Community Dermatologist Shares Her Specialty

Session 91

Dr. Reid is a community-based dermatologist who’s been out in practice now for five years. She talks about how she first got interested in Dermatology, what led her down the path, and so much more.

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[01:10] Interest in Dermatology

Her interest in Dermatology started during rotations in medical school. She actually did a lot of rotations including pediatrics, general surgery, internal medicine, immunology, rheumatology, and infectious disease. The problem was she liked them all so she couldn’t decide at that time. Her peer (who has become her husband now) suggested that she did dermatology because it would give her the opportunity to have a piece of all those different specialties rolled into one. So she did a dermatology rotation and from there she knew it was the one. She likes being able to teach from one specialty to another and that what dermatology provides.

“It’s one of those fields of medicine where you can really tailor what you want to do, how you want to spend your time, what patient population you want to see.”Click To Tweet

She also did a rotation in medical school in Malawi, Africa where she studied tropical infectious disease dermatology. She found it to be all-encompassing which she described as the tip of the iceberg. For her, it showed the versatility of the field.

“You really can do everything in Dermatology and not feel overwhelmed.”Click To Tweet

Emergency medicine is also something a lot of doctors choose due to its versatility. However, in dermatology, you only have limited calls and few patient emergencies. And for the most part, you get to control your schedule. This has given her the opportunity to still be present for her family and kids.

That being said, if you want to be in the academic setting, there’s a high likelihood of emerging cases and call opportunities if you choose to.

[04:30] Traits that Lead to Being a Good Dermatologist

Dermatology has a very high procedural component so you’ve got to have good manual dexterity and surgical skills. You must have the ability to follow visual cues and pattern recognition. You have to have attention to detail and the ability to foster good relationships with patients. You have to be both an active listener and an active learner. Usually, patients that come into her are referred to other specialties. They all come with many ideas of what the diagnosis should be. They also come in with treatments that have already been tried. Hence, you need to have that ability to take a step back and start from zero.

Building relationships with patients is important in Dermatology. Listening is a big part, especially that you have a lot of face to face interactions.

[06:34] Community vs. Academics

She works at a single specialty private practice but she also works at a major city academic hospital. So she’s basically dipping into both worlds. She does private practice four days a week and sees patients in the clinic. And she’s also on call at the hospital a couple of times in a month where she gets to see acute cases. Nevertheless, she likes the stability of private practice. She’s able to set her time and her days. For the most part, she sees a variety of patients. She sees old and young patients. She does skin cancer checks and sees chronic skin conditions. The next day, she does surgeries

or procedures. And then the day after that, she’s back in the clinic seeing patients.

[08:05] Types of Patients

People have this assumption that acne or eczema are all that dermatologists see. But acne only makes up 10% of her practice. That said, the majority of her practice is doing general dermatology and a lot of it is skin cancer-based. This involves skin cancer checks over patients and seeing a lot of chronic skin conditions like psoriasis and eczema.

She also does one day a week where she does cosmetic dermatology. These are minor cosmetic procedures such as Botox, fillers and other simple injectable procedures.

Around 20% of her new patients come in with an exact diagnosis. A lot of times, they’re referred by other specialties. But when they end up in the dermatology office, it’s usually because there’s a problem with the diagnosis or the treatment. It may not be going well or they need some more ideas. Oftentimes, they do skin biopsies for lesion or rash to determine where they are. They set It up with the pathology and then from there, they can guide the referring physician in terms of treatment and follow-up care.

On her clinic day, around 30% of her patients will have a biopsy done on a lesion or rash to determine what’s going on. Skin cancer excisions are scheduled separately. So these are the patients they see on a separate day. The procedure usually takes 30 minutes for each patient that they can do outpatient,

There are also cases where she would have to send them to other specialties such as oculoplastics when the patient has a problem with the eyes. Skin cancer on the face is also another subspecialty of dermatology. For melanoma patients with nodal involvement or that are pass stage 1, she sends them to surgical oncology at a major academic facility or a cancer center. They come back to them for follow-up checks.

[13:15] Taking Calls and Typical Day

They split the calls based on their group of five providers and they rotate so they get called twice a year. It’s something they can decide on doing or not.

“It’s always nice to get your feet into acute dermatology because that’s a really important part of dermatology.”Click To Tweet

Although it depends upon physician to physician, Dr. Reid sees an average of 30 patients a day. It’s a very fast-paced specialty. In fact, she wished she had known this before having decided to enter into this specialty. She sees most of those patients for skin check or chronic conditions. She also sees adolescent patients with acne or eczema as well as infants and kids with chronic and acute skin conditions. After her work at the community hospital at the end of the day, she may have to see a patient for an acute skin condition, for instance.

A lot of dermatologists are diagnostic and procedural. So she’d do biopsies on skin lesions or scraping the skin for skin rash or to look for fungus.

“There’s also a lot of psychology involved in Dermatology. People carry a lot of emotions when dealing with chronic skin conditions.”Click To Tweet

Dr. Reid also explains that even when conditions are not life-threatening, they can really take a toll on someone’s quality of life. Hence, a lot of compassion is necessary in Dermatology.

On procedural days, she does skin cancer excisions or destructive procedures. She also does very simple cosmetic procedures like Botox and fillers. She does teledermatology, where she reviews pictures of cases of patients who are in rural settings. These patients are unable to come to the office so she reads images and prescribes from that. She does volunteering through the teledermatology platform where she assists in the diagnosis and treatment of skin conditions in a clinic in Africa.

