Why Derm?

[StringerBell]

Pardon my naivete, but it seems well-accepted that Derm is the most competitive/coveted residency. My question is...WHY?

I understand that it will be lucrative and that the residency will likely not have some of the ungodly hours of other residencies. But how many of you really want to do Derm for any reason other than those? I guess I'm not understanding why Derm is so competitive.

While we're all (for the most part) going to make fine physicians, I truly wonder if the best-and-brightest of us should be in derm, or in more pressing fields like Cardiology or EM.

I realize that I will probably get some angry responses from some people who really want to go into Derm. And I do recall the Seinfeld episode in which Jerry refers to a Dermatologist as "Pimple-Popper, M.D." only to be reminded of the significance of skin cancer. But am I missing something here, or do the majority of people who want to match into Derm doing so for superficial reasons?

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[Vano]

You said it yourself--good residency and post-residency lifestyle with a pretty good reimbursement considering the hours is what, in my opinion, drives most people to derm. Personally I'm not interested/anticipate to be interested in that field but "never say never". And yes, I do think that such competitive students could apply themselves in some more demanding fields, but it's their choice.

 

[Green Pirate]

And I do recall the Seinfeld episode in which Jerry refers to a Dermatologist as "Pimple-Popper, M.D." only to be reminded of the significance of skin cancer. But am I missing something here, or do the majority of people who want to match into Derm doing so for superficial reasons?

great episode.

Yeah... derm doesn't really appeal to me as far as subject matter goes. I'm sure there are those out there who are in love with skin and find it fascinating, but just from what I've heard, it seems as if most people are just in love with the cushy lifestyle and handsome paycheck.

 

[smq123]

Pardon my naivete, but it seems well-accepted that Derm is the most competitive/coveted residency. My question is...WHY?

I understand that it will be lucrative and that the residency will likely not have some of the ungodly hours of other residencies. But how many of you really want to do Derm for any reason other than those? I guess I'm not understanding why Derm is so competitive.

I do not want to do derm, but, through the course of med school, I've come to respect what many dermatologists do:

1) Dermatology is one of the specialties in medicine where they need a lot of really good bench researchers. If you're interested in bench research, genetics, cell bio, etc., derm is a good field.

2) Dermatologists try to find treatments for some of the most devastating diseases in the world. Epidermolysis bullosa, for example, is a terrible, terrible disease, but one of my friends did research with a dermatologist on this topic when he was in grad school. I mean - the skin is the largest organ in the body. Finding out what keeps it healthy and functional is pretty important.

3) Dermatologists do pick up a lot of serious systemic diseases. Skin cancer, of course, is one. Sometimes, dermatologists are the first doctor to diagnose someone with AIDS - Kaposi's sarcoma is sometimes the first symptom of HIV/AIDS that people notice. Actually, I do know someone who worked in an HIV clinic, and he said that most of the patients there were more concerned about the Kaposi's than about HIV - those big purple lesions attract a LOT of notice.

4) I know that people dismiss derm as just "cosmetic/pimple poppers," but, people DO judge you on your appearance. Ask any young adult with severe, pitting, scarring acne if it has affected his/her self-esteem, and I'm sure that they would say that it has. People with severe psoriasis have so much trouble going out in public (because they attract a lot of staring), and might even have trouble holding down certain jobs. For example, if you're a salesman with terrible psorasis on your hands, who is going to want to shake hands with you? Or even want to stand near you - the average person would look at a psoriatic lesion and wonder if it's contagious.

The social aspect of some derm diseases is so severe that people have committed suicide. Being able to treat the disease and prevent the unnecessary suicide/depression would be pretty cool.

 

[Jccripe]

yeah but Derm is a lifetime of dealing with acne. uhh... no thanks.

 

[DocOB]

great episode.

Yeah... derm doesn't really appeal to me as far as subject matter goes. I'm sure there are those out there who are in love with skin and find it fascinating, but just from what I've heard, it seems as if most people are just in love with the cushy lifestyle and handsome paycheck.

Yeah, I knew a guy like this once. I think his name was Buffalo Bill.

