Updated Ophtho vs Derm Comparison

[alex.jl1994]

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[Dr. Doctor MD]

Hey guys,

Posting for my fiance, who's also in med school but not on SDN. I know that there are already a few great threads comparing ophtho vs derm, but I haven't seen anything with more updated data. My fiance has done research in ophtho at our school and has some connections with the faculty here, but is now considering derm. He's likely taking a research year off and currently deciding which field to pursue and do research in.

I'd really appreciate any updated data about these two fields (as well as any other opinions/thoughts/advice for someone considering both) in terms of:

1) Job market--Especially in a city in New England or in a suburb near a city (like suburbs of NJ, NY, or Boston)

2) Residency lifestyle--I know that this is just a few years and isn't nearly as important as lifestyle as an attending. However, we are getting married soon and would like to start a family while in residency (and both of us will be in residency, me also in ophtho). Would this be as easy to do in ophtho as in derm?

3) Overall job satisfaction

Compensation isn't as much a consideration for us, as I think job satisfaction and lifestyle will be a bigger factor for us given that we would like to start a family and spend quality time with our kids (and hopefully with both of being in medicine, we'll do ok and save enough for our kids educations).

Thanks guys!

Honestly Optho and Derm are probably very similar in all those aspects

1. Job Market: Overall good for both, however both derm and ophtho suffer in large highly desirable cities. It can be hard to find jobs, and the ones you will find will take a pay cut. Also near impossible to start a private practice in these highly desirable competitive markets. Move to any smaller/medium sized city and you'll be fine, and rural you will make a killing.

2. Lifestyle: Again super similar, I wouldn't necessarily say that one is better or worse than the other. There exist both derm and ophtho emergencies and both specialties will take call on nights/weekends to cover the hospital throughout residency, but both fields are usually 7-8 am to 5-6 pm M-F.

3. Job satisfaction: Excellent in both, some of the happiest doctors, and both get to make huge impacts in patient lives.

4. Salary: Again near identical ($350-400k). Ophtho likely starts lower in the first few years but once you make partner or get the volume you will do very very well. I would say optho has a much higher ceiling than general dermatology based on their surgical volume, and some general optho can hit $1 million per year in the right surgical practice, obviously on the flip side they can make a lot less if they aren't operating or never get the volume. But 5 years out in either field, you're likely looking at the same salaries.

My advice: Both fields are almost identical in the aspects you are looking at. He needs to find out what he loves and want to do for 40 years. Derm and Ophtho, despite some similarities in job/lifestyle are vastly different fields of medicine. He can't go wrong with either though!

 

[CidHighwind]

If they already have connections in optho then just stick with that. If those connections can vouch for them it will make matching a bit easier. Both have great lifestyles, call for Derm is slightly better in that it’s rare they’ll ever have to show up at the hospital. Derm can make up to 7 figures, but I think some of the richest doctors are optho (think 7-8 figures a year). Obviously not typical, but not impossible.

Also, could you please elaborate on some of the con$iderations your fiancé made that is making him think Derm?

 

[alex.jl1994]

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[Tenk]

Honestly Optho and Derm are probably very similar in all those aspects

1. Job Market: Overall good for both, however both derm and ophtho suffer in large highly desirable cities. It can be hard to find jobs, and the ones you will find will take a pay cut. Also near impossible to start a private practice in these highly desirable competitive markets. Move to any smaller/medium sized city and you'll be fine, and rural you will make a killing.

2. Lifestyle: Again super similar, I wouldn't necessarily say that one is better or worse than the other. There exist both derm and ophtho emergencies and both specialties will take call on nights/weekends to cover the hospital throughout residency, but both fields are usually 7-8 am to 5-6 pm M-F.

3. Job satisfaction: Excellent in both, some of the happiest doctors, and both get to make huge impacts in patient lives.

4. Salary: Again near identical ($350-400k). Ophtho likely starts lower in the first few years but once you make partner or get the volume you will do very very well. I would say optho has a much higher ceiling than general dermatology based on their surgical volume, and some general optho can hit $1 million per year in the right surgical practice, obviously on the flip side they can make a lot less if they aren't operating or never get the volume. But 5 years out in either field, you're likely looking at the same salaries.

My advice: Both fields are almost identical in the aspects you are looking at. He needs to find out what he loves and want to do for 40 years. Derm and Ophtho, despite some similarities in job/lifestyle are vastly different fields of medicine. He can't go wrong with either though!

Disagree on lifestyle. I have had numerous occasions where I have had patients go directly from the ED to the OR for open globes and countless patients who were consulted on for other either urgent or emergent interventions.

I have never spoken to or seen a dermatologist while in the ED. They basically don’t have real call. That’s a pretty big difference.

 

[ball123]

Hey guys,

Posting for my fiance, who's also in med school but not on SDN. I know that there are already a few great threads comparing ophtho vs derm, but I haven't seen anything with more updated data. My fiance has done research in ophtho at our school and has some connections with the faculty here, but is now considering derm. He's likely taking a research year off and currently deciding which field to pursue and do research in.

