According to Dr. Morris, she has a few patients in their 20s who come in for Botox. So they start getting Botox preventatively, and it works. I have a few that come in in their 20s because they never want to have a wrinkle, so they start early. This woman brought her daughter over and rolled up her sleeves and asked me to look at a mole. I was with my mother, my mother-in-law, and all my friends. I also had a guy in a bank pull up his shirt to show me a mole. That kind of stuff really bugs me.
When that happens, I tell them they need to make an appointment, that I really need to look in better lighting and use a little scope that lets me see pigment.
I would never give an opinion without documenting what I see. Dermatology is not an easy specialty. Dermatology is a very visual specialty. Morris remembers one patient in particular, a little boy who was born as a collodion baby. His skin is red and it just peels off, and he flakes all the time. As an infant, there were some mistakes made in the hospital and he lost his hand. You just can't. I never give those diagnoses over the phone.
I always want to have more time with the patients and have [next steps] lined up for them. Your job, as a derm, is to assure patients that you will be there to help them manage their disease or condition along the way. 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. 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. 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.
Patients generally only need local anesthetics. 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.
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. This first year is called your intern year. After that, dermatology residency is 3 years. 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 and the average Step 2CK score is There are a handful of fellowships to choose from after residency, each lasting between 1 and 2 years. Mohs surgery requires a 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. 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. With my family around me I opened up that thin envelope to learn my fate: Dermatology.
Each day I get to incorporate medical, cosmetic, and procedural dermatology, see patients of both genders of all ages, treat skin cancer, and there are always interesting rashes to keep my on my toes; no day is like another.
The patients make it worth it. You love many different specialties in med school. The skin is often the window to underlying medical conditions, so a good understanding of other conditions is key to being a strong dermatologist. I often work with pathology, rheumatology, ob-gyn, primary care, oncology, plastic surgery, ophthalmology, and psychiatry to name a few specialties.
You like a fast-paced environment. Dermatology is fast-paced due to the number of patients typically seen in a given day. It is a high volume specialty. There are pros and cons to this, but for me I like interacting with people and it energizes me.
You like to work with your hands. Of course, you can choose if you want to do more or less procedures when you practice. Everyday there are typically shave and punch biopsies to help with diagnoses or testing suspicious skin cancers, injections such as for acne, keloids, and hair loss , laser treatments, skin surgeries, and cosmetic treatments such as fillers, neuromodulators ie botox , chemical peels, and more.
You can choose what you are most interested in, whether it is one of the previously mentioned procedures, or all of them. You like to study.
Dermatologists have more typical office and on-call hours than other specialities, but dermatology is a very study intensive specialty. Plan to spend a lot of time after clinic studying, particularly in residency. This is what makes a dermatologist unique.
You want to save lives. There are a lot of skin exams in a dermatology practice. One person dies of melanoma every hour.
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