Dermatology vs orthopedics

[tcerm16]

Hey everyone,

I'm a third year medical student having a tough time deciding between dermatology and orthopedic surgery. I would appreciate any feedback on the pros and cons of each.

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[Substance]

Money is killer in both.

Time is better in derm.

Winner = derm.

 

[DOCTORSAIB]

Hey everyone,

I'm a third year medical student having a tough time deciding between dermatology and orthopedic surgery. I would appreciate any feedback on the pros and cons of each.

What are some similarities between derm and ortho?

 

[Dral]

I think most of the similarities lie in the fact that you'll be a specialist if you're in one of these fields. I guess it just depends on which type of specialist you'll be. Derm has a surgery aspect, but obviously not nearly as much as ortho.

Both have a lot of clinic, but obviously derm is for the most part a clinic field, while ortho uses clinic mostly to get people in the OR (and follow up with them).

As far as I can tell, consults are a lot more of a component of Ortho. That's not to say that Derm doesn't have a lot of consult time, but from my limited experience, the orthopods at the hospital I'm at get slammed with consults (especially to the ED).

On medicine service I was following a patient with a kinda nasty superficial knee infection. You'd think there would be a derm consult...nope...consult Ortho in case it might go into the joint space. heh.

 

[DOCTORSAIB]

I think most of the similarities lie in the fact that you'll be a specialist if you're in one of these fields. I guess it just depends on which type of specialist you'll be. Derm has a surgery aspect, but obviously not nearly as much as ortho.

Both have a lot of clinic, but obviously derm is for the most part a clinic field, while ortho uses clinic mostly to get people in the OR (and follow up with them).

As far as I can tell, consults are a lot more of a component of Ortho. That's not to say that Derm doesn't have a lot of consult time, but from my limited experience, the orthopods at the hospital I'm at get slammed with consults (especially to the ED).

On medicine service I was following a patient with a kinda nasty superficial knee infection. You'd think there would be a derm consult...nope...consult Ortho in case it might go into the joint space. heh.

I was being a bit facetious when I asked that question. It's clear that both are specialities and both do consults.

But this could be said for many fields -- derm vs ophtho, derm vs ent, derm vs...you get the point.

It sounds to me that the OP has no "real" reasons for wanting to pursue derm vs ortho as the two are vastly different specialties.

Some soul-searching and mentorship are in order. I'll let the derm residents take over from here.

 

[moinmoin]

Crazy as it sounds, I am in the same boat as the OP. I had been on the Derm track (i.e. research year, net-working, etc) but recently had an event that really sparked an interest in orthopedics. Maybe the OP and I are the only ones but it is a decision I will be struggling with for the next couple of months. I'll probably end up in derm but still, I feel the OP's pain...

 

[sore eye asses]

i was gung-ho derm since day 1 of medschool, and the only thing that made me waver (for a nanosecond) was my ortho rotation in 4th year. So much fun! Then I thought about the residency, and the call, and the hospital work, and I had a small stroke (which conveniently obliterated the small portion of my brain that had entertained the thought of a career in ortho).

 

[starbuckscoffee]

It annoys me when people assume that someone is not sincerely interested in a field or interested for the "right reasons" just because the person is interested in 2 fields that don't have a ton in common. Many people enjoy multiple rotations, even if they have nothing in common. It's not like there is one field that each person is destined to do.

On that note, who is to say what the right reasons are for pursuing a specialty. Obviously we all know that on residency interviews there are certain reasons you should give for your specialty choice and others that should stay out of it (i.e. easy lifestyle, money, prestige, etc). However, I think everyone who cares about things like earnings/lifestyle should factor these things into his or her career decision. As long as you dedicate yourself to your chosen specialty and do the best job that you can do, who cares if you went into it partially for the money or the prestige or the lifestyle.

Now to answer the OP's question:

I don't know a ton about the pluses or minuses of ortho since I never really considered this as a career option, so I'll stick to derm.

