What is a derm life actually like?

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bad bunny

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Does someone have insight into what being a derm attending is actually like? Can you really work 4 days a week and make 300+? Or do med school students just glorify it because its hard to match?
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I work 4.5 days per week, 7:30-4pm on full days. See 30-40 patients daily, with a good mix of skin cancer/full skin checks, spot checks, rashes, etc. I have a reputation with my practice and within the region for being one of the more “academic” private practice derms, so I get cases filtered to me from the garbage PE-backed midlevel derm factories which are sometimes boring and sometimes interesting.

The last hour or two of my day is usually spent doing excisions. Nice way to wind down.

I don’t take hospital call. I get maybe 2 calls from patients during the months I’m on call for the practice.

I love what I do, and I find it extremely interesting overall. I don’t blame medical students who have no understanding of dermatology for not thinking it would be interesting. From the outside looking in, it probably looks boring. From in the trenches, it’s absolutely the best field there is.
 
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username456789 said:
From in the trenches, it’s absolutely the best field there is.
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Agree to disagree 🙂 cause I think my field is the best.... i mean where else could I say “I just nailed your grandma” and have them go, “thanks doctor!”


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OrthoTraumaMD said:
Agree to disagree 🙂 cause I think my field is the best.... i mean where else could I say “I just nailed your grandma” and have them go, “thanks doctor!”


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LMAO

I was about to reply and say we all think our field is the best but then you went and brought nailing grandmas into it. You win
 
Just to see if this thread can go back on topic, does anyone else have some input on the daily life of a derm that they can share?


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bad bunny said:
Just to see if this thread can go back on topic, does anyone else have some input on the daily life of a derm that they can share?


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Daily life is similar to most other outpatient clinic specialties

In the very broadest sense, most clinics typically start somewhere between 7-9 am and end sometime between 4-6pm. So anywhere from 7-10 hour days. This is typically done 4-5 days per week. Some derms may do Mon-Thur full days and 1/2 day on Fridays. I think there are some out there that work 6 days a week and have Saturday clinics, or work super part time and only do 3 days a week, but these extremes are probably less common.

Derms usually see anywhere between 3-6 patients per hour. Less than three would be extraordinarily slow. 6+ would be very fast. Then add in 0-2 hours of charting per day based on your EMR/Scribes/MAs/Dictation system. Some doctors barely spend any time after clinic finishing notes if they have excellent support staff, while others may consistently do 1-2 hours after patients have left.

Call is variable, but for any practice there is almost always a derm on call at all times. This means they answer the phone for any patient in the practice during the nights and weekends. As for how often you are on call, this will vary immensely based on practice setting. Rarely dermatologists may need to physically see a patient while on call or go into the hospital. Most is done via the phone.
 
bad bunny said:
Just to see if this thread can go back on topic, does anyone else have some input on the daily life of a derm that they can share?


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I shadowed a derm every other week for around 3 months when I was pre-med. I got bored quick.

I thought I would like the practice variability-- you get to see patients, build relationships with them, and still do some neat procedures and "surgeries"-- but I was just totally disinterested in it. Maybe it was because of the cases the derm I shadowed chose to see, but it seemed like every case was a basic skin check followed by freezing some pre-cancerous moles or whatever. The doc I shadowed definitely has an amazing lifestyle, though.
 
fldoctorgirl said:
I shadowed a derm every other week for around 3 months when I was pre-med. I got bored quick.

I thought I would like the practice variability-- you get to see patients, build relationships with them, and still do some neat procedures and "surgeries"-- but I was just totally disinterested in it. Maybe it was because of the cases the derm I shadowed chose to see, but it seemed like every case was a basic skin check followed by freezing some pre-cancerous moles or whatever. The doc I shadowed definitely has an amazing lifestyle, though.
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Sounds like the dream. I had a job at a grocery store where all I did was dust shelves and stock items. My coworkers hated how boring it was but I saw it as getting paid to do easy work. I would love this low stress job.
 
puahate said:
Sounds like the dream. I had a job at a grocery store where all I did was dust shelves and stock items. My coworkers hated how boring it was but I saw it as getting paid to do easy work. I would love this low stress job.
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I used to think that if they paid me enough, I’d do any menial task required. My wife is that way. She is an RN and never complained about having to clean a patient’s room or make their bed if housekeeping was busy because she was getting paid very well to change a bed.

Personally, I hate doing a bunch of boring stuff. I know being a physician has boring things in it no matter what specialty it is, but I just couldn’t do it all day lol.

