Why is Dermatology so Competitive?

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JustMeditate

JustMeditate

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So...

After hanging out here for a while, I've learned that Dermatology is a super-dooper competitive specialty, and I was wondering why. I, personally, have no interest in dermatology (peds and neuro sound cool to me, but that could probably change once I'm in med school), but I am trying to figure out why it is so competitive. Does anyone know?
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JustMeditate said:
So...

After hanging out here for a while, I've learned that Dermatology is a super-dooper competitive specialty, and I was wondering why. I, personally, have no interest in dermatology (peds and neuro sound cool to me, but that could probably change once I'm in med school), but I am trying to figure out why it is so competitive. Does anyone know?
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It's a 9-5 job if you want it to be, seems to have a fairly nice residency most places, and you make boatloads of money.

Somehow I doubt that most of the people who go into it do so because the really love dermatology. Here is a thread on residency applicants trying to answer "Why derm?".
 
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DrBowtie said:
Great Money, Great Lifestyle, and very very few residency spots.
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People always say that, but sometimes I really have to question it. It can certainly be a low-time commitment specialty, but does 1/3 of your day looking at skin lesions and rashes count as "great lifestyle" to you?
 
Long Way to Go said:
People always say that, but sometimes I really have to question it. It can certainly be a low-time commitment specialty, but does 1/3 of your day looking at skin lesions and rashes count as "great lifestyle" to you?
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As you progress, you'll learn what matters with lifestyle. Regular hours and minimal call schedule.

Getting called in for a 10+hr ruptured AAA repair @ 3AM vs. not taking any call at all.
 
Long Way to Go said:
People always say that, but sometimes I really have to question it. It can certainly be a low-time commitment specialty, but does 1/3 of your day looking at skin lesions and rashes count as "great lifestyle" to you?
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Life=/=lifestyle. While I agree spending 8 hours a day looking at skin lesions isn't how I want to spend my life, your lifestyle outside of the hospital will be awesome--not only will you have lots of time, you'll also be rich. If lifestyle is more important to you than how you spend those 8 hours a day or whatever, then derm may be for you.

BTW, I've got nothing against dermatologists. They do fulfill a necessary role, and we do need them; at the end of the day, I don't really care if they went into it because of the lifestyle or because they "love skin," and if they see going into the derm lifestyle as the "reward" for busting their ass throughout med school, more power to them as far as I'm concerned.
 
I'm interested in derm not only for the great lifestyle and money, and I think it's rewarding to help people with their appearance, too.

It's also one of the few types of doctors that don't have to be splitting people open or talking about diarrhea on a daily basis.
 
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Derm is competitive because it has a low number of spots (~400), a great income (300k+), and a great lifestyle (~45 hrs/wk with no call). It's not competitive due to extreme intellectual demand like in Rads or N-surge, imo.
 
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It's competitive because skin is usually one of the less gross parts of the body...
 
GoSpursGo said:
Life=/=lifestyle. While I agree spending 8 hours a day looking at skin lesions isn't how I want to spend my life, your lifestyle outside of the hospital will be awesome--not only will you have lots of time, you'll also be rich. If lifestyle is more important to you than how you spend those 8 hours a day or whatever, then derm may be for you.

BTW, I've got nothing against dermatologists. They do fulfill a necessary role, and we do need them; at the end of the day, I don't really care if they went into it because of the lifestyle or because they "love skin," and if they see going into the derm lifestyle as the "reward" for busting their ass throughout med school, more power to them as far as I'm concerned.
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In some places, though, (in NYC, for example) you may be required to stay for 10, sometimes even 12 hours, because there is such a high demand for fixing skin problems, due to a myriad of factors (pollution, misuse of skin products, etc.).

I had a family friend, Dr. Ostad, who is a dermatologist working in NYC and works most weekdays for 9 hours. I shadowed him two times because I was looking into dermatology as well, and it was quite intense. He was seeing patient after patient with no break in sight. At the end of the day, he would accept a walk-in or two, so he would stay up to an extra couple of hours. I've also seen him outside of the office. He always gets calls from patients, but he has a pretty decent golf game and social life.

Doing derm's not easy, that's for sure, but I think I'd do it anyway. Certainly better than neurosurgery.