POSITIVES OF DERM
1. Continuity of patient relationships
2. Healthy patients
3. Make a real difference in happiness/self esteem
4. Low stress, few emergencies
5. Call is very light, good lifestyle
6. $$$$$
7. Interesting diseases, lots of variety (from acne to cutaneous manifestations of connective tissue disease)
8. Combination of medicine, path, surgical procedures
9. Visual diagnosis- don't have to take long histories
10. Very little inpatient work!

NEGATIVES OF DERM
1. Some of the diseases are pretty gross
2. Some disrespect from other physicians who think derm isn't "real medicine"
3. Hardest specialty to get into
4. Most procedures are pretty small (negative if you're into more gen surg type stuff)
5. Boards are annoying- have to learn lots of useless stuff about very rare diseases (I hate genetic syndromes)

I was being a bit facetious when I asked that question. It's clear that both are specialities and both do consults.

But this could be said for many fields -- derm vs ophtho, derm vs ent, derm vs...you get the point.

It sounds to me that the OP has no "real" reasons for wanting to pursue derm vs ortho as the two are vastly different specialties.

Some soul-searching and mentorship are in order. I'll let the derm residents take over from here.

 

[eddie13231]

It annoys me when people assume that someone is not sincerely interested in a field or interested for the "right reasons" just because the person is interested in 2 fields that don't have a ton in common. Many people enjoy multiple rotations, even if they have nothing in common. It's not like there is one field that each person is destined to do.

On that note, who is to say what the right reasons are for pursuing a specialty. Obviously we all know that on residency interviews there are certain reasons you should give for your specialty choice and others that should stay out of it (i.e. easy lifestyle, money, prestige, etc). However, I think everyone who cares about things like earnings/lifestyle should factor these things into his or her career decision. As long as you dedicate yourself to your chosen specialty and do the best job that you can do, who cares if you went into it partially for the money or the prestige or the lifestyle.

Now to answer the OP's question:

I don't know a ton about the pluses or minuses of ortho since I never really considered this as a career option, so I'll stick to derm.

POSITIVES OF DERM
1. Continuity of patient relationships
2. Healthy patients
3. Make a real difference in happiness/self esteem
4. Low stress, few emergencies
5. Call is very light, good lifestyle
6. $$$$$
7. Interesting diseases, lots of variety (from acne to cutaneous manifestations of connective tissue disease)
8. Combination of medicine, path, surgical procedures
9. Visual diagnosis- don't have to take long histories
10. Very little inpatient work!

NEGATIVES OF DERM
1. Some of the diseases are pretty gross
2. Some disrespect from other physicians who think derm isn't "real medicine"
3. Hardest specialty to get into
4. Most procedures are pretty small (negative if you're into more gen surg type stuff)
5. Boards are annoying- have to learn lots of useless stuff about very rare diseases (I hate genetic syndromes)

Very nice post. I will also add that there is a variety of patient population: men, women, children, old people (of course). Pts also seem to care a lot about their skin and take an active role in its health which is nice to see.

 

[moinmoin]

i was gung-ho derm since day 1 of medschool, and the only thing that made me waver (for a nanosecond) was my ortho rotation in 4th year. So much fun! Then I thought about the residency, and the call, and the hospital work, and I had a small stroke (which conveniently obliterated the small portion of my brain that had entertained the thought of a career in ortho).

My wife is hoping that I have that same stroke. I probably will.

Thumbs up to starbuckscoffee's post as well. Hate Howard Schultz but love your post.

 

[DOCTORSAIB]

It annoys me when people assume that someone is not sincerely interested in a field or interested for the "right reasons" just because the person is interested in 2 fields that don't have a ton in common. Many people enjoy multiple rotations, even if they have nothing in common. It's not like there is one field that each person is destined to do.

Calm yourself son. Where did I say people are "destined" for a field? I didn't.

You can find two (even three) rotations interesting but when it comes to picking a CAREER, having a difficult time choosing between two VASTLY different fields shows serious lack of insight into said field(s). Which is why I said the OP needs some soul-searching and/or mentorship.

 

[sore eye asses]

Calm yourself son. Where did I say people are "destined" for a field? I didn't.

