Massive CrossRoads! Offered Derm swop few months into Rads Residency

[Jezza1985]

have analized and agonized from every angle and viewpoint possible. Used every resource and recourse I could muster. As a Medstudent Derm was first choice ended up not matching (applied only to a very few top tier programs in my location - as family illness responsibility made a move impossible. Matched into a great Rads program which started only a few months ago (Rads was never really on the radar as pregrad exposure is relatively non-exitestent in terms of true to life expore to the specialty.). Now three months into Rads i've been offerred a Derm match (seems the previous candidate was very quickly removed for 'legal' reasons). Three months ago, before starting Rads this would have been a 'no-brainer'...and now i've come to see Rads as the incredibly stimulating specialty it is. Stuck! And have to notify accpetance/decline Derm spot ASAP. Opinions/long term-thinking wisdom please?!

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[mpdoc2]

have analized and agonized from every angle and viewpoint possible. Used every resource and recourse I could muster. As a Medstudent Derm was first choice ended up not matching (applied only to a very few top tier programs in my location - as family illness responsibility made a move impossible. Matched into a great Rads program which started only a few months ago (Rads was never really on the radar as pregrad exposure is relatively non-exitestent in terms of true to life expore to the specialty.). Now three months into Rads i've been offerred a Derm match (seems the previous candidate was very quickly removed for 'legal' reasons). Three months ago, before starting Rads this would have been a 'no-brainer'...and now i've come to see Rads as the incredibly stimulating specialty it is. Stuck! And have to notify accpetance/decline Derm spot ASAP. Opinions/long term-thinking wisdom please?!

Derm has more job security, mobility. But you only live once. Make sure you like what you're doing in that ONE life.

 

[Jezza1985]

Derm has more job security, mobility. But you only live once. Make sure you like what you're doing in that ONE life.

Thats the crux of my problem. No time to make sure. Student exposure to these two 'non-core' pregrad training field leaves one ignorant to say the least. You only really know as a resident for a few months and in these two (especially derm) its a one time only offer

 

[meister]

Unless you are completely head over heels for rads after such a short time in the field I don't know why a former aspiring dermatologist would turn this offer down.

 

[mpdoc2]

Unless you are completely head over heels for rads after such a short time in the field I don't know why a former aspiring dermatologist would turn this offer down.

I agree. If you're not completely sure you want to radiology, I'd go for derm. Most derms never regret doing dermatology.

 

[badasshairday]

I agree. If you're not completely sure you want to radiology, I'd go for derm. Most derms never regret doing dermatology.

Yeah. I would take the dermatology spot in a heart beat. I have derm envy for sure. 8 to 5. No inpatient drama, weekends, holidays. And make bank. No Brainer for a former dermy like you. Shorter residency and no need for fellowship unless you want to be a super baller doing a MOHS fellowship.

 

[deleted564680]

Yeah. I would take the dermatology spot in a heart beat. I have derm envy for sure. 8 to 5. No inpatient drama, weekends, holidays. And make bank. No Brainer for a former dermy like you. Shorter residency and no need for fellowship unless you want to be a super baller doing a MOHS fellowship.

I'm going to be the contrarian here... Even if derm made twice as much money I wouldn't do it. It's incredibly boring and there's a reason why it's one of the least popular fields in other countries where money and lifestyle are more equal across fields.

Everyone makes fun of the "if it's wet, dry it and if it's dry, wet it" mantra but honestly it's pretty damn true with adding "get a biopsy to find out what it is." 90% or more of a typical derm practice is not only monotonous but actually really busy. You can tout 8-5 but they are seeing a high volume of fast-paced in-and-out stuff. I'm not a clinic person and that's a HUGE difference between rads and derm. There's also concerns about NPs doing derm residencies and Medicare slashing biopsy payments and the way they pay for Mohs.

I say this as someone who thought about derm and did 1 month with an 90% outpatient/10% inpatient group practice. Obviously that's not a lot of time but just wanted to give the other point of view. Rads is diverse and intellectually stimulating. If you're only concerned about lifestyle and money then you're always going to be disappointed.

 

[fentanyl]

Derm no question there whatsoever. One word...call. It hurts and it doesn't end with residency. You'll be taking hard call as an attending for many years to come. Not so much with derm. I would've accepted yesterday if I were you.

 

[shark2000]

If you take your interest out of the equation, derm is a better field. Much better life style, better pay/hour and better job market.

Both fields make a good money and after 10-15 years of working in private practice you won't care that much about 50K more or less. Other factors will be more important in your total net worth. Having said that, except for MOHS and successful cosmetic derm offices, an average radiologist makes more than an average dermatologist.

Do what you like. You live once and you have to do what you enjoy or at least what you don't hate. Looking at moles and acnes the rest of your life and dealing with demanding cosmetic patients is not for everyone.

 

[mpdoc2]

If you take your interest out of the equation, derm is a better field. Much better life style, better pay/hour and better job market.

Both fields make a good money and after 10-15 years of working in private practice you won't care that much about 50K more or less. Other factors will be more important in your total net worth. Having said that, except for MOHS and successful cosmetic derm offices, an average radiologist makes more than an average dermatologist.

Do what you like. You live once and you have to do what you enjoy or at least what you don't hate. Looking at moles and acnes the rest of your life and dealing with demanding cosmetic patients is not for everyone.

As a cancer doctor my most demanding patients are the ones with the least aggressive cancers. There's an inverse correlation with how demanding the patient is and how aggressive their disease is. Kind if interesting.

 

[deleted564680]

As a cancer doctor my most demanding patients are the ones with the least aggressive cancers. There's an inverse correlation with how demanding the patient is and how aggressive their disease is. Kind if interesting.

This is a bit off topic, but is it related to socioeconomic status more than how aggressive the cancer? Such as higher socioeconomic = more likely to be screened/caught early = most demanding/bigger a$$holes and entitled attitudes vs. lower socioeconomic = less likely to be screened/caught early = more thankful for the care they get?

