Thursday, June 21, 2012

Why I Didn't Do Dermatology

I've mentioned on this blog before that I had good grades and scores in med school, although not freaking awesome. So it seems like the reason I didn't do dermatology should be obvious: I wasn't freaking awesome. And that's what you need to be to match in derm these days.

But between you and me, I actually did have a possible opportunity to do derm. My cousin is a big cheese dermatologist and assured me multiple times that he'd get me a residency spot if I wanted it. I don't know if this was a true offer, but needless to say, I didn't take him up on it. It was tempting, for sure. Dermatologists make good money and have a great lifestyle. I like procedures and dermatologist get to do lots of those. Part of the reason I didn't try was because of location (yet again), but there were some other reasons:

1) I looked at the people in my class who matched in derm and I thought about those people being my colleagues for the rest of my life, and I felt ill.

2) I felt that as a dermatologist, the pressure to have perfect skin would be too intense, and would cause me to break out.

3) I have a slight inherited tremor in my hands that I worry might get worse with age and keep me from doing really fine work.

4) I didn't like the idea of getting a spot through nepotism. Everything I've ever gotten in my life was earned through my own hard work and it didn't feel right to take a coveted spot just because of connections.

All that aside, I feel angry at the culture of dermatology. When I was in med school, a young girl came to talk to our class about her experience with bullous pemphygoid and how it inspired her to want to be a dermatologist, and all I could think was, "Good luck with that." Here was a person who was genuinely interested in skin conditions, yet she had very little chance of becoming a dermatologist because it's so damn competitive. Your dermatologists don't have a passion for skin, trust me.

I've heard that the number of dermatology spots are intentionally limited, so that it continues to stay competitive and salaries remain high. This is why we have to wait so long to see a dermatologist. Plus a lot of the females who go into the field do it for lifestyle, and the first thing they do after graduating is to cut back to parttime. I can't personally throw stones at that, but it kind of sucks to limit the number people going into a field, when many of those people don't intend to work full time.

In general, I don't think it says anything great about physicians that the most competitive fields are the ones with the highest pay and best lifestyle. But again, can't throw stones.

50 comments:

  1. You nailed it. Derm MD I knew from FancyPants Medical school/residency was a male who worked 4 days a week and hated it. Wished he became a musician instead (his true passion).

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  2. The one girl I knew who matched into Derm at my school was really quite nice. However, she studied HARD (at levels no one could match). Furthermore, she studied everything without joy or love of the material. While most of what we study in medical school is dry and hard to love, there is always something that catches our attention. With her it seemed that nothing but matching derm would make her happy. It was a little sad to see, but in a sense I really admired her focus.

    PDG

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  3. Very interesting, because it's a little different in South Africa... there is a shortage of dermatologists working in public hospitals (not really a shortage in private), and med students tend to consider it "lovely but lame".

    The dermatologists on my rotation were also awesome people, but obviously very bright.

    I think #2 would be a very valid reason for me too, and #4 is a good reason too.

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  4. Wow, it's so different here. Derm is usually for the ones who don't have the best grade. I had a friend who really wanted to do derm, but changed his mind against it, because he felt he was too smart for it, and would rather go into neuro. It's kinda sad how these things work.

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    1. Where! Idiot what location? LOL

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  5. I also think it is funny how the general public has no idea about all this nonsense. There's too much physician on physician hate out there.

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  6. I thought about derm, briefly, after I got my step 1 score. My own doctor's wife does derm. She works 2 days a week. My doctor works 5. He told me she makes more than he does. Compelling, if you like it, not worth it if you don't,

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  7. My biostatistician (who is Australian) told me that in Aus, Dermatologists are kind of like dentists.

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    1. I'm an Aussie doc. He must have been kidding? I reckon dermatology in Australia is at least as competitive to get in as in the States if not more so. Only a few spots each year.

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  8. Fizz, can you do PM&R even though you did it?

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    1. Believe it or not, I actually understand this request. I'll try to do it.

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    2. Haha...thanks! :)

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  9. Could you do rad onc? It's such an obscure field yet very attractive to a lot of students..

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    1. I would if I knew anything about rad onc or even considered it for a half second.

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  10. MS3 here. I have the grades and board scores for derm, but sadly I don't have the heart. You can't beat the pay (and I'm going to be over 300k in debt) for that lifestyle (and I'd like to be involved in my kids' lives), so I feel like I SHOULD be gunning for derm. Like you said, however, I look at the people in derm... and that's just not me. I'm more excited by the idea of running around an ED at 3am with no makeup and my hair in a messy bun than the idea of sitting in a cushy office all day evaluating/treating acne, rashes, skin cancers, etc. Maybe that will change someday. I think I'll end up in IM subspecialty, EM or critical care... but I'll always wonder if I could have done derm without wanting to shoot myself in the face.

