why is it so hard to get into dermatology?

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DermViser said:
I'll say that it requires a lot of brainpower, bc the level of extensive detail on the Dermatology boards is enormous (@GuyWhoDoesStuff might have more to contribute), which even then a non-insignificant number still fail. It's like med school basic sciences on steroids. So yes, I believe that if you want to be a board certified practicing Dermatologist, then yes, you have to be "smarter".
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OK this. Thinly disguised arrogance. Smarter than who.

DermViser said:
In Peds, a lot of the stuff that residents have to deal with is the mundane. You don't really get to enjoy the detailed academic aspects. Those who want that go into subspecialties. That being said, besides the top programs, most pediatricians DON'T WANT to delve into those aspects. They want to practice clinically and that's it.

If you like basic science, you'll like Derm (bc of the emphasis on Immunology, Histology, Pathology, etc.) If you don't, you'll absolutely hate Derm. Derm in residency is very academic. Pediatrics doesn't tend to emphasize basic science as much, which isn't surprising as it is more primary care focused.
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I rotated at a nationally renown quatenary children's hospital--nothing but immensely complex medicine at full tilt with absolutely grueling training. And most train in peds at least teritiary centers. You don't learn that kind of medicine by memorizing derm slides after cutting out at 3 pm on friday for the weekend. idk what your rank is. But you talk a lot for not knowing wtf you're talking about here.

We need to be deferential to each other. Like warriors visiting the camp of another tribe. Not like little pricks who's first instinct is to prove how much better they are. Which is what happens in my opinion, almost inevitably, in order to reach the heights of medical school academic performance.

Notice I showered you first with the respect and accolades you deserve for the kind of hard work required to achieve a derm match. Reserving cynical criticism only when stereptypical arrogance became apparent.

Learn how to treat others and you'll be treated with respect. From me at least. As I'm interested in a pan-physician political agenda.
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Nasrudin said:
OK this. Thinly disguised arrogance. Smarter than who.

I rotated at a nationally renown quatenary children's hospital--nothing but immensely complex medicine at full tilt with absolutely grueling training. And most train in peds at least teritiary centers. You don't learn that kind of medicine by memorizing derm slides after cutting out at 3 pm on friday for the weekend. idk what your rank is. But you talk a lot for not knowing wtf you're talking about here.

We need to be deferential to each other. Like warriors visiting the camp of another tribe. Not like little pricks who's first instinct is to prove how much better they are. Which is what happens in my opinion, almost inevitably, in order to reach the heights of medical school academic performance.

Notice I showered you first with the respect and accolades you deserve for the kind of hard work to achieve a derm match. Reserving cynical criticism only when stereptypical arrogance became apparent.

Learn how to treat others and you'll be treated with respect. From me at least. As I'm interested in a pan-physician political agenda.
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I never said that what Pediatricians do is not hard or not grueling training. Where did I say that? Yes, most pediatric residents work in children's hospitals in which there are many pediatric subspecialists. I myself, wish to go for Pediatric Dermatology.

The truth is that Dermatology selects for people with high board scores bc the Dermatology boards is VERY hard. The literature has correlated USMLE Step 1 performance to Dermatology board failure. Even AFTER selecting for this group, there are STILL people who fail the Derm boards. This isn't something I'm pulling out of my ass. PDs don't want to have the worry about selecting someone to their residency program, finishing residency, and then failing the Derm boards which then is blamed on the residency program bc each year has so few residents to begin with.
 
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DermViser said:
I never said that what Pediatricians do is not hard or not grueling training. Where did I say that? Yes, most pediatric residents work in children's hospitals in which there are many pediatric subspecialists. I myself, wish to go for Pediatric Dermatology.

The truth is that Dermatology selects for people with high board scores bc the Dermatology boards is VERY hard. The literature has correlated USMLE Step 1 performance to Dermatology board failure. Even AFTER selecting for this group, there are STILL people who fail the Derm boards. This isn't something I'm pulling out of my ass. PDs don't want to have the worry about selecting someone to their residency program, finishing residency, and then failing the Derm boards which then is blamed on the residency program bc each year has so few residents to begin with.
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OK. So you have culture steeped in dorkery that enjoys making it harder for each other academically like dorks do. Derm wasn't always competitive from what I hear so there's nothing inherently more intellectually rigorous in the clinical practice of one specialty from another. They require different type of skills to be sure.