 

[Dral]

"if it's wet, dry it and if it's dry, wet it" mantra but honestly it's pretty damn true with adding "get a biopsy to find out what it is."

Do you really think that? I shadowed a radiologist at a community practice third year of med school. He sat at this screen all day basically just staying "Dictaphone, normal bone" for most of the cases....with an added "Doc, can you come do this thorocentesis on this patient now?"

Was it my impression of what the field was? I guess sorta at the time. Do I now really believe that's what radiology is all about? Of course not...I know there is much more to it than what I saw and realize that was just my small window into the field. This just stresses the difficulty the OP is having.

Until you really experience a field first hand in several settings, it's hard to make a true judgement.

OP, someone in the derm thread (now closed and referred here) mentioned that if you do rads and want patient contact, do IR and if you do derm and don't want as much, do dermpath. I just want you to know ahead of time, that the job market for Dermpath is not that good right now. It seems to be on the upswing, but it is not anywhere close to 'get a full time Dermpath position wherever you want'.

So if you are leaning towards no or little patient contact, rads may be a better choice.

 

[deleted564680]

Do you really think that? I shadowed a radiologist at a community practice third year of med school. He sat at this screen all day basically just staying "Dictaphone, normal bone" for most of the cases....with an added "Doc, can you come do this thorocentesis on this patient now?"

Was it my impression of what the field was? I guess sorta at the time. Do I now really believe that's what radiology is all about? Of course not...I know there is much more to it than what I saw and realize that was just my small window into the field. This just stresses the difficulty the OP is having.

Until you really experience a field first hand in several settings, it's hard to make a true judgement.

OP, someone in the derm thread (now closed and referred here) mentioned that if you do rads and want patient contact, do IR and if you do derm and don't want as much, do dermpath. I just want you to know ahead of time, that the job market for Dermpath is not that good right now. It seems to be on the upswing, but it is not anywhere close to 'get a full time Dermpath position wherever you want'.

So if you are leaning towards no or little patient contact, rads may be a better choice.

Yeah, I tried to look deeper and see if there was another level. Because like you said obviously rads is different than "dictaphone normal" but I was unable to find anything extra in derm.
Every dermatologist, derm resident, or med student that wants to do derm always says lifestyle and money if they're leveling with me. I've never had someone say they are intellectually stimulated by derm or that they love the actual day to day derm stuff. If there are those who like it for what it is then I feel bad all these people who don't really like it are poaching it.
I mean there's a reason I picked rads. I think lots of specialties are super boring not just derm.

 

[Dral]

There are definitely a lot in the field who are in it for those reasons. It's unfortunate because it gives the field a bad name.

Oh well. I myself find it very interesting and rewarding. Some of the appeal is that you can really do a lot to make patients feel better. People do not like things wrong with their outward appearance, especially when dealing with things like acne, alopecia, vitiligo, psoriasis, eczema, etc. It's pretty rewarding to have people who are so very thankful for us improving these things.

I'm not seeing crazy cases every day, but we get our share. That keeps it very intellectually stimulating for me. However, I am doing dermpath and at an academic center...both I'm sure increase chances of coming across the good cases.

I'm guessing this is similar in rads...there are private practice radiologists who are happy with the 'normal bone' cases all day and there are academic radiologists who get to see a bunch of cool cases. I think the practice setting has a lot to do with how intellectually stimulating a field is.

It's just up to the individual to find baseline what field is stimulating to them...which brings us back to the OP...I hope this discussion helps you in some way but it is obviously ultimately up to you to decide your baseline interest.

 

[scootad.]

Yeah. I would take the dermatology spot in a heart beat. I have derm envy for sure. 8 to 5. No inpatient drama, weekends, holidays. And make bank. No Brainer for a former dermy like you. Shorter residency and no need for fellowship unless you want to be a super baller doing a MOHS fellowship.

Its possible to have this (no inpatient, no weekends, no nights) in radiology. I have this at my current job. But I agree its not the typical radiology job and definitely more common in Derm than Rads.

Another obvious factor to consider is...do you like seeing patients in heavy doses and quick succession. Like 30-40 in a day? I would find this extremely draining. But I hated 3rd year clinical rotations. Can you picture yourself dealing with people's annoying complaints, laundry list of symptoms, interrupting the chatter boxes who will never shut up so you can get to the next patient in the waiting room full of people?

But this too isn't a deal breaker. My sister went through derm residency and decided she didn't like the patient interactions so much. Then she chose Dermpath.

 

[shark2000]

There are definitely a lot in the field who are in it for those reasons. It's unfortunate because it gives the field a bad name.

Oh well. I myself find it very interesting and rewarding. Some of the appeal is that you can really do a lot to make patients feel better. People do not like things wrong with their outward appearance, especially when dealing with things like acne, alopecia, vitiligo, psoriasis, eczema, etc. It's pretty rewarding to have people who are so very thankful for us improving these things.

I'm not seeing crazy cases every day, but we get our share. That keeps it very intellectually stimulating for me. However, I am doing dermpath and at an academic center...both I'm sure increase chances of coming across the good cases.

I'm guessing this is similar in rads...there are private practice radiologists who are happy with the 'normal bone' cases all day and there are academic radiologists who get to see a bunch of cool cases. I think the practice setting has a lot to do with how intellectually stimulating a field is.

It's just up to the individual to find baseline what field is stimulating to them...which brings us back to the OP...I hope this discussion helps you in some way but it is obviously ultimately up to you to decide your baseline interest.

Your impression of radiology is very wrong. In private practice people don't see normal bones all the time.

The variety and scope of practice in radiology is as broad as the entire field of medicine. It doesn't have any limits. Patients don't go straight to academic centers. In fact, most complex cases in academics are referrals from private practice.

