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Why is Derm competitive?

Discussion in 'Clinical Rotations' started by Mikado, May 1, 2001.

  1. Mikado

    Mikado Senior Member
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    Why is it so hard to get into Derm? Apart from money what could possibly motivate anyone to practice dermetology? Who would want so bad to build a career treating pimples and wrinkles?

    Don't get me wrong I'm not knocking dermetologists. I just don't understand why this field is so damn desirable to so many. Before I learned how competitive it is I would have guesed that it would be a highly unpopular choice. If there is something I'm missing please enlighten me.
     
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  3. acaban

    acaban Senior Member
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    Hi Mikado, I understand that of all the specialties there exists in medicine, derm is one of those 9-5pm jobs that really dont require a pager or have huge emergencies. At the same time, there is a trend for many cosmetic skin problems to be fixed so medical students are heading in that direction. But your question is really good and I am interested in learning from people that are Matching now. AJC
     
  4. Amadeus

    Amadeus Member
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    Actually to make the good money as a dermatologist you've got to work more than
    9-5. Most successful dermatologist that I know have weekend and evening hours.
     
  5. lilycat

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    From what I understand (and this is all second-hand knowledge), derm is popular essentially because of the lifestyle it allows one to lead -- the money:hours ratio is quite good compared to other specialties; there is minimal or no call, etc.

    I work in peds nephrology, and when all the nurses and docs around me need an example of a "cushy" specialty, they always use derm.
     
  6. Pathologist

    Pathologist Senior Member
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    Well, for one thing there basically isn't an on call situation.
     
  7. Winged Scapula

    Winged Scapula Cougariffic!
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    And lets not forget that besides the lifestyle issues of less call, less hours, less trauma, death, etc. the pay is pretty darn incredible. So not only do you get to have a life, you can enjoy it as well (as much as money brings happiness or toys to play with).
     
  8. puffy1

    puffy1 Senior Member
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    I'd love to be a Pimple Popper, MD.
     
  9. Medigirl

    Medigirl Member
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    My family has two dermatologists in it. Here's why they chose it:

    1. hours are great
    2. no call (seriously)
    3. your patients do not tend to die on you
    4. lots of procedures now are "fee for service" (not covered by insurance). These include all the lazer wrinkle removals, chemical peels, etc.
    5. money
     
  10. omores

    omores sleep deprived
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    I'm very interested in Derm myself (although it's way too early in the game for me to be committed to it), but I really dislike the (often entirely justified) notion of derms as being interested only in perfecting the skin of those who can afford their non-insurance-covered services.

    There certainly are many dermatologists who make the bulk of their money by doing chemical peels, laser resurfacing, or even developing and selling their own skin care lines. There are also derms who rebel against this. My aunt, for example, is a hospital-based dermatologist who refuses to do any cosmetic procedures. She's also the only derm for hundreds of miles around who takes Medicaid. As a result, she sees many interesting and rare cases -- far less of the pimples-and-wrinkles variety than some of the others in the field.


    She works long hours, but only five days a week, and yes, she has scads of money.
     
  11. lilycat

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    Are there dermatologists who primarily work with burn patients? I always thought that would be a very interesting way to go with derm...
     
  12. Amadeus

    Amadeus Member
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    Other fields that are also relatively benign:

    1. Radiology - pros: good hrs and pay, no running around from ward to ward, you stay seated

    cons: general diagnostic: sitting in a dark room and dictating image after image after image; interventional: inability to have your own pt pool, the hospital basically forks over the pts to you, cardiologists will probably take over most of the vascular procedures since they have their own pt base

    2. Anesthesiology: pros: hrs and pay are good and you are not on your feet as often as other specialties, once the pt is under you just keep a watchful eye for most uncomplicated pts. I do think crnas are of little threat to the field. Can have your own pt base if one is involved in pain clinic

    Cons: you're one of the first to be called if the pt goes down the tubes so you'll be sweating bullets

    3. Ophthalmology:
    Pros: good hrs and pay, no running around in the wards, you do procedures, call is light but not as light as derm

    Cons: you're dealing with a very sensitive organ so must have a light and precise touch, like a radiologist your life is often spent in the dark
     
  13. Winged Scapula

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    I'm not sure what their role would be with Burn patients as the managment is primarily surgical and PT - at least that's what we did on my Burn Trauma elective. Never saw it suggested that a patient see a Dermatologist unless it was for another condition, although I suppose for a slightly raised scar some laser resurfacing might be in order, although we referred to plastic surgeons for that.

    Any ideas on what I'm missing you Derm types?

    :confused:
     
  14. livquiv

    livquiv Member
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    What is there to know?
    If it's wet...dry it.
    If it's dry...wet it.
    If it's ugly...cover it up.
    If you don't know what it is...put glucocorticoids on it.
     
  15. GeoLeoX

    GeoLeoX Ancient
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    For the MD/PhD or research-bent, there are lots of research possibilities in derm. Given the relatively benign clinical duties (I said, relatively) one can also have time for laboratory work.

    Geo
     
  16. Pathologist

    Pathologist Senior Member
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    I don't think so. It's primarily surgeons (plastic, to be specific) who do burn care.
     
  17. Winged Scapula

    Winged Scapula Cougariffic!
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    yeah...that's what I thought (see my post above). Burn surgeons are either Plastic or Trauma surgeons in my experience and the management of burn patients is surgical and PT.
     
  18. drusso

    Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    It's mostly lifestyle. As others have mentioned, other lifestyle fields include: Radiology, Anesthesia, and Ophtho. Another lifestyle field that med students are getting wise to is PM&R. The earning potential isn't as great as those above, but can be with training in the right procedures--flouro guided joint injections, IDET, etc. The down side to PM&R is that its not widely recognized and most of the patients are chronic dumps from other services (spinal cord injuries, failed back surgeries, etc.)
     
