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. 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 personal YouTube 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.
What is Dermatology?
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 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 require 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 shortlist 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.
How to Become a Dermatologist
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 the 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.
Subspecialties within Dermatology
There are a handful of fellowships to choose from after residency, each lasting between 1 and 2 years.
Mohs Micrographic & Dermatology Oncology
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.
Pediatric dermatology 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.
What You’ll Love About Dermatology
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.
What You Won’t Love About Dermatology
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.
Should You Become a Dermatologist?
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 writing of this post. 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.
Thank you all so much for being fans of the MSI blog! What specialty do you want me to cover next?