I'd really appreciate any updated data about these two fields (as well as any other opinions/thoughts/advice for someone considering both) in terms of:

1) Job market--Especially in a city in New England or in a suburb near a city (like suburbs of NJ, NY, or Boston)

2) Residency lifestyle--I know that this is just a few years and isn't nearly as important as lifestyle as an attending. However, we are getting married soon and would like to start a family while in residency (and both of us will be in residency, me also in ophtho). Would this be as easy to do in ophtho as in derm?

3) Overall job satisfaction

Compensation isn't as much a consideration for us, as I think job satisfaction and lifestyle will be a bigger factor for us given that we would like to start a family and spend quality time with our kids (and hopefully with both of being in medicine, we'll do ok and save enough for our kids educations).

Thanks guys!

I am an ophthalmology resident so I can speak more for ophtho than I can for derm (have a few friends in derm residency).

1. Job market is wide open right now for all ophthalmologists but more so for comprehensive/general ophthalmologists. This includes major metropolitan areas that you mentioned! There is a huge demand for ophthalmologists right now for 2 reasons: 1) Aging population and 2) More retiring ophthalmologists than new graduating ophthalmologists. I can’t speak too much about dermatology but the job market is probably good too.

2) Ophtho will generally have a slightly busier lifestyle in residency since they have to see patients during call and may have to go to the OR. Both still have superior lifestyles compared to most other specialties in medicine. However, the learning curve is high for ophtho as you are essentially learning something that wasn’t heavily emphasized in medical school, learning difficult examination techniques, and learning surgery. There’s a lot of reading involved on days off. Attending lifestyle is great for both.

3) Both ophtho and derm continue to have amazing career satisfaction. They are generally the two highest satisfied careers on most polls. Speaking from the ophtho side, I’ve noticed the patients are extremely grateful of your work. When you can do surgery or a procedure on someone with poor sight and help them see again, you really do feel rewarded. Hence why I think ophthalmology always has good career satisfaction. I think it’s more than just having a good lifestyle and good pay, although that certainly helps.

There’s a reason why both have remained in the top tier of competitive specialties for over 30-40 years.

 

[longhaul3]

2. Lifestyle: Again super similar, I wouldn't necessarily say that one is better or worse than the other. There exist both derm and ophtho emergencies and both specialties will take call on nights/weekends to cover the hospital throughout residency, but both fields are usually 7-8 am to 5-6 pm M-F.

Honest question: What is an example of a dermatologic emergency? Do they call derm for SJS/TEN and things like that?

 

[Hotei]

Honest question: What is an example of a dermatologic emergency? Do they call derm for SJS/TEN and things like that?

And when the diagnosis is in doubt.

Derm emergencies and higher acuity things I’ve been called into their ER to see this past yeRinclude

Eczema herpeticum
Disseminated HSV/VZV
Angioinvasive fungal infectiosn
DRESS
SJS/TEN, tho will be managed by trauma/burn after dx
Vancomycin induced LABD
Erythroderma (sezary syndrome, eczema, psoriasis, drug eruptions, contact derm with id reaction...)
Post surgical bleeding (lol)
Atypical mycobacterial infection from filler injection
Kawasaki
MIRM
AGEP
Generalized Pustular psoriasis

Non emergencies you still get called in for
- urticaria multiforme
- sweet syndrome
- urticaria vasculitis, other types of vasculitis
- nasty ulcers like pyoderma gangrenosum
- disseminated Lyme disease
- calciphylaxis


Nec fasc, RMSF, angioedema Meningococcaemia will be diagnosed without derm help. Maybe the others too depending on comfort level of Er doc with derm. Lots of the ER consults are “we don’t know what this rash is but don’t think it’s life threatening and want to be sure”

Maybe these aren’t all emergencies but it’s what I could think of offhand that’s higher acuity or confusing... that’s being said while there are some emergencies in derm this is NOT a high acuity field in general... typing on mobile so typos

 

[PhillyMed777]

And when the diagnosis is in doubt.

Derm emergencies and higher acuity things I’ve been called into their ER to see this past yeRinclude

Eczema herpeticum
Disseminated HSV/VZV
Angioinvasive fungal infectiosn
DRESS
SJS/TEN, tho will be managed by trauma/burn after dx
Vancomycin induced LABD
Erythroderma (sezary syndrome, eczema, psoriasis, drug eruptions, contact derm with id reaction...)
Post surgical bleeding (lol)
Atypical mycobacterial infection from filler injection
Kawasaki
MIRM
AGEP
Generalized Pustular psoriasis

Non emergencies you still get called in for
- urticaria multiforme
- sweet syndrome
- urticaria vasculitis, other types of vasculitis
- nasty ulcers like pyoderma gangrenosum
- disseminated Lyme disease
- calciphylaxis