If you're specialty wasn't sweet then it wouldn't be competitive and it would either fail more or calibrate its boards to suit the academic tendencies of its members.

So when you come to these discussions. Think diplomatically. We all know you must've been an academic killer to match derm. But adroit and astute clinical practice is demanding in each of our fields. Which is where we derive much of our identity from hence forth, like it or not. Like tribes. So a certain level of ceremony regarding each other displays astute social skill. Something I think you blew past obliviously.


Just because this is a troll thread doesn't mean we can't do something useful with it.
 
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Nasrudin said:
OK. So you have culture steeped in dorkery that enjoys making it harder for each other academically like dorks do. Derm wasn't always competitive from what I hear so there's nothing inherently more intellectually rigorous in the clinical practice of one specialty from another. They require different type of skills to be sure.

If you're specialty wasn't sweet then it wouldn't be competitive and it would either fail more or calibrate its boards to suit the academic tendencies of its members.

So when you come to these discussions. Think diplomatically. We all know you must've been an academic killer to match derm. But adroit and astute clinical practice is demanding in each of our fields. Which is where we derive much of our identity from hence forth, like it or not. Like tribes. So a certain level of ceremony regarding each other displays astute social skill. Something I think you blew past obliviously.

With that rectified, I can go back to being a dermviser supporter.

Just because this is a troll thread doesn't mean we can't do something useful with it.
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Where did I compare the clinical practice of the two specialties? I am talking about the certification boards in Dermatology. The literature is quite clear on this. I don't know what you're arguing about.
 
Anastomoses said:
I'm not trying to be nasty, but what are most dermatologists actually doing? I know two that run very successful laser hair removal clinics/medspas + another whose clinic is purely liposuction. These are not FMs, but dermatologists.

More interesting is...let's say Derm is incredibly intensive and calls for brilliance. Has it always been so competitive? Say 30, 40, 50 years ago? I'm genuinely asking because I haven't a clue.
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Yes, I am also curious about this.

Is there something inherently "harder" about derm or ortho that requires a Step 1 score around 24o, or are they just more desirable than others at the moment and that just happens to be the weed-out metric?
 
Mt Kilimanjaro said:
Yes, I am also curious about this.

Is there something inherently "harder" about derm or ortho that requires a Step 1 score around 24o, or are they just more desirable than others at the moment and that just happens to be the weed-out metric?
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Desirability hands down. The best indication of the reality of this is the pendulum swing of competitiveness that specialties have evolved through over the decades. They don't become more or less difficult as that happens.
 
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I'm not sure what Nasrudin's objection to DermViser is. I haven't looked through the entire thread, but he basically provided a straight answer to my question, and I haven't seen him say anything like "Pediatricians are stupid."
 
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Dave89 said:
I'm not sure what Nasrudin's objection to DermViser is. I haven't looked through the entire thread, but he basically provided a straight answer to my question, and I haven't seen him say anything like "Pediatricians are stupid."
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He said derms have to be smarter. And singled out pediatrics for being mostly mundane. Clearly indicating bias because any clinician knows most things become more mundane with increased knowledge and skill.

I don't expect you to react the same way as your clinical identity is still noncommittal.
 
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Dave89 said:
I'm not sure what Nasrudin's objection to DermViser is. I haven't looked through the entire thread, but he basically provided a straight answer to my question, and I haven't seen him say anything like "Pediatricians are stupid."
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DV is fairly contemptuous of many specialties and quite a few people on here find it offensive. As Nasrudin mentioned, you and I probably don't notice or care so much because we aren't locked on anything yet.
 
I dunno. I'm still keeping Peds on the list (theoretically - if I win the lottery, lol).
 