OP, if you have "the itch" for that, more power to you! 😀

GoSpursGo, I can tell you that from my experiences from shadowing Dr. Ostad that he really loves his work, but his lifestyle isn't exactly the most extravagant, nor does he have lots of time. Heck, he occasionally has had to do work on weekends because of emergency situations. So yes, you would have to do this for the love of skin in order to survive.
 
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Dermatology is competitive because when the time comes no one wants to work 80 hours a week and take q3 call, despite all the "you should only go into medicine if you really really want to help people, like me!" crap the typical pre-med likes to spew.
 
RSimonson said:
In some places, though, (in NYC, for example) you may be required to stay for 10, sometimes even 12 hours, because there is such a high demand for fixing skin problems, due to a myriad of factors (pollution, misuse of skin products, etc.).

I had a family friend, Dr. Ostad, who is a dermatologist working in NYC and works most weekdays for 9 hours. I shadowed him two times because I was looking into dermatology as well, and it was quite intense. He was seeing patient after patient with no break in sight. At the end of the day, he would accept a walk-in or two, so he would stay up to an extra couple of hours. I've also seen him outside of the office. He always gets calls from patients, but he has a pretty decent golf game and social life.

Doing derm's not easy, that's for sure, but I think I'd do it anyway. Certainly better than neurosurgery.

OP, if you have "the itch" for that, more power to you! 😀

GoSpursGo, I can tell you that from my experiences from shadowing Dr. Ostad that he really loves his work, but his lifestyle isn't exactly the most extravagant, nor does he have lots of time. Heck, he occasionally has had to do work on weekends because of emergency situations. So yes, you would have to do this for the love of skin in order to survive.
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You don't say? A doctor working on weekends? Poor guy.
 
cowme said:
There are also dermatologists who work 8-1, 4 days a week, and make plenty of money (if they are efficient)
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Sure, maybe if you're the owner of a very large practice with doctors working under you, and spend 10 minutes on every patient that you see. I highly doubt this is the norm.
 
FIREitUP said:
Sure, maybe if you're the owner of a very large practice with doctors working under you, and spend 10 minutes on every patient that you see. I highly doubt this is the norm.
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That's very possible. We have two dermatologists who work part-time. They see a normal amount of patients and probably make the same amount of money as some other specialties would full-time, and this is a county hospital. I don't know if that's the norm, but it happens.

I spent three months working in a derm department (doing clinical research) and I have a great amount of respect for dermatologists. One of the things they kept pointing out with me is that they get to do everything in their specialty: a little surgery, a little clinic, a little pathology. So you can really do anything you want with it, which I think is definitely a positive beyond lifestyle. It does have a serious side if you are a derm who specializes in skin cancer.

Lifestyle definitely is a plus. Our hospital was flexible in letting you choose your hours (see above) and I think because it's not a high-stress specialty in general, everyone was super laid-back and friendly. Of course, that could work for any department and largely depends on the people, but I thought there was definitely a difference between low-stress and when I've shadowed high-stress departments like surgery, even if everyone is nice, it's a different attitude and environment. The most stressful things that happened were one TEN case and some cancer cases. Resident clinic started at 8, attending clinic started at 9, and it was over at 3-4. They usually stayed a little longer to finish work they didn't get done during the day. Depending on how many cases there were and how long they took MOHS (melanoma surgery) could be done as early as 1 or 2.

Edit to add: And... yeah. I'm not a queasy person and had no problems in general surgery. But there were a lot of gross moments for derm. I think general surgery wasn't as bad for me because you cut through all the layers and focus on the bigger picture and we've all seen pictures or diagrams of organs and bones before. But different layers of skin can just be gross.
 
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While there is nothing wrong with derm, I'd take a 70 hour week doing surgery over a 50 hour a week doing derm any day. Everybody has their preferences.

I shadowed a pathologist that worked about 4 hours out of the 8 hour day (could have to do with efficiency, I don't know) and left at 2 on Fridays to go to wine tasting with some other docs. Nice lifestyle and 250k pay, but way too boring. I don't see a problem with someone wanting that lifestyle, and at least they are doing something meaningful while at work. Not interesting enough for me though.
 