The scope of practice and the variety in dermatology is not even close. I don't intend to bash dermatology, but in terms of variety and scope of practice these two fields are on two different sides of spectrum.

I myself said that derm is a better field if you see it from business/hours stand point only. But come on. Advanced imaging is probably one of the biggest inventions of the last 50 years. You can not say the same for Derm. The holy grail of dermatology which is MOHS surgery is a technique that goes back to 1940s. Compare it to any part of radiology. Most of what we do today in our day to day practice was only at research level or did not exist in 1990s.

 

[Dral]

Your impression of radiology is very wrong. In private practice people don't see normal bones all the time.

The variety and scope of practice in radiology is as broad as the entire field of medicine. It doesn't have any limits. Patients don't go straight to academic centers. In fact, most complex cases in academics are referrals from private practice.

The scope of practice and the variety in dermatology is not even close. I don't intend to bash dermatology, but in terms of variety and scope of practice these two fields are on two different sides of spectrum.

I myself said that derm is a better field if you see it from business/hours stand point only. But come on. Advanced imaging is probably one of the biggest inventions of the last 50 years. You can not say the same for Derm. The holy grail of dermatology which is MOHS surgery is a technique that goes back to 1940s. Compare it to any part of radiology. Most of what we do today in our day to day practice was only at research level or did not exist in 1990s.

I guess I was wrong (as I had already admitted in my first post in this thread)

Well I'm still very happy being a Dermatologist and Dermatopathologist, despite the apparent limitations and lack of innovations (molecular genetics?)

Good luck OP, I hope you are happy with your career choice in the end as well

Oh and Jezza, if you have any specific questions about Derm or dermpath, feel free to pm me. I'm always happy to help out if I can.

 

[FIREitUP]

Your impression of radiology is very wrong. In private practice people don't see normal bones all the time.

The variety and scope of practice in radiology is as broad as the entire field of medicine. It doesn't have any limits. Patients don't go straight to academic centers. In fact, most complex cases in academics are referrals from private practice.

The scope of practice and the variety in dermatology is not even close. I don't intend to bash dermatology, but in terms of variety and scope of practice these two fields are on two different sides of spectrum.

I myself said that derm is a better field if you see it from business/hours stand point only. But come on. Advanced imaging is probably one of the biggest inventions of the last 50 years. You can not say the same for Derm. The holy grail of dermatology which is MOHS surgery is a technique that goes back to 1940s. Compare it to any part of radiology. Most of what we do today in our day to day practice was only at research level or did not exist in 1990s.

so you're saying the advancements in biologic therapy and immunotherapy in derm are unimportant? why don't you ask former president carter what he thinks of the current advancements in the field?

 

[maxxor]

so you're saying the advancements in biologic therapy and immunotherapy in derm are unimportant? why don't you ask former president carter what he thinks of the current advancements in the field?

Aren't these are managed largely by MedOnc?

It almost seems like Derm is the "primary care" of the skin. They diagnose and treat, but if it's a BIG excision and/or Melanoma, they are referring to surg/onc, med/onc, and/or rad/onc for definitive treatment.

At least, that's my impression when I'm on nucs and injecting melanoma all morning for lymphoscintigraphy.

 

[Silent Cool]

have analized and agonized from every angle and viewpoint possible. Used every resource and recourse I could muster. As a Medstudent Derm was first choice ended up not matching (applied only to a very few top tier programs in my location - as family illness responsibility made a move impossible. Matched into a great Rads program which started only a few months ago (Rads was never really on the radar as pregrad exposure is relatively non-exitestent in terms of true to life expore to the specialty.). Now three months into Rads i've been offerred a Derm match (seems the previous candidate was very quickly removed for 'legal' reasons). Three months ago, before starting Rads this would have been a 'no-brainer'...and now i've come to see Rads as the incredibly stimulating specialty it is. Stuck! And have to notify accpetance/decline Derm spot ASAP. Opinions/long term-thinking wisdom please?!

.

What's it like to be anal-ized?

 

[Tamahawk]

Your impression of radiology is very wrong. In private practice people don't see normal bones all the time.

The variety and scope of practice in radiology is as broad as the entire field of medicine. It doesn't have any limits. Patients don't go straight to academic centers. In fact, most complex cases in academics are referrals from private practice.

The scope of practice and the variety in dermatology is not even close. I don't intend to bash dermatology, but in terms of variety and scope of practice these two fields are on two different sides of spectrum.

I myself said that derm is a better field if you see it from business/hours stand point only. But come on. Advanced imaging is probably one of the biggest inventions of the last 50 years. You can not say the same for Derm. The holy grail of dermatology which is MOHS surgery is a technique that goes back to 1940s. Compare it to any part of radiology. Most of what we do today in our day to day practice was only at research level or did not exist in 1990s.

Can't we all jus get along?? Lol

I imagine radiology is very interesting and intellectually stimulating to those who love it. I find the breadth of dermatology and Dermpath to be more stimulating to me personally, but this is because we are all different and driven by different factors. To suggest that either Derm or rads is limited in scope reflects ignorance of the respective fields. I'm sure there are countless radiologic entities you surely can recite that we dermies are clueless of. Likewise, your knowledge of Derm and/or Dermpath is equally as sparse.

The only statement that accurately pertains to the OP's original question is that you must make a personal decision regarding what interests you most and stick with that. The money is good in both, the variability in practice settings in wide in both and the intellectual stimulation is great in both.

 

[Tamahawk]

Yeah, I tried to look deeper and see if there was another level. Because like you said obviously rads is different than "dictaphone normal" but I was unable to find anything extra in derm.
Every dermatologist, derm resident, or med student that wants to do derm always says lifestyle and money if they're leveling with me. I've never had someone say they are intellectually stimulated by derm or that they love the actual day to day derm stuff. If there are those who like it for what it is then I feel bad all these people who don't really like it are poaching it.
I mean there's a reason I picked rads. I think lots of specialties are super boring not just derm.

