Why is derm so competitive?

[deleted862527]

I talked to my Dermatologist, and he recalled even 20 years ago when he applied for his residency they only accepted 4 candidates. Wtf for? Why four?

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[el_duderino]

Lots of money, great hours, interesting work, plus the prestige of knowing that people in medicine know how competitive it is. It's also one of the few residencies left where it's reasonable to own your own private practice.

 

[Welshman]

I talked to my Dermatologist, and he recalled even 20 years ago when he applied for his residency they only accepted 4 candidates. Wtf for? Why four?

Probably because there were only 4 spots...

But really, there are only 423 derm spots nationwide each year.... Thats gunna create some competition

 

[radiculating spines]

The answer is green and rhymes with funny.

 

[AnatomyGrey12]

It is the epitome of money and lifestyle.

 

[mariposas905]

Does med school ranking matter when it comes to derm?

 

[begoood95]

I'm not 100% sure about this, but didn't whatever body that is in charge of creating residency spots for dermatology also artificially keep the number of available spots low? Chiming our resident medical historian @gonnif, who might know a thing or two about this

 

[frosted2]

The answer is green and rhymes with funny.

I chuckled.

 

[HomeSkool]

The answer is green and rhymes with funny.

I don't get it...

 

[efle]

View attachment 228255
I don't get it...

wrong kind, the derms want

 

[bananafish94]

I gue$$ there'$ no way of knowing.

 

[frosted2]

 

[AnatomyGrey12]

Does med school ranking matter when it comes to derm?

Yes.

 

[Anti-PD1]

Huge opportunities in cosmetics. Never underestimate suburban moms.

 

[DrRiker]

Lots of money, great hours, interesting work, plus the prestige of knowing that people in medicine know how competitive it is. It's also one of the few residencies left where it's reasonable to own your own private practice.

Honest question, what aspects of derm are interesting? Is it differentiating between 5 different conditions that look remarkably similar, and having to understand the minutiae of each? From my naive perspective, derm seems like it would be somewhat drab intellectually, when compared to IM and its subspecialties or rads/path.

 

[AnatomyGrey12]

Honest question, what aspects of derm are interesting? Is it differentiating between 5 different conditions that look remarkably similar, and having to understand the minutiae of each? From my naive perspective, derm seems like it would be somewhat drab intellectually, when compared to IM and its subspecialties or rads/path.

Derm as a field is actually pretty academic and requires a ton of reading during residency.

 

[begoood95]

Derm as a field is actually pretty academic and requires a ton of reading during residency.

Right, but I don't think that really answers the question: what makes derm interesting, if anything? They mentioned that it doesn't seem like there's much to it compared to other residencies. Is that true? In other words, are other specialties (gas, ophtho, IM, and etc) more "interesting" and contain more "variation" in practice and diagnoses?

 

[jqueb29]

Honest question, what aspects of derm are interesting? Is it differentiating between 5 different conditions that look remarkably similar, and having to understand the minutiae of each? From my naive perspective, derm seems like it would be somewhat drab intellectually, when compared to IM and its subspecialties or rads/path.

The part where you can make $400k working 35 hours a week is pretty interesting. Seriously though, the complex diseases are very interesting, as are the Sherlock Holmes moments of diagnosing an internal disease based on dermatologic manifestations.

 

[AnatomyGrey12]

what makes derm interesting

500k and 40 hour work weeks is pretty interesting.... [="begoood95, post: 19646906, member: 819369"]They mentioned that it doesn't seem like there's much to it compared to other residencies. Is that true?[/QUOTE]

What? I don’t like the idea of derm myself but to assume that they don’t have to know an ish ton of stuff is disengenious.. it isn’t all plantar warts and teen acne..

 

[Ribonucleic Acid]

Which is more competitive, surgery or dermatology?


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[frosted2]

Huge opportunities in cosmetics. Never underestimate suburban moms.

Or their addiction to amphetamines.
And Xanax.
And hot yoga.
And Range Rovers.

Goodnight everyone!

 

[begoood95]

500k and 40 hour work weeks is pretty interesting....

What? I don’t like the idea of derm myself but to assume that they don’t have to know an ish ton of stuff is disengenious.. it isn’t all plantar warts and teen acne..

