So you want to be a dermatologist. You like the idea of treating nails, hair, and the
largest human organ, the skin. Let’s debunk the public perception myths of what it means
to be a dermatologist, and give it to you straight. This is the reality of dermatology.
Dr. Jubbal, MedSchoolInsiders.com.
Welcome to our next installment in So You Want to Be. In this series, we highlight a
specific specialty within medicine, such as dermatology, and help you decide if it’s
a good fit for you. You can find the other specialties on our So You Want to Be playlist.
A lot of you asked for dermatology, so that’s what we’re covering here. If you want to
vote in upcoming polls to decide what future specialties we cover, make sure you’re subscribed.
If you’d like to see what being a dermatologist looks like, check out my second channel, Kevin
Jubbal, M.D., where I do a second series in parallel called a Day in the Life. Once the
world is back to a more normal baseline, we’ll be doing a Day in the Life of a Dermatologist.
Dermatology is the specialty that manages diseases of the skin, hair, and nails, and
involves both medical and procedural aspects. Skin may seem relatively straightforward,
but it’s far more complicated than it seems. A dermatologist can identify and treat more
than 3,000 conditions, including eczema, psoriasis, and skin cancer, among others.
You can think of dermatology as falling within 4 main categories:
Medical dermatology deals with the general and common dermatologic concerns, such as
skin cancer, viral warts, acne, rosacea, hair loss, and rashes. This also includes some
procedures such as injections, skin biopsies, and excisions.
General dermatology is very predictable, with fast-paced office visits but also longitudinal
continuity with patients. At academic institutions, you can expect to manage more complex skin
diseases as well.
It’s much more than just acne though. The conditions they treat are wide ranging, such
as inflammatory skin conditions, psoriasis, eczema, ulcerative skin conditions, and blistering
skin conditions that may requite systemic medications or chronic management.
Aesthetic dermatology primarily deals with cosmetic concerns, such as rhytides and wrinkles,
volume loss, hyperpigmentation, textural changes, scar revisions, and redness — all through
cosmetic procedures and laser technologies. This is also clinic-based with in-office procedures.
Procedures include blepharoplasties to fix droopy eyelids, rhytidectomies also known
as facelifts, fat transplantation, laser resurfacing, chemical resurfacing, microdermabrasion, collagen
fillers, botox, sclerotherapy, and scar revision.
Surgical dermatology focuses on Mohs micrographic surgery, which is a precise surgical technique
used to treat skin cancer. Mohs surgeons don’t just do Mohs surgery, though. They often overlap
with simple excisions, as you would in general dermatology, as well as cosmetic dermatology
procedures.
While this is as surgical as dermatology gets, understand that these are still clinic-based,
in-office procedures. This doesn’t happen in the operating room. Patients generally
only need local anesthetics.
You’re also more likely to have repeat customers. Not only do these patients need follow up
for monitoring their excised skin cancers, but once you get skin cancer, you’re also
at higher risk of getting another.
Inpatient dermatologists work as a consult to primary services in the hospital, such
as internal medicine, pediatrics, or surgery, who are managing hospitalized patients with
dermatologic conditions. These dermatologists work in other capacities and have their own
clinical practices, but can be on call for the hospital.
There is a short list of dermatologic emergencies, and while there aren’t many, these are the
dermatologists who would be providing recommendations to the managing service.
Patients in this category can be very sick and develop skin diseases concurrently, or
alternatively the skin disease can be a systemic disease manifestation, telling the story of
what other disease processes are occurring under the surface.
After finishing medical school, you’ll complete a 1 year prelim year or transitional year.
This first year is called your intern year. After that, dermatology residency is 3 years.
There are a few combined internal medicine/dermatology 5 year programs, but there are only a few
in the entire country. The 1 + 3 model is much more typical.
In terms of competitiveness, dermatology is consistently the first or second most competitive
specialty in medicine, switching off with plastic surgery depending on the year. The
average Step 1 score is 249 and average Step 2CK score is 256.
Approximately half of practicing dermatologists are female, and about 2/3 of dermatology trainees
are women.
Dermatology residency is more cush than most, and you’ll on average be enjoying fewer
and more predictable hours than even your nonsurgical colleagues.
There are a handful of fellowships to choose from after residency, each lasting between
1 and 2 years.
