When did you decide on derm?

[Prime2000]

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At what point in your medical school years did you decide on derm, and what really prompted you to pursue it full speed ahead?

Thanks for sharing.

 

[Dral]

Started thinking about it during my last rotation of 3rd year. I took a dermatology elective at a local private office and knew after day 1 it was what I wanted to do.

 

[Prime2000]

Started thinking about it during my last rotation of 3rd year. I took a dermatology elective at a local private office and knew after day 1 it was what I wanted to do.

Dumb question (I apologize in advance I'm just a newbie MS1): what if you really, really like derm but just are not able to match? is there anything you can do to still satisfy your interests in derm--I mean can a family medicine doc or peds doc shape his practice to see purely derm cases that are minor and within his training (acne/rashes/psoriasis/etc.) and refer out the tough cases? Do dermatologists get offended by that type of practice?

 

[asmallchild]

Dumb question (I apologize in advance I'm just a newbie MS1): what if you really, really like derm but just are not able to match? is there anything you can do to still satisfy your interests in derm--I mean can a family medicine doc or peds doc shape his practice to see purely derm cases that are minor and within his training (acne/rashes/psoriasis/etc.) and refer out the tough cases? Do dermatologists get offended by that type of practice?

I'm sure it's possible and someone out there is doing it (I was told on the interview trail that as recently as a couple of years ago, the most successful "dermatologist" in the Boston area was actually a family medicine physician who owned a chain of derm clinics). But I'm also certain you would be facing an uphill climb and that story is likely the exception and not the rule.

There are cases that may start out looking minor and patients will not be happy if you have to keep referring out because it's not within your scope of practice/comfort level.

As for dermatologists being offended, there's plenty of business to go around so I wouldn't worry in that regard. What dermatologists won't like is having to pick up a patient that has been mishandled because someone wanted to play skin doctor without the appropriate training.

 

[reno911]

I mean can a family medicine doc or peds doc shape his practice to see purely derm cases that are minor and within his training (acne/rashes/psoriasis/etc.) and refer out the tough cases? Do dermatologists get offended by that type of practice?

1. This is very common. These individuals market themselves very deceptively. They never make any written claims that they are dermatologists, but when it comes to their practice names and the way they market themselves they always use terms like "Dermatology", "Skin care", "Skin treatment", etc., so that most patients will assume they are dermatologists.

My favorite was someone whose business card read something like this

John Doe, M.D.
Candyland Dermatology and Skn Care Center

Board Certified


Of course he was board certified in IM and heme-onc, but not dermatology. Yet he saw no problem in printing such cards.

2. Of course dermatologists frown upon it, but there is pretty much nothing we can do.


I have always wanted to go into one of these practices as a patient and ask the doctor, "Are you a dermatologist?", just to see what they said.

 

[goodies]

during medical school, i had to shadow a family med doctor at his clinic and he had lasers at his practice and did microdermabrasion as well as botox. he would tell all of his patients that he was considered the 'dermatologist of [....] county'

 

[asmallchild]

1. This is very common. These individuals market themselves very deceptively. They never make any written claims that they are dermatologists, but when it comes to their practice names and the way they market themselves they always use terms like "Dermatology", "Skin care", "Skin treatment", etc., so that most patients will assume they are dermatologists.

My favorite was someone whose business card read something like this

John Doe, M.D.
Candyland Dermatology and Skn Care Center

Board Certified


Of course he was board certified in IM and heme-onc, but not dermatology. Yet he saw no problem in printing such cards.

2. Of course dermatologists frown upon it, but there is pretty much nothing we can do.


I have always wanted to go into one of these practices as a patient and ask the doctor, "Are you a dermatologist?", just to see what they said.

I suspect this may happen more in rural areas where physician quantity is a problem. My brother-in-law completed a dermatology residency in a fairly urban area that is renowned for its cutthroat medical malpractice environment (I think I pretty much gave the area away 😛)

In between all the academic centers offering services, the private practitioners offering services, and the threat of being sued, he's never seen encroachment by a non-derm-boarded physician in that area.

 

[sensitive skin]

Before derm, I wanted to be an ob/gyne. As a kid, I was obsessed with "Miracle of Life." BUT...an M1 career planning session pointed strongly toward dermatology. I was set up to shadow with several dermatologists in private practice -- general derm, cosmetics, Mohs. They totally changed my opinion about the field (ie, pimple popper MD and steroids for everything) and I decided on derm pretty much after the first day! Which was really scary because until then, I'd been an average student. This was the kick in the butt I needed to work extra hard -- I ended up top of my class and matching at a program I loved.


Not gonna lie, derm is *super* fabulous. I always loved skincare, beauty products, and promoting healthy living...no wonder I fell in love with derm immediately. And (as cliche as this sounds) for the first time in my life, I felt like I was really helping people. Yes, the lifestyle/$ is great too (!!!), but really LOVING your career is the icing on the cake. Life is awesome.