Note: I’m not saying derm is boring. I’m just saying if I found it boring, I couldn’t do it.
 
puahate said:
Sounds like the dream. I had a job at a grocery store where all I did was dust shelves and stock items. My coworkers hated how boring it was but I saw it as getting paid to do easy work. I would love this low stress job.
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Matthew9Thirtyfive said:
I used to think that if they paid me enough, I’d do any menial task required. My wife is that way. She is an RN and never complained about having to clean a patient’s room or make their bed if housekeeping was busy because she was getting paid very well to change a bed.

Personally, I hate doing a bunch of boring stuff. I know being a physician has boring things in it no matter what specialty it is, but I just couldn’t do it all day lol.

Note: I’m not saying derm is boring. I’m just saying if I found it boring, I couldn’t do it.
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Seeing 30+ patients a day doesnt seem like a dream to me even if it boring. Sounds like a grind.
 
Matthew9Thirtyfive said:
I used to think that if they paid me enough, I’d do any menial task required. My wife is that way. She is an RN and never complained about having to clean a patient’s room or make their bed if housekeeping was busy because she was getting paid very well to change a bed.

Personally, I hate doing a bunch of boring stuff. I know being a physician has boring things in it no matter what specialty it is, but I just couldn’t do it all day lol.

Note: I’m not saying derm is boring. I’m just saying if I found it boring, I couldn’t do it.
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Ophtho is still calling your name!
 
libertyyne said:
im sorry, i missed the memo where people discussed post tax salaries. Do we incorporate tax exemptions , and other s-corp like shelters in the conversation as well?

Obviously taxes are a thing.
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We discuss post-tax salaries when somebody says "300k appears in your bank account," but I guess you missed that too. It's cool, reading is hard. Meant to reply to the other person, and I see that got you all riled up, so that's my bad.

Wouldn't be SDN without a joke being brutally drawn out and beaten to death
 
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appalachian_man said:
We discuss post-tax salaries when somebody says "300k appears in your bank account," but I guess you missed that too. It's cool, reading is hard. Meant to reply to the other person, and I see that got you all riled up, so that's my bad.

Wouldn't be SDN without a joke being brutally drawn out and beaten to death
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Maybe if you had qouted the right person it wouldnt have seemed as idiotic. Its cool, interneting is hard. So is being funny.
Once again Im glad you are able to estimate post tax salaries for everyone working in different states , cities, and counties with different dependents and practice structures.
 
I thought it would be cool. Seemed like a good fit for me. I like path but wouldnt want to just look at histo slides and gross all day. Being good at that aspect, being a good diagnostician, as well as those sweet hours seemed pretty cool.

Then when we got to our derm block I realized its just a bunch a nerds tryin’ to flex about how much they know about rashes.

It’s a macule!

It’s a papule!

It’s maculopapular!

OMG!!!

Uh, yeah cool story. Stop talking about filaggrin already. Literally no one cares!
 
Ho0v-man said:
Yes, finding the content boring and the lecturers pretentious is clearly a problem with me.
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You made it pretty clear you were intimidated by the basic science and by the terminology. Dermatology lives and dies by description of primary lesions. Some of the best medical students I had rotate with me when I was a resident were family medicine/internal medicine type kids who were there to learn the basics so they didn’t embarrass themselves when addressing dermatologic concerns or when consulting a dermatology colleague.

I get it, dermatology is a lot different than most things you approach in medicine. And most people run away from it for this reason. Which is one of the reasons why most non-dermatology physicians are completely deficient in it. Almost by choice, because dermatology represents an expansive wilderness of disease that pretty much never gets touched on a medical school. It’s very intimidating to most medical students; you’re not alone.

I am of course not suggesting that everybody should take a strong interest in it and pursue it. But like every other specialty, the willful ignorance approach doesn’t serve you well in the long run.
 
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username456789 said:
You made it pretty clear you were intimidated by the basic science and by the terminology. Dermatology lives and dies by description of primary lesions. Some of the best medical students I had rotate with me when I was a resident were family medicine/internal medicine type kids who were there to learn the basics so they didn’t embarrass themselves when addressing dermatologic concerns or when consulting a dermatology colleague.

I get it, dermatology is a lot different than most things you approach in medicine. And most people run away from it for this reason. Which is one of the reasons why most non-dermatology physicians are completely deficient in it. Almost by choice, because dermatology represents an expansive wilderness of disease that pretty much never gets touched on a medical school. It’s very intimidating to most medical students; you’re not alone.

I am of course not suggesting that everybody should take a strong interest in it and pursue it. But like every other specialty, the willful ignorance approach doesn’t serve you well in the long run.
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I never said it was intimidating. I was just bored by the material. Not for me. I just wasn’t interested in analyzing rashes. It’s cool that you are, I guess. I have no doubts that it is challenging.

My post was more about how I was put off by the residents and attendings teaching my classes. Every specialist knows a ton about their specialty. That’s kinda the point. But they seemed really pretentious compared to other lecturers. Like its somehow a bigger deal to be a dermatologist than a surgeon for example. That was my gripe.

