Why Derm?

[Law2Doc]

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.

Many older docs have openly expressed distaste for the attitudes of the most recent generation of physicians, and in numerous articles/interviews, have called it an "air of entitlement". In addition to the scaled back residency hour maximums, you are seeing significant increase in interest in even some of the less competitive of the lifestyle fields, a fall off of interest in some of the more hour intensive things, and increased demand for part-time options. And salary expectations are reportedly not jibing well with reality in some regions - people are still coming out of residency expecting some of the salaries of years past. Acording to some news reports, this has actually worked as a boon for nontrads, who come into their employment years with more realistic (or at least pessimistic) expectations.

It will be curious to see how people adjust to the ever increasing hourly demands coupled with decreasing reimbursement amounts likely on the horizon. Everybody going into this field should have their eyes open -- the medical world is changing rapidly and what you see now may not stay the same for long.

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[Pop]

I don't understand why more residency slots can't be opened. I think it is the demotologists to blame for a shortage of professionals in their field.

1. If there isn't federal funding for residency placement, then start a derm residency and pay the residents 0$.

2. People who really want the better lifestyle and higher paycheck and sacrifice income during their residency years.

3. This will increase the # of dermatologists, reducing the riduculous wait times to get an appointment, and reducing the rising cost of health care.

WHY doesn't this happen?!? My guess is that dermatologists and their professional organizations try to prevent additional competition so they can run up the bill.

Seriously WHY?

 

[etf]

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.

yeah, but as a surgical resident you'll be lucky if you get comped meals in the hospital cafeteria; meanwhile bankers at least get to eat nice - my brother is getting reimbursed $30 per meal, and he's just an intern. how the f do you spend $30 on breakfast?

 

[Law2Doc]

I don't understand why more residency slots can't be opened. I think it is the demotologists to blame for a shortage of professionals in their field.

1. If there isn't federal funding for residency placement, then start a derm residency and pay the residents 0$.

The dermatologists absolutely have intentionally limited the spots in their field. It is not an accident. The powers that be are not unhappy with the status quo, and so there is no movement to change it.

As for your first suggestion, not too many people are willing to work for $0, but even if they were, it is a very dangerous precedent to set, and opens the flood gates to a variety of litigation, liability and employment issues. And no funding means not only no salary for the resident, but no money to cover his medmal for the hospital, health insurance, safety costs, etc. It is not free to the hospital, although the resident certainly may earn his/her keep.

This is simply not something anybody wants, and would lead to lesser qualified doctors with family money circumventing the match. And would make it difficult for regulation of the specialties if other than a single regulating body could decide what programs got additional residents. You would end up with gluts of physicians in specialties, and not enough in the more necessary, funded primary care slots.

 

[Law2Doc]

how the f do you spend $30 on breakfast?

If you've been to some of the restaurants near Wall Street, it's not very hard to spend more than that.

 

[psipsina]

After getting a little taste of what an 80+ hr workweek might feel like as an MS1 I have a much greater understanding of why someone might pick a field thats a tad less intellectually exciting but offers the chance to enjoy some of the money you are making. I have begun to question a few paths that looked great as a premed and now look like setting myself up for misery. I'm not personally taking money into account when looking at residencies but I can also see how after puting a quarter of a mill out there for the education and working this hard some might expect to be more than just comfortable in the end. If there are a whole lotta other medstudents feeling this way, you can see why the fields that offer the best money with the best lifestyle become the competitive ones.

 

[psipsina]

If you've been to some of the restaurants near Wall Street, it's not very hard to spend more than that.

Lol, you don't even have to go to Wall St, my hubby worked at a restaraunt with 40$ omlettes in NOLA.

 

[Law2Doc]

If there are a whole lotta other medstudents feeling this way, you can see why the fields that offer the best money with the best lifestyle become the competitive ones.

And yet this is a relatively recent trend, probably a generational thing. Students a few years back flocked to the more challenging programs for not a whole lot better money, notwithstanding the many years of 100 hour/wk residency they had to get through. Lately, some of the less hour intense fields have been brought back from the near dead because the lifestyle is better. (And this is even after residency hours have been capped). It will be curious to see if this is just a cyclical thing.

 

[MJB]

you should have gone into business

Please elaborate. I'm eager to hear this...


As for primary care, I have an interest in it because of the long term relationships it allows you to have...but I'm not sure what i want to do. Derm is interesting...for many reasons other than money and hours...some of the stuff they do is amazing.

 

[braluk]

As a whole I think most things move in cycles- but I think if med schools are "supposed" to increase enrollment by 30% (or at least suggested by AAMC) I would imagine that residencies would open up more spots. With the increase in saturation I wouldn't imagine 100+ hours to be necessary given that responsibilities are then expanded over the new increase in med students- I believe that those ungodly hours were during years in which we saw a huge increase in physician need after a large stock of physicians entered retirement? Id be curious to see if these hours will hold or will even shrink if the physician numbers begin to repopulate. Itd also be interesting to see how things will be in 40-50 years- would we have too many physicians so that the government has to cap admissions yet again (i.e. cycle)

 

[MJB]

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).

I'd agree if it weren't for all the poor saps I've seen that are smacked into middle management. You couldn't pay me enough to stay in corporate world.