You can find two (even three) rotations interesting but when it comes to picking a CAREER, having a difficult time choosing between two VASTLY different fields shows serious lack of insight into said field(s). Which is why I said the OP needs some soul-searching and/or mentorship.

I did a solid year of sole-searching, but could only find Tilapia. This is proof positive that it takes more than merely searching for fish when choosing your career in medicine.

I dispute doctorsaib's claim. You can want to do two separate things. Matter of fact, I say you pioneer a new field of orthoderm. You will be known around the world as the periosteal whisperer.

 

[DOCTORSAIB]

I did a solid year of sole-searching, but could only find Tilapia. This is proof positive that it takes more than merely searching for fish when choosing your career in medicine.

I dispute doctorsaib's claim. You can want to do two separate things. Matter of fact, I say you pioneer a new field of orthoderm. You will be known around the world as the periosteal whisperer.

You are one funny cat.

 

[Dermocrat]

having a difficult time choosing between two VASTLY different fields shows serious lack of insight into said field(s).

I think you're over-analyzing. He/she just likes two things. It implies no lack of insight. Sure, he needs to think about it some more, because in the end he can't rank both number one, and it would be a huge waste of money and time to apply for both.

 

[starbuckscoffee]

I think you're over-analyzing. He/she just likes two things. It implies no lack of insight. Sure, he needs to think about it some more, because in the end he can't rank both number one, and it would be a huge waste of money and time to apply for both.

I agree. Hey, you could always do sports derm ...yes, it is a field (most of the literature deals with treatment of infectious skin diseases in wrestlers).

Going to guess this wouldn't interest you though.

 

[FixItUp Chappie]

Hey everyone,

I'm a third year medical student having a tough time deciding between dermatology and orthopedic surgery. I would appreciate any feedback on the pros and cons of each.

Believe it or not, when you sit down and have a beer with a few derm attendings you learn all kinds of things...including that your problem is not uncommon at all.

I have had several such conversations since matching into derm and two of my mentors have expressed to me that they found themselves in the same exact situation during their 3rd year.

While monetary aspects of the two fields are similar, I think the determined the fields are similar because they both allow for well-rounded patient care, in a specialty setting with (often) rapid and visible improvement in the patient's overall well being.

So, if you're suns out guns out jacked...go ortho. If not - go derm.

 

[asmallchild]

Believe it or not, when you sit down and have a beer with a few derm attendings you learn all kinds of things...including that your problem is not uncommon at all.

I have had several such conversations since matching into derm and two of my mentors have expressed to me that they found themselves in the same exact situation during their 3rd year.

While monetary aspects of the two fields are similar, I think the determined the fields are similar because they both allow for well-rounded patient care, in a specialty setting with (often) rapid and visible improvement in the patient's overall well being.

So, if you're suns out guns out jacked...go ortho. If not - go derm.

We have a MOHS surgeon who was actually gungho ortho before doing an ortho rotation and realizing he absolutely hated it. He was lost, adrift at sea, before stumbling upon Grand Rounds in derm and the rest is history.

So it does happen

 

[moinmoin]

I was cruising around orthogate.org the other day and saw someone with a user name "asmallchild." Were you once a closet ortho-liker as well or are there more than one small children lurking around internet forums?

 

[asmallchild]

I was cruising around orthogate.org the other day and saw someone with a user name "asmallchild." Were you once a closet ortho-liker as well or are there more than one small children lurking around internet forums?

hahaha, I don't think I'm quite big enough to make it in the ortho OR so I never really developed that side interest

although clearly this person has exquisite taste in selecting a SN

 

[N-Surge]

I was pretty bent on Neurosurgery before Dermatology. There are stranger things. At least melanoytes come from the neural crest.

To the OP; I don't think you can go wrong either way. I think this will definitely be a question of life style.

 

[basupran]

Depends, how much can you bench?


<315 lbs, derm
>315 lbs, ortho

 

[moinmoin]

Depends, how much can you bench?


<315 lbs, derm
>315 lbs, ortho

Looks like it's derm for me. Could I substitute mile-time for bench press?

