an option (mind you one that would be way easier to get).

Actually, neither derm nor ophtho are two of the highest paid specialties out there. and Derm typically pays much more than ophtho by a long shot.

 

[BlondeDocteur]

These are two extraordinarily different fields with quite different lifestyles (ophtho is a call-heavy, long-hours, stressful residency. Surprise! Bet you didn't know that!). It should be very easy to decide between them.

1) Do you like eyes?
2) Like, really really really like eyes?
3) Do you like doing real operations, not just excisional biopsies? Like, delicate operations with 11-O suture, or blasting someone's EYE FOR GOD'S SAKE with a LASER and possibly blinding them?
4) Do you like old obese diabetic men?
5) Do you like old obese diabetic men enough to get 3 inches from their face for a 20-minute exam?

Or:

1) Do you like rashes?
2) Like, really really like rashes? Would it be the coolest thing EVER for you to look at a rash and say "hey, I know what that is!"
3) Do you like adjectives? Would, off the cuff, you say that adjectives are your favorite part of speech?
4) Do you like steroid creams? How about antifungal creams? Do you like any other medications or treatment modalities? HAHAHAHA DENIED
5) Do you like putting photos in your consult notes?
6) Do you want to look at your Primary Inpatient Service list and not ever, not once, EVER see a single patient on it?
7) Quite seriously, is cosmetic 'medicine' something you get can behind?

 

[rokshana]

Actually, neither derm nor ophtho are two of the highest paid specialties out there. and Derm typically pays much more than ophtho by a long shot.

note I said two OF the highest paying…not THE highest paying…that evidently still is ortho...

 

[rokshana]

These are two extraordinarily different fields with quite different lifestyles (ophtho is a call-heavy, long-hours, stressful residency. Surprise! Bet you didn't know that!). It should be very easy to decide between them.

1) Do you like eyes?
2) Like, really really really like eyes?
3) Do you like doing real operations, not just excisional biopsies? Like, delicate operations with 11-O suture, or blasting someone's EYE FOR GOD'S SAKE with a LASER and possibly blinding them?
4) Do you like old obese diabetic men?
5) Do you like old obese diabetic men enough to get 3 inches from their face for a 20-minute exam?

Or:

1) Do you like rashes?
2) Like, really really like rashes? Would it be the coolest thing EVER for you to look at a rash and say "hey, I know what that is!"
3) Do you like adjectives? Would, off the cuff, you say that adjectives are your favorite part of speech?
4) Do you like steroid creams? How about antifungal creams? Do you like any other medications or treatment modalities? HAHAHAHA DENIED
5) Do you like putting photos in your consult notes?
6) Do you want to look at your Primary Inpatient Service list and not ever, not once, EVER see a single patient on it?
7) Quite seriously, is cosmetic 'medicine' something you get can behind?

exactly….its like the poster who said they were interested in doing cards/GI/hem/onc….they really are very different and who truly has the interest in such wildly different specialties.

 

[pgy100]

Maybe bc of the difficulty in landing a job after Pathology if you go to the Pathology forums. My guess is the OP would want to pursue Dermpath if he went the Pathology route.

If I were to go with pathology I'd definitely try for dermpath but from what my attendings in path tell me is that it is extremely difficult to get as a path resident.

These are two extraordinarily different fields with quite different lifestyles (ophtho is a call-heavy, long-hours, stressful residency. Surprise! Bet you didn't know that!). It should be very easy to decide between them.

1) Do you like eyes?
2) Like, really really really like eyes?
3) Do you like doing real operations, not just excisional biopsies? Like, delicate operations with 11-O suture, or blasting someone's EYE FOR GOD'S SAKE with a LASER and possibly blinding them?
4) Do you like old obese diabetic men?
5) Do you like old obese diabetic men enough to get 3 inches from their face for a 20-minute exam?

Or:

1) Do you like rashes?
2) Like, really really like rashes? Would it be the coolest thing EVER for you to look at a rash and say "hey, I know what that is!"
3) Do you like adjectives? Would, off the cuff, you say that adjectives are your favorite part of speech?
4) Do you like steroid creams? How about antifungal creams? Do you like any other medications or treatment modalities? HAHAHAHA DENIED
5) Do you like putting photos in your consult notes?
6) Do you want to look at your Primary Inpatient Service list and not ever, not once, EVER see a single patient on it?
7) Quite seriously, is cosmetic 'medicine' something you get can behind?

While ophtho residency is physically demanding I've heard that life as an attending ophtho is much better. The ophtho residents I've worked with say home call is by no means cush but they still average around a total of 6 hours of sleep on a call night which is not too bad although they have to come back to work the next day.
From what I've seen from on my derm rotation, while the weekday hours were around 7 to 5-6 or so, there is so much studying to be done that 2-4 hrs of reading needs to be done every night. On weekends even more time studying is expected (8+ hours a day).