Nasrudin said:
Desirability hands down. The best indication of the reality of this is the pendulum swing of competitiveness that specialties have evolved through over the decades. They don't become more or less difficult as that happens.
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Not to toot my own specialty's horn, but you have to be pretty darn smart to be a good radiologist. The vastness of the material you have to know is pretty intimidating.
 
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DermViser said:
I never said that what Pediatricians do is not hard or not grueling training. Where did I say that? Yes, most pediatric residents work in children's hospitals in which there are many pediatric subspecialists. I myself, wish to go for Pediatric Dermatology.

The truth is that Dermatology selects for people with high board scores bc the Dermatology boards is VERY hard. The literature has correlated USMLE Step 1 performance to Dermatology board failure. Even AFTER selecting for this group, there are STILL people who fail the Derm boards. This isn't something I'm pulling out of my ass. PDs don't want to have the worry about selecting someone to their residency program, finishing residency, and then failing the Derm boards which then is blamed on the residency program bc each year has so few residents to begin with.
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Do you believe the higher the step 1 score you have the smarter you are?
 
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just wondering but why are there so few dermatology residencies? (if so many ppl want to get in)
 
Nasrudin said:
He said derms have to be smarter. And singled out pediatrics for being mostly mundane. Clearly indicating bias because any clinician knows most things become more mundane with increased knowledge and skill.

I don't expect you to react the same way as your clinical identity is still noncommittal.
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The question asked by @Dave89 was: "For instance, do dermatologists have to be smarter than those who are in "lowly" Pediatrics*, or are the hoops that applicants have to jump through simply there because the Derm people have the leverage to snatch up the most boast-worthy applicants?"

I never singled out Pediatrics. I answered his question directly as to why Dermatology residencies want people with high board scores. The Derm literature has demonstrated a HIGH correlation between USMLE Step 1 scores and In-Training Exam scores, and the eventual Dermatology boards. Derm PDs have real qualms about choosing students with lower board scores, due to the concern about their performance on the ITE and eventual failure of boards.

Pediatrics clinical residency is dealing with a lot of mundane things clinically, which is expected as it is a primary care specialty. You're talking about "genetic errors of metabolism pathophysiology" on the boards as somehow indicative of the emphasis of Pediatrics boards as a whole focusing on basic science is silly. It's definitely not a huge portion of it. And guess what we have to know those too, bc some of them have skin manifestations.
 
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DermViser said:
I never said that what Pediatricians do is not hard or not grueling training. Where did I say that? Yes, most pediatric residents work in children's hospitals in which there are many pediatric subspecialists. I myself, wish to go for Pediatric Dermatology.

The truth is that Dermatology selects for people with high board scores bc the Dermatology boards is VERY hard. The literature has correlated USMLE Step 1 performance to Dermatology board failure. Even AFTER selecting for this group, there are STILL people who fail the Derm boards. This isn't something I'm pulling out of my ass. PDs don't want to have the worry about selecting someone to their residency program, finishing residency, and then failing the Derm boards which then is blamed on the residency program bc each year has so few residents to begin with.
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DermViser said:
Out of that quote, where did I say the higher the Step 1 score, the smarter you are?
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come on you implied it pretty damn hard
 
just in case anyone missed my question

just wondering but why are there so few dermatology residencies? (if so many ppl want to get in)
 
titanlord1 said:
just in case anyone missed my question

just wondering but why are there so few dermatology residencies? (if so many ppl want to get in)
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I don't think there is a high enough demand for dermatologists to open up a bazillion residency spots.
 
southernIM said:
One could also argue it is in the interests of dermatologists to keep the supply chain limited so as not to flood the market with excess competition.
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Then you would be incorrect. Setting up a dermatology residency in which you have to be able to provide General Derm, Peds Derm, Dermpath, and Procedural Derm experience, to get RRC approval is tough. As hospitals are mainly inpatient oriented, they would much rather push spots towards inpatient services (i.e. Ortho, IM, etc.) than spend it on Derm which is mainly an outpatient specialty.
 
