Why is derm so competitive?

[prettyslick]

Why?

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[brsboarder]

great pay, great lifestyle

 

[Jolie South]

this has been talked about ad nauseum, but the bottom line is. . .

it pays well and has better hours than most specialties.

 

[LucidSplash]

Why?

Because it is extremely lucrative and has very little call with what amounts to "normal" work hours.

 

[Long Dong]

Because it is the best specialty in the universe.

 

[prettyslick]

this has been talked about ad nauseum, but the bottom line is. . .

it pays well and has better hours than most specialties.

I'd like to think med students would go for derm for "other reasons" over "hours" and "pay"

I mean I don't see anything wrong if med students are gunning for derm for those reason mainly (pay, hours etc)

but then why do pre-med students get knocked down when they say they are choosing their field (medicine) due to "money" reasons... i.e having a decent lifestyle.

To me, thats the same thing!

 

[167649]

As said it has excellent pay, and very predictable (and flexible) hours. You don't get called into the ER at 3am to burn someone's wart off.

Yet despite it's great lifestyle there are relatively few residency spots. Put it all together and you have a competitive field.

 

[CoolSpot7Up]

I'd like to think med students would go for derm for "other reasons" over "hours" and "pay"

I mean I don't see anything wrong if med students are gunning for derm for those reason mainly (pay, hours etc)

but then why do pre-med students get knocked down when they say they are choosing their field (medicine) due to "money" reasons... i.e having a decent lifestyle.

To me, thats the same thing!

It pretty much is the same thing. Pre-meds just hate admitting that they like to do things for more money. They'll say it's not "altruistic." I mean, if money is your ONLY reason for going into medicine, then that's dumb. But, medicine is also a profession, and people have lives to live...choosing better pay and hours is what any working adult would like.

I know I plan on looking into that.

 

[prettyslick]

What makes you a competitive applicant for derm residency? Step 1 scores mainly?

 

[CoolSpot7Up]

What makes you a competitive applicant for derm residency? Step 1 scores mainly?

Pretty much the same things that makes you competitive for all the others:

Step 1 scores
Research/publications
AOA

 

[LucidSplash]

It pretty much is the same thing. Pre-meds just hate admitting that they like to do things for more money. They'll say it's not "altruistic."

Exactly - this is what pre-meds think. Frankly, many med students begin to wise up and look at life more realistically once they are actually in medical school. Which is not to suggest people don't go into primary care, but there's something to be said for signing that promissary note and learning more about how reimbursements work and watching laws get passed further cutting reimbursements that makes many of those with the best grades, scores, rank, etc stop and look around a bit more and really figure out how altruistic they feel.

 

[GreenShirt]

1) $$$$$$$$$$$$$
2) Can you say 9-5?

 

[Droopy Snoopy]

Exactly - this is what pre-meds think. Frankly, many med students begin to wise up and look at life more realistically once they are actually in medical school. Which is not to suggest people don't go into primary care, but there's something to be said for signing that promissary note and learning more about how reimbursements work and watching laws get passed further cutting reimbursements that makes many of those with the best grades, scores, rank, etc stop and look around a bit more and really figure out how altruistic they feel.

Some specialties like neurosurgery or orthopaedic surgery are able to make up for a ****ty lifestyle with lots of dough and/or being inherently incredibly interesting and challenging. But yeah, the reason half of American family medicine residencies go unfilled is because family doctors make about $60/hr compared to a cardiologist's $280/hr. Which sounds like a lot to many of you working part-time for a waiter's wage, but if the doc is carrying all the liability and only making $15-20 more per hour than his nurse something is very wrong.

 

[seraph524]

greed and laziness of humanity.

sorry, i'm kind of a pessimist

 

[brsboarder]

look, its not necessarily that bad. I have no interest in it, but at least its not being a corporate lawyer.

 

[seraph524]

haha, its not bad at all! im just really really really bored and sarcastic

 

[ninjapenguin]

Also don't forget the cosmetics aspect of dermatology. Let's face it, no matter the state of our healthcare system, people will always fork up cold hard cash for beauty and aesthetics.