EDIT: During one of the lectures being given by a resident an attending came in and started pimping him on half the cases. Won’t lie, that looked intimidating lol.
 
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username456789 said:
You made it pretty clear you were intimidated by the basic science and by the terminology. Dermatology lives and dies by description of primary lesions. Some of the best medical students I had rotate with me when I was a resident were family medicine/internal medicine type kids who were there to learn the basics so they didn’t embarrass themselves when addressing dermatologic concerns or when consulting a dermatology colleague.

I get it, dermatology is a lot different than most things you approach in medicine. And most people run away from it for this reason. Which is one of the reasons why most non-dermatology physicians are completely deficient in it. Almost by choice, because dermatology represents an expansive wilderness of disease that pretty much never gets touched on a medical school. It’s very intimidating to most medical students; you’re not alone.

I am of course not suggesting that everybody should take a strong interest in it and pursue it. But like every other specialty, the willful ignorance approach doesn’t serve you well in the long run.
Click to expand...

I agree with this. My specialty is also not well taught in Med school (despite comprising about 35% of primary care visits). Don’t knock something or deride it as boring/simple/not worth it, because you don’t know it well.


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Ho0v-man said:
I never said it was intimidating. I was just bored by the material. Not for me. I just wasn’t interested in analyzing rashes. It’s cool that you are, I guess. I have no doubts that it is challenging.

My post was more about how I was put off by the residents and attendings teaching my classes. Every specialist knows a ton about their specialty. That’s kinda the point. But they seemed really pretentious compared to other lecturers. Like its somehow a bigger deal to be a dermatologist than a surgeon for example. That was my gripe.

EDIT: During one of the lectures being given by a resident an attending came in and started pimping him on half the cases. Won’t lie, that looked intimidating lol.
Click to expand...

Sounds like you may have some DBs in your school’s derm department. That’s a shame. Most departments and individuals I’ve interacted with bae been anything but that; however, there are always bad apples in every specialty.

I do CME lectures for IM docs working on board recertification and my “lectures” are basically enthusiastic discussions. Each year I try to bring some newer/emerging trends or tidbits of information that the internist would find relevant ( psoriasis as a risk factor for metabolic syndrome, understanding that bilateral lower extremity cellulitis is a unicorn, when to perform a punch versus a shave biopsy, advancements in the metastatic melanoma treatment, etc). My talks are extremely well received, primarily because I “don’t lecture at” the docs, and I carefully select the topics and the appropriate depth/superficiality for discussion. But it’s a little different lecturing licensed physicians vs M1/M2 students. Unfortunately some basics of the language still need to be learned and understood.

When I was a medical student, the dermatology department at my school was extremely friendly and receptive to me approaching them. My residency program at another institution with even more friendly and collegial, and that really helped to shape my enjoyment of my field. In a world where many specialties tend to want to eat their own, my experiences in dermatology were the opposite. But I have definitely witnessed and experienced some departments who take up much more aggressive and self-destructive route.
 
username456789 said:
Sounds like you may have some DBs in your school’s derm department. That’s a shame. Most departments and individuals I’ve interacted with bae been anything but that; however, there are always bad apples in every specialty.

I do CME lectures for IM docs working on board recertification and my “lectures” are basically enthusiastic discussions. Each year I try to bring some newer/emerging trends or tidbits of information that the internist would find relevant ( psoriasis as a risk factor for metabolic syndrome, understanding that bilateral lower extremity cellulitis is a unicorn, when to perform a punch versus a shave biopsy, advancements in the metastatic melanoma treatment, etc). My talks are extremely well received, primarily because I “don’t lecture at” the docs, and I carefully select the topics and the appropriate depth/superficiality for discussion. But it’s a little different lecturing licensed physicians vs M1/M2 students. Unfortunately some basics of the language still need to be learned and understood.

When I was a medical student, the dermatology department at my school was extremely friendly and receptive to me approaching them. My residency program at another institution with even more friendly and collegial, and that really helped to shape my enjoyment of my field. In a world where many specialties tend to want to eat their own, my experiences in dermatology were the opposite. But I have definitely witnessed and experienced some departments who take up much more aggressive and self-destructive route.
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My humble recommendation is to not interact with non-derm people on this website regarding dermatology. It's clear everyone is an expert and wont change their opinions. As such over the years derm representation has gone way down on this side of the website, we might as well aim for zero. Let people on the outside stay on the outside, and entertain/reaffirm their own strange beliefs amongst themselves
 
username456789 said:
Sounds like you may have some DBs in your school’s derm department. That’s a shame. Most departments and individuals I’ve interacted with bae been anything but that; however, there are always bad apples in every specialty.