Count me as your first person in Derm to tell you that I find Derm intellectually stimulating and love day to day Derm stuff

 

[meister]

No. My specialty is better than yours and you suck.

 

[deleted564680]

Count me as your first person in Derm to tell you that I find Derm intellectually stimulating and love day to day Derm stuff

Then I'm glad you matched it

 

[deltamed]

Aren't these are managed largely by MedOnc?

It almost seems like Derm is the "primary care" of the skin. They diagnose and treat, but if it's a BIG excision and/or Melanoma, they are referring to surg/onc, med/onc, and/or rad/onc for definitive treatment.

At least, that's my impression when I'm on nucs and injecting melanoma all morning for lymphoscintigraphy.

Most melanoma care (of which you see probably 5% or less) is done in dermatology. The exceptions being sentinel node care (since we aren't a hospital/OR based specialty) and chemo/immunotherapy for metastatic disease. Saying we are the "primary care of the skin" is like saying nephrologists are "primary care of the kidney" just because metastatic renal cell carcinoma is seen by med/onc. Not to mention the 999 other skin cancers we treat in derm for every 1 melanoma you might see in the hospital.

In any case, he wasn't probably even talking about managing that type of immunotherapy - think more enbrel/humira/cosentyx or older immunomodulators like mtx, imuran, cellcept.


Sent from my iPhone using SDN mobile app

 

[shark2000]

so you're saying the advancements in biologic therapy and immunotherapy in derm are unimportant? why don't you ask former president carter what he thinks of the current advancements in the field?

When I asked President Carter, he talked mostly about MRI and PET-CT. He also mentioned that radiology is a much more interesting field.

 

[Jezza1985]

When I asked President Carter, he talked mostly about MRI and PET-CT. He also mentioned that radiology is a much more interesting field.

Shark when I was 'researching' Rads upon notification of my post. One of the first threads I read was 'how has your perception of Radiology changed'. In it, you were very actively 'dissuading' docs from going into Rads, describing the day to day work as 'sweat-shop conditions' and openly telling all that had an ear to lend that Derm was the 'best gig' in medicine and if anyone can 'stomach it' that they should absolutely go for it. Youre rhetoric wreaked of somebody who sounded like they were on the brink of suicide and I remember someone commenting about how depressing it was to see you become 'more and more jaded' about your field as time passed. There where quite a few OP's who 'thanked' you for the 'insight' and said they were definitely, upon your word, going to re-evaluate the fact that they deemed Radiology a good option. Did you change partnership in the mean time/grow
a pair/ started taking SSRI's? Over the years many a Rad fellow has see-sawed from defence to absolute disgruntledness of their field on SDN, there never been a single example of that in the Derm theads. I think evidence based medicine probably makes my decision easy. This years annual Medscape physicians compensation/satisfaction report came out last week. Since Medschool I've always only looked at one column of this survey report; 'would you choose the same specialty if tou could choose again'. And for the last ten years Medscapes been doing the reports there's only been one unchanged constant in every years report; Derms are this year once again, like all the years before, most satisfied with their specialty choice, by a massive margin. Only 50% of Rads would choose Rads again, just like last year and the year before. The specialty satisfaction directly correlates with only one thing (nope its not mean annual earnings)...its amount and possibility of overtime (call). Survey proves year after year that no matter personality/intellectual stimulation/perceived ideas...were all the same in the end...if you 'like' working nights and weekends a Psych Axis 1 diagnosis is in order. No ammount of 'intellectual stimulation'/interest keeps a divorced, suicidal, sleep-deprived human 'satisfied'.

 

[scootad.]

Weird. I haven't gotten that impression from Shark at all. He always gives a realistic impression of the field, pros and cons and is a valuable contributor to this site. Why the immature attack? Also you have to remember that a lot of times people's views of the field changes during the course of their training and even early on when they are attendings. You don't really get a good sense of it all until you've been practicing for many years and can look back with some perspective.

 

[deleted564680]

Derm sucks. Rads rules. Go Cubs.

 

[jupiterianvibe]

Shark when I was 'researching' Rads upon notification of my post. One of the first threads I read was 'how has your perception of Radiology changed'. In it, you were very actively 'dissuading' docs from going into Rads, describing the day to day work as 'sweat-shop conditions' and openly telling all that had an ear to lend that Derm was the 'best gig' in medicine and if anyone can 'stomach it' that they should absolutely go for it. Youre rhetoric wreaked of somebody who sounded like they were on the brink of suicide and I remember someone commenting about how depressing it was to see you become 'more and more jaded' about your field as time passed. There where quite a few OP's who 'thanked' you for the 'insight' and said they were definitely, upon your word, going to re-evaluate the fact that they deemed Radiology a good option. Did you change partnership in the mean time/grow
a pair/ started taking SSRI's? Over the years many a Rad fellow has see-sawed from defence to absolute disgruntledness of their field on SDN, there never been a single example of that in the Derm theads. I think evidence based medicine probably makes my decision easy. This years annual Medscape physicians compensation/satisfaction report came out last week. Since Medschool I've always only looked at one column of this survey report; 'would you choose the same specialty if tou could choose again'. And for the last ten years Medscapes been doing the reports there's only been one unchanged constant in every years report; Derms are this year once again, like all the years before, most satisfied with their specialty choice, by a massive margin. Only 50% of Rads would choose Rads again, just like last year and the year before. The specialty satisfaction directly correlates with only one thing (nope its not mean annual earnings)...its amount and possibility of overtime (call). Survey proves year after year that no matter personality/intellectual stimulation/perceived ideas...were all the same in the end...if you 'like' working nights and weekends a Psych Axis 1 diagnosis is in order. No ammount of 'intellectual stimulation'/interest keeps a divorced, suicidal, sleep-deprived human 'satisfied'.