 

[AmoryBlaine]

Exactly - this is what pre-meds think. Frankly, many med students begin to wise up and look at life more realistically once they are actually in medical school. Which is not to suggest people don't go into primary care, but there's something to be said for signing that promissary note and learning more about how reimbursements work and watching laws get passed further cutting reimbursements that makes many of those with the best grades, scores, rank, etc stop and look around a bit more and really figure out how altruistic they feel.

Derm combines all those things which pre-meds feel like they can't admit they care about...

1. Money
2. Time off
3. No call
4. Relatively easy training (once you get in)
5. Time off
6. Money
7. Money

Saying you don't mind "working your butt off" is alot easier to do when you haven't actually done it yet. Saying "money is not important" is equally easier to do when you have no real expenses.

 

[AmoryBlaine]

As said it has excellent pay, and very predictable (and flexible) hours. You don't get called into the ER at 3am to burn someone's wart off.

Yet despite it's great lifestyle there are relatively few residency spots. Put it all together and you have a competitive field.

Yeah, FYI sometimes you hear people describe derm as "a field with only 2 emergencies" namely...

1. Necrotizing fasciitis
2. TENS/Stevens-Johnson

The funny thing is that I don't think Dermatologists come anywhere near the management of either one. Maybe #2 but #1 is a surgical disease.

 

[HIVdoc2b]

Derm combines all those things which pre-meds feel like they can't admit they care about...

1. Money
2. Time off
3. No call
4. Relatively easy training (once you get in)
5. Time off
6. Money
7. Money

Saying you don't mind "working your butt off" is alot easier to do when you haven't actually done it yet. Saying "money is not important" is equally easier to do when you have no real expenses.

My dad's a dermie. While it's true there's no call - his pager has been sitting in a kitchen drawer with dead batteries for at least the last seven years, and I laugh when people say "I paged him but he never answered..." - I would argue with the "easy" training. Hours-wise, maybe it's easier, but he works his students and residents' butts off.

And if money is important... don't work for the Feds!

But yeah, it's a lifestyle specialty.

 

[tiedyeddog]

Let me sum it up...

If it's dry, wet it. If it's wet, dry it.

Not too hard, eh?

 

[Blade28]

Pretty much the same things that makes you competitive for all the others:

Step 1 scores
Research/publications
AOA

You're forgetting letters of recommendation and away rotations.

 

[brianmartin]

You don't get called into the ER at 3am to burn someone's wart off.

The thing is there are derm emergencies but sometimes even the dermatologists don't handle those. For example once a burn gets to a certain point it is a surgical/wound care issue and there is no reason for dermatology to be involved. I can count on zero fingers the number of times I've seen a dangerous rash present in the ED. Even then if it's something suggestive of a bleeding disorder, your first call is to the hematologist. I've never seen or heard a dermatologist be called once from the ED.

 

[Nilf]

It pretty much is the same thing. Pre-meds just hate admitting that they like to do things for more money. They'll say it's not "altruistic." I mean, if money is your ONLY reason for going into medicine, then that's dumb. But, medicine is also a profession, and people have lives to live...choosing better pay and hours is what any working adult would like.

I know I plan on looking into that.

Keep in mind that the reimbursement can change dramatically with one stroke of pen of a bureaucrat in Washington... Specialties wax and wane... 15 years ago rads would go unfilled, look at them now. Derm is no exception to the rule. Moh's surgery medicare reimbursement went down, which is bound to have effect on how competitive this subspecialty will be in the future.

One this you can bet on: ALL specialties, and hence medicine as whole, is bound to cease being lucrative. Some would argue it already has.

Bottom line: reimbursement should be distant third-fourth item on your list of reasons for specialty choice.

 

[Squiddie]

Also don't forget the cosmetics aspect of dermatology. Let's face it, no matter the state of our healthcare system, people will always fork up cold hard cash for beauty and aesthetics.

