blank'/> A LITTLE BIT OF LACQUER: Why Dermatology?

January 4, 2016

Why Dermatology?


Hello all! Today I'm coming in and finally addressing one of the most frequently asked questions I get - what made me choose dermatology! I already did a post on things to think about when considering a specialty (read it here if you missed it), so this post will be more of my personal experiences with deciding on a specialty.

I first came to thinking about dermatology during a relatively "dark" time in medical school - second year (I've written about that here if you care to read more)! Seeing so many unhappy or overworked physicians was disheartening to say the least, but when we started our dermatology block, I actually saw physicians who looked satisfied with their life! They shared interesting cases during case discussions, but could also talk about what they did with their kids for the weekend, and I couldn't believe it! And then we had an African-American vitiligo patient (a depigmenting disorder) come in and talk about losing her blackness, about losing part of her identity, and I fell in love with the idea of practicing dermatology and helping patients like her. How powerful. But then we got the opportunity to work in clinic with a dermatologist, and I'll be honest, it just wasn't that interesting to me. So I sort of stopped thinking about dermatology after that.

I continued through the rest of second and most of third year searching for a specialty and still couldn't really find my calling. But I sure had crossed a lot more off of my list - I loved radiology, but I didn't think I would be happy without actually having patients and offering treatments (interventional radiology gets this, but I didn't really like that lol). I loved path, but for the same reasons as radiology couldn't see myself actually doing it - I'm too much of a people person (although in all truthfulness I'm a total introvert, I still am happiest and feel most fulfilled when I'm directly helping people - not that pathologists and radiologists don't directly help - they're usually what all other doctors base their decisions off of! But I like sitting face to face with patients - read more in the comments below about my path experience and from an amazing practicing pathologist if you're interested!). I loved medicine, but rounding all day on the inpatient side pretty much made me want to jump off a building, and the outpatient side of repeatedly telling patients they needed to lose weight just wasn't for me (and I am obviously waaay oversimplifying all of this - primary care physicians do SO much, it just still felt like we were saying the same thing to every patient)! I loved pediatrics but felt like the hard days hurt a little too much, and parents sort of drive you crazy (I'm now one of them and I'm pretty sure I also drive the girls' pediatrician crazy - I don't know how they do it). Most of all I fell head over heals for surgery. I loved surgery. I loved the OR, I loved using my hands, I loved almost all of it. Except as hard as I tried I could not find a female mentor in surgery who also had kids and a husband with an equally demanding career. This last part is the most important, because though there were female surgeons who had families, all of the ones I met had husbands with much less demanding and more flexible careers, and they were able to help much more. I knew both N and I would likely have equally demanding careers. And surgical residency is no joke. Surgery just seemed like it required a lot more sacrifices than what I was willing to make. But it was still the leading specialty until I had a short dermatology elective that changed the game.

After doing clinics in other fields, dermatology clinic actually felt interesting the second time around. And when I did hospital dermatology (derm consults from inpatient services) I fell in love - I was a bit spoiled at Harvard because our hospitals see some of the rarest of the rare, but oh my gosh it was all so cool. I realized that skin really is "an indicator of systemic disease, a canary in a coal mine of sorts... Most of all skin is part of our human identity, and the diseases that affect it are nothing short of dehumanizing, as so many of my patients have described to me." Yes I just quoted from my personal statement lol!

Then I worked in excision clinic, where dermatologists excise melanomas and other skin cancers, and I was sold. It was just enough procedural stuff that I loved - being in an OR like environment again was just so nice - I really love the OR. And then there was the other derm surgery and lasers I was exposed to - there was just so much cool stuff! One big difference between traditional larger surgeries and dermatologic procedures/surgeries though is that patients are usually awake the whole time (just using local anesthesia vs general anesthetic)! That doesn't bother me, but it may not be the right fit for some people. Then there are the more practical aspects, like more control of your schedule, a variety of practicing environments, and happy colleagues! So I made up my mind, asked around to find who was the person I needed to talk to about derm, spoke to him, and he got me in touch with my research advisor who was the biggest blessing of med school. This woman ran a huge lab, saw patients in clinic (and her patients raved about her), and had daughters who she called throughout the day and went on mini-girls' vacations with (I love this idea and can't wait to do it with my girls! Sorry N!) I spent a year working in her lab between third and fourth year getting ready for dermatology applications (and also having Liv) and it was one of the best years of med school! Anywho, that's just about most of it. Most people interested in derm know that it's incredibly competitive, so I will mention that I had a competitive Step 1 score and got high honors in most of my rotations (our preclinical classes have no grades and Harvard has no AOA, so I can't comment on those things). I also got strong letters of recommendation (at least that's what I was told)!