I do CME lectures for IM docs working on board recertification and my “lectures” are basically enthusiastic discussions. Each year I try to bring some newer/emerging trends or tidbits of information that the internist would find relevant ( psoriasis as a risk factor for metabolic syndrome, understanding that bilateral lower extremity cellulitis is a unicorn, when to perform a punch versus a shave biopsy, advancements in the metastatic melanoma treatment, etc). My talks are extremely well received, primarily because I “don’t lecture at” the docs, and I carefully select the topics and the appropriate depth/superficiality for discussion. But it’s a little different lecturing licensed physicians vs M1/M2 students. Unfortunately some basics of the language still need to be learned and understood.

When I was a medical student, the dermatology department at my school was extremely friendly and receptive to me approaching them. My residency program at another institution with even more friendly and collegial, and that really helped to shape my enjoyment of my field. In a world where many specialties tend to want to eat their own, my experiences in dermatology were the opposite. But I have definitely witnessed and experienced some departments who take up much more aggressive and self-destructive route.
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Yeah it’s funny how your (my) limited experience with one derm department can shape one’s perception of an entire field. Perhaps the program at my school would be considered a tad on the malignant side then.

Didn’t mean to crap on your field. I hope whatever field I choose I enjoy as much as you seem to enjoy yours.
 
After you spend time in a busy derm clinic (or any legit high volume clinic really), you will begin to notice that this type of clinic grind is straight up exhausting to all but a select few personalities. It is not a walk in the park to create such a well oiled machine and see so many patients every day of work. In a vacuum, it would be a nightmare for most people, but relative to other fields with so many deep flaws of course it is going to look like paradise. To be frank, a huge reason derm is popular (beyond those that legit like the field) is because it is a lesser of evils and one of the last bastions of being your own man in medicine.
 
Neopolymath said:
After you spend time in a busy derm clinic (or any legit high volume clinic really), you will begin to notice that this type of clinic grind is straight up exhausting to all but a select few personalities. It is not a walk in the park to create such a well oiled machine and see so many patients every day of work. In a vacuum, it would be a nightmare for most people, but relative to other fields with so many deep flaws of course it is going to look like paradise. To be frank, a huge reason derm is popular (beyond those that legit like the field) is because it is a lesser of evils and one of the last bastions of being your own man in medicine.
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I doubt it. It's all about setup. I was recently in an outpatient clinic in my desired specialty in which my preceptor sees about 40-60 pts a day. Work was chill and enjoyable. It's a straight up grind if you're in the wrong specialty.
 
Black Coffee 24/7 said:
I doubt it. It's all about setup. I was recently in an outpatient clinic in my desired specialty in which my preceptor sees about 40-60 pts a day. Work was chill and enjoyable. It's a straight up grind if you're in the wrong specialty.
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It can take years to find the right staff, or this sort of well run clinic won’t happen. Don’t gloss over this fact.
 
Had a fresh Derm grad talk to our school (DO who trained in acgme program). Dude legit works 3-4 days a week and makes 400k. Large Midwest city too.
 
Dr.Bruh said:
Had a fresh Derm grad talk to our school (DO who trained in acgme program). Dude legit works 3-4 days a week and makes 400k. Large Midwest city too.
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Do you know where he did his residency? DO matching ACGME Derm is impressive. And did he really disclose his salary? lol
 
Deecee2DO said:
Do you know where he did his residency? DO matching ACGME Derm is impressive. And did he really disclose his salary? lol
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Yes I do know but I was told not to disclose on here where (I did a write up on the DO med student forum about the take away from his talk). He graduated from my school and his younger brother is in my class so he came and talked to our class. Every doc we’ve ever had come talk to one of our clubs always told us their salary tho.
 
Dr.Bruh said:
Yes I do know but I was told not to disclose on here where (I did a write up on the DO med student forum about the take away from his talk). He graduated from my school and his younger brother is in my class so he came and talked to our class. Every doc we’ve ever had come talk to one of our clubs always told us their salary tho.
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Strange since Americans, in general, don't like to talk about their salary...
 
Splenda88 said:
Strange since Americans, in general, don't like to talk about their salary...
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That's because the bosses have you brainwashed into not doing so. What is the disadvantage to you? If you learn that Sally is making 2x what you are for the same job, then you'd go to the bosses and demand a raise. Who stands to gain from people not talking about their salaries?
 
Psai said:
That's because the bosses have you brainwashed into not doing so. What is the disadvantage to you? If you learn that Sally is making 2x what you are for the same job, then you'd go to the bosses and demand a raise. Who stands to gain from people not talking about their salaries?
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I agree. Only one PGY3 in my program (IM) shares what her contract is like. She makes the same case you make.
 
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