Especially because God forbid Precious has to show up at her first day of high school with a single zit that's mostly covered by her hair!

 

[dienekes88]

Keep in mind that the reimbursement can change dramatically with one stroke of pen of a bureaucrat in Washington... Specialties wax and wane... 15 years ago rads would go unfilled, look at them now. Derm is no exception to the rule. Moh's surgery medicare reimbursement went down, which is bound to have effect on how competitive this subspecialty will be in the future.

One this you can bet on: ALL specialties, and hence medicine as whole, is bound to cease being lucrative. Some would argue it already has.

Bottom line: reimbursement should be distant third-fourth item on your list of reasons for specialty choice.

Nilf, if you approached all your posts in such a calm and reasonable manner, you wouldn't get flamed so much.

For the record, I agree with you. I just don't think you communicate your point very well.

 

[facetguy]

Why? CASH MONEY!! Derm is perhaps the specialty best positioned to go to an all-cash practice. There are plenty of people willing to pay whatever you charge for a whole list of cosmetic procedures. That, and having the ability to do dermatological research, etc. (!)

 

[jult24er]

look, its not necessarily that bad. I have no interest in it, but at least its not being a corporate lawyer.

 

[Mobius1985]

Derm combines all those things which pre-meds feel like they can't admit they care about...

1. Money
2. Time off
3. No call
4. Relatively easy training (once you get in)
5. Time off
6. Money
7. Money

I would add to your list the altruistic motive of saving the world from the ravages of psoriasis and acne, one patient at a time.

 

[lord_jeebus]

A major factor not mentioned is the limited number of residency training spots available, which is just as significant as the number of people seeking a specialty.

 

[Nilf]

Nilf, if you approached all your posts in such a calm and reasonable manner, you wouldn't get flamed so much.

For the record, I agree with you. I just don't think you communicate your point very well.

Point by point:

1. Do you really think that I care what an anonymous internet user thinks about me?
2. Controversy generates publicity.
3. English is my third language.

 

[dienekes88]

Point by point:

1. Do you really think that I care what an anonymous internet user thinks about me?
2. Controversy generates publicity.
3. English is my third language.

Point by point back

1. I don't think you do, but I do think you want to get your point across... that's why you post in the first place.

2. True. I can't argue that. However, a lot of people have written you off and shut you out, because of this. These are people who are losing the message.

3. Impressive. However, you have the capacity to get your point across... as evidenced by your latest post.

 

[Depakote]

Yeah, FYI sometimes you hear people describe derm as "a field with only 2 emergencies" namely...

1. Necrotizing fasciitis
2. TENS/Stevens-Johnson

The funny thing is that I don't think Dermatologists come anywhere near the management of either one. Maybe #2 but #1 is a surgical disease.

I've seen some derm consults for Grades 3-4 cutaneous Graft Versus Host Disease post bone marrow transplant. I doubt they were called out of bed for it, though.

Would derm be involved in burn care/recovery? (again, not in the emergency care aspect but more long term recovery)

Now that I think about it I'm trying to peg down the more complicated aspects of what they manage aside from wetting what's dry, drying what's wet and throwing steroids at everything else.

 

[Blade28]

Would derm be involved in burn care/recovery? (again, not in the emergency care aspect but more long term recovery)

Not sure about other programs' experiences, but at our burn center here (the largest in the state), patient care is handled exclusively by Surgery. We're the ones that handle wound care and debridement...and when that fails, we take the patient back to the OR for tangential excisions and split- or full-thickness skin grafts.

Since I started residency I've never had to ask for a Derm consult. Having said that, they tend to be very busy when they're at work because of huge numbers of patients in clinic and lots of skin cancer cases (where they'll do biopsies).

 

[TheRealMD]

Not sure about other programs' experiences, but at our burn center here (the largest in the state), patient care is handled exclusively by Surgery. We're the ones that handle wound care and debridement...and when that fails, we take the patient back to the OR for tangential excisions and split- or full-thickness skin grafts.