I know what this is: I recall a few weeks ago some disgruntled nuclear medicine doctor coming here and laying into Shark2000 with personal attacks. My impression is that Jezza1985 is the same guy using a sockpuppet. He really holds a grudge.

Think about the story: how likely is it that a derm applicant gets rejected from derm, matches to rads as a backup, and is then offered a derm spot afterwards because one of the derm residents got kicked out of their program? Derm residents don't get kicked out of programs. They're usually the best at not pissing people off.

Both posters also have a similarly stilted grammar - fluent in English but its certainly not their first language.

 

[Jezza1985]

I know what this is: I recall a few weeks ago some disgruntled nuclear medicine doctor coming here and laying into Shark2000 with personal attacks. My impression is that Jezza1985 is the same guy using a sockpuppet. He really holds a grudge.

Think about the story: how likely is it that a derm applicant gets rejected from derm, matches to rads as a backup, and is then offered a derm spot afterwards because one of the derm residents got kicked out of their program? Derm residents don't get kicked out of programs. They're usually the best at not pissing people off.

Both posters also have a similarly stilted grammar - fluent in English but its certainly not their first language.

Must say I really enjoyed reading this! Not everything in life is a conspiracy theory (very very little in fact is) - unless one's paranoia is dangerously close to being Schizotypal, some introspection perhaps Jupiterian?

The cherry on the cake was your 'stilted grammar and definitely not their first language' comment: To appease your paranoia, let me clarify; I was born in Britain (yes we 'invented' this 'stilted' language which to your educated ears sounds so 'foreign'), but before you feel better about your assessment of my use of it (by thinking 'ok' UK/US grammar 'difference') moved to the US at a very young age, but I guess I was just never dumb enough to 'dumb down' my grammar to the Kardashian tweets you must be using as your 'grammar checker'. Majored in English Lit. for a year...won't bother to let you in on what my grades were...

Makes me remember reading about, now lets use the grammar your used to for the rest of this story shall we, 'this guy that was sitting in a corporate meet with Bill Gates when he was still a young start-up. The guy asked Bill if he was a foreigner, Bill was confused *perplexed* and asked what he this guy meant; 'do I have an accent?' The guy says; no its the words you use, Bill replied; 'yes its english.'
You get Bill's drift homey...?

As to your 'likelihood' comments, wierd things become pretty likely when one's an AOA 1-4 and has Step scores way out of your stratosphere. Remember I said I severly limited my initial Derm apps due to circumstances.

Upon getting my Rad match first thread I read on SDN is the 'how has your perception of radiology changed '. Shark2000 was most active of all the participants in this one and if he's an honest and upstanding guy, will attest to everything I said he wrote and more. Literally to the point where another poster commented how sad it was to see him become more and more 'jaded' with his specialty choice day by day. And another OP literally thanked him for causing him to 're-think' Rads. So I obviously felt very 'positive' about starting my residency after reading this...Imagine my surprise to find him replying to my question with the typical 'intellectual derm bash' attitude . The greatest minds in academic derms and rads will all tell you the same thing; 'In my career of 30 years there hasn't been a day gone by where I didn't see something that i'd never seen before.

Peace out and in light of your preffered grammatical use of 'your' english language Jupiterian: 'Aint nobody got time fo this'

 

[shark2000]

Must say I really enjoyed reading this! Not everything in life is a conspiracy theory (very very little in fact is) - unless one's paranoia is dangerously close to being Schizotypal, some introspection perhaps Jupiterian?

The cherry on the cake was your 'stilted grammar and definitely not their first language' comment: To appease your paranoia, let me clarify; I was born in Britain (yes we 'invented' this 'stilted' language which to your educated ears sounds so 'foreign'), but before you feel better about your assessment of my use of it (by thinking 'ok' UK/US grammar 'difference') moved to the US at a very young age, but I guess I was just never dumb enough to 'dumb down' my grammar to the Kardashian tweets you must be using as your 'grammar checker'. Majored in English Lit. for a year...won't bother to let you in on what my grades were...

Makes me remember reading about, now lets use the grammar your used to for the rest of this story shall we, 'this guy that was sitting in a corporate meet with Bill Gates when he was still a young start-up. The guy asked Bill if he was a foreigner, Bill was confused *perplexed* and asked what he this guy meant; 'do I have an accent?' The guy says; no its the words you use, Bill replied; 'yes its english.'
You get Bill's drift homey...?

As to your 'likelihood' comments, wierd things become pretty likely when one's an AOA 1-4 and has Step scores way out of your stratosphere. Remember I said I severly limited my initial Derm apps due to circumstances.

Upon getting my Rad match first thread I read on SDN is the 'how has your perception of radiology changed '. Shark2000 was most active of all the participants in this one and if he's an honest and upstanding guy, will attest to everything I said he wrote and more. Literally to the point where another poster commented how sad it was to see him become more and more 'jaded' with his specialty choice day by day. And another OP literally thanked him for causing him to 're-think' Rads. So I obviously felt very 'positive' about starting my residency after reading this...Imagine my surprise to find him replying to my question with the typical 'intellectual derm bash' attitude . The greatest minds in academic derms and rads will all tell you the same thing; 'In my career of 30 years there hasn't been a day gone by where I didn't see something that i'd never seen before.

Peace out and in light of your preffered grammatical use of 'your' english language Jupiterian: 'Aint nobody got time fo this'

I don't know what you want to prove by your long post. It is a gross generalization to say both fields are similar intellectually.

I am honest in my opinion. Even in this thread I have said that derm is the better field if you see it only from lifestyle/money perspective. Scootad. made a very valid point. Our perspective about our field changes over time. If you are a fellow with 200K+ debt looking for a job your perspective is very different than an attending with a few years of experience and a nice pay check.