Kaputt said:
Not to toot my own specialty's horn, but you have to be pretty darn smart to be a good radiologist. The vastness of the material you have to know is pretty intimidating.
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Obviously our ilk as a whole needs very little prompting to toot their own horn. There's lots of tooting going on everywhere.

Could it be, just maybe, that our function as clinicians is perhaps similar enough that you could easily say you have to be smart to be good at any of it? Or is the cacophony of toots our only music?

If I need a derm consult I want the guy I can trust and who I know is careful, conscientious, and caring as much as smart, for my loved ones or patients. Is it any different when I need pediatrician for them. Or a surgeon. Or a ....

How about we start tooting the guy next to us. Like a big kumbaya circle jerk jamboree. Then we might just do something for each other as a profession. Instead of fighting each other for scraps like a bunch of cunty self-tooting hyenas.
 
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DermViser said:
The truth is that Dermatology selects for people with high board scores bc the Dermatology boards is VERY hard. The literature has correlated USMLE Step 1 performance to Dermatology board failure. Even AFTER selecting for this group, there are STILL people who fail the Derm boards. This isn't something I'm pulling out of my ass. PDs don't want to have the worry about selecting someone to their residency program, finishing residency, and then failing the Derm boards which then is blamed on the residency program bc each year has so few residents to begin with.
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Do you really believe this? You don't think they select people with high board scores just because they have the applicant pool for it? So, do you think plastics and ortho have high average step 1 scores because their boards are so difficult?

So does a low-tier FM residency just take a bunch of FMGs because their PD is like, "f*** it, our boards are so easy. We'll just make paper airplanes out of the apps and the 10 that go the farthest get in."

If you say your boards are especially difficult I'm definitely not gonna disagree, but to think PDs are selective out of necessity and not just the fact that programs have the ability to make a cutoff at 240 and still have a sizeable pool of applicants is pretty illogical.
 
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Donald Juan said:
Do you really believe this? You don't think they select people with high board scores just because they have the applicant pool for it? So, do you think plastics and ortho have high average step 1 scores because their boards are so difficult?

So does a low-tier FM residency just take a bunch of FMGs because their PD is like, "f*** it, our boards are so easy. We'll just make paper airplanes out of the apps and the 10 that go the farthest get in."

If you say your boards are especially difficult I'm definitely not gonna disagree, but to think PDs are selective out of necessity and not just the fact that programs have the ability to make a cutoff at 240 and still have a sizeable pool of applicants is pretty illogical.
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this and your Waffle House post - 10/10
 
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Donald Juan said:
Do you really believe this? You don't think they select people with high board scores just because they have the applicant pool for it? So, do you think plastics and ortho have high average step 1 scores because their boards are so difficult?

So does a low-tier FM residency just take a bunch of FMGs because their PD is like, "f*** it, our boards are so easy. We'll just make paper airplanes out of the apps and the 10 that go the farthest get in."

If you say your boards are especially difficult I'm definitely not gonna disagree, but to think PDs are selective out of necessity and not just the fact that programs have the ability to make a cutoff at 240 and still have a sizeable pool of applicants is pretty illogical.
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I don't know about derm but I heard an ENT pd say that they take people with high board scores because you need to be above a certain percentile to pass the boards (I recall him saying around 66% pass but I'm not sure about that). And since you're competing against other ENT residents, it's hard to do.
 
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Donald Juan said:
Do you really believe this? You don't think they select people with high board scores just because they have the applicant pool for it? So, do you think plastics and ortho have high average step 1 scores because their boards are so difficult?

So does a low-tier FM residency just take a bunch of FMGs because their PD is like, "f*** it, our boards are so easy. We'll just make paper airplanes out of the apps and the 10 that go the farthest get in."

If you say your boards are especially difficult I'm definitely not gonna disagree, but to think PDs are selective out of necessity and not just the fact that programs have the ability to make a cutoff at 240 and still have a sizeable pool of applicants is pretty illogical.
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So much fail in your post, you're giving me a headache. I don't know anything about Ortho or Plastics boards, you'll have to check the medical literature on that. The dermatology boards aren't just multiple choice questions with images and photographs. There are also microscope slides on real microscopes for dermpath as well.

