Residency isn't forever, and young dermatologists on the verge of starting their careers must make big decisions. At the 2016 CalDerm Symposium, a continuing education seminar offered by the California Society of Dermatology & Dermatologic Surgery, a panel of experienced dermatologists offered insight and advice to dermatology residents about embracing their futures. They followed with more comments in interviews.
Here's a look at how several of the panelists answered some of the biggest questions facing these young derms:
How important are mentors?
The University of California at Irvine's Patrick K. Lee, M.D., is a strong advocate for mentors since they can serve as guiding figures throughout a dermatologist's career.
“Most of us get where we are thanks to brains, hard work and insecurity, which is really what drives a lot of us," he said to laughter.
As a result, he said, "you may be a bit hesitant. A lot of times you’re not sure what you’re able to accomplish. I really believe that mentors can really help shape you and see your potential."
Dr. Lee, professor and director of dermatologic surgery at UC Irvine Department of Dermatology, says residency is the perfect time to search for a mentor, especially since official mentor programs may be available.
“Find the person who's living the life you want to live and see if they'll counsel you,” he advises.
“The best type of mentor is someone you feel like you have a good vibe with. They can help you in the right direction even if they don't do what you want to do."
Is a fellowship a good idea?
Dr. Lee addressed the sentiment that most residents are just trying to finish training to start making money. He advised those who are thinking of careers in teaching to consider fellowships seriously.
If you have any aspiration for academics, you will need a fellowship, he stressed. He recommended that everyone consider this option.
“The issue is that you may not know you have academic aspirations until you are done. I've had several residents who weren't sure they wanted to go into fellowships at first and realized later they wanted to,” said Dr. Lee, who is the immediate past president of the California Society of Dermatology & Dermatologic Surgery.
A fellowship can lead you to your mentors, too, he noted. “Many of us are still very close to those who trained us.”
He encouraged the audience: “If you have any inkling that you might want a fellowship, go for it.”
What about a dermatopathology fellowship?
Linda Wong, M.D., a Kaiser Permanente dermatologist in the Los Angeles area, is a fan of dermatopathology ("dermpath") fellowships.
“I would encourage you to do dermpath. It helps you to at least know what you don't know, which is a very high level of knowledge to achieve,” she said.
“And it helps you judge and assess the accuracy of some of the results you get back, which helps you with the patients.”
However, in dermatopathology, "you're not directly working with the patients so they get to like and love you,” she noted. This can sometimes lead to a higher legal risk she cautioned. “A patient may say, 'I love my dermatologist,' but if you're just some name on a piece of paper, they may think, 'Who's that person? She must have been wrong.'”
Dr. Wong serves on the Board of Directors for the California Society of Dermatology & Dermatologic Surgery.
Should I go into private practice?
Jerome Potozkin, M.D., a Walnut Creek, Calif., dermatologist, noted that private practice is getting a bad rap.
“In general, people are afraid to go into private practice and feel they would be more protected by being in a large group,” he says. “People fear change whether it's the ACA or whatever the Trump Administration has in store for us.”
But, he told the young residents, “doom and gloom is good for you guys. It will scare people away from private practice so you’ll have a lot of opportunities," he says. “I’m really happy with what I do, and I love what I do."
Should I hope to run the office myself?
Dr. Potozkin cautioned the residents that being in charge has pluses and minuses.
“As a dermatologist, you can somewhat control your schedule in terms of seeing patients. You probably won’t be there in the middle of the night. But if you own your own business, you have two jobs. You have the job of being the provider of services and then you have the job of running a business.
"We don’t have the luxury of other fields where they can just leave work and not think about it. I have those days where I fantasize about what it would be like to be at Kaiser Permanente and not think about all those managerial things, staff and human resources.”
Who's the best person to take charge of a clinic? “Someone who's brave, independent, creative and wants to run their own business,” he says.
Dr. Potozkin also advises dermatologists to keep in mind three rules published in the Harvard Business Review:
1. Better before cheaper.
2. Revenue before cost.
3. There are no other rules.
Dermatology is a medical specialty involving the management of skin conditions. It is one of the most diverse specialties treating patients from all age groups with inflammatory, inherited, environmental, occupational and malignant skin diseases.
Dermatology is predominantly outpatient based within the hospital. However, patients with acute systemic upset or severe inflammatory or blistering skin disorders frequently require specialist care within a day-care or dermatology inpatient facility.
Dermatologists link closely with other specialities and we are frequently asked to provide consults on hospital inpatients.
Skin cancer comprises a large and ever increasing volume of a Dermatologist's workload and skin surgery is integral to the service. Complex skin cancer cases are discussed weekly at the Skin Cancer Multidisciplinary meeting. We work closely with our colleagues from Pathology, Plastic surgery, Ophthalmology, ENT & Oncology.
Dermatology training includes subspecialty experience in areas such as Paediatric dermatology, phototherapy/ photobiology, dermatopathology, allergic disorders and dermatological surgery. The field of medical dermatology has really taken off, with many dermatologists running specific chronic disease clinics for the patients on immunosuppressive therapy. The development and licensing of the biological therapies for conditions such as psoriasis have helped transform patient's lives. With new drugs continuing to evolve it is an exciting time for both patients and clinicians.
Most consultant dermatologists develop a subspecialty interest and are encouraged to spend time in specialised centres elsewhere in the UK or further afield. Participation in research and medical education is also encouraged.
Medical students unfortunately gain limited exposure to Dermatology, usually within the third year of studies, but the length of placement varies around the UK from none at all to 2 weeks. This is too short a time to secure a firm knowledge of the speciality, particularly when you consider that up to 20% of GP consultations relate to skin conditions.
Dermatology is a competitive speciality so career planning is crucial. It is important to demonstrate interest in the speciality and it is most valuable to gain clinical experience before pursuing higher specialist training. As an undergraduate there are Special Study Modules which are helpful at providing an insight to the life of a Dermatologist. Taster modules can also be arranged for foundation year doctors.
To further a career in Dermatology junior doctors are encouraged to apply for a core medical training post at either CT 1 or CT 2 level to gain experience in the speciality. ST3 posts are always competitive and full MRCP is required prior to taking up a training post. An alternative career path is as a specialty doctor in dermatology.
Dermatology specialist training is 4 years. During this time trainees are encouraged to attend a number of core specialty courses and meetings.
Training can be extended by 2 or 3 years if time is taken out to complete an academic degree to MD or PhD level. Recently the Specialty Certificate Examination (SCE) was introduced and this is now sat in year 2 of training.
So what is your week like Consultants will do 5 outpatient clinics, 2 ward rounds, attend the Skin Cancer MDM and carry out regular liaison ward work. Teaching of the medical students and junior doctors is built into the weekly timetable. Most UK units have a core teaching session, which all doctors attend, and this involves clinical cases, audit, journal club and guest lectures. On call varies around the UK, with many units having lost their on call service. Dermatology units who are still able to provide out of hours cover are on call from home.
So do you want to be a Dermatologist? It is a highly varied and rewarding specialty. You are very busy during daytime hours seeing a great mix of clinical cases and life is never dull I thoroughly recommend it!!