I know many of you also want me to write about ranking programs and matching, and I can definitely comment on that from a general perspective if you think it'd be useful, but our situation was really unique and definitely not applicable to pretty much anyone else! For now I'll just share that we will both be starting our advanced residencies (N ophthalmology and me derm) in Miami come this July!

40 comments:

  1. I loveeee your blog...so inspiring...your my new mentor in my head

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  2. I loveeee your blog...so inspiring...your my new mentor in my head

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  3. Thank you for sharing your thought process on this! I'm in PA school at the moment and I've been drawn to dermatology since I've started school. I can't wait to see what you have to discuss in the future and wish you the best to you and N in your future adventures!

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  4. I love how realistic and straight-forward you keep things. I think that a lot of people have a Grey's Anatomy view on the medical field, especially assuming that once you go to med school, you're a surgeon and it's a domino effect from there and nothing else exists. I'm in undergrad planning to go the med school route next year and appreciate how you keep everything so realistic. Love, love, love your blog!!!!

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  5. As a post-baccalaureate pre-med student, I can relate to so much to your entire blog (particularly the part where you met other professionals and decided medicine was right for you). I have long-awaited this post because I've been doing Research Associate work in a Pediatric ER at Columbia and really like the derm cases, but never really knew about the range of cases you could do. Lasers?!!!! I used to be a publicist and totally relate to the idea that skin is a huge part of identity ( i hated being around celebrity clients with hormonal acne). Thank you for the insight, definitely feeling more motivated about med school now. P.S. I hope I have your determination and wit to get into med school. P.P.S I wish you were my older sister. Te admiro muchisimo! =)

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  6. This blog is such helpful insight. I am getting my MPH & planning to continue on to medical school afterwards. Im leading towards pediatrics, but its good to know that I don't have to have it all figured out right now. People say so many things about the entire process so its great to get as many perspectives from those who have gone through the process.

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  7. Very cool. Thanks for sharing, Laura :)

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  8. I love reading your insight Laura! I'm an MSII currently, and am in a similar boat to what it sounds like you were at this point in school: I love some parts of certain specialties but hate other parts (I loved the rural Family Med that I got to see pre-Med school, but urban FM doesn't hold the same interest for me...and while I would be totally happy living somewhere rural myself for the rest of my life, I know from experience that it's harder for your spouse to get their dream job or your kids to access to good schools and extracurriculars in a rural setting). Getting a look at why you chose Derm was so helpful to see how you weighed things (and to see that I'm not totally behind the game if I haven't come to a firm decision yet!).

    Thanks, as always, for sharing!

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  9. Thank you for sharing your thought process, Laura. It's really helpful to hear someone else's opinion. I'm currently an MS2 and love dermatology, but there's a lot out there I think I'd enjoy too, including surgery. I'm worried about committing my heart to derm this early on when I haven't taken Step 1 yet, and haven't had rotations in other specialties yet. If you do another post on specialties, I would love to hear more about your thoughts on competitive specialties, how to deal with the stress surrounding them, and also grappling with surgery as a female. I've heard from so many female physicians who say that even if you love surgery, and you think you might want to go into it to kind of show you can do it, it's really not a great lifestyle fit for everyone.

    Everything you share about med school - is so incredibly helpful to other women in medical school. Thank you for opening up!

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  10. Laura,

    Loved reading this post! I agreed with many of the reasons you listed for why you love derm. I also love the overlap between derm and medicine and how the skin is a window into what's going on underneath. The visual aspect of the field is so wonderful and interesting and I am loving derm residency at NYU!

    I actually published a post today about my experience applying into derm which was quite different from yours. I was a non traditional applicant in the sense that I decided to do my first derm elective one month before fourth year of medical school began. I had been pre ophtho beforehand for three years and did basic science research, community service, and had presented and published on ophtho topics already. But when I did the rotation...I realized I didn't love it. After I did derm I fell in love with the specialty and then there began an incredibly tough few months during the application process that involved a lot of breakdowns, a lot of self doubt, soul searching and ultimately leaning on my friends, family, hubby, and God to help me through. I think it would be an interesting perspective to share with some of your readers who may not be the traditional derm candidate with a lot of derm experience. Would love to hear what you think. Post link here: http://www.teawithmd.com/2016/01/the-ups-and-downs-in-my-path-to-dermatology/

    Also are you and N heading to Miami derm and Bascom? One of my best friends from med school is a pgy-II at Bascom and I recently visited her and her husband. It is hands down an amazing program!

    Excited to meet you at future AAD events and to be fellow derm bloggers :)

    Best,
    Joyce
    www.teawithmd.com
    A dermatologist's guide to health and beauty

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    1. I just came here to say as an aspiring derm I love the BOTH of your blogs so very much!!!