A low-tier FM PD (your example) doesn't CHOOSE to take IMGs. They take them bc that's who they match. If they rank all Americans at the top and still end up getting the IMGs they ranked at the bottom, that means if they had not ranked those IMGs they would have gone unmatched as a program, and they would be screwed.

Dermatology PDs (like medical students, considering they were once med students) are very risk averse. Unlike IM, where you have tons of residents in a class who takes boards, in Derm, you have 2-3 residents per class. If any one of them fails boards, that goes back to the program who can get a citation by the RRC. Along with that, the literature points out the correlation between USMLE Step 1 score -- the In-Training Exam score during residency -- and passing the Derm boards. Even with that high marker, 5%-10% of first-time test takers of the Derm boards still fail. I don't get why it is so difficult for you to understand.
 
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DermViser said:
So much fail in your post, you're giving me a headache. I don't know anything about Ortho or Plastics boards, you'll have to check the medical literature on that. The dermatology boards aren't just multiple choice questions with images and photographs. There are also microscope slides on real microscopes for dermpath as well.

A low-tier FM PD (your example) doesn't CHOOSE to take IMGs. They take them bc that's who they match. If they rank all Americans at the top and still end up getting the IMGs they ranked at the bottom, that means if they had not ranked those IMGs they would have gone unmatched as a program, and they would be screwed.

Dermatology PDs (like medical students, considering they were once med students) are very risk averse. Unlike IM, where you have tons of residents in a class who takes boards, in Derm, you have 2-3 residents per class. If any one of them fails boards, that goes back to the program who can get a citation by the RRC. Along with that, the literature points out the correlation between USMLE Step 1 score -- the In-Training Exam score during residency -- and passing the Derm boards. Even with that high marker, 5%-10% of first-time test takers of the Derm boards still fail. I don't get why it is so difficult for you to understand.
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Let's try this. Say for whatever reason magically derm/ent drops in pay and starts to need to work more hours compared with other specialties. DV darling, are you still with me?

1. Do you suppose that the "quality" of the applicants would drop?
2. Do you suppose maybe the boards would be adapted to have more passing of a larger percentage of the dermatologists or do you suppose we'd just go without?

Also the Don Juan conceded that he couldn't quantify/qualify how difficult the derm board is.
 
I don't get how you apply your logic as it suits you. It is you who fail.

The combustion engine developed to take advantage of the properties of refined fossils fuels. We didn't build the engines first and then go hunting around for previously unknown exploding liquids. Standardized tests are like an arms race. They develop to distinguish between a competitive field when such measures are needed.

If derm...became inexplicably undesirable. Maybe by requiring weekends and heavy call. They might need to drop their standards just a bit to fill.

Do you ever notice the convenience of self-justifying ideas that also happen to massage the ego? Does it occur to you logic can suit situation if you take for granted certain elements of pre-determined truth?

Regardless. This conversation has become tedious. You can dominate it with volume and call it winning as you like.
 
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Nasrudin said:
I don't get how you apply your logic as it suits you. It is you who fail.

The combustion engine developed to take advantage of the properties of refined fossils fuels. We didn't build the engines first and then go hunting around for previously unknown exploding liquids. Standardized tests are like an arms race. They develop to distinguish between a competitive field when such measures are needed.

If derm...became inexplicably undesirable. Maybe by requiring weekends and heavy call. They might need to drop their standards just a bit to fill.

Do ever notice the convenience of self-justifying ideas that also happen to massage the ego? Does it occur to you logic can suit situation if you take for granted certain elements of pre-determined truth?

Regardless. This conversation has become tedious. You can dominate it with volume and call it winning as you like.
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Honestly, if a schmuck like me can score higher than all but 8 of the 450 other Derm residents in his PGY class nationally, surely we must be overselling its difficulty.

I don't even know how to titrate Retin-A.
 
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DermViser said:
Here's why: http://www.bloomberg.com/news/2013-...al-school-rejects-as-taxpayers-fund-debt.html

iGmDILFvMJqg.jpg
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Caribbean school #s look the same as U.S. D.O. school numbers - apart from the class size of 900 (seriously?) of Ross.
 