 

[reno911]

I suspect this may happen more in rural areas where physician quantity is a problem. My brother-in-law completed a dermatology residency in a fairly urban area that is renowned for its cutthroat medical malpractice environment (I think I pretty much gave the area away 😛)

In between all the academic centers offering services, the private practitioners offering services, and the threat of being sued, he's never seen encroachment by a non-derm-boarded physician in that area.

I've only practiced in metropolitan areas with populations over 1.5 million and with academic medical centers. I've still seen it everywhere. Now sure, these guys will probably not open up an office in Manhattan or in the center of a big city. But they can still thrive close by.

You're right that it probably happens more in rural areas, but even urbanized areas are not immune. The person who I mentioned in my prior post (with the deceptive card) literally practices across the street from a friend of mine who is a board certified derm in an affluent (and probably more educated) suburb of one of the largest cities in the US.

 

[reno911]

during medical school, i had to shadow a family med doctor at his clinic and he had lasers at his practice and did microdermabrasion as well as botox. he would tell all of his patients that he was considered the 'dermatologist of [....] county'

I wonder what he'll say if a board certified derm moves into town.

 

[oracle07]

If it gets out of hand, I'm sure (I hope) the AAD will start advertising campaigns that expose the truth and how to find a dermatology trained "skin care" doctor.

I've seen ER docs, anesthesiologists, IM, OBGYNs, etc etc call themselves "skin care" doctors of "dermatology" doctors with mis-leading references to their board certification as well.

There are also crock "boards" of dermatology that you can pay for certification in, rather than get real residency training and pass a test.

Like I said, if it gets out of hand, I really would have no problem with the AAD recommending that patients check their doctor's residency training specialty and exposing what to look out for...

I can see the commercials now...

"Would you go to a dentist for your heart surgery?"

 

[Dral]

I'd think this is a long way off from happening, even if it does. I was talking to a drug rep about Dermatologists in our state and the conversation revolved around how there are so many areas that don't even have access to a dermatologist, or how the one dermatologist in the town just retired and no one has stepped in to take his or her place.

It seems that family med/internists almost need to take over the task, but that if a dermatologist would be available, he or she would be very much welcomed.

 

[oracle07]

I see your point, Dral.

I'm sure there are rural areas without a dermatologist. They could target advertising to bigger cities where dermatologists have to clean up the mismanaged patients. We see it all the time.

There are clearly docs mis-representing themselves as dermatologists or "board certified physicians" who specialize in skin care. I have no problem with them focusing a large part of their practice on skin care as long as they they say "Board Certified Family Practitioner" or listed their specialty -- I'd go to an FP if I couldn't see a dermatologist. I wouldn't go to an anesthesiologist, though. I think rural patients where there isn't access to a dermatologist would feel the same way.

 

[N-Surge]

During the middle of M3 when my research background made it clear to me that Derm, GI, or Onc were probably the best choices. In the end, the connection between my research and skin disease won me over.

 

[Corker]

Started thinking about it during my last rotation of 3rd year. I took a dermatology elective at a local private office and knew after day 1 it was what I wanted to do.

These are follow-up questions to Dral's statement...

Had you done any derm research before that point? Did you end up taking a year off to do derm research, or picking up some projects during your fourth year? What were the obstacles to matching after deciding so "late"?

Another question for the forum... how is research in other fields considered during the match? For example, if a person is president of another interest group (i.e. Radiology, Anesthesiology, etc.) and has done research in that field (prior to deciding on derm), would that research be regarded as significant in such a competitive environment? Would it be necessary to also secure some derm research before applying for residency? I realize the derm contacts would be important (especially for recommendation letters), but if there isn't enough time left to do anything significant, would the research already done (and the recommendations from docs/mentors in another field) be enough (assuming the rest of the application - board scores, top 20 school, etc. is competitive)? (Just some added context... no PhD, no pubs (yet), just abstracts/posters.)

Thanks for any input!!!

 

[asmallchild]

Had you done any derm research before that point? Did you end up taking a year off to do derm research, or picking up some projects during your fourth year? What were the obstacles to matching after deciding so "late"?

I met a lot of people on the interview trail who had research as early as their 1st year.

I also met plenty of people who didn't decide until 3rd year or later and just ended up taking a year off. 1 year off is nothing if you match into the field that is right for you (a good 30+ year career). Many PDs do NOT consider research to be significant unless you have publications and at least a 12 month commitment (yes, that means taking time off)

Many schools have an elective-laden 4th year so it's possible to continue your research into the 4th year.

Another question for the forum... how is research in other fields considered during the match? For example, if a person is president of another interest group (i.e. Radiology, Anesthesiology, etc.) and has done research in that field (prior to deciding on derm), would that research be regarded as significant in such a competitive environment? Would it be necessary to also secure some derm research before applying for residency? I realize the derm contacts would be important (especially for recommendation letters), but if there isn't enough time left to do anything significant, would the research already done (and the recommendations from docs/mentors in another field) be enough (assuming the rest of the application - board scores, top 20 school, etc. is competitive)? (Just some added context... no PhD, no pubs (yet), just abstracts/posters.)