 

[Law2Doc]

As a whole I think most things move in cycles- but I think if med schools are "supposed" to increase enrollment by 30% (or at least suggested by AAMC) I would imagine that residencies would open up more spots. With the increase in saturation I wouldn't imagine 100+ hours to be necessary given that responsibilities are then expanded over the new increase in med students- I believe that those ungodly hours were during years in which we saw a huge increase in physician need, Id be curious to see if these hours will hold or will even shrink if the physician numbers begin to repopulate. Itd also be interesting to see how things will be in 40-50 years- would we have too many physicians so that the government has to cap admissions yet again (i.e. cycle)

If residency spots are not increased for a while (and my guess is they won't match the increase in students), the increase may just prove to be a move to tighten the screws on the offshore educated crowd -- there have been a lot of buzzwords about US schools filling US needs coming from a lot of the professional organizations over the last couple of years, and this is a good way to close the gates. A bit of a conspiracy theory, I know, but not of my own origination and it seems plausible.

As for an increase in saturation -- it won't happen for many years, because as the aging baby boomers reach the years of most significant medical need, the need for physician hours will increase pretty significantly. (It already has in the states catering to the most retirees.) At the same time, a lot of the current crop of physicians seem to be expressing interest in part-time options, which will also serve to limit the number of physician man hours out there. 40-50 years from now, who knows?

 

[Law2Doc]

You couldn't pay me enough to stay in corporate world.

Yes, but that's a different question entirely. Whether it is a good work/career environment to be in or not doesn't mean that plenty of people aren't being paid nicely there.

 

[braluk]

Guess we gotta come back and post here in a 4-5 decades when we figure out how things have changed

 

[Pinkertinkle]

Many older docs have openly expressed distaste for the attitudes of the most recent generation of physicians, and in numerous articles/interviews, have called it an "air of entitlement". In addition to the scaled back residency hour maximums, you are seeing significant increase in interest in even some of the less competitive of the lifestyle fields, a fall off of interest in some of the more hour intensive things, and increased demand for part-time options. And salary expectations are reportedly not jibing well with reality in some regions - people are still coming out of residency expecting some of the salaries of years past. Acording to some news reports, this has actually worked as a boon for nontrads, who come into their employment years with more realistic (or at least pessimistic) expectations.

It will be curious to see how people adjust to the ever increasing hourly demands coupled with decreasing reimbursement amounts likely on the horizon. Everybody going into this field should have their eyes open -- the medical world is changing rapidly and what you see now may not stay the same for long.

You almost sound like you've actually practiced medicine.

 

[Law2Doc]

Guess we gotta come back and post here in a 4-5 decades when we figure out how things have changed

If the cyborgs let us keep SDN going under their rule.

 

[Law2Doc]

You almost sound like you've actually practiced medicine.

No but as a prior professional, I've worked with lots of older docs and had the opportunity to pick their brains extensively before (and while) going down this road. I also got to talk to some folks I wouldn't have if I was just approaching it from the premed shadowing angle. I know I got a bit of a different perspective than many.

 

[Long Dong]

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.

I agree with this guy, to lazy to put my thoughts right now but to me derm is the greatest field in the universe.

 

[MJB]

Yes, but that's a different question entirely. Whether it is a good work/career environment to be in or not doesn't mean that plenty of people aren't being paid nicely there.

And there are way, way, way more folks making a decent salary, but not being near 6 figures.

To say a person should go into "business" if they want to make 250K might be the funniest thing I've read on here in a while.

 

[Law2Doc]

And there are way, way, way more folks making a decent salary, but not being near 6 figures.

To say a person should go into "business" if they want to make 250K might be the funniest thing I've read on here in a while.

I didn't say that, although I stand by the fact that in pure number (not by percent), there are more people earning more money in business than in medicine. The average of many physician specialties is well below $250k so it's certainly not the ideal path for that kind of income.

 

[MJB]

I didn't say that, although I stand by the fact that in pure number (not by percent), there are more people earning more money in business than in medicine. The average of many physician specialties is well below $250k so it's certainly not the ideal path for that kind of income.

I know you didn't say it..

I will stand by the belief that if you want a path directly to 6 figures, "going into business" is not your best bet.


As for your statement about "average" salaries of many physicians. What do you figure the "average" salary is in corporate America?

 

[45408]

Many older docs have openly expressed distaste for the attitudes of the most recent generation of physicians, and in numerous articles/interviews, have called it an "air of entitlement". In addition to the scaled back residency hour maximums, you are seeing significant increase in interest in even some of the less competitive of the lifestyle fields, a fall off of interest in some of the more hour intensive things, and increased demand for part-time options.

Some/many of those older docs just say that because they're forgetting what medicine was like 40 years ago compared to now. Here's how PBMD put it:

My biggest criticism of residency training is that it was devised for a more lesiurely era when the pace of hospitals was a good deal slower than it is today. As I have mentioned before, there were fewer interventions, far fewer medications, and much less to be done for most patients except to observe and hope that the limited supportive care available at the time would give the patient a chance to heal. One of my attendings, for example, related to me that when he was a young resident at our hospital, there were exactly three ventilators in the entire city. One of the jobs of the medical students was to “bag” the patients until one of the ventilators could be secured, often for hours at a time.

Today, the same hospital has close to eighty fully staffed Intensive Care Beds. And they are all occupied, usually by the kind of patient who could not have existed even fifty years ago when people routinely died of things we can treat today and could never have survived to become the kind of multiply co-morbid train wrecks which are now routine. Not to mention the hundreds of regular beds that are full of people who would have been considered insanely complicated patients by our collegues from the 1950s.

This is a good thing for the most part. It is true that we tend to get a little crazy with end-of-life care, often spending hundreds of thousands of dollars to preserve the anatomical functioning of people who maybe should be allowed to die peacefully, but I’m glad that I may have the chance some day to live beyond something that would have killed me if I had been born in the nineteenth century. The result of this is, however, that the hospital has been transformed from a sleepy hotel for the sick and a minor part of the urban landscape into a bustling hive of activity, almost a small city in its own right, and often the biggest employer and largest source of economic activity for many municipalities.