Yo I never said any of that; I just asked a question. I plead ignorance.

 

[efle]

Which is more competitive, surgery or dermatology?


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In terms of average scores, needing research to be competitive etc derm and the competitive surgeries (like plastics, ortho, neurosurg, ENT) are about the same. General surgery is a lot less competitive.

Very different personality types though.

 

[AnatomyGrey12]

Which is more competitive, surgery or dermatology?


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“Surgery” is too broad of a term. You’re going to have to specify. General surgery is a lot less competitive. ENT, plastics, or Urology are going to be just as competitive.

 

[Mad Jack]

$ome might $ay derm is overrated, but I think it is a decent field with good life$tyle and intellectual challenge compared to most other field$

 

[libertyyne]

Huge opportunities in cosmetics. Never underestimate suburban moms.

You don't have to be a dermatologist to do this. Many of the cosmetics folks in my area are FP doctors .

 

[libertyyne]

In terms of average scores, needing research to be competitive etc derm and the competitive surgeries (like plastics, ortho, neurosurg, ENT) are about the same. General surgery is a lot less competitive.

Very different personality types though.

Also people are forgetting the first two rules for applying to derm and plastics.
1. Be attractive.
2 . Don't be unattractive.

 

[Lucca]

Bringing back the SDN Classics

Lots of money (latin names, so you can bill for more)
Lots of money (people pay cash for acne and hair creams)
Lots of money (we live in a vain country and people are willing to pay)
Lots of money (botox is easy, you hire PAs to do it FOR you)

Hours are ballin (no emergencies, no call, no inpatient)

What you're getting at with the end of your question is the thing that plagues people who actually want to do good. The people with good hearts, with good souls want to touch the lives of patients. To really cure disease, mend the wounded, and cure the sick. Too many people enter medical school with good intentions but are then met with hours upon hours of misery, the world closing around them, their relationships lost, their souls beaten. The response? "Man, i did really well... and for what? I hate patients, I have no friends, I lost my hobbies, and now I'm in debt. Do I really want to do family medicine?" BOOM the dermatologist is born. The REASON they went into medical school is no longer the REASON they want to do derm. They want a life. They want money. They did well enough to get it, so why not?

 

[mariposas905]

500k and 40 hour work weeks is pretty interesting.... [="begoood95, post: 19646906, member: 819369"]They mentioned that it doesn't seem like there's much to it compared to other residencies. Is that true?

The part where you can make $400k working 35 hours a week is pretty interesting. Seriously though, the complex diseases are very interesting, as are the Sherlock Holmes moments of diagnosing an internal disease based on dermatologic manifestations.

Where are you getting this information? 😕 It says the average is around 320K, but how do you know dermatologists can work only 35-40 hrs a week and make so much? Do you mean they make this much after a certain number of years of experience?

 

[DBC03]

That sounds incredible actually. Mind sharing a couple of examples?

One example off the top of my head would be lupus - it can manifest as a particular type of rash. I’m sure there are others - possibly celiac disease, etc.


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[OneTwoThreeFour]

One example off the top of my head would be lupus - it can manifest as a particular type of rash. I’m sure there are others - possibly celiac disease, etc.


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Dermatitis herpetiformis for celiacs, weird nodules with funky names for endocarditis, rashes & keratoses for certain cancers, etc. There's other funky tox stuff like cutaneous anthrax. But I don't think many of these come through clinic. I've only ever seen IM or EM diagnose these diseases because inpatient derm is almost across the board unhelpful.

 

[Anti-PD1]

Every specialty requires tons of reading at home. Having to remove a 4th ventricle tumor, doing a cardiac ablation for arrhythmia, hell, just keeping up with ACOG guidelines.

 

[libertyyne]

Every specialty requires tons of reading at home. Having to remove a 4th ventricle tumor, doing a cardiac ablation for arrhythmia, hell, just keeping up with ACOG guidelines.

I agree except ACOG guidelines. They are the lamest of soft peddling guidlines only second to interventional cath guidelines.

 

[Anti-PD1]

I agree except ACOG guidelines. They are the lamest of soft peddling guidlines only second to interventional cath guidelines.

Lol I hate memorizing guidelines. I know, I know, EBM = religion, but I feel like a cog when it comes to ACOG.