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Anastomoses said:
Let's try this. Say for whatever reason magically derm/ent drops in pay and starts to need to work more hours compared with other specialties. DV darling, are you still with me?

1. Do you suppose that the "quality" of the applicants would drop?
2. Do you suppose maybe the boards would be adapted to have more passing of a larger percentage of the dermatologists or do you suppose we'd just go without?

Also the Don Juan conceded that he couldn't quantify/qualify how difficult the derm board is.
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The information stays exactly the same. And as academic and research focused it is, that's not surprising. Do you think the textbook is going to automatically start decreasing in size and diseases will start disappearing out of books? I also think a huge plus for dermatology is that it's visual, there's a procedural component, and you can actually FIX the problem and SEE the results - hence the quality wouldn't drop by much.
 
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GuyWhoDoesStuff said:
Honestly, if a schmuck like me can score higher than all but 8 of the 450 other Derm residents in his PGY class nationally, surely we must be overselling its difficulty.

I don't even know how to titrate Retin-A.
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Yes, bc the latter definitely can't be looked up as it's agent specific. :rolleyes: Derm Boards were never meant to mirror actual clinical practice. The same way NBME shelf exams aren't necessarily correlative with the rotation.

Considering that you did well in your class even with preclinicals as letter graded, I think you give yourself a lot less credit than you should.
 
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DermViser said:
The information stays exactly the same. And as academic and research focused it is, that's not surprising. Do you think the textbook is going to automatically start decreasing in size and diseases will start disappearing out of books? I also think a huge plus for dermatology is that it's visual, there's a procedural component, and you can actually FIX the problem and SEE the results - hence the quality wouldn't drop by much.
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I can't help but think this must have been the same sort of delusional optimism the first proponents of communism had. I mean that in a nice way.
 
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GuyWhoDoesStuff said:
Honestly, if a schmuck like me can score higher than all but 8 of the 450 other Derm residents in his PGY class nationally, surely we must be overselling its difficulty.

I don't even know how to titrate Retin-A.
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So your field has evolved and engineered extreme selectivity. Such that steep rates are paid for cushy gigs. If you want help from the rest of us defending it's supposedly unapproachably difficult but nonetheless gravy practice from mere mortals you might want the profession's help as a whole: http://www.nadnp.net/?AboutNADNP.

Or maintain your current public demeanor. In which case:

37013.jpg
 
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Nasrudin said:
So your field has evolved and engineered extreme selectivity. Such that a steep rates are paid for cushy gigs. If you want help from the rest of us defending it's supposedly unapproachably difficult but nonetheless gravy practice from mere mortals you might want the profession's help as a whole: http://www.nadnp.net/?AboutNADNP.

Or maintain your current public demeanor. In which case:

37013.jpg
Click to expand...

I always have David Bowie's "Space Oddity" playing in my head when I read your posts.
 
Nasrudin said:
So your field has evolved and engineered extreme selectivity. Such that a steep rates are paid for cushy gigs. If you want help from the rest of us defending it's supposedly unapproachably difficult but nonetheless gravy practice from mere mortals you might want the profession's help as a whole: http://www.nadnp.net/?AboutNADNP.

Or maintain your current public demeanor. In which case:

37013.jpg
Click to expand...
Yawn. So much fail, so litttle time to explain (since you don't actually care). Summary: if you think a specialist can be REPLACED by a NP, you're gravely mistaken.
if you think a specialist can be REPLACED by a NP.
 
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Instatewaiter said:
And they could have lowered the bar get a 95% pass rate.
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You do know vast amount of money it takes to do a standardized oral exam, right? Why impose something on Derm you wouldn't do for IM or Cards?
 
DermViser said:
You do know vast amount of money it takes to do a standardized oral exam, right? Why impose something on Derm you wouldn't do for IM or Cards?
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What your point?

The orthopods could make the passing score easier for their oral exams and have a 95% pass rate. It belies to your earlier point that the derm boards are so difficult
 
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