I repeated several times that derm is a better field if you take intellectual part out of the equation. I don't have any problem with it because I feel very good and very secure in my position without any need for external confirmation. The intellectual nature of my work VERY VERY EASILY beats the better lifestyle of derm and I prefer to work some nights and some weekends in exchange for a more interesting and more intellectual and less boring job. In this sense, I don't care even if 100% of dermatologists are happy with their job and only 50% of radiologists are happy. It doesn't make sense. The satisfaction in life is something personal and does not come at once. It is a big lie to say there were not moments during my training or my job that I had thought about my choice of specialty. Nothing is perfect in life and once we face negative aspects of something, naturally we may have moments of doubt about our decision. However, it does not mean that if we wanted to do it again, we would choose a different field.

My recommendation to other people on this forum. Don't look at the numbers or other people's opinion to choose a field. The fact that 60% of dermatologists are happy in their career does not mean that you won't be one of those 40% who are not happy. The same for 50% in radiology. Follow what you think is right for you. Satisfaction is very personal.

You may chose derm and may become very happy in it. But you can not sell me the bull$hit that derm is as intellectual and even close to radiology. If you feel good and secure in your choice of derm, you won't be offended if people tell you the fact that it is not as intellectual as rads (When people tell me the fact that derm has a better lifestyle or is more competitive or had better pay/hour I don't care). However, the UNDERLYING MAIN reason that you try to insult me and prove to the people that derm is as intellectual as rads comes from your doubt about your specialty choice.

Now go back and prescribe your topical steroid plus Eucerin.

 

[shark2000]

Weird. I haven't gotten that impression from Shark at all. He always gives a realistic impression of the field, pros and cons and is a valuable contributor to this site. Why the immature attack? Also you have to remember that a lot of times people's views of the field changes during the course of their training and even early on when they are attendings. You don't really get a good sense of it all until you've been practicing for many years and can look back with some perspective.

4+.

 

[Dral]

Derm residents do get booted. I know of two second year residents, each at different programs who were let go this year.

 

[DermResident]

Derm residents do get booted. I know of two second year residents, each at different programs who were let go this year.

Do you know what the circumstances were? Poor performance? What does poor performance even mean at the derm resident level? Or did they want to leave for personal reasons? I'm just starting off so this is rather unnerving.

 

[deleted564680]

Do you know what the circumstances were? Poor performance? What does poor performance even mean at the derm resident level? Or did they want to leave for personal reasons? I'm just starting off so this is rather unnerving.

I heard that it was an incident of a patient have a dry itchy rash and the derm resident dried it instead of wetting it.



In all seriousness, 99% of the time a resident is dismissed due to a professionalism reason.

 

[deltamed]

I heard that it was an incident of a patient have a dry itchy rash and the derm resident dried it instead of wetting it.



In all seriousness, 99% of the time a resident is dismissed due to a professionalism reason.

Agree. I knew 1 or 2 derm residents who were dismissed. It's almost never for poor clinical/board performance- it's always either poor judgement (lying, sexual harassment etc) or drug/alcohol problem.

In regards to intellectual stimulation I really don't think you can assign a "level" to a field- it's very personal. I am personally 100% certain I could not do radiology. Despite the fact I'm sure you guys see an amazing range of pathology, I literally cannot stay awake sitting in front of a computer for hours on end looking at studies. For that reason I also always knew I couldnt do dermpath. I need to be walking around, talking to people and doing things with my hands (ie quick procedures) to be happy. Maybe I'd be happy in IR but the other fields I considered before derm (despite the obvious other differences) were emergency medicine and surgery.

I'm pretty happy with derm though right now having been out for 6 years and not just from a money/lifestyle experience. Sure, in every field things get routine, so acne/mild eczema/another 10 BCC/SCC will be part of every single day (as I'm sure normal studies comprise most of a radiologist's day). But I can also say that almost every day I will also see 1-2 interesting and stimulating things. Maybe a new early melanoma I found on a routine skin exam possibly really helping a patient. Possibly a severe erythrodermic psoriasis case covering 80% of a patient's body requiring systemic therapy. Possibly a new cutaneous vasculitis, pemphigoid/pemphigus, maybe rarely a lymphoma or solid organ cancer I detected due to skin findings.

In any case, medicine is a weird cult where we like to stereotype different specialties based on very little information. Hopefully each person will find a field they find rewarding and stimulating.


Sent from my iPhone using SDN mobile app

 

[Dral]

Do you know what the circumstances were? Poor performance? What does poor performance even mean at the derm resident level? Or did they want to leave for personal reasons? I'm just starting off so this is rather unnerving.

I don't know all the details, so I am not at liberty to give the reasons on a public forum.

If you work hard enough and remain professional, you should have no problem making it through residency.

Plus that's getting OT from the purpose of the thread...Radiologists ripping on Dermatology.

deltamed, I think the main point people were trying to make was that in general, radiology is thought to be more academic. I typically think of Pathology as the academic field in medicine, but I could easily lump radiology in as another one that just seems more academic...so I can't really argue with the idea that radiology (and pathology) are in general more academically oriented than other fields of medicine.

I'm with you though in that the academic content of radiology doesn't interest me as much (which is why I am of course not a radiologist)...and I know for a fact the academic content of dermatology is not a good fit for many people (people randomly in other threads on sdn always feel the need to make that abundantly clear. haha)

 

[shark2000]

Agree. I knew 1 or 2 derm residents who were dismissed. It's almost never for poor clinical/board performance- it's always either poor judgement (lying, sexual harassment etc) or drug/alcohol problem.

In regards to intellectual stimulation I really don't think you can assign a "level" to a field- it's very personal. I am personally 100% certain I could not do radiology. Despite the fact I'm sure you guys see an amazing range of pathology, I literally cannot stay awake sitting in front of a computer for hours on end looking at studies. For that reason I also always knew I couldnt do dermpath. I need to be walking around, talking to people and doing things with my hands (ie quick procedures) to be happy. Maybe I'd be happy in IR but the other fields I considered before derm (despite the obvious other differences) were emergency medicine and surgery.