FIREitUP said:
Sure, maybe if you're the owner of a very large practice with doctors working under you, and spend 10 minutes on every patient that you see. I highly doubt this is the norm.
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Not the norm, no. But dermatology, more so than any other field, there are doctors who do quite well working 3 days per week or half days every day. No, you do not have to own a large practice to do this either. I have seen dermatologists as a patient a handful of times, and I can't remember a visit that lasted longer than 10 minutes.
 
circulus vitios said:
Funny things pre-meds say.
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Funny thing lots of docs say.

Theres no inherent reason why a private practice gen surgeon or private practice neurosurgeon in a large group needs to work 80 hours a week. Sure a solo practice hours will be a lot worse due to call, but call burden is spread out in a large group. They work these hours because they choose to, and because that is the culture of the field and hence the type of person the field attracts.

Dermatologists can work 2x as long for more then 2x the profit (expenses covered) but they choose not to. Likewise many surgeons could work 1/2 as long for much less cash (still a decent salary), but they choose not to.

Derm has the benefit of being well paying per hour, allowing one to work good hours and still make a good amount of money. There is also the aspect of cosmetics, which allows good money while not dealing with insurance.
 
DoctwoB said:
Funny thing lots of docs say.

Theres no inherent reason why a private practice gen surgeon or private practice neurosurgeon in a large group needs to work 80 hours a week. Sure a solo practice hours will be a lot worse due to call, but call burden is spread out in a large group. They work these hours because they choose to, and because that is the culture of the field and hence the type of person the field attracts.

Dermatologists can work 2x as long for more then 2x the profit (expenses covered) but they choose not to. Likewise many surgeons could work 1/2 as long for much less cash (still a decent salary), but they choose not to.

Derm has the benefit of being well paying per hour, allowing one to work good hours and still make a good amount of money. There is also the aspect of cosmetics, which allows good money while not dealing with insurance.
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I think you hit the nail right on the head--it's a matter of CHOICE to some extent. Granted, there are some fields that will "require" more strenuous hours than others, but in general, it's what you make of it. If you choose to enter a "small group" with large call-burdens, you'll work accordingly. If you choose a larger group with the calls spread out, you'll work with less crazy hours. My cousin who works as a GP in a larger clinic has no call, works 9-5 and no weekends. He also makes good money, around 240K per year.
 
also, there's the climate effect. There's a derm office on just about every corner in the Tampa area... plenty of pale-skinned northerners coming down who develop the need for Mohs.
 
The few derms I've seen worked, charged, and abused by insurance companies like family doctors. Where are the big bucks coming from?
 
dbeast said:
It's competitive because skin is usually one of the less gross parts of the body...
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Dermatology is pretty freaking gross if you ask me. If I had to see one more picture of a disgusting groin rash during my integumentary block, I swore I would flip the f*** out
 
I went to a derm grand round last summer, it was horrible. It started and ended w many of the physicians making jokes about derm.

"I tried to get a derma consult once...but it was after 5." laughter erupts.

Even though they were playful in nature, i kind of felt bad for her bc she got defensive at the end. Never seen a group of physicians look down at any other specialty as they did that day.

Has anyone else had an exp like this?
 
slammer922 said:
I went to a derm grand round last summer, it was horrible. It started and ended w many of the physicians making jokes about derm.

"I tried to get a derma consult once...but it was after 5." laughter erupts.

Even though they were playful in nature, i kind of felt bad for her bc she got defensive at the end. Never seen a group of physicians look down at any other specialty as they did that day.

Has anyone else had an exp like this?
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don't worry... most derm folk find swimming to be a very de-stressing activity.

scrooge-mcduck.jpg
 
DoctwoB said:
Funny thing lots of docs say.

Theres no inherent reason why a private practice gen surgeon or private practice neurosurgeon in a large group needs to work 80 hours a week. Sure a solo practice hours will be a lot worse due to call, but call burden is spread out in a large group. They work these hours because they choose to, and because that is the culture of the field and hence the type of person the field attracts.

Dermatologists can work 2x as long for more then 2x the profit (expenses covered) but they choose not to. Likewise many surgeons could work 1/2 as long for much less cash (still a decent salary), but they choose not to.