“Dermatology really allows you to have a further niche.”Click To Tweet

Finally, at the end of the day would be doing administrative component – patient charts and patient notes for all those 30 patients she had seen during the day. Some patients may call in for their biopsy results or treatment follow-up.

[17:55] Time Outside of Clinical Care

She believes that Dermatology is one of those fields where you get to choose whether you want little or more time. Personally, she has set her balance at four days a week where she’s at the clinic from 8:30 to 4:30. Then she could still have time for her family and her kids.

[18:40] The Training Path

Dermatology residency is four years long. The first year is an internal medicine year or surgical year. Some people do a transitional year or pediatrics for that year if they’re interested in pediatric dermatology. The next three years would be dermatology-specific. Then you start clinic from Day 1 of residency so it’s a very clinic-based learning. You get exposed to basic dermatology in the first year. You compound that with clinic time, consultation time in a hospital setting. You learn surgery and pathology in pediatric dermatology or cosmetic dermatology. So it’s three years of just dermatology. Then you may decide to see patients on your own.

For the internship year, you have to apply separately. But there are more and more programs now that have a joint internal medicine year attached to their dermatology residency program. It’s a lot of juggling to do considering you have to apply to two programs to match into them.

[21:28] Fellowship Opportunities

If you want to do a more surgery based dermatology, you could pursue a procedural surgery fellowship. This takes one to two years depending on the program. There’s also the cosmetic procedural dermatology fellowships. Most dermatologists are general dermatologists. Among the most popular groups are surgery and pediatric dermatology.

Another subspecialty is dermatopathology which comes from either dermatology residency or pathology residency. It’s a very competitive specialty but it’s a very fulfilling career for someone interested in pathology. Another fellowship is laser dermatology. Becoming more common are these med/derm combinations. There’s a medical dermatology residency now as well. There are for people who really just enjoy general medicine but they want to specialize in dermatology. This is a joint 5-year med/derm residency.

For Dr. Reid, she decided to stay in general dermatology because she wants the variety of it.

Dermatology is a very competitive program. To be competitive, a great board score is not enough. So try to find a mentor preferably in your home medical school. This way, you have that support from your department once residency comes. You also need to diversify your application. Some candidates have second degrees. For her, her MBA in healthcare management made her stand out. A lot of dermatologists have PhD or MPH who have done some kind of research. So participation in research is also key.

Additionally, try to do a lot of away rotations at other medical school departments so you get to know that department. This almost guarantees you an interview if you perform well.

“Getting a great board score is not enough.”Click To Tweet

[25:25] Bias Against DOs

Dr. Reid works closely with DO’s and their training ability have never been questioned by patients or staff. That being said, she really doesn’t see any difference or any bias against DOs.

[26:15] Working Primary Care and Other Specialties

“Dermatology encompasses a lot more than dealing with acne.”Click To Tweet

Dr. Reid wishes for students wanting to get into primary care to know that most dermatologists see far more skin cancer patients than they do acne patients. Dermatology has a lot of chronic illnesses that fall into many internal medicine umbrellas such as rheumatology, allergy, autoimmune disease. It’s not just a one-stop shop where the patient gets a biopsy and it’s done. They’ve got to treat it afterwards.

Other specialties she works closely with include internal medicine, family medicine, emergency medicine, rheumatology, pediatrics, allergy, surgical oncology, and plastic surgery.

[29:05] Special Opportunities Outside of Clinical Medicine

Teledermatology is still clinical medicine but it does take you further away from your day to day patient care. It’s an emerging field not only in dermatology but in all of medicine. You can do clinical research or academia. She had colleagues who underwent burnout from overwhelming patient load who ended up going to pharma working as a consultant to pharma companies or medical directors. Some venture into clinical trial dermatology.

[30:30] Most and Least Liked Things

What she wished she knew that she knows now is how the academic component is so heavy. But this goes across all specialties now. They see so many patients so the administrative work can be challenging. They have to deal with insurance companies to get coverage for simple dermatology medications to treat skin disease is a daily struggle, for instance. This impacts your prescribing behaviors. It’s a shame because you want the best for your patients.

'If you're not able to cope with a fast paced environment, then dermatology is probably not the specialty for you.'Click To Tweet

What she likes most about her specialty is the relationship she has built with patients. For the most part, her patients are happy. They’re generally healthy so you deal much less with dying people. On the flip side, paperwork is her least liked aspect in the field. That being said, if she had to choose dermatology again, she would still have chosen the same specialty.

[34:15] Major Changes in the Future of Dermatology

Technology is essentially playing a huge role in shaping the future of dermatology. There several noninvasive skin lesion tools on the market right now. For example, there’s a special imaging tool to identify a bad mole This will guide decision-making on whether or not a biopsy should be done. This isn’t standard practice yet, but she can see these imaging tools becoming more standard in Dermatology. There’s also the technology of robotics and whole body mapping for detection of skin cancer.

[35:30] The Biggest Myth About Dermatology

The biggest myth about dermatology is that most dermatologists are cosmetic dermatologists. In fact, the majority of dermatologists are medical dermatologists who treat a lot of skin cancers and acute and chronic dermatologic diseases.

Another myth is that dermatology is not a serious field, which other specialties may joke around about. But they, too, save lives everyday when they catch a mole and stop it from changing or when they remove skin cancer. Skin cancers are becoming quite common even in younger age groups. So this is a field that has a long way to go.

[37:08] Final Words of Wisdom

Dermatology is becoming more competitive. There are a lot of people who don’t get into residency the first time they apply. So they do a year of medicine, surgery, or research before they apply again. If dermatology is really something you want to do and you can’t see doing anything else, then don’t give up!