Lifestyle issues during residency aside, I enjoyed both rotations during medical student and I truly think I'd be happy with a career in either one. If I absolutely had to pick one I'd lean towards derm with the goal of subspecializing in Mohs. However, going through the match process this year, I've seen how ultra competitive derm can be and in the end it could very well be a dream that never pans out.

 

[Law2Doc]

Derm vs optho is a bad pairing because they don't go through the same match -- you really can't rank one as primary and the other as "backup". And both are very competitive so you could easily come up short for both. We know the OP is at best a Borderline candidate for derm, and maybe wasn't as close to the border as he/she would have liked to be. The next years crop of applicants for the specialty could be even more competitive (specialties vary in popularity year to year), so the OPs target could be a Moving one -- what would have made the cut last year might not even be close this year. OP should try again for derm (what he/she really wants) and as a backup pick something more attainable (not quite as competitive) and tht is rank-able IN THE SAME MATCH.

 

[Substance]

Derm is so competitive that luck appears to play the greatest role in matching. You could do everything right and still not match. Needing to do a two year research scut-a-thon to have the possibility of matching in derm is an unreasonable waste of time for very little return - a gamble, essentially.

Go ophthalmology. If you like it, it is a very rewarding, extremely specialized, career. Focus your attention in that direction now. Kiss derm goodbye.

Rads is at a low point now, which means its the perfect time to buy in. It might suffice as a backup.

Don't bother with path unless you want to be an employee for one of your former classmates who matched into derm when you didn't. Dermpath programs look like they're run by derm departments for the most part, and who can blame them for that? If I were a PD and had to choose between a path applicant and a derm applicant, it'd be like choosing a Tata vs a Ferrari.

 

[ophthope]

i find it a bit interesting that you are trying to decide between 2 of the highest paying specialties out there.

I'll point you to this document for some information about how wrong you are on that one. You'll find only average numbers there as well which are skewed by high volume refractive surgeons that make in the millions - but very few Ophthalmologists end up in that sort of practice. Similarly, numbers for internal medicine are skewed down by the number of part-time outpatient medical practitioners which make less money and pull the average down. IMED starting salary is higher than Ophtho. If the man wanted money he'd be telling us he wants do Cards or GI. Heck a hospitalist working 7 on 7 off makes as much as most Ophthalmologists. I'm making it a point to talk about this every time someone spouts out this incorrect information. It's people like this that end up at AMA meetings or congress complaining that our specialties make too much money even though they have no idea about the day to day work that we do.

Derm and Ophtho are both very visual fields with manageable lifestyles. It shouldn't be too difficult to understand why the poster is making this decision.

exactly….its like the poster who said they were interested in doing cards/GI/hem/onc….they really are very different and who truly has the interest in such wildly different specialties.

Your posts are just so off-base here. As a current internal medicine resident I have a number of colleagues who are in this exact dilemma right now - choosing between cards and GI because they like them both. You do know that as a hospitalist you deal with a lot of cardiology and gastroenterology issues every day, right? Is it really that incomprehensible that one could be interested in both? Both deal with ischemia on a day to day basis, both have urgent/emergent procedures, both involve history taking of nebulous conditions difficult to diagnose by history alone that can ultimately be ferreted out by a procedure to look at what's going on (scope or cath or echo or pill cam, etc).


To the OP: it's okay to admit to yourself as well that you could be happy doing either of these specialties. I of course am biased towards Ophthalmology since that's what I'm doing. Saving sight is such an incredible thing, our surgeries are far more intense than it may seem to the outside observer but they are awesome, and the 'boring' parts aren't bad to me (refracting). If eyes gross you out or you don't want to be in an old dude's face that's fine, but I don't want to see old dudes stark naked looking for AKs and melanomas. I do respect those who do that, however.

Figure out what kept you from matching derm, ask people, email people, do some digging. Fix that no matter which specialty you choose to apply to.

 

[DrZeke]

This is such a crazy thread for me to read. I'm THAT person that was often looking away and feeling nauseated in derm lectures...I could never imagine choosing derm over ophtho.

 

[rocketbooster]

I'll point you to this document for some information about how wrong you are on that one. You'll find only average numbers there as well which are skewed by high volume refractive surgeons that make in the millions - but very few Ophthalmologists end up in that sort of practice. Similarly, numbers for internal medicine are skewed down by the number of part-time outpatient medical practitioners which make less money and pull the average down. IMED starting salary is higher than Ophtho. If the man wanted money he'd be telling us he wants do Cards or GI. Heck a hospitalist working 7 on 7 off makes as much as most Ophthalmologists. I'm making it a point to talk about this every time someone spouts out this incorrect information. It's people like this that end up at AMA meetings or congress complaining that our specialties make too much money even though they have no idea about the day to day work that we do.

Derm and Ophtho are both very visual fields with manageable lifestyles. It shouldn't be too difficult to understand why the poster is making this decision.