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    2. Joyce I love you and don't even know you! I am SO excited for when we can finally meet! Yes we were torn between staying in Boston here at MEEI/HMS and Bascom won him over! And I thought a change from Boston could be fun!

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  11. Wow, congratulations to both you and your hubby! Those are incredibly competitive specialties, with such an amazing experience/background to lead up to your decision on your part. So exciting and so incredible - thank you for sharing your journey. The part where you said you loved surgery hit home for me, because that is exactly how I feel. I am single and without children, but I would definitely love to have a family one day - just don't know what that looks like yet. Part of me wonders and worries, but mostly I want to pick a specialty for the right reasons, and want to love my job/have all of this worth it in the end - I know that lifestyle is something that negates some specialties for some, but it is a factor that I will make work if I really don't find anything else I love more.

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  17. Would love to hear your thoughts on whether you considered the more in-clinic heavy surgical subspecialties (ophtho, ENT, etc.) as the "surgery" you mention in this post. I'm an MS2 and am dating someone who I believe will also be entering a very busy career, and really appreciated what you outlined here!

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    1. ENT was actually my favorite of the surgical subspecialties and exactly what I was considering - my ENT mentor was an AMAZING female surgeon, but she always reiterated that she couldn't have gotten through training without her husband (who was an entrepreneur, definitely pulling in money, but essentially able to stay at home with their young kids). I think being in a more clinic-heavy specialty is totally doable (especially once you're actually in practice) - I think it would just be more realistic to have kids (if you're considering it) after residency, since surgical training is still surgical training! And for us we knew kids would definitely be in the picture during training. But I'm sure if you search for it you will be able to find women who have made it work, so don't be discouraged if it's what you really want to do!

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    2. Hey Laura! I appreciate your response to the above comment. My partner is an MS3 planning on going into ortho. I don't know what field I'm going into yet but I'm pretty certain it's not surgery. That work-life balance is so important to me and as sexy as surgery may seem, it ain't it for me Lol. I'm sure once I get into the wards 3rd year i'ld have a better idea. Right now, I'm considering IM and sub-specializing in cardiology. Always kinda thought kids would be during residency but based on your comment, maybe I should reconsider Lol. Thanks for all this info!

      www.curveballsandmedschool.com

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    3. Hey Laura! I appreciate your response to the above comment. My partner is an MS3 planning on going into ortho. I don't know what field I'm going into yet but I'm pretty certain it's not surgery. That work-life balance is so important to me and as sexy as surgery may seem, it ain't it for me Lol. I'm sure once I get into the wards 3rd year i'ld have a better idea. Right now, I'm considering IM and sub-specializing in cardiology. Always kinda thought kids would be during residency but based on your comment, maybe I should reconsider Lol. Thanks for all this info!

      www.curveballsandmedschool.com

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    4. I have two friends who were deciding between dermatology and ENT. The post-training life can be very similar (I'm actually considering going into practice with one of them after training), but ENT residency is MUCH busier.

      The answer will come down to a combination of what drives you intellectually and what you want your life to look like. If you plan on having kids during the first 3 years of your residency training and want a very involved roll in their lives, ENT might not be the best choice. On the other hand, one of my friend's husband is into business/tech and is also super busy. They're putting off kids for 3-4 years while he completes his MBA and they get more settled in their careers , so the fact that they're both really busy really works for them.

      In general, I think relationships can be flexible if you and your partner in agreement of what that relationship will look like. Kids are less flexible.

      I'm actually working on a "how to chose a specialty" post for next month. This question was really helpful for me.

      www.loveandthesky.com
      Career, finance, and lifestyle advice for the millennial professional and professional student.

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  18. I legit love dermatology for the same reasons! YAY! I cannot wait to see your progress! Would you shine some light into what changed from match day to placement? I remember you saying how everything worked out, and it really inspired me! I'm a career changer so it's very inspiring!

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  20. Laura, I just want to say I appreciate your blog and relate to you in many ways as a woman of color, resident, and mother to 2 young children. This is my first time commenting because I feel compelled to defend my specialty, pathology. I take issue with your statement: "I loved path, but for the same reasons as radiology couldn't see myself actually doing it - I'm too much of a people person (although in all truthfulness I'm a total introvert, I still am happiest and feel most fulfilled when I'm directly helping people)." Specifically, your comment that you are "too much of a people person to do pathology." It is really frustrating to see this inaccurate stereotype propagated by other medical professionals. As a pathology resident, I interact with people ALL DAY LONG. EVERY. DAY. And like you, I am also an introvert AND a people person (it is possible to be both). It is also incredibly disappointing to hear other medical professionals deride pathologists as "not directly helping patients". This couldn't be further from the truth. We may not sit down face to face with patients, but make no mistake, the care we provide patients is absolutely critical to care. No doubt, it is one of the most under-appreciated and most taken-for-granted of all the medical specialties. It may not be glamorous and sexy like derm, surgery, radiology etc, but you will never find more dedicated, patient-oriented, hardworking, diligent and conscientious providers as you will in pathology. We care (literally and figuratively) immensely for our patients. At my program, dermatology residents spend considerable time rotating through pathology and learning to read skin biopsies. If your future program is similar, this is something you will come to appreciate first hand. In fact, dermatology is the only clinical specialty through which you can become a pathologist (by doing dermpath fellowship). I am sure you know all of this, but I felt compelled to speak up in case someone out there who was considering path as a specialty, read your comments and felt dismayed.