I'm pretty happy with derm though right now having been out for 6 years and not just from a money/lifestyle experience. Sure, in every field things get routine, so acne/mild eczema/another 10 BCC/SCC will be part of every single day (as I'm sure normal studies comprise most of a radiologist's day). But I can also say that almost every day I will also see 1-2 interesting and stimulating things. Maybe a new early melanoma I found on a routine skin exam possibly really helping a patient. Possibly a severe erythrodermic psoriasis case covering 80% of a patient's body requiring systemic therapy. Possibly a new cutaneous vasculitis, pemphigoid/pemphigus, maybe rarely a lymphoma or solid organ cancer I detected due to skin findings.

In any case, medicine is a weird cult where we like to stereotype different specialties based on very little information. Hopefully each person will find a field they find rewarding and stimulating.


Sent from my iPhone using SDN mobile app

You can be extremely happy in dermatology or any other field. But facts are facts. For example, trauma surgery has crappy hours and terrible lifestyle. You can not claim that its lifestyle is equivalent to derm.

It is interesting how dermatologists on this forum get offended if you tell them that their field is not intellectualizing stimulating or is not as broad and as diverse as some other fields. It is a reality (similar to lifestyle and trauma surgery). After doing derm for 10 years you knowledge of medicine is on par with a hairdresser. You have to accept the fact and move on. It is a joke to say all fields are similar and you can not assign a level to a field.

At the end of the day what makes you happy in a field may not be its intellectual stimulation depending on your personality. But you can not put all fields in the same category.

And it is funny that you yourself mentioned that it is a WEIRD culture that people stereotype different specialties base on VERY LITTLE INFORMATION. Then you yourself stereotyped radiology and sitting in front of the computer. Are you talking to yourself?

 

[Dral]

After doing derm for 10 years you knowledge of medicine is on par with a hairdresser.

That is an incorrect assumption that simply does not apply to every dermatologist. You pointed out that I incorrectly assumed things about radiology. So I would ask you to please not do the same about Dermatology. I know you're trying to make a point that I generally can agree with, but the extent of your statement is just not generally applicable.

Since I am also a Dermatopathologist, I get where you're coming from. Although the breadth of Dermpath is not like radiology of gen path, it still just has a more academic feel to it than clinical medicine.

However, there are dermatologists who are increasingly managing systemic meds like biologics and immune modulators. While Dermatologists do not keep their breadth of medicine knowledge, they still have to remember and know aspects of medicine...at least the good dermatolgists.

 

[mpdoc2]

After doing derm for 10 years you knowledge of medicine is on par with a hairdresser.

Now don't be jelly.

 

[meister]

ITT a radiologist tells someone who runs a clinic that he has the medical knowledge of a hairdresser.

Stop dude, you're embarrassing us.

 

[Jezza1985]

I don't know what you want to prove by your long post. It is a gross generalization to say both fields are similar intellectually.

I am honest in my opinion. Even in this thread I have said that derm is the better field if you see it only from lifestyle/money perspective. Scootad. made a very valid point. Our perspective about our field changes over time. If you are a fellow with 200K+ debt looking for a job your perspective is very different than an attending with a few years of experience and a nice pay check.

I repeated several times that derm is a better field if you take intellectual part out of the equation. I don't have any problem with it because I feel very good and very secure in my position without any need for external confirmation. The intellectual nature of my work VERY VERY EASILY beats the better lifestyle of derm and I prefer to work some nights and some weekends in exchange for a more interesting and more intellectual and less boring job. In this sense, I don't care even if 100% of dermatologists are happy with their job and only 50% of radiologists are happy. It doesn't make sense. The satisfaction in life is something personal and does not come at once. It is a big lie to say there were not moments during my training or my job that I had thought about my choice of specialty. Nothing is perfect in life and once we face negative aspects of something, naturally we may have moments of doubt about our decision. However, it does not mean that if we wanted to do it again, we would choose a different field.

My recommendation to other people on this forum. Don't look at the numbers or other people's opinion to choose a field. The fact that 60% of dermatologists are happy in their career does not mean that you won't be one of those 40% who are not happy. The same for 50% in radiology. Follow what you think is right for you. Satisfaction is very personal.

You may chose derm and may become very happy in it. But you can not sell me the bull$hit that derm is as intellectual and even close to radiology. If you feel good and secure in your choice of derm, you won't be offended if people tell you the fact that it is not as intellectual as rads (When people tell me the fact that derm has a better lifestyle or is more competitive or had better pay/hour I don't care). However, the UNDERLYING MAIN reason that you try to insult me and prove to the people that derm is as intellectual as rads comes from your doubt about your specialty choice.

Now go back and prescribe your topical steroid plus Eucerin.

Don't sweat it my long is your short. Your dualistic reasoning is hilarious; implying gross generalization and then applying exactly that to your dermatological ignorance.
There is absolutely no difference between the rationale of your uninformed opinion about dermatology to the ignorant gnats (some of them colleagues) who comment: "Oh Radiology, how boring it must be to sit in the dark and look at xrays all day." - You object to another poster doing this and then promptly apply exactly that kind of ignoramus to Dermatology.

I found a way to make all of our 'ignorocities' imperically testable: Imagine someone board certified in both specialties...I found one! Man was the question of intellectual prowess required/stimulated by residency in each specialty an interesting conversation...he laughed for quite a while, mentioned that one has to remember that each specialty attracts their majority share of PD's, mentioned that the ignorant like to forget (they dont know actually) that in derm one basically qualifies in three subsets nowadays: Gen derm (diseases of the largest organ in the human body, not to mention that most systemic diseases have a skin/mucousal tell-tail sign for the Sherlocks out there + PATH (yeah in good modern programs derms have to be able to do their own path reports) + Plastics (jip the best programs in the country dont call it dermatological disease and skin surgery dept for nutty reasons).