Your posts are just so off-base here. As a current internal medicine resident I have a number of colleagues who are in this exact dilemma right now - choosing between cards and GI because they like them both. You do know that as a hospitalist you deal with a lot of cardiology and gastroenterology issues every day, right? Is it really that incomprehensible that one could be interested in both? Both deal with ischemia on a day to day basis, both have urgent/emergent procedures, both involve history taking of nebulous conditions difficult to diagnose by history alone that can ultimately be ferreted out by a procedure to look at what's going on (scope or cath or echo or pill cam, etc).


To the OP: it's okay to admit to yourself as well that you could be happy doing either of these specialties. I of course am biased towards Ophthalmology since that's what I'm doing. Saving sight is such an incredible thing, our surgeries are far more intense than it may seem to the outside observer but they are awesome, and the 'boring' parts aren't bad to me (refracting). If eyes gross you out or you don't want to be in an old dude's face that's fine, but I don't want to see old dudes stark naked looking for AKs and melanomas. I do respect those who do that, however.

Figure out what kept you from matching derm, ask people, email people, do some digging. Fix that no matter which specialty you choose to apply to.

Those Medscape surveys are completely inaccurate. Go check out the last slide. Only 2% of ophthalmologists responded to it lol. The same is true for basically every field. I think the most of any field was 6%. The MGMA survey is the most accurate one out there and even that has a <50% response rate. MGMA usually puts ophtho average closer to 400k. Also, the MGMA is what groups use as the standard to determine salaries.

 

[ophthoapp2010]

You know what has tools, lasers, lots of major and minor procedures, and pathology/histology? Oh, and also MOHS, except we do the repair after you make a giant defect in the skin next to the eye?

Oculoplastics, which is a two year ASOPRS fellowship after ophthalmology residency. You should look into it if you are considering ophtho.

 

[pgy100]

Thanks for the all help guys. Still trying to decide between the two... need to decide soon.

You know what has tools, lasers, lots of major and minor procedures, and pathology/histology? Oh, and also MOHS, except we do the repair after you make a giant defect in the skin next to the eye?

Oculoplastics, which is a two year ASOPRS fellowship after ophthalmology residency. You should look into it if you are considering ophtho.

I'll definitely check it out. We actually have a few residents applying from my home program to oculoplastics though they tell me the match rate has historically been abysmal. Best of luck to them!

A question for the ophtho people. IF I were to apply to ophtho, how would PDs view the fact that I previously tried for derm? If I list my derm research stuff on the CAS, invariably questions about my interest in derm will arise. Obviously I would try to sell my interest in ophtho the best I can but would my prior derm history be a huge red flag?

 

[dantt]

Obviously I would try to sell my interest in ophtho the best I can but would my prior derm history be a huge red flag?

I can't imagine how you would spin this. Also consider the match rate for non-US seniors is horrible. (5% in the last match). You may have missed the bus.

 

[pgy100]

I can't imagine how you would spin this. Also consider the match rate for non-US seniors is horrible. (5% in the last match). You may have missed the bus.

Indeed this would be a difficult task. I was even considering the possibility of a preresidency fellowship to further prove my interest in ophtho.

About the stats, it looks like SF Match changed they way they are reporting the match percentages some time ago. The numbers currently seem to represent percent of positions filled by each applicant category instead of the percent matching in each category.

There was a discussion on this thread

http://forums.studentdoctor.net/threads/sf-match-screwed-up-again.360109/page-2

Look at post 63 and 64. I don't know what the actual US grad match percent is for this year but historically it has been anywhere from 30-60%.

 

[pgy100]

So I've been looking into settin up an ophtho rotation during intern year but my school doesn't allow visiting rotations for outside residents. My community hospital program does have an ophtho rotation with a community practitioner. Would that be an OK option?

 

[DermViser]

This is such a crazy thread for me to read. I'm THAT person that was often looking away and feeling nauseated in derm lectures...I could never imagine choosing derm over ophtho.

Funny, I feel the same way about touching someone's eyes. Too weird for me.

 

[DermViser]

Derm vs optho is a bad pairing because they don't go through the same match -- you really can't rank one as primary and the other as "backup". And both are very competitive so you could easily come up short for both. We know the OP is at best a Borderline candidate for derm, and maybe wasn't as close to the border as he/she would have liked to be. The next years crop of applicants for the specialty could be even more competitive (specialties vary in popularity year to year), so the OPs target could be a Moving one -- what would have made the cut last year might not even be close this year. OP should try again for derm (what he/she really wants) and as a backup pick something more attainable (not quite as competitive) and tht is rank-able IN THE SAME MATCH.

How is the OP a borderline candidate? He's top 1/3 with a 259 Step 1! Nearly 50% of those who match don't have AOA. If anything he/she could do a research fellowship with a program that takes its own fellows and match, or apply again during intern year.