 

[Mr. Tee]

Don't forget that part of the fierce competition comes from the very small number of spots (like 60 or 70 seats in the whole country).

More like 300.

 

[SupergreenMnM]

Last year:

Dermatology
US Applicants 709
Residency Spots 316
Ratio 2.24

Only combined plastics was harder to get into spot/app wise, while rad oncology was only slightly easier to match.

 

[Green Pirate]

Yeah, I knew a guy like this once. I think his name was Buffalo Bill.

that joke went right over my head

 

[NovemberWhiskey]

that joke went right over my head

The character Buffalo Bill in the movie Silence of the Lambs kills people in an effort to make a cape(?) with their skin.

 

[Green Pirate]

The character Buffalo Bill in the movie Silence of the Lambs kills people in an effort to make a cape(?) with their skin.

yeah I'm not really into movies, so that explains it.

 

[bigdog8829]

I'd take a 9-5 job where i can make $250K a year.

 

[Green Pirate]

I'd take a 9-5 job where i can make $250K a year.

you should have gone into business

 

[degoo_]

yeah I'm not really into movies, so that explains it.

go rent silence of the lambs, your finals can wait!

 

[DropkickMurphy]

Am I the only one who finds derm interesting for reasons other than money and the lack of overtime?

 

[Yehosh]

Stringbell,

I've been wondering this myself for quite a while now, so when I visited my family physician this week, I asked him. He gave me a great example why it is considered such an easy line of work.

Lets say he does a complete physicial on someone. The works. The whole systemic evaluation including rectal and vaginal (if female) examinations. Thats around 45 minutes. During that he finds a small mole he thinks should get looked at by a dermatologist. He refers the patiets to one. The dermatologist takes 5 minutes to examine it and dismiss it (in most cases, or so he told me). The he commented that the Dermatologist just made quadruple the pay in 5 minutes then what he made for the 45 minute physical. Note that this for the Ontario health care fee system, but I'm sure there is a similar ratio in the US.

so... is he a litter bitter that he isn't a dermatologist? most likely

is he working ten times harder for the same buck? most likely

is this the reason why many choose dermatology?

 

[DropkickMurphy]

What I can't understand is why anyone would voluntarily become a primary care doc......

 

[DoctorMom78]

What I can't understand is why anyone would voluntarily become a primary care doc......

Dem dare's fightin' wards!

 

[Darkshooter326]

What I can't understand is why anyone would voluntarily become a primary care doc......

Possibly a genuine interest in the field? What's that about?


There are also scholarshp programs that require students to go into primary care/rural healthcare

 

[DropkickMurphy]

There are also scholarshp programs that require students to go into primary care/rural healthcare

Contractual obligations notwithstanding (At least there are rewards in something like dermatology.....

Possibly a genuine interest in the field? What's that about?

More like they bombed their boards and had to settle (DoctorMom78 notwithstanding of course)

[YOUTUBE]http://www.youtube.com/watch?v=ooaGhYFHIzg[/YOUTUBE]
(Pardon the crappy video, but I couldn't find a better one with this song)

 

[DrZeke]

The character Buffalo Bill in the movie Silence of the Lambs kills people in an effort to make a cape(?) with their skin.

Actually he makes an entire suit/dress out of women's skin so he can undergo a transformation.

 

[DropkickMurphy]

Actually he makes an entire suit/dress out of women's skin so he can undergo a transformation.

I think it was supposed to be a take on Ed Gein.

 

[Pinkertinkle]

More like they bombed their boards

Bingo

 

[QuantumMechanic]

And I do recall the Seinfeld episode in which Jerry refers to a Dermatologist as "Pimple-Popper, M.D."

Call a MOHS surgeon a "pimple popper" and he'll probably pop a cap in one's ass for being ignorant of the knowledge of pathology required to perform such a delicate operation and how such an operation can turn a deadly skin malignancy into something that was simply a scare.

For that matter, most derms aren't managing acne for the most lucrative (and fulfilling) parts of the their practice, FMs can manage such skin disorders easily and only very difficult cases need derms to manage them. (Ever tried to get an appointment with a derm? In some areas its nearly impossible to get one in less than 3 months notice).