His answer: he unequivocally found both as intelectually challenging and stimulating, because in essence...he's an intellectual. Derm wasnt acne and creams and Rads wasnt xrays in a dark room. Go figure? Let me know if I can PM you his details. Wanna geuss which specialty he's currently practicing?

PS. I showed your comments to the senior partners at the Private Rad firm I shadowed at over the weekend...they laughed and said that your going to 'struggle' out there as you're not the kind of guy (partner) they see themselves enjoying a round of golf with over the weekend.

The senior partner mentioned that you might have not learnt that they as Rads have no leverage in PP as the clinicians bring in all the patients and are King according to hospital admin. He suggested you started to learn how to suck up to the clinical specialties you like to bash as your basically going to work for them in PP. Funny enough we had two staging CT's (from the dumb derm guys) for melanomas on their staging list

 

[meister]

I'm guessing he's doing derm, 'cause who wants to deal with insurance or Medicaid? No sane person.

 

[Dral]

Unfortunately we still have those headaches...pretty much the most frustrating part of day to day. We had an insurance claim bounce back the other day for labs we ordered on a young female with hair loss...TSH, CBC, ANA and a few others. A resident actually wrote this long essay type thing that laid out all the reasons someone can experience hair loss (with references) in an attempt to get insurance to cover the labs. I think we're still waiting to hear if they approve it. Ugh.

A young woman with hair loss is a lot of times not your happiest patient...now add in a bill for labs on top of that.

 

[Gadofosveset]

There are no "kings" in medicine... only different kinds of jokers.

As a rad with a relative in derm, both specialties are equally challenging at an academic level and equally numbing at a PP level.

 

[GadRads]

I think every field of medicine is important. If OP wants to do derm, let him/her have at it. I also disagree with the opinion that after 10 years in practice a dermatologist's knowledge is like that of a hairdresser, although this was probably hyperbole. FWIW, I know a resident who applied to both derm and rads, but matched derm after ranking all derm programs over rads. He still finds derm interesting (PGY3).

Personally, I find radiology more interesting than derm.

 

[shark2000]

Don't sweat it my long is your short. Your dualistic reasoning is hilarious; implying gross generalization and then applying exactly that to your dermatological ignorance.
There is absolutely no difference between the rationale of your uninformed opinion about dermatology to the ignorant gnats (some of them colleagues) who comment: "Oh Radiology, how boring it must be to sit in the dark and look at xrays all day." - You object to another poster doing this and then promptly apply exactly that kind of ignoramus to Dermatology.

I found a way to make all of our 'ignorocities' imperically testable: Imagine someone board certified in both specialties...I found one! Man was the question of intellectual prowess required/stimulated by residency in each specialty an interesting conversation...he laughed for quite a while, mentioned that one has to remember that each specialty attracts their majority share of PD's, mentioned that the ignorant like to forget (they dont know actually) that in derm one basically qualifies in three subsets nowadays: Gen derm (diseases of the largest organ in the human body, not to mention that most systemic diseases have a skin/mucousal tell-tail sign for the Sherlocks out there + PATH (yeah in good modern programs derms have to be able to do their own path reports) + Plastics (jip the best programs in the country dont call it dermatological disease and skin surgery dept for nutty reasons).

His answer: he unequivocally found both as intelectually challenging and stimulating, because in essence...he's an intellectual. Derm wasnt acne and creams and Rads wasnt xrays in a dark room. Go figure? Let me know if I can PM you his details. Wanna geuss which specialty he's currently practicing?

PS. I showed your comments to the senior partners at the Private Rad firm I shadowed at over the weekend...they laughed and said that your going to 'struggle' out there as you're not the kind of guy (partner) they see themselves enjoying a round of golf with over the weekend.

The senior partner mentioned that you might have not learnt that they as Rads have no leverage in PP as the clinicians bring in all the patients and are King according to hospital admin. He suggested you started to learn how to suck up to the clinical specialties you like to bash as your basically going to work for them in PP. Funny enough we had two staging CT's (from the dumb derm guys) for melanomas on their staging list

We receive almost no referrals from dermatology, so don't sell that BS to me.

Also other than a few exceptions dermatologists don't bring a significant revenue to the hospital. Your argument doesn't apply to derm.

Anyway, with your logic every field that is referral based is working FOR other clinicians. So if you get a referral from family doctors, you are working for them and you should not give your opinion about their field. Oh, I forgot that most family doctors are very well capable of treating most skin problems.

Anyway, I have never checked Derm forum on this site. Is there any reason that dermatologists are checking radiology forum constantly? Is it buyer's remorse? Or feeling of insecurity?

Or none of them. Probably you guys don't have anything to talk about in your forum other than dry and wet skin and need more challenge.

Again can someone tell me why should a dermatologist check radiology forum left and right? In my opinion it is due to feeling doubt about their own choice of specialty.

Don't forget that this is a radiology forum.

 

[shark2000]

ITT a radiologist tells someone who runs a clinic that he has the medical knowledge of a hairdresser.

Stop dude, you're embarrassing us.

Yes, because they have.

Recently I was doing a liver biopsy on a family member of a dermatologist and his knowledge of medicine was definitely less than my PA and was not any better than a hairdresser. Nothing wrong with it. They don't need it to prescribe Eucerin and do dermablation.


Having said that derm is a better field than radiology because you have specialist salary with the hours of beauty salons and the knowledge of hairdressers.

 

[Dral]

This is why we were in this thread and why we aren't really posting anywhere in this forum other than in this thread:

http://forums.studentdoctor.net/thr...m-swap-few-months-into-rad-residency.1192381/