Derm has the benefit of being well paying per hour, allowing one to work good hours and still make a good amount of money. There is also the aspect of cosmetics, which allows good money while not dealing with insurance.
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Thank you for saying what I actually meant but in a much more clear manner. I don't think people go into neurosurgery or other sub-specialties because of the salary. You can do less exhausting specialties for better or equal money. Surgery attracts a lot of people that can only see themselves doing surgery, and choose to work higher hours. As you said, a gen surgeon could work half the hours and still make 150k, but most don't.
 
slammer922 said:
I went to a derm grand round last summer, it was horrible. It started and ended w many of the physicians making jokes about derm.

"I tried to get a derma consult once...but it was after 5." laughter erupts.

Even though they were playful in nature, i kind of felt bad for her bc she got defensive at the end. Never seen a group of physicians look down at any other specialty as they did that day.

Has anyone else had an exp like this?
Click to expand...

Well the fact is that everyone knows you have to be a stud to get into derm, so I'd say they get some respect for that. Cosmetics is generally less respected, but there are a lot of top notch academic dermatologists that do great research in wound healing, burns, skin grafts, cancer, etc.

A lot of people like to feel like they're extra badass for working extra hours (I'm only a medstudent and I've already heard more then my share of "back in the day before work hour restrictions" stories), but in reality its not like working that extra hour makes you a better person.
 
Closing in on finishing 3rd year rotations.

Not going to do derm, but it is much more interesting than some would think. Many diseases present with rashes or other skin disorders. So derm has a very challenging diagnostic aspect that goes "deeper" than just the skin.

And oh, skin is the grossest organ, imho.

And oh, money and hours.
 
WingedOx said:
ugh, I've seen this up close... though it was the vasuclar surgeon who dealt with it.
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There are a lot of severe illnesses where the derm component may be the first presenting symptom. The dermatologist may be the only physician who sees the patient in time to actually get him the care he needs. But certainly things like TEN (described above), Stevens Johnson, necrotizing fasciitis ("flesh eating bacteria") and certain spider bites are the bigger emergencies which may find their way under dermatology care (in addition to the care of surgeons and others). But they sometimes go to their skin doctor first. Recognizing things like syphilis, etc before the disease progresses can also save lives, but you probably wouldn't get called in at 2am for this.

But in general, derm is popular because:
(1) it is well paid due to limited residency slots in this field of high demand,
(2) the lifestyle is generally very good for physicians -- usually less than 50 hours/week. (Though not usually as low as the 25 hours/week some of you guys are describing -- best to not focus on the rare outliers. Good hours for physicians and good hours for part time folks are not the same thing.)
(3) In most cases, your patients don't have issues severe enough that will they need to wake you up in the middle of the night or call you in on the weekends. So there won't be as much call in private practice derm.
(4) A lot of skin conditions don't get better. So you will have patients for life. Makes for a very steady full schedule, and you can be booked up months in advance. Other physicians have to advertise and pitch for more business.
(5) Except for a handful of emergencies which won't come up on a weekly basis, most of your clients won't die of their derm ailments. So you won't have to break bad news to families or some of the other emotional stuff physicians have to do.
 
RSimonson said:
In some places, though, (in NYC, for example) you may be required to stay for 10, sometimes even 12 hours, because there is such a high demand for fixing skin problems, due to a myriad of factors (pollution, misuse of skin products, etc.).

I had a family friend, Dr. Ostad, who is a dermatologist working in NYC and works most weekdays for 9 hours. I shadowed him two times because I was looking into dermatology as well, and it was quite intense. He was seeing patient after patient with no break in sight. At the end of the day, he would accept a walk-in or two, so he would stay up to an extra couple of hours. I've also seen him outside of the office. He always gets calls from patients, but he has a pretty decent golf game and social life.

Doing derm's not easy, that's for sure, but I think I'd do it anyway. Certainly better than neurosurgery.

OP, if you have "the itch" for that, more power to you! 😀

GoSpursGo, I can tell you that from my experiences from shadowing Dr. Ostad that he really loves his work, but his lifestyle isn't exactly the most extravagant, nor does he have lots of time. Heck, he occasionally has had to do work on weekends because of emergency situations. So yes, you would have to do this for the love of skin in order to survive.
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You do realize that if he works "most weekdays" (heck, let's give him the benefit of the doubt and say all 5) for 9 hours, that's a 45 hour week, right? :laugh:
 
DoctwoB said:
Well the fact is that everyone knows you have to be a stud to get into derm, so I'd say they get some respect for that.
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Well no. You are thinking of derm now. Derm 15-20 years ago you did not have to be a stud. I think it was more competitive just based on lack of numbers.
 
