January 4, 2016
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!