Medicine is a diverse career where there are jobs where you can save the world, or you can do much less idealistic work. Whatever path you take, you shouldn't feel ashamed or embarassed by your career choice. Every doctor provides services through his expertise to those who need or desire his help.

 

[NonTradMed]

Call a MOHS surgeon a "pimple popper" and he'll probably pop a cap in one's ass for being ignorant of the knowledge of pathology required to perform such a delicate operation and how such an operation can turn a deadly skin malignancy into something that was simply a scare.

For that matter, most derms aren't managing acne for the most lucrative (and fulfilling) parts of the their practice, FMs can manage such skin disorders easily and only very difficult cases need derms to manage them. (Ever tried to get an appointment with a derm? In some areas its nearly impossible to get one in less than 3 months notice).

Medicine is a diverse career where there are jobs where you can save the world, or you can do much less idealistic work. Whatever path you take, you shouldn't feel ashamed or embarassed by your career choice. Every doctor provides services through his expertise to those who need or desire his help.

Well said.

It's what I say to people who complain about people's residency choice. Whatever area you go into, you will end up helping people, so money as one of your criteria for residency does not make you a "lesser" doc.

I have question about derm's competitiveness though. Since everyone says people go into derm for the lifestyle and income ratio, why is combined plastic the second most competitive? At my school, ortho was considered the most competitive next to derm last year (as told to me by a upperclassmen). Both ortho and plastics are pretty demanding lifestyle jobs, if lifestyle was so important, then why isn't something less demanding more competitive? Is it because money is a greater motivator than lifestyle (i.e if I can't get a job with a good lifestyle AND paycheck, I'll settle for a job that has only a good paycheck). Can someone explain this to me?

 

[Steve203]

Well said.

It's what I say to people who complain about people's residency choice. Whatever area you go into, you will end up helping people, so money as one of your criteria for residency does not make you a "lesser" doc.

I have question about derm's competitiveness though. Since everyone says people go into derm for the lifestyle and income ratio, why is combined plastic the second most competitive? At my school, ortho was considered the most competitive next to derm last year (as told to me by a upperclassmen). Both ortho and plastics are pretty demanding lifestyle jobs, if lifestyle was so important, then why isn't something less demanding more competitive? Is it because money is a greater motivator than lifestyle (i.e if I can't get a job with a good lifestyle AND paycheck, I'll settle for a job that has only a good paycheck). Can someone explain this to me?

happiness is the greatest motivator in life.

period

 

[eight sat up]

Ortho and plastics residents have an aura of prestige surrounding them

 

[DropkickMurphy]

....plastics are pretty demanding lifestyle jobs

Only if you do major reconstructive procedures.....here our plastics docs only come in after hours if the patient has DAMN good insurance, has a credit card with a high limit or has a suitcase full of cash with them. It's tough to get them to come in during regular business hours for someone with Medicaid or *gasp* no insurance.

There is a reason why what my plastics friends up in Indy consider "simple" (relatively speaking) cases get sent to them from our facility. The docs here won't see them, so the patient gets an ambulance ride to the trauma center in Indy.

 

[NonTradMed]

Only if you do major reconstructive procedures.....here our plastics docs only come in after hours if the patient has DAMN good insurance, has a credit card with a high limit or has a suitcase full of cash with them. It's tough to get them to come in during regular business hours for someone with Medicaid or *gasp* no insurance.

There is a reason why what my plastics friends up in Indy consider "simple" (relatively speaking) cases get sent to them from our facility. The docs here won't see them, so the patient gets an ambulance ride to the trauma center in Indy.

But I thought most plastic surgeons work on reconstructive surgeries....and I thought surgery lifestyles in general were pretty rough (am I wrong on this?). I know that plastics can do a cosmetic/cash-only business, but my understanding is that this is not common and you have to really have good business and technical skills to establish a cash-only business.

 

[StringerBell]

Thanks for the honest opinions and information. From the following:

You said it yourself--good residency and post-residency lifestyle with a pretty good reimbursement

I'd take a 9-5 job where i can make $250K a year.