Since I started residency I've never had to ask for a Derm consult. Having said that, they tend to be very busy when they're at work because of huge numbers of patients in clinic and lots of skin cancer cases (where they'll do biopsies).

There's such a thing as a "Derm consult"?? O_O

 

[ViolaGreene]

it's really about lifestyle first. hours are (relatively) low, predictable and pay is decent for medicine. which translates to great quality of life.

 

[lord_jeebus]

Not sure about other programs' experiences, but at our burn center here (the largest in the state), patient care is handled exclusively by Surgery.

That's how it is at my program too.

I do remember that once on Burn we called a Derm consult - but the patient was not a burn patient but had a very rare dermatological reaction to vancomycin (linear IgA bullous dermatosis) that required Burn ICU care...

 

[BigRedder]

Dermatologist Consult
http://www.youtube.com/watch?v=dgupJ2WN0Zw

 

[Monica Lewinsky]

Yeah, FYI sometimes you hear people describe derm as "a field with only 2 emergencies" namely...

1. Necrotizing fasciitis
2. TENS/Stevens-Johnson

The funny thing is that I don't think Dermatologists come anywhere near the management of either one. Maybe #2 but #1 is a surgical disease.

As for #1, SJS and TEN are horrible syndromes but the dermatologist isn't going to be able to do much (other than to figure out what drug caused it and to make sure the patient isn't getting any more of it). You examine the skin, take some biopsies, and you are off with rest of your day. The patient stays in the burn unit, and surgery gets stuck with the boring and disgusting management work. The derms worry about making a precise diagnosis (which doesn't actually matter too much...SJS vs. TEN you're still in bad shape)


Derms do consults in the hospital and they get to see the interesting skin manifestations of disease that sometimes puzzle other docs. But just as in the case of TEN in the burn unit, they are never stuck closely following the patient like docs on the wards have to.

 

[Law2Doc]

There's such a thing as a "Derm consult"??

Absolutely. There's nothing an internist wants to deal with less than someone's pustulant blistering sores. Your obese diabetic cardiac patient has ugly oozing bumps up and down his body that you don't recognize, after doubling your gloves, you call in someone more knowledgeable to take a look. I'd say psych, derm and substance abuse get the most consults about things the admitting teams just don't want to deal with.

 

[unsung]

This is part of what's wrong with America. Seriously. I mean, in what other country is this the case? Why should dermatologists get paid so much, while physicians in the much more needed specialties get paid so little ? Great way to screw yourself over, Country. Good job.

 

[Droopy Snoopy]

This is part of what's wrong with America. Seriously. I mean, in what other country is this the case? Why should dermatologists get paid so much, while physicians in the much more needed specialties get paid so little ? Great way to screw yourself over, Country. Good job.

I think on the long list of things wrong with the American healthcare system, let alone the country as a whole, the fact that a dermatologist gets paid more than a OB/Gyn is pretty trivial.

 

[TheRealMD]

Absolutely. There's nothing an internist wants to deal with less than someone's pustulant blistering sores. Your obese diabetic cardiac patient has ugly oozing bumps up and down his body that you don't recognize, after doubling your gloves, you call in someone more knowledgeable to take a look. I'd say psych, derm and substance abuse get the most consults about things the admitting teams just don't want to deal with.

Sorry, L2D. You took me seriously.

I am reminded of that one Scrubs episode with a derm consult. Haha, that was funny.

 

[unsung]

I think on the long list of things wrong with the American healthcare system, let alone the country as a whole, the fact that a dermatologist gets paid more than a OB/Gyn is pretty trivial.

Well, hmm, what if that OB/Gyn or Family doctor were compensated more on par with the dermatologist? That would go a long way toward repairing that shortage of primary care physicians plaguing the country. I hardly consider that trivial.

 

[Blade28]

Currently procedure-based fields make a lot more money than those fields that don't perform procedures.