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  11. Hi there! I'm a nursing student & also a recent patient of a dermatologist.

    I live in a mid-sized city in Northern Ontario and the dermatologist who has an clinic here (make that a doctor's office/expensive cosmetic/aesthetic procedure clinic) is the only dermatologist for all of Northern Ontario with a very long waiting list.

    Last year I got a referral from my family doctor to see her for some issues I was having with slight hirsutism (which ended up only being more of a inheritance compared to a hormonal problem, according to my bloodwork.) I think the only reason I was able to see her so quickly was also because I made an appointment for laser hair removal at her clinic, and since I was already there for that and they were getting paid for the consult, the doctor saw me.

    She prescribed me 100mg of spironolactone for its androgen reducing qualities (my nursing drug guide has done me well) and I'm just about to refill my prescription, which will give me at least 100+ days until I need to renew my prescription.

    My only problem is that I'll probably need to make the appointment now to be seen in time to refill the prescription.

    I mean, I could be wrong seeing as this is my first time seeing a dermatologist and being prescribed medications, so I really don't know what the routine is for renewing prescriptions, but I have a feeling it's not going to be working in my favour.

    I just thought this post was really interesting (and I now I realize I probably didn't need to post my whole life story here) and I wanted to share my experience with a derm who seems to be like the ones you mentioned in the above post.

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  12. haha, here's it's known as dermaholiday, and really isn't competitive!

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  13. You are really bitter about not being a dermatologist. That's unfortunate. There are a lot of Derms who are excited and invested in treating skin disease. Most of us do work full time. You should work on giving accurate information. There is a shortage of dermatologists because the federal government refuses to fund more spots as they do not feel that the field is a priority and would rather fund spots for primary care. Try reducing the vitriol and increasing the factual information. Thanks....

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    1. I'm not bitter about not being a dermatologist, since as I said, I could have gotten a spot if I wanted one. I *am* bitter about the incredibly unpleasant interactions I've had with future dermatologists that I worked with. And hey, here's one more! Way to prove the stereotype.

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  14. You have no idea at all if you would have got into a residency position, the influence of 'one big cheese' is often overstated, decisions are made by committees to avoid such influence.

    You need good grades because it is a demanding speciality with hundreds of disease that are difficult to diagnose.

    Sorry you did not like your colleagues in Medical School. I wont what they would have thought of you?
    Shame thats enough for you to tar an entire speciality.

    There are 'shortages' of dermatologists because 25% of the population has skin issues and all the other doctors out there know very little about skin problems.

    Do you know for sure that the person with experience in BP did not get in? Places do get filled you know, and a lot of the time its not the best and the brightest even though it should be. Just wanting to do something does not automatically get you in, how many people did you beat out to get into medical school? I bet some of them were really passionate about wanting to be a doctor. Passion alone does not get you there.

    Forgive me for not "trusting you" that doctors who choose and work hard to get into a specialty they love "do not have a passion for skin". Your comments really show you have no idea what you are talking about and belittle the many doctors who work hard for people suffering with skin disorders.

    There is no one specialty better than another. A dermatologist is as much use to a person having a heart attack as a cardiologist is to someone with lichen planus. We all do good work, we are all needed. Your simple minded dismissal of a specialty reveals more about you than the specialty.

    here let me save you some finger taps
    "well...uhhh..you just proved (my made up) stereotype"

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    1. The few people in my class who matched in derm were universally despised by the rest of the class for their behavior in clerkships. One of them was so passionate about skin that on every clerkship he was on, he swore to the attendings he was interested in that particular specialty. On peds? "I want to be a pediatric cardiologist!" Their behavior was abominable. It's a shame that's what it takes to match in derm, but it's just a fact.

      Actually, you've just inspired me to write a new post about competitiveness! Thanks! To be continued....

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    2. Hi Fizzy, I'm a 3rd yr med student interested in dermatology. I just stumbled across this blog and felt pretty disheartened by the broad brushstrokes with which you dismiss an entire group of people. Do you believe that all current and future dermatologists are horrible people? Is it likely that many are quality people genuinely interested in being great medical practitioners? Besides the many other reasons that propagating a disparaging stereotype is a bad idea, it alienates and hurts the good people in the group too.