These opinions seem to align with my impression of dermatology. I'm not saying that everyone should have altruistic reasons for pursuing medicine, but it seems that the "cushy job with great pay" aspect does indeed play a factor, and may reinforce the age-old notion of some doctors going into the field for the money.

Am I the only one who finds derm interesting for reasons other than money and the lack of overtime?

I would sincerely hope that there are those out there who find derm attractive for reasons other than money/schedule. What are your personal reasons for finding derm interesting?

The social aspect of some derm diseases is so severe that people have committed suicide. Being able to treat the disease and prevent the unnecessary suicide/depression would be pretty cool.

I guess this does happen, but it seems to fall under the category so often found on SDN of "anecdotal evidence." As such, I would imagine this to be more the exception than the rule, and is kind of a long leap to identifying oneself as a life-saver due to curing a dermalogical disease and the accompanying social stigma.

Again, I'm not criticizing dermatologists, as I have a very good one who has helped me with some of my own skin problems. But I do appreciate frank discussion about why it's such a coveted residency. Thank you all for your input.

 

[DropkickMurphy]

It's not a cash only business....they just do a medical version of what paleontologists call "high grading a site"- meaning you only take the most interesting or valuable specimens and leave the rest to erode away or be picked up by someone else.

If you have insurance that would make it worth their while to deal with you, then you get seen; if not.....you either go elsewhere or you deal with a general surgeon.

But yes, you are right....surgical lifestyles aren't that great normally.

 

[DropkickMurphy]

What are your personal reasons for finding derm interesting?

I just find cutaneous manifestations of systemic diseases interesting....especially toxidromes and autoimmune disorders.

 

[zbruinz]

a lot of people going into medicine wants money?

 

[DropkickMurphy]

a lot of people going into medicine wants money?

Duh?

 

[Law2Doc]

money is the greatest motivator in life.

period

Spoken like someone who never worked.

There are plenty of folks on the nontrad board who gave up big money to go into medicine for a loss. Once you get to the point where you are earning good money, you will see that it simply isn't the most important motivator. Not even close. You have to enjoy what you do, first and foremost (and if you don't, you have to do it as few hours a day as possible - unfortunately no professional job adequately meets this criteria). If you aren't excited to get up each morning, no amount of $ in your paycheck will make it worth slogging 50-80 hrs/wk (i.e. your entire waking life) in the salt mines. This is a hard point to convey to folks without substantial work experience, but we are talking about most of the hours in the day that you are awake, for the rest of your life. What good is a big house if you just crash there for 6 hours a night and a nice car that you just use for the morning commute 10 mins each day?

Most people who go into derm had lots of other options, but chose derm. Some did it for the relatively cushy lifestyle, but hopefully they enjoyed it too, because the 45-50 hours/wk that most dermatologists work, while light for medicine, is not zero, and still accounts for most of their remaining awake life. For the same reason, you will see many of the top students at various med schools not choosing derm, and often choosing things like IM or surgery (not even the most competitive or lifestyle friendly options they could get), simply because they were more interested in or enjoyed those areas more. You pick what you like. The salary is secondary, a nice perq if it goes along with what you like to do.

 

[smq123]

4) I know that people dismiss derm as just "cosmetic/pimple poppers," but, people DO judge you on your appearance. Ask any young adult with severe, pitting, scarring acne if it has affected his/her self-esteem, and I'm sure that they would say that it has. People with severe psoriasis have so much trouble going out in public (because they attract a lot of staring), and might even have trouble holding down certain jobs. For example, if you're a salesman with terrible psorasis on your hands, who is going to want to shake hands with you? Or even want to stand near you - the average person would look at a psoriatic lesion and wonder if it's contagious.

The social aspect of some derm diseases is so severe that people have committed suicide. Being able to treat the disease and prevent the unnecessary suicide/depression would be pretty cool.