It is also notable to mention that once hearing what dermatologists do, a lot of students (i.e. mostly high school) say "I wanna be a derm". Unfortunately they do not know the kind of work and step 1 scores that matter.......In the end, I just smile warmly and wish them good luck...
 
FIREitUP said:
Sure, maybe if you're the owner of a very large practice with doctors working under you, and spend 10 minutes on every patient that you see. I highly doubt this is the norm.
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That is the norm for every Dermatologist attached to my school. That's why everyone competes to rotate with them for outpatient surgery, working with them is basically a vacation. That's also why Derm is so incredibly competitive: by artifically limiting the supply of dermatologists and fighting legal wars to make sure no one else is allowed to do their jobs they've created a profession where you can be paid like a surgeon to work like a housewife (the kind without kids).
 
FIREitUP said:
Sure, maybe if you're the owner of a very large practice with doctors working under you, and spend 10 minutes on every patient that you see. I highly doubt this is the norm.
Click to expand...

That is the norm for every Dermatologist attached to my school. That's why everyone competes to rotate with them for outpatient surgery, working with them is basically a vacation. That's also why Derm is so incredibly competitive: by artifically limiting the supply of dermatologists and fighting legal wars to make sure no one else is allowed to do their jobs they've created a profession where you can be paid like a surgeon to work like a housewife (the kind without kids, nothing but props to stay at home Moms out there).
 
Perrotfish said:
That is the norm for every Dermatologist attached to my school. That's why everyone competes to rotate with them for outpatient surgery, working with them is basically a vacation. That's also why Derm is so incredibly competitive: by artifically limiting the supply of dermatologists and fighting legal wars to make sure no one else is allowed to do their jobs they've created a profession where you can be paid like a surgeon to work like a housewife (the kind without kids, nothing but props to stay at home Moms out there).
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Working 8-1 doesn't sound like the norm to me for any physician, but you would know better than I. It pains me that our compensation system is so backwards that removing a cyst pays similar to removing a gall bladder.
 
FIREitUP said:
Working 8-1 doesn't sound like the norm to me for any physician, but you would know better than I. It pains me that our compensation system is so backwards that removing a cyst pays similar to removing a gall bladder.
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Well its the norm only for the less financially ambitious members of one very tiny, insanely hypercompetitive field of medicine which is benifiting from a transient fluke of economics. Its normal for an abnormal field.
 
Perrotfish said:
That is the norm for every Dermatologist attached to my school. That's why everyone competes to rotate with them for outpatient surgery, working with them is basically a vacation. That's also why Derm is so incredibly competitive: by artifically limiting the supply of dermatologists and fighting legal wars to make sure no one else is allowed to do their jobs they've created a profession where you can be paid like a surgeon to work like a housewife (the kind without kids, nothing but props to stay at home Moms out there).
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This post is so Nation.
 
It is very important to remember that as a physician, you have almost zero control over your future income. Reimbursements can change on a whim of congress or the RUC (committee that helps set Medicare reimbursement), and things tend to go in cycles.

Radiologists used to make pretty average money and now they rake in the big $$, and are likely targets for future cuts. Anesthesia paid about as well as primary care in the 90s, and now pays big bucks. Medical oncologists used to make bank from delivering chemo, now they don't. Spine surgeons make tons of money due to coding issues in which multiple levels are billed separately, and word is that could next on the chopping block. Dermatology could very well be next. The key is to ask yourself if you would still be happy with your chosen profession if reimbursements took a major cut. If you pick a field and reimbursements go down, that sucks, but you can still be happy if thats the field that you have the most passion for.

Cosmetics is somewhat insulated from this, but in this regard Derm is starting to create its own worst enemy. By restricting supply to boost salaries, they create a niche in which FPs can step in and do botox or other basic cosmetics., and even NPs are trying to do derm "residencies" to cash in on this.
 
Thanks for the info, guys. Again, I'm not all that interested in derm, but I was a little surprised when I saw it being compared to neuro surg. and rads as far as competitiveness.
 
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