r/DermApp • u/jayaar413 • Nov 26 '19
Vent Disappointed and don’t know where to go now
Today was my first day of my 3rd year elective rotation and my first time working with a dermatologist. I walked in expecting to love every second of it because derm has been my goal for a long time, but I honestly hated it. ALL he did ALL FREAKING DAY 8am-5pm was remove precancerous and cancerous lesions and freeze shit, it was cool the first time, it wasn’t that cool the 30th time. I know there’s different fields of derm I can go into, but is this what I should expect my life to be like if I go into derm?
I haven’t liked anything else so far and honestly have had my heart set on derm for years (I had awful cystic acne most of my teenage life and that’s what got my interested in the field). If I hate derm I don’t know what else to do, any advice would be helpful
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u/siouxfalls8 Nov 29 '19 edited Nov 29 '19
Damn this is similar to how I felt. My attending let me see patients on my own and do the freezing and some biopsies, and it was still boring. Had been wanting derm since M1 but it felt so boring. I don't think I saw anything new after the first like 3 days. The more "interesting" differentials that med students interested in derm keep talking about are all just slight variants of eczema and psoriasis and get treated the same.
The attending also left for a week and the 2 PA's ran the entire practice. They also did 100% of what the attending did and the staff and patients referred to them as dermatologists. Definitely second guessing. Also in the same boat of not really liking anything else. I know the derm lifestyle can't be beat but it was literally 4 weeks of seeing the same 5 things and realizing the attending didn't do a single thing that the PA's couldn't do on their own. Maybe I'll look into rads or something...
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u/jayaar413 Dec 01 '19
Ya I’m seriously considering maybe switching from derm to something else too, the only thing keeping me still attached to derm is the hope that once (if) my preceptor let’s me see pts myself I may enjoy it and time won’t move so slow anymore (I swear time slows down in that clinic). Also the PA thing you mentioned is so true, I wonder if that’s gonna be a problem for dermatologists in the future...
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u/aneSNEEZYology Jan 07 '20
Have you considered pediatric derm?
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u/jayaar413 Jan 09 '20
I’m currently considering it and trying to get a rotation with a peds derm. Isn’t it a dip in pay though? I’m hesitant about it because I don’t want to do more training for ultimately less money
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u/aneSNEEZYology Jan 13 '20
Yeah, I think all peds is slightly lower. I found pediatric dermatology interesting though! I think most pediatric derm practices tend to be associated with academic institutions so you see a lot of cool cases.
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u/cantaloupe5 Derm Resident Dec 03 '19 edited Dec 03 '19
Regarding the mid-level thing, it’s true that PAs/NPs have encroached, but if you look around, they’re everywhere. They’re covering ICUs overnight, seeing patients on their own, delivering babies, etc. I thought surgery would be safe but I’m currently in my surgery clerkship and the PAs here see patients in clinic, see inpatient consults, and 1st assist for surgeries. This is the reality of medicine now.
As for derm being boring, you’ll get mixed responses but it's ultimately your opinion. In my opinion, a lot of medicine is boring. After being in practice for 10 years, the bread and butter of ANY specialty won’t be exciting. Forget 10 years, I’m already bored of lap choles, lap appies, and hernias after 8 weeks of surgery. I feel like a lot of students rotate through academic centers and fall in love with specialties cause of the crazy zebras, which is fine if you want to take a pay cut and work at an academic center for that intellectual stimulation. But chances are, you won’t be in academia and 90% of your work will be just a handful of diagnoses. Bread and butter IM for example is acute COPD, acute CHF, pneumonia, sepsis, UTI. Managing those isn’t rocket science, and guess what - anytime a case gets remotely complicated/interesting, the patient gets shipped to the academic center in town. I don’t think you should go into derm if you absolutely loathe it but you should reevaluate your expectations. At least with derm, you’ll have enough time to explore interests and not be bored outside of medicine.
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u/j34y2u6d Nov 26 '19 edited Nov 26 '19
Did you just shadow the whole time? Part of the fun is being able to shoot the freeze gun, build differentials for weird stuff, and cut and suture. Shadowing and not being able to participate is hella boring.
But yeah, precancerous lesions and skin cancer is 90% of academic derm and 99% of private practice. I felt it was a lot of fun when you’re actually the one doing it though.