I guess this does happen, but it seems to fall under the category so often found on SDN of "anecdotal evidence." As such, I would imagine this to be more the exception than the rule, and is kind of a long leap to identifying oneself as a life-saver due to curing a dermalogical disease and the accompanying social stigma.

I don't think that many dermatologists are so self-deluded as to call themselves "life-savers" because they manage to treat someone's psoriasis. But the general point is that dermatologists DO treat medically important conditions, not just pimples.

Actually, the suicide risk in certain dermatological disorders, especially psoriasis, is pretty well documented:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8444530&dopt=Abstract

Of course - not all derms are in it for altruistic purposes. But you'll find that a lot of your med school classmates aren't in medicine for altruistic reasons either. A lot of them are here because it's a good, decent paying job (even an FP will probably make more than your average corporate drone) with great job placement and stability. You'll always be in demand somewhere, which you can't always say about professors. It's probably a varied mix, but I don't think it's fair to say that most, if not all, derms are driven by a desire for a cushy job and a big paycheck.

 

[QuakerPreMed]

I'm deluded enough to think that if I match into Plastics, I'll wake up one day and look like Mark Sloan.

Seriously though, people should go into pediatric derm. Massive shortage of that specialization and important work w/ all kinds of strange disorders. Not my cup of tea, but I understand it's a good thing.

 

[gujuDoc]

I think that while derm probably does have a lot of fascinating cases and types of diseases, the fact of the matter is that all fields do no matter what you go into. Fact is that Derm has better hours, better pay rates/hour when you do the math, and they aren't as demanding in residency either when compared to surgical residencies or other high paying fields. A lot of people, especially women, seem to be attracted to derm because of the aforementioned reasons. We are living in a day and age when it many (not all) but many people are not willing to settle for specialities that have high demands for time. People want time to spend with their families, to enjoy other fun activities, etc.

So yes, fields like Derm, Rads, Rad Onco, Plastic Surgery, etc. which are both high paying and have better lifestyles (Plastics depends on whether you are doing reconstructive or cosmetic) tend to win out in the end. I don't think its so much as just the high earning potential so much as the lifestyle factor that goes in there though.

There is also probably a lot less hassle in malpractice related matters with derm then something like say OB/GYN, surgical fields, and so forth.

 

[Law2Doc]

Seriously though, people should go into pediatric derm. Massive shortage of that specialization and important work w/ all kinds of strange disorders.

Shortages in derm are self imposed, as indicated above. There are an intentionally very finite number of residency slots, which limits the numbers of people who can get into the field.

 

[ny skindoc]

Shortages in derm are self imposed, as indicated above. There are an intentionally very finite number of residency slots, which limits the numbers of people who can get into the field.

In the last few years due to the recognized shortage of dermatologists in some parts of the country (not a problem in NY or San Francisco) an effort to increase the number of training slots has been attempted. You cant just open a residency program or add slots without funding for the residents and this is difficult to obtain from the feds. Some controversial efforts to get drug companies to fund residencies is under discussion.

 

[Llenroc]

Pardon my naivete, but it seems well-accepted that Derm is the most competitive/coveted residency. My question is...WHY?

This is why:

I understand that it will be lucrative and that the residency will likely not have some of the ungodly hours of other residencies.

But how many of you really want to do Derm for any reason other than those? I guess I'm not understanding why Derm is so competitive.

You're probably still in that idealistic phase, where you think putting on a pair of scrubs and going in to do a surgery at 2 am is a fun thing to do. That will likely be gone a few months into your third year, when all you want is an easy job and easy life.

While we're all (for the most part) going to make fine physicians, I truly wonder if the best-and-brightest of us should be in derm, or in more pressing fields like Cardiology or EM.

What's so pressing about EM? Arguably Dermatology is more pressing, because they cleverly limit the number of residency positions to prop up their own salary. Average wait to see a dermatologist is like 6 months. Isn't that pressing? Cardiology is a ****ty job, that will likely involve being on call every 4th night for the rest of your life. Who wants to deal with that?

I realize that I will probably get some angry responses from some people who really want to go into Derm. And I do recall the Seinfeld episode in which Jerry refers to a Dermatologist as "Pimple-Popper, M.D." only to be reminded of the significance of skin cancer. But am I missing something here, or do the majority of people who want to match into Derm doing so for superficial reasons?