  19. Colorado_2

    Colorado_2 Member
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    Drusso,

    Is PM&R the same as Pain Management?
     
  20. Chucky Painkomo

    Chucky Painkomo Junior Member
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    PM&R: Physical Medicine and Rehabilitation

    So the "PM" doesn't stand for "Pain management." However, to answer your question, this residency does have fellowship positions in pain management. Looks like an interesting profession. I might take a good look at it since I'm a future D.O. and OMM is used often in PM&R.
     
  21. Floyd77803

    Floyd77803 Member
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    frankly, I think derm is a joke. I want to be a doctor to make a difference, to really touch somebody's life, and I don't mean by popping their pimples. It's almost like there are critical fields that deal with life and death (ie. surgery, IM, EM, etc.)and then there are the fields that tend to make life better (ie. derm, plastic surgery) Well I want to have to knowledge not to pop a zit, but to crack a chest and a save a life. That's what medicine is to me.
     
  22. PimplePopperMD

    PimplePopperMD Senior Member
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    There can only be one, my friend.
     
  23. Winged Scapula

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    While you are certainly entitled to your opinion about what medicine entails and what is right for you, you may wish to reconsider your stance on Plastic Surgery (I shall leave the defense of Derm to my Derm colleagues).

    It is true that a certain segment of the practicing Plastic Surgeons do focus on treatments and procedures that "make life better" (Aesthetic Plastic Surgeons), there are many who are involved in saving lives (without cracking chests).

    Witness the plastic surgeon who removes the eschar from a burn patient and covers the extensive areas of burn with grafts - without such procedures the patient would die.

    Witness the plastic surgeon who remodels the craniosynostotic skull of the newborn; without such a procedure the infant would perhaps not survive for long, and certainly not without considerable cognitive and motor deficits.

    Witness the plastic surgeon who reimplants digits torn off in a grisly accident; an injury which would normally render the hand useless, a devastating disability.

    Witness the plastic surgeon and dermatologists who remove cancerous and pre-cancerous lesions from the skin, H & Ns of their patients. Have you see a patient die from untreated melanoma? I have and its not pretty. I've also seen patients die with metastatic melanoma, after removal of primary lesions - without intervention frm their plastic surgeon their life span would have been considerably shorter.

    I've seen plastic surgeons remove foreign bodies embedded in the oral and orbital cavities, wrapped around the facial nerve and other treacherous places. FB, which left in situ, would have posed a threat to the structures nearby as well as being a focus for on-going infection. Yes, the patient's life was likely made better in all of these cases, but at the risk of blindness, paralysis or a potential H&N infection had the FB been left.

    There are numerous other cases in which Plastic Surgeons are known to do more than simply make peoples's lives better. It is true that the rate of death in Plastic Surgery is less than that in other surgical specialties (unless you choose a Burn fellowship) and that many are attracted to it because of that. But please don't discount the importance of making lives better - whether its through lipoplasty, facial muscle plication, breast reconstruction after mastectomy, prevention of skin cancer or reconstruction of congential malformations. It should not be suprising to you that people who are happy with their lives and their appearance live longer than those who are not - thus, the importance of a field which caters to this - both for aesthetic and reconstruction purposes.
     
  24. acaban

    acaban Senior Member
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    You Rock Kimberli Cox, Good Answer! AJC :D
     
  25. windex

    windex Junior Member
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    Here, here Kimberli! I totally agree with what you said and I thank you for writing my thoughts so eloquently.
     
  26. droliver

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    I concur with Kimberli's post. My father, a practicing plastic surgeon, this week did 6 hand cases, 6 melanomas, a radical neck disection for squamous cell CA, a reduction ammoplasty, and a TRAM flap breast resconstruction. It's not all about T&A, although a growing # of plastic surgeons have gone to more exclusively cosmetic surgery due to the paucity & headaches of insurance reimbursement
     
  27. Doggy

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    Last I checked, a doctor's job is NOT ONLY to preserve life but to IMPROVE THE QUALITY OF LIFE. So think about that when you see that not all doctors crack open a chest, perform brain surgery, or reattach a limb. Just because a doctor doesn't take a knife to someone and save his life on the operating table does not make him any less of a doctor (or any more of a joke, to use your eloquent expression).
     
  28. shosh

    shosh Junior Member
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    Another lifestyle field that med students are getting wise to is PM&R. The earning potential isn't as great as those above, but can be with training in the right procedures--flouro guided joint injections, IDET, etc.

    What are these procedures? Do PM&R MDs learn to heal w/their hands?
     
  29. Lubdub

    Lubdub Junior Member
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    I can't believe the nerve some people have, to post a message and say that a medical profession (e.g. Dermatology) is a joke. We don't need doctors who are going to look down at their collegues! And for your information Dermatology is not pimple popping, it is a medical field which involves:
    skin biopsies
    EDC (electrodesiccation and curettage)
    Treatment of skin cancers,
    and other skin problems (psoriasis dermatomycosis, eczema)
    MOHS surgery (micrographic surgery to remove skin cancers)
    etc etc

    But yes there are also some cosmetic procedures:
    Skin resurfacing
    hair removal
    chemical peels
    botox and collagen injections
    blepharoplasties (removal of excess fat of the eyelids)
    hair transplants

    So remember, there are no "joke" professions, only joke premeds like you who watch too many episodes of ER and don't even have a clue of what medicine really is.

    I'd like to see you land a "joke" derms residency!

    ~Lubdub
     

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