 

[BadHorse]

Any field requires knowing a ton to be good, but derm does have a huge amount of memorization of subtle disease manifestations and requires an extraordinarily broad base knowledge to practice effectively.

As has been mentioned just looking at a patient and making a snap diagnosis of an obscure condition is pretty sexy, happens more for straight up dermatological conditions than medical diagnoses cause that's usually why you get seen by a derm, and pretty much nine times out of ten they're gonna do a punch biopsy to confirm the diagnosis. Surprised no one mentioned the surgical and procedural elements of derm. Mohs surgery is a precise and important procedure. They also work with lasers and do all sorts of excisions. It's like a combination of medicine, surgery and pathology (gotta be up on your dermatopathology), has a nice life-style with good pay and rarely need to take call, artificially limited number of residency spots to keep their specialty undersaturated. Not hard to see why it's desirable.

 

[SpartanDOnoharm]

That sounds incredible actually. Mind sharing a couple of examples?

Another one would be DRESS, drug rash/reaction with eosinophilia and systemic symptoms.

Edit: Thinking more about this after I posted it, I don't think it would be caught by a dermatologist as much as it would be an ER physician or internal medicine.

 

[BadHorse]

Another one would be DRESS, drug rash/reaction with eosinophilia and systemic symptoms.

Edit: Thinking more about this after I posted it, I don't think it would be caught by a dermatologist as much as it would be an ER physician or internal medicine.

Yeah there are tons of cool pathognomonic rashes for life threatening conditions but hopefully they get caught in the ED: Rocky Mountain Spotted Fever, the petechiae of neisseria meningitis, staph scalded skin syndrome, SJS/TEN, necrotizing fasciitis, secondary syphilis, lyme, phlegmasia cerulia dolens-- I've seen most of them in the emergency department, which, incidentally is a great field and very rewarding 🙂

 

[Deecee2DO]

Lupus, endocarditis, rheumatic fever, Still's, Lyme, dermatomyositis, etc. have pathognomonic (or at least quite specific) cutaneous manifestations but are all unlikely to be diagnosed by derm. Usually the rash is the least of these patients' worries.

On the more extreme end, SJS/TEN, GAS necrotizing fasciitis, meningococcemia (+/- Waterhouse-Friedrichsen), acute pancreatitis have obvious and classical skin findings but are more likely to be discovered on autopsy than in derm clinic.

This is all we need to know for Step 1 right? 🤣

 

[Anti-PD1]

This is prolly my favorite non-meme image. Numbers don't lie (unless you want them to). Derm's a cush non-surgery field in the top right.

Original article:
US Residency Competitiveness, Future Salary, and Burnout in Primary Care vs Specialty Fields

 

[OneTwoThreeFour]

Any field requires knowing a ton to be good, but derm does have a huge amount of memorization of subtle disease manifestations and requires an extraordinarily broad base knowledge to practice effectively.

As has been mentioned just looking at a patient and making a snap diagnosis of an obscure condition is pretty sexy, happens more for straight up dermatological conditions than medical diagnoses cause that's usually why you get seen by a derm, and pretty much nine times out of ten they're gonna do a punch biopsy to confirm the diagnosis. Surprised no one mentioned the surgical and procedural elements of derm. Mohs surgery is a precise and important procedure. They also work with lasers and do all sorts of excisions. It's like a combination of medicine, surgery and pathology (gotta be up on your dermatopathology), has a nice life-style with good pay and rarely need to take call, artificially limited number of residency spots to keep their specialty undersaturated. Not hard to see why it's desirable.

Moh's is to derm as derm is to residency. Extremely competitive to get those fellowships.

 

[SunsFun]

I thought about this too and being further along in my training I feel like it has to do with a skewed perspective med students have of different fields. Uro, ent, and plastics are also very competitive but how much the life of established soecialist in those fields better than endocrine or a breast surgeon? Of course there is a length of training argument, but I think it’s prestige of not matching into “just” Gen Surg that attracts med students. The rest is, IMO, just rationalizations based in misconceptions and lack of exposure.

I bet if cards was a stand-alone residency, it would be more competitive than derm. All because you don’t have to feel like you “settled for just IM”.