What's so superficial about wanting a good paying job with reasonable hours? It's going to be a long painful fall for you when you start your third year and see some of the realities of medical practice.

 

[DoctorMom78]

I just find cutaneous manifestations of systemic diseases interesting....especially toxidromes and autoimmune disorders.

Autoimmune disorders are really fascinating, but rheumatology is better if you are interested in that. If only I could do FM and OB and neurology and rheumatology.

 

[ryandote]

you should have gone into business

Classic. Just classic. What percentage of "business"-men actually make 250k working 9-5 ? In fact, what percentage make 150k working from 9 - 5 ?



(wait for it.....WAIT FOR IT...) Investment Bankers!

 

[etf]

Am I the only one who finds derm interesting for reasons other than money and the lack of overtime?

yes.

 

[DropkickMurphy]

Autoimmune disorders are really fascinating, but rheumatology is better if you are interested in that. If only I could do FM and OB and neurology and rheumatology.

Yeah....but rheumatology doesn't pay that great!

 

[etf]

Classic. Just classic. What percentage of "business"-men actually make 250k working 9-5 ? In fact, what percentage make 150k working from 9 - 5 ?



(wait for it.....WAIT FOR IT...) Investment Bankers!

bankers usually work about the same hours as surgeons. until you work your way up, that is.

 

[ryandote]

bankers usually work about the same hours as surgeons. until you work your way up, that is.

Wall Street investment bankers may even work more in the first few years than a surgical resident. Wall Street doesn't have those silly rules that limit hours.

 

[braluk]

bankers usually work about the same hours as surgeons. until you work your way up, that is.

And also, there seems to be a common misconception that all fresh ibankers will earn 6 figures easily. Some make very modest incomes because they couldn't put in the ungodly hours and cut it. It seems to be a very cutthroat/exhausting career to get into, and requires an incredible amount of workhours to put considered for promotion + bonus, not to mention a large part of it is dependent on who you know and your networks. Granted when they work their way up theyll see a larger salary, but that doesn't mean its a 9-5 job by any means. I think the suggestion to go into ibanking if you're in it for the money or as a "cop-out" if you're not dedicated to the hours is not necessarily the most accurate assessment of the field (not directed to anyone here- just to premeds in general that ive met personally that sometimes refer to ibanking as somehting you should go into if you complain about money and hours working as a doctor).

 

[Biscuit799]

If you look, you'll see the "competitive-ness" of a specialty correlates nicely with a combination of money and time off. I'm sure there's some smart math people out there that could come up with a formula that would nicely illustrate the amount of money, combined with time off, which would spit out exactly how competitive the specialty it.

As an aside: I believe it isn't bc students today are "lazy" so much as we just don't want to be treated like crap. It's not so much that we want specialties that don't work that much and are reimbursed so, so much as we want specialties that DON'T work 100hrs/wk and pay $95K/yr. If gen surg or IM started working 40 hrs/wk and paying 400K/yr, it's competitiveness would skyrocket.

 

[Law2Doc]

Classic. Just classic. What percentage of "business"-men actually make 250k working 9-5 ? In fact, what percentage make 150k working from 9 - 5 ?



(wait for it.....WAIT FOR IT...) Investment Bankers!

If you look at percentages you get the answer you suggest, but that is an apples and oranges comparison. If you look at raw numbers, there are many more business men earning more than physicians. But there are many more business men out there, so by percentage, it is not very good. A fairly modest percentage of the world's business men outnumber the number of physicians. Folks with the brainpower to get into medicine likely (but not certainly) could probably be in the portion of individuals who do well in business, as they have the necessary combination of smarts and enduring drive. And there are many more well paying jobs in business besides I Banking -- that one just gets thrown around most because they are notorious for paying impressive sums to fairly young rookies. But that is only a small slice of the six digit income business pie.
Neither group really works 9-5, so that shouldn't be part of the analysis (even dermatologists average more than 40 hrs/wk).