Research in other fields still counts but obviously, derm research is the best. Being president of another interest group doesn't help and can actually work against you. Derm is certainly lifestyle-friendly but I've met plenty of attendings in the field who hold it against applicants for selecting the field based on that fact. Being the president of the radiology/anesthesiology society only serves to exacerbate that point.

Ultimately, I would recommend securing derm research prior to applying. Your first shot is your best shot so I would not waste it with the glaring hole of no derm research on your app. Assuming you have good board scores and good grades from a top 20 school, why not take a year off to get some solid research and pubs, and then apply the following year with a ton of confidence?

 

[Corker]

Thanks for the input, asmallchild!!! Not exactly what I was hoping for, but I always prefer to get it straight! I definitely need to talk with my home Derm department and see what I can get going in the way of research! Thanks for taking time to post!

 

[N-Surge]

Had you done any derm research before that point? Did you end up taking a year off to do derm research, or picking up some projects during your fourth year? What were the obstacles to matching after deciding so "late"?

During my M4 year (prior to interviews) I spent a block of time starting up a new project on a set of proteins involved in the structural integrity of skin. If you have some ideas and know faculty, ask for resources! Go for it!

Another question for the forum... how is research in other fields considered during the match?

If it is related to skin, some will get it! If the programs don't get it I think it may be hard to spin research one did in the noise reduction of image processing to improve the specificity of diagnostic abdominal ultrasounds. Then again, if you were to discuss how your knowledge in such matters could be applied in Dermoscopy, and how you were going to use similar algorithms to help clinicians differentiate melanoma from the benign, then the programs you apply too might just get it! 🙂

Would it be necessary to also secure some derm research before applying for residency?

If you have the 250+, AOA, might not be.
If you don't have this then probably yes!

Thanks for any input!!!

Always happy to help, or least make some noise! 🙂

 

[Corker]

Thanks, N-Surge! Ya... trying to tie my summer NIH project to derm might be a hard sell! 😛 I am actually still involved in that project (and others that originated from it), so I know I won't have time to start any derm projects until after my boards in June.

I am definitely aiming high on the boards... no AOA at my school, so that won't be helpful. I am thinking I will wait and see how I do on the boards... if I think I am in the ballpark for derm, I will take on some derm-specific research during third and fourth year.

Thanks for the post! I appreciate the input!

 

[dermRus]

I knew that I wanted to do derm before I went to med school based on previous in-depth experiences. That made it easier for me to start research right off the bat and get involved with the department. It makes a big difference in setting up your research and in knowing academic goals that will give you the best chance with your application. I think it made all of the difference because I had a stress-free application process and matched where I wanted to go. It also made med school pretty fun, even during the third year because I tried to learn as much on each rotation (despite the hard personalities) because I was inwardly confident about what I wanted to eventually do and why.

 

[Dral]

These are follow-up questions to Dral's statement...

Had you done any derm research before that point? Did you end up taking a year off to do derm research, or picking up some projects during your fourth year? What were the obstacles to matching after deciding so "late"?

Another question for the forum... how is research in other fields considered during the match? For example, if a person is president of another interest group (i.e. Radiology, Anesthesiology, etc.) and has done research in that field (prior to deciding on derm), would that research be regarded as significant in such a competitive environment? Would it be necessary to also secure some derm research before applying for residency? I realize the derm contacts would be important (especially for recommendation letters), but if there isn't enough time left to do anything significant, would the research already done (and the recommendations from docs/mentors in another field) be enough (assuming the rest of the application - board scores, top 20 school, etc. is competitive)? (Just some added context... no PhD, no pubs (yet), just abstracts/posters.)

Thanks for any input!!!

My thesis research involved basic science and had no research experience in Derm before I found my interest in it. I'm currently taking a year off to explore other educational experiences and to work on starting my dermatology research career (hopefully).

Getting whatever experience you can in terms of research is good. It shows dedication to the field to put in that sort of work. If you feel you need more experience in this area, you can take the year between 3rd and 4th year, or you can shoot for a derm research fellowship after 4th year (most fellowships require an MD iirc).

 

[asmallchild]

Getting whatever experience you can in terms of research is good. It shows dedication to the field to put in that sort of work. If you feel you need more experience in this area, you can take the year between 3rd and 4th year, or you can shoot for a derm research fellowship after 4th year (most fellowships require an MD iirc).

I've gotten quite a few PMs on research and I'd say Dral's advice is spot on.

If you are going to talk seriously about pursuing an academic career in dermatology, it typically does require taking some time off (if not going all out for the PhD). It's hard to be taken seriously if you just have the summer after MS1 in terms of research experience. (Not that that isn't helpful, but I'd advise against waxing on and on about pursuing a career in academics during interviews if that's the only background a person has in research)

 

[N-Surge]

It also can help if you are able to bring a new angle in studying skin pathology to the table. One of the great things about Derm and academics is that there are so many open question, not just in understanding pathological processes but in the development of techniques to better undserstand the biochemical pathways as well as in the design of new clinical tools.