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    1. Hi Paula! Thank you SO much for your comment! Whenever I write posts it's always hard to say *everything* I want to say about every topic fully - it's a balance between trying to say what I want to say but not writing posts that could be published into books because they're so lengthy! So I'm sorry I didn't explain my comments about path fully and I'm so glad you brought it up. I actually did two path electives and absolutely loved it - part of the reason I loved derm is that there IS so much path involved - dermpath is one of my favorites! And pathologists absolutely work with people all day - they are the doctor's doctor, and most of what happens to the patient is based on what the pathologist determined! Trust me I say all this because I really was considering it. What I did miss though is exactly what you mention - the actual act of sitting down face-to-face and speaking directly to patients. At the end of the day you have to know what recharges you in your profession, and for me it's hearing a patient say thank you (even if it doesn't happen that often lol)! Anyway, I'll make sure to post a little disclaimer in the post above so people can scroll down here and see these comments!!

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  21. Thanks for your quick response Laura. I do appreciate that your intent was not to put the specialty down. Obviously, each and every medical specialty is necessary, and we all have our own valid reasons for being drawn to one over the others, as is your desire to see and treat patients face to face. What you said is spot on- you have to know what recharges you. I get it-- as a blogger it must gets tiring parsing words for fear that they get taken the wrong way, so thank you for clarifying! My comment was really for the benefit of anyone considering pathology. It is an incredibly rewarding specialty and it would be a shame for someone who was drawn to path to turn away because of the way it is often portrayed. It has always puzzled me from the time I was in medical school to hear other med students or residents criticize other specialties as not being important or valid for whatever reason. Pathology gets thrown lots of shade not just from outside the medical profession (which I get--I am constantly explaining what pathologist do in social situations and no- it's not like CSI lol) but when I hear from people within medicine say "you are too good with people to be a pathologist," or assume that I went into pathology because I don't like patients, it really gets to me. One of the things I struggled with was hearing people say that I wouldn't be a "real doctor" if I wasn't seeing patients (I went into med school thinking I'd do primary care). It is a misunderstood profession because unlike you, not many people get exposed to it during medical school, or get to interact with pathology trainees during residency and all they know are the stereotypes. What we do is almost completely behind the scenes but like you said, is critical. Something that stuck with me was hearing a surgeon say "if you need a surgical second opinion, don't see another surgeon, get another pathologist." I personally became drawn to pathology for similar reasons that you mention: I saw how happy and un-burned out (is that even a word?) pathologists were and I found a woman mentor who had kids and achieved true work-life balance while raising a family as a pathologist. Then as I rotated through, I fell in love with being the diagnostician instead of the data-gatherer and ultimately, the pros outweighed the cons of giving up seeing patients. At the end of the day, we each have to follow our hearts as you have done. Good luck in your residency and enjoy those path rotations ;)

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  23. Found you via instagram & came to your blog looking for the compression socks lol. Enjoyed your story. I'm a PGY-4 Ophtho resident at Vandy who had no idea I'd end up in Ophtho. Your husband will have an awesome experience in Miami -- great people there. Good luck with derm as well! xo

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  24. I agree with a lot of what you wrote. It's a dilemma I'm finding myself dealing with. I really like the idea of emergency medicine. I just don't think it's sustainable in the long run in terms of having some semblance of a normal life. Family medicine is looking more appealing than ever before. It does leave me wondering whether I'm just drawn towards the 'safe' choice rather than the one that excites me.

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  28. I know I'm a bit behind the times, but congratulations on getting the residency! (To you and N.) I love your blog, but this post in particular is very special to me. I don't think I've ever seen a description of my kind of introvert articulated so well. Secondly I'm a nascent med student (waiting to hear if I got in to 2017 entry- I'm Australian), and your top picks of specialties have been what I've kind of conceptualizing- obviously I've got a long road yet, but it's been so wonderful reading a bit about your journey, and I eagerly anticipate more.
    Much love,
    Courtney T.

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