And believe it or not, doing four or five quick office procedures in a day would reimburse more than one or two huge OR cases (e.g. CABG). This constantly amazes me - that huge, life-saving operations don't get much reimbursement at all.

 

[Narmerguy]

Well, hmm, what if that OB/Gyn or Family doctor were compensated more on par with the dermatologist? That would go a long way toward repairing that shortage of primary care physicians plaguing the country. I hardly consider that trivial.

I agree. I wonder if there will come a point when many (or even most) specialties are required by their employers to do primary care work along with their normal responsibilities? Of course it would have to be in small doses and they would probably do less in their specialty concentration as well but I suppose it would address the shortage for some of those procedures other doctors may be able to do? Then of course there are those things they can't so I guess this wouldn't solve the problem

 

[Law2Doc]

I agree. I wonder if there will come a point when many (or even most) specialties are required by their employers to do primary care work along with their normal responsibilities? Of course it would have to be in small doses and they would probably do less in their specialty concentration as well but I suppose it would address the shortage for some of those procedures other doctors may be able to do? Then of course there are those things they can't so I guess this wouldn't solve the problem

Not going to happen. The solutions will be (1) generate more doctors over time, (2) increased reliance on more NPs, PAs and other ancillary healthcare professionals to do much of the routine primary care legwork (a really bad idea for physicians to allow but we are going down this road and it has strong public appeal because few understand what doctors do for their "high incomes"), (3) continue to import offshore trained docs to fill our "unwanted" positions, and (4) wait out the baby boomer generation -- as soon as they die off there won't be a shortage.

 

[Narmerguy]

Not going to happen. The solutions will be (1) generate more doctors over time, (2) increased reliance on more NPs, PAs and other ancillary healthcare professionals to do much of the routine primary care legwork (a really bad idea for physicians to allow but we are going down this road and it has strong public appeal because few understand what doctors do for their "high incomes"), (3) continue to import offshore trained docs to fill our "unwanted" positions, and (4) wait out the baby boomer generation -- as soon as they die off there won't be a shortage.

Ah those seem very likely solutions. I wonder if the direction we are taking in terms of wages,taxes, and compensation will counteract the progress we would make in the four areas you pointed out because of the deterrence it may cause? It sort of seems as if the system is working against itself.

 

[harold56]

alright thanks,

but for the top schools,

would my chances be very slim?

for admissions for the top 20 med schools, what would be an "ideal" application? for instance, what would be great extracurricular activities, gpa, mcats, ETC.

Thanks.

 

[BlondeDocteur]

alright thanks,

but for the top schools,

would my chances be very slim?

for admissions for the top 20 med schools, what would be an "ideal" application? for instance, what would be great extracurricular activities, gpa, mcats, ETC.

Thanks.

There is a large source of information on such questions; it's called "the pre-allo forum."

It may interest you to know that derm actually ranks pretty low in terms of physician satisfaction (the highest field in terms of self-reported physician satisfaction is actually pediatric surgery, which requires 2 years of q2 call in fellowship, and where attendings work 80+ hour weeks routinely). I attribute this to three things [please bear in mind these are *generalizations,* and everyone will have a favorite uncle or college roommate who contradicts this]:

1) few dermatologists are attracted to the field of dermatology, prima facie, and actually spend their days quite bored and hating seeing patients.
2) most went into it for lifestyle and money reasons. By most I mean 99%. There will always be other jobs out there that make more money, and it's not a perfect 9-to-5. They suffer from serious grass-is-greener syndrome.
3) most were bright people who didn't really know what they were getting into when they went to med school (family pressures and expectations, too much Grey's, you name it). They were dissatisfied with medicine in general and saw dermatology residency as an escape. They remain unsatisfied.

Being very competitive does not necessarily mean that a field is very satisfying. Some highly competitive fields have good satisfaction scores-- ortho, radiology and neurosurgery are some. Others, including ENT and ophtho, do not.

PS all of this information is from the University of Buffalo's physician surveys.