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    3. I agree with the above. I'm passionate about derm and i actually ended up leaving a comfortable life as a dentist once I realized I was more interested in the patients skin conditions than their teeth. Now doing derm, im still passionate about it than when i started. Its upsetting the perceptions that people have of dermatologists. Yes there are nutheads in every professions- but dont categorize all of us.. Some of us are VERY passionate about what we do and it is a very satisfying career. Beldar, i wouldnt take this post to heart and just focus on why you want to be in the profession.

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    4. It's also incredibly accurate, and I should know as I interviewed for Dermatology residency this year. And before I am called "bitter', I matched, so I have no dog in this fight.

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  15. What are derm wannabes/residents like, exactly?

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  16. Loved this post. #1 was the major reason I can't stand people applying into derm, either.

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  17. A good dermatologist has to be a pathologist, a surgeon, a paediatrician, a mini-geneticist and an elderly care physician as well as everything else. Being a good dermatologist is a challenging career for those who like to diagnose with their eyes.

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  18. I enjoyed this post because I have struggled with many of the same issues. I have always really liked the skin, and I am interested in derm for all of the reasons listed by the person in the last post. However, I am different from many of the other students I see going into dermatology (and like you I have good grades, but I am not a baby genius).
    I have done a lot of work with the homeless, global health work, and public health oriented projects. I love derm because of the diseases and manifestations, but I do not have the singular focus that many of the other dermophiles I see have. I will always need to serve the underserved, and I will always need to do projects that focus on broader aspects of medicine/health and patient care.
    Although I know many of the students in medical schools who are applying for dermatology fit the stereotypes... I have met many good dermatologists who clearly care about their patients and do not seem as cut-throat and narrow in focus as the stereotypical dermatology student.

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  19. I am doing my med in India. I have recurrent herpes labialis attacks (one attack a month, when i'm about to get my period.) And it's my dream to become a dermatologist. Should I go ahead? Is it going to affect my career? I really need some advice, preferably from fellow doctors.

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    1. take valtrex.

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    2. I take valcyclovir (zimivir)
      Valtrex is not available here. But that wasn't my question. Can I become a dermatologist with this problem?

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  20. I'm in derm and I think your view is too generalized. No need for the hate. Some of us really care a lot and work super hard for the patient and love the patient care aspects of it. I think you need to be careful about broad strokes as I know plenty of jaded physicians in all fields. There are caring doctors in all fields and not so caring ones as well. You can't predict this based on the field as I can name people that I wouldn't want as colleagues that entered every field of medicine.

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  21. Why the hate? How would you feel if others attack your field?

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  22. you are very rude

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  23. This comment has been removed by the author.

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  24. this article just makes you sound incredibly bitter.

    My husband matched into Dermatology a year ago and he is incredibly passionate about the field. He is even thinking about a Derm Pathology fellowship.

    Being an MA at a Derm office before med school is what inspired him to go to Medical School. He has been incredibly well liked by all of his attendings and professors in school. Basically, he's the exact opposite of everything that you described in your blog post.

    So, yeah, this makes you just sound incredibly bitter, and makes me feel a little sad for you.

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    1. It's also incredibly accurate, so I feel more sad that you can't see that.

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  25. VERY ACCURATE post! Derm has really shady characters involved. You will meet people that would throw you to the wolves to get ahead.

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  26. Greatest, truest post ever. Knew people in my med school who took amphetamines to study enough in order to gun for derm Disgusting.

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  27. Met lots of applicants for dermatology, one word, scumbags. I think the women in dermatology happen to be the worst. The biggest gunner smile in your face screw you behind your back types. They are very manipulative. Some of the guys weren't bad, other guys were very "feminine" and borderline gay. No offense to gay people because I don't want them associated with these derm types.

    There was lots of behind scenes drama and talk about splitting hairs. All they did was nitpick at each other and applicants. This was not unique to one office, it was widespread. I never seen a group of individuals drinking the Kool-Aid like they were. I could tell most didn't care about the field except that it was the challenge and prestige to say "I am a dermatologist". The women seemed more interested in their Coach purses and fancy dinner they went to.

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  28. I think your post is 100% on Fizzy. I went through the match this year for Derm (I matched - so no one can accuse me of being "bitter"), and some of the most entitled, narcissistic, gunners by far, were at my interviews. They knew exactly which boxes to check off and knew how to play the game well: "Oh, I just found out I loved Derm during my 3rd year!" -- Oh, is that why you started doing Derm research earlier than that? Yeah, uh-huh.