 

[basupran]

Looks like it's derm for me. Could I substitute mile-time for bench press?

Hmmm, can you do a sub 7 min mile?

 

[moinmoin]

Hmmm, can you do a sub 7 min mile?

I can get off my couch and run a sub 6 minute mile. Maybe that is still a derm thing... ha ha.

 

[starbuckscoffee]

I can get off my couch and run a sub 6 minute mile. Maybe that is still a derm thing... ha ha.

I think pretty much every other person I met on the derm interview trail was a runner, so either running is a medicine thing or a derm thing

I too am a runner, although I can't do sub-6 min milers anymore. I could easily do sub-7 though

 

[swman]

I think pretty much every other person I met on the derm interview trail was a runner, so either running is a medicine thing or a derm thing

I too am a runner, although I can't do sub-6 min milers anymore. I could easily do sub-7 though

Runner here too, about to apply to derm. I've also noticed the trend.

 

[ShaveBiopsy]

i'm not a runner...but i have heard the theory that people who are good at individual competitive sports usually have high levels of motivation in general...so goes along with being a dermatologist.

 

[sore eye asses]

i'm not a runner...but i have heard the theory that people who are good at individual competitive sports usually have high levels of motivation in general...so goes along with being a dermatologist.

I'm a champion at the ultimate individual competitive sport...

I even made myself a trophy with a giant hand clutching at a sausage to prove it.

I doubt you have such an accolade proving your greatness at individual competitive sports.

 

[moinmoin]

I'm a champion at the ultimate individual competitive sport...

I even made myself a trophy with a giant hand clutching at a sausage to prove it.

I doubt you have such an accolade proving your greatness at individual competitive sports.

I'm not sure that's a sanctioned sport.

 

[elenaP]

I can say I've never looked at Ortho, but the appeal of dermatology for me is the chance to refute general stupidity on a daily basis. Such as the people who don't want to wear sunscreen because of Vitamin D deficiency.

The incredible breadth of misinformation on skin and skin conditions amongst the general population makes me want to make at least a small dent in it.

 

[Dral]

I can say I've never looked at Ortho, but the appeal of dermatology for me is the chance to refute general stupidity on a daily basis. Such as the people who don't want to wear sunscreen because of Vitamin D deficiency.

The incredible breadth of misinformation on skin and skin conditions amongst the general population makes me want to make at least a small dent in it.

I'm not calling your career choice into question by any means, but if you would want to make that kind of difference, a big way to do it is in fields like medicine.

Let's compare Psoriasis to Diabetes (Not TOO far fetched...both are chronic 'incurable' conditions that dermatologists and internists deal with respectively. People with psoriasis have something on their body surface that is not really life threatening, yet unpleasant from an aesthetic and sensory standpoint. If you give patients meds and instructions, they seem to do what you say.

Diabetes? It's not like everyone is non-compliant, but I've seen pts at the VA that are half blind with bilateral BKAs who still have A1C's in the teens. Tackle that issue and you'll win some kind of humanitarian prize...or at least a golf clap from me.

 

[Palintology]

Let's compare Psoriasis to Diabetes (Not TOO far fetched...both are chronic 'incurable' conditions that dermatologists and internists deal with respectively. People with psoriasis have something on their body surface that is not really life threatening, yet unpleasant from an aesthetic and sensory standpoint.

Not to be an ******* (although women tend to think that I am), but there's a lot of recent research to suggest that psoriasis actually is life threatening. At least with respect to its associations.

 

[elenaP]

Dral, you make an incredibly valid point.
I love that you brought up diabetes in particular. My family on the whole is very lucky when it comes to "genes are a risk factor diseases", but diabetes s the only one that anyone suffers from. My maternal grandpa has been diagnosed for about 6 years now and to this day refuses to modify his diet or lifestyle in order to better manage his disease. His point of view is that there's no point in living long if you can't eat unhealthy but delicious foods. Much to my mother's lament, I have a disgustingly overactive sweet-tooth and am about as close as anyone can be to addiction. Although I know modifying my diet would be in my best insterest, I can't stomach a cup of coffee unless half of it is dissolved sugar.