Nec fasc, RMSF, angioedema Meningococcaemia will be diagnosed without derm help. Maybe the others too depending on comfort level of Er doc with derm. Lots of the ER consults are “we don’t know what this rash is but don’t think it’s life threatening and want to be sure”

Maybe these aren’t all emergencies but it’s what I could think of offhand that’s higher acuity or confusing... that’s being said while there are some emergencies in derm this is NOT a high acuity field in general... typing on mobile so typos

Very very accurate list (coming from a derm resident here)
A lot of residents in other fields from other programs give me puzzled looks when I tell them how destroyed we get on consults and say "what would derm be consulted for?" Just goes to show how many low quality training programs there are sadly. Even some decent name programs are sometimes so lacking in clinical diversity. At a lot of less impressive hospitals and/or docs without appropriate exposure during residency, many of the consultation reasons u brought up are likely not even recognized.

Your list is very accurate. A few differences from my side
-only post op ppl we see are post mohs bleeding/infection (this may be what you are referring to). I explicitly tell them to not go the ER if possible and call us instead.
-have not seen sezary or MIRM but looking out for it
-never get consulted for Kawasaki, the residents seem to handle this on their own
-get high volume vasculitis consults
-so much overdiagnosis of cellulitis and calling things "drug rash" by the people who are the primary teams

If you are going into a field like medicine and not seeing the above your training is incomplete.

If you are going into dermatology, at most (but not all) places you will see and deal with the above. If that does not appeal to you please do me a favor and dont try to become my co-resident. It's been very busy at work and i need people up to the task.

 

[longhaul3]

And when the diagnosis is in doubt.

Derm emergencies and higher acuity things I’ve been called into their ER to see this past yeRinclude

Eczema herpeticum
Disseminated HSV/VZV
Angioinvasive fungal infectiosn
DRESS
SJS/TEN, tho will be managed by trauma/burn after dx
Vancomycin induced LABD
Erythroderma (sezary syndrome, eczema, psoriasis, drug eruptions, contact derm with id reaction...)
Post surgical bleeding (lol)
Atypical mycobacterial infection from filler injection
Kawasaki
MIRM
AGEP
Generalized Pustular psoriasis

Non emergencies you still get called in for
- urticaria multiforme
- sweet syndrome
- urticaria vasculitis, other types of vasculitis
- nasty ulcers like pyoderma gangrenosum
- disseminated Lyme disease
- calciphylaxis


Nec fasc, RMSF, angioedema Meningococcaemia will be diagnosed without derm help. Maybe the others too depending on comfort level of Er doc with derm. Lots of the ER consults are “we don’t know what this rash is but don’t think it’s life threatening and want to be sure”

Maybe these aren’t all emergencies but it’s what I could think of offhand that’s higher acuity or confusing... that’s being said while there are some emergencies in derm this is NOT a high acuity field in general... typing on mobile so typos

Thanks for a great post. The only high acuity case I've seen was a quasi-emergent consult on an inpatient with sezary syndrome. I like to think I'm pretty well rounded but some of these I've never even heard of.

 

[alex.jl1994]

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[ball123]

Thanks ball123 for the detailed response!! It sounds like ophtho is a great field and there are lots of opportunities in terms of the job market.

Question for you--for someone who is just starting out (and doing an elective in ophtho soon), are there any resources you'd recommend as an introduction to the most common diseases you see and the most common procedures?

Of course!

For an ophtho elective - I would just read ophthobook by Tim Root (free online) and Eyeguru.org. Both are excellent! For more detail on diseases you can check out Eyerounds made by the residents/faculty at the University of Iowa and/or Kanski Clinical Ophthalmology (available via ClinicalKey which should be free via your med school library). Eyewiki is not bad either but I like Eyerounds better - more images (no pictures/images at all on Eyewiki), cleaner, more complete, etc.

If you are doing an elective in glaucoma - check out the Univerisity of Iowa glaucoma curriculum by Dr. Alward, which has amazing and free lectures that seem reminscent of Pathoma. Wills Eye Portal also has some good lectures as well and it is free if you just register.

I think for an elective - ophthobook and Eyeguru should suffice! On most rotations, the expectations are very little, if any.

 

[Mohsaic]

Agree with all the above for urgent/emergent derm consults. Keep in mind we get consulted any time any one of these things crosses the mind of the primary team, not just when it actually is that. We may not have to go in overnight, but we get a lot of consults that we see on a daily basis as any skin finding that is noted but cannot be explained by the primary team is likely to buy a consult, regardless of whether or not it is related to the admission (because they often aren't sure if it is related in many cases).

Would also add:
autoimmune blistering disease
fever of unknown origin with a skin finding (consult question: could this skin lesion be the cause of the fever?)
neonatal and especially any premie rashes
GVHD
R/o scabies

 

[PhillyMed777]

GVHD

bone marrow transplant service at my place absolutely overloads our clinics with urgent visits and consults like crazy for GVHD

 

[alex.jl1994]

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