    Of course to faculty on interviews, they would talk about how much they "love" skin and wanted to be academic dermatologists and were completely different when not in front of a faculty member -- just wanted to cash out and loved the perceived prestige of Derm just being hard to get into, as well as, of course, lifestyle. I agree with above, the women were the worst in terms of materialism. The derm faculty elites are truly kidding themselves if they think they're recruiting people who want to further the field. Trust me, they could care less. It's quite sad.

    If you're a sociopath, with good grades (maybe helped with amphetamines as stated above), you'll get into Derm no question. Derm doesn't select for people like the girl above with bullous pemphigoid who have a true love for skin. It selects for the gunner.

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    1. That's exactly my opinion of them. Luckily (or not) is that over here, in Romania-central europe, the derms are those with the lowest grades and yes, basically careless. I know this from people that study medicine.

      It's funny, though, that even if they told me that, they still criticize me for not seeing a derm for my acne and say I don't know shit.

      I read everything I can about it and other conditions, I read clinical trials on drugs very often (i even studied dermatology at a make-up course...2000 pages of pics of conditions and text) so I already know what they're going to prescribe me...antibiotics and crap (already tried them, it came back) and finally, accutane. I'm just trying to decide if it's worth it, knowing the side effects.

      I also read about ingredients and their role...and now I wish I never used zynerit (zinc and erythromicine in a pool of irritating alcohol...) because after 2 courses of it my skin is permanently flaky AND oily...I assume it's seborrheic dermatitis...not a cool combo with my acne.

      I manage it with urea creams and i try to spend some time out (but not so much as to tan cause that's no good, either)...as for the acne, baker's yeast and less stress, omega 3 and good sleep help a lot. My biggest problems are that i have horrible sleep patterns (it gets worse after nights of going to sleep at 4 am) and i eat junk food sometimes (i gave up on dairy 90% and am trying to limit fried stuff and sugar...it's a vice and i'm addicted). Sleep problems affect me the most as I used to eat way more junk before but as I slept better my acne was only mild to moderate sometimes but always there. now it's moderate, i guess.

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    2. Hello. Next year, I will begin dermatology internship. In my country, it's very difficult to enter, but luckily I got it. I admit!The possibility of having a more confortable lifestyle and the afraid of not be so good in surgery, made me choose dermatology, instead of plastic surgery. It's not that I like most skin diseases. I had a skin disease, which affected me deeply and I realize the impact these diseases can have. I was followed for many years by a bad dermatologist. One day I came across a brand new dermatologist who changed my life. In that day, I decided I wanted to be like her.
      This year I made a plastic surgery stage and I fell in love with this area. It is wonderful to help someone who feels different because he had a disease or an accident.
      But i think i will be a better dermatologist and i hope i can change people life too.

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  29. I want to add my two cents. I'm a dermatology resident right now but I was a nontraditional applicant who was scared away from the field because of the rumors about what it takes to match. I did my first dermatology rotation in June of my third year, three months before residency applications were due. I was half hoping I WOULDN'T like the field because actually changing my career path was extremely difficult. I ended up falling in love with derm, the overlap between medicine and derm mixed in with procedures, and the impact that dermatologists could make for people with debilitating skin disease (bullous disease, bad psoriasis, cutaneous B cell or T cell lymphomas, or even cutaneous manifestations of systemic disease). I wrote about my entire journey recently in a blogpost (http://www.teawithmd.com/2016/01/the-ups-and-downs-in-my-path-to-dermatology/). I wanted to share my story here because I definitely wasn't the "typical derm gunner." I had average board scores and was not in the top of my class. I did basic science ophtho research for years. I focused my time in med school on my extracurricular activities, including spending a year off doing medical journalism at the WHO and at NBC in New York. I think that if you think derm is really what you want to do, you can show that in ways OTHER than just research and board scores. Not all dermatologists are gunners who step on others who get ahead; in fact, if we notice that kind of behavior in an applicant, we tend to NOT want to accept those people. Bottom line is, if derm is what you really love and what you want to do, go for it. Don't be scared off by the rumors.

    Joyce
    http://www.teawithmd.com/2016/01/the-ups-and-downs-in-my-path-to-dermatology/

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    1. Joyce, great advice! The original author of this post obviously just wanted to tear down a specialty based on stereotypes. It makes me so mad that people trash dermatology as a field for people who only want a certain lifestyle/money/prestige. It's more important to be open minded!

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    2. Note there's no prestige in dermatology. Lifestyle and money, yes.

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  30. I don't find you bitter, I don't find your post inaccurate either. I just feel that you are very restricted in your view about Derma Residents\Dermatologists in general. You're only focusing on the USA residency program and by doing so insulting and ignoring the rest of the world, where people go through the residency because they want to help out people (like many physicians) while being interested more about their skin.

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