Mohs surgery requires a 1-2 year fellowship. The joke is that these people wanted to become
surgeons, but also wanted a good schedule and lifestyle. Compared to other dermatologists,
the stereotype is that they may have a lower tolerance for mistakes, work at a fast pace,
and tend to be perfectionists.
This is the specialty for those dermatologists who enjoy working with their hands and the
process of spending years fine tuning nuanced technique.
Cosmetic dermatology is a 1 year fellowship. You’re more likely to be doing private practice,
and to be successful here you should have an entrepreneurial inkling.
If you love children and want to work with kids, but also love skin, then pediatric dermatology
is a good fit for you.
Peds derm is a 1 or 2 year fellowship for those who want to work with the pediatric
population exclusively. While generally clinic-based, this may require visits to the operating room,
usually at academic institutions, as kids sometimes require sedation to tolerate procedures.
Dermatopathology is a 1 or 2 year fellowship after completing either a pathology or dermatology
residency. You may choose to be focused exclusively on dermatopathology, or you may choose to
have a few days of clinic. This is ideal for those who are highly visual, love recognizing
patterns, and love histology. Plus, it offers a highly predictable schedule, as you’re
looking through a microscope for most of the day.
There’s a lot to love about dermatology, and it attracts a large number of medical
students. It’s no surprise that it’s one of the most competitive specialties. In a
recent Medscape Lifestyle, Happiness, & Burnout Report, dermatology ranked first in terms
of happiness compared to other specialties.
Dermatology is a highly visual field with high clinic volume that’s relatively fast-paced
compared to other specialties. It’s also a field that allows for both medical aspects
and procedural aspects, which is appealing to someone who desires continuity with patients
in addition to performing detail-oriented procedures.
You may not fully appreciate this now if you’re early on in your training, but dermatologists
also spend less time than the average physician on paperwork and administration. That’s
a huge deal.
And if you appreciate beauty in your work, in a visual way, cosmetic dermatology is an
attractive option — no pun intended.
One of the strongest draws is the excellent lifestyle and work-life balance that isn’t
afforded by most other disciplines within medicine. Given the outpatient nature, low
acuity of medical conditions, limited call, and flexible workdays, dermatologists generally
have more control over how they work.
It also doesn’t hurt that dermatologists are highly compensated, usually ranking in
the top 5 highest paid specialties in medicine — on average over $400,000 per year.
Dermatology isn’t perfect. One of the most obvious downsides is how insanely competitive
it is. It’s a desirable specialty, but a small specialty, with a limited number of
residency spots. For this reason, many applicants find it necessary to take several years off
during medical school to bolster their application with dermatology research to improve their
chances.
You may find the field often misunderstood. Those who don’t fully understand and appreciate
the specialty may dismiss your profession as being only skin-deep. Typical surgeons
often won’t consider your work real surgery, even if you specialize in Mohs.
The fast-paced nature of clinic is a double edged sword. On one hand it’s exciting and
engaging, but on the other hand it may not suit all personalities, particularly if you
want to spend more time with a patient.
How can you decide if dermatology is a good fit for you?
If you love the pathologies related to skin, enjoy working in clinic at a fast pace, like
procedures, but not so much to be surgical, and are willing to be a self-directed learner
to tackle the amount of independent study that is required to be successful, then dermatology
may be worth considering.
And finally, dermatology is one of the most competitive specialties, so you’ll need
to be willing to put in the time and effort to become a top student. That translates to
more than just high board scores, but also playing the research game, being a leader,
and acing your clinical rotations.
And who better to learn from and be mentored by than dermatologists themselves. Big shout
out to the dermatologists at Med School Insiders that helped me in the creation of this video.
If you need help acing your MCAT, USMLE, or other exams, our tutors can maximize your
test day performance. If you’re applying to medical school or dermatology residency,
our dermatologists can share the ins and outs of what it takes and how to navigate the highly
competitive process most effectively. We’ve become the fastest growing company in the
industry, and it’s no surprise. Our customers love us because we’re committed to delivering
results, period. Learn more at MedSchoolInsiders.com .
Thank you all so much for watching! What specialty do you want me to cover next? Leave a comment
down below, and make sure you’re subscribed to vote in the upcoming polls. If you enjoyed
the video, hit that thumbs up button to keep the YouTube gods happy. Much love to you all,
and I will see you guys in that next one.