I think my grandpa's and my behavior is indicative of a general trend. We want to enjoy daiy life, even if how we enjoy it is unhealthy.

On the flipside, I tantamountly refuse to skip a day of sunscreen use. I wish I could honestly say this is because I fear skin cancer, but that would be a bold faced lie. I fear wrinkles. It's sick, it's vain and it's ridiculous, but I think that this too is indicative of a larger trend.

Never neglect how much time and money women (and some men) spend on trying to look good, it's an all encompassing obsession for some. Even if it's a ridiculous reason like vanity, I feel that any reason that is convincing enough to get someone to stop smoking (or eat more vegetables etc.) is valid. Maybe I just feel like being on the winning side? I don't know, but thank you for making me question myself.

 

[Dral]

There's nothing wrong with not wanting wrinkles. For the most part, it's human nature to want to appear as attractive as possible to other humans.

I believe, just as one should not question those who apparently are not concerned with such things, I think those who do care should not be questioned either.

 

[elenaP]

There's nothing wrong with not wanting wrinkles. For the most part, it's human nature to want to appear as attractive as possible to other humans.

I believe, just as one should not question those who apparently are not concerned with such things, I think those who do care should not be questioned either.

I like to question it! I like to question my own thoughts and impulses and those of others. If I didn't ask myself what it is internally that compels me to do what I do, well that wouldn't be very self-reflective would it?

 

[Dral]

When I say question, I meant quite literally. Like if I knew you irl and said to you "Why are you that concerned with your wrinkles anyway? Are you that vacuous?".

Maybe that's what you mean as well.

 

[elenaP]

In both ways, I guess. I've had tons of people ask me why it matters so much and I think when it comes to that type of thing, it would take years of introspection to understand, and frankly I prefer to spend my 20's more productively. But the closest I've come to an answer is that those who grew up relying on their looks to get what they want (which is a lot of women) are those that seem to fear losing them the most. I'll be honest, being a cute kid got me what I wanted from my family, being a cute girl got me what I wanted in high school and even though I've always known there was more to me than looks, I never wanted to show off about things like that. It's a sad day when a 13 year old girl realizes that her adeptness at mascara application and her looks are generally looked upon more favorably than being smart.

 

[sore eye asses]

you need to spend your early 20's huffing glue.

you've made a gross misstep somewhere along the line.

this can all be cured by a quick trip to the hobby store. there is still time to get your life back on track.

 

[vancouvergeorge]

Depends, how much can you bench?
>315 lbs, ortho

This is such BS. All the ortho docs I knew were skinny or not particularly fit. One was a little Asian woman.

 

[sore eye asses]

This is such BS. All the ortho docs I knew were skinny or not particularly fit. One was a little Asian woman.

You've made a mistake, and it's not your fault. I'm sure what happened in this situation is that a small Asian woman was sleepwalking, and wandered into the OR. Clearly, she was dreaming about her being an awesome orthopedic surgeon, and the scrub techs went with it. She gowned up, and performed a bilateral hip replacement like a champ. Then she somnambulated to the doctors lounge where she proceeded to talk about hunting and running and wrestling with the other orthopods. Then she got sleepy in her dream, and went to sleep. She awoke to Leonardo Dicaprio looming over her, screaming unintelliglible things like "you're two levels down!" and "time is different here" and "are you the architect I asked for? you don't look like the girl from juno, but i'm willing to go with it because small Asian women are reputedly very skilled in the visuospatial arts." At which point she awoke on an airplane, having placed the notion in your mind that a small Asian woman could be a skilled orthopod.

Dude, you've been incepted!

 

[N-Surge]

And he's still 4 levels down. Better go find him. While your at it you can finish an entire derm residency, become an attending, retire, and then come back to blow the socks off of your current program. Of course, this means you will need to have you PD incept you with Bolognia! =)

 

[asmallchild]

I've watched more movies in the theater during my 1st month of derm residency than all of internship combined

And I agree, Inception was phenomenal.