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Dermatology vs Opthalmology


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Hi All,

I would like to get some advice if anyone has any insight!

I have been struggling to decide on a specialty as I am nearing the end of my second year. I have entered medical school with ophthalmology in mind and started a few things. However, I am doubting if optho is really what I want as I am not a surgical person or very good with technology. I am also questioning whether I really find the eye interesting and sometimes think the pathology is a little creepy. 

I am someone who needs a low-stress environment, as I am a generally anxious person and kind of an indecisive person (I need for there to be clear answers on what to do). I am also a bit older, so the next few years are critical for starting a family, so I do not want a residency with terrible hours and many calls. 

I thought maybe dermatology would be great if I am second guessing optho, as I have always been interested in skin and wanted to do it since I was younger. Derm would also have a great lifestyle with low calls. However, I am not interested in cosmetic dermatology (botox, etc.), so wondering if this would limit me? I am also wondering whether I would find the pathology gross as many do. I do not mind rashes, eczema, psoriasis, etc., but not sure how if I would be okay with all the genital derm. 

I have shadowed but feel like shadowing does not give you a complete picture and you need to do the job to know how it feels (hopefully clerkship will help, but I need to decide now for competitive specialties). I am also an undecisive person which makes this difficult. I know that I value lifestyle as I do want to have a family the next few years. I feel like having the best lifestyle possible during residency is ideal. I also LOVE children, but Peads I heard has a tough residency and many calls. 

I would appreciate any insights anyone has and any recommendations for particular programs and schools. I would prefer to stay in southwestern Ontario and don't need a large program like UofT. 

Thank you :)

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Peds derm (peds then +1 in derm at SickKids or derm then +1, these are not accredited fellowships as far as I understand) might be a good use of your dual interests. No cosmetics and potentially no call.

Also, it is a misconception that you absolutely need derm research. It is probably favored at some institutions, but people definitely get in with non-derm publications or a strong CV in other areas. 

Lastly, derm is not a lifestyle residency. It is entirely institution dependent and there is a lot of variability. Some programs put you closer towards internal medicine-like schedules, while others are vastly more "chill", but still not in entirety as the hours tend to pick up towards PGY3/the first two years on service.

 

With approximately 18-22 english spots per year, it is difficult to aim and match to one specific program and you will need to be mentally willing to go anywhere in Canada.

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2 hours ago, attempt2 said:

Peds derm (peds then +1 in derm at SickKids or derm then +1, these are not accredited fellowships as far as I understand) might be a good use of your dual interests. No cosmetics and potentially no call.

Also, it is a misconception that you absolutely need derm research. It is probably favored at some institutions, but people definitely get in with non-derm publications or a strong CV in other areas. 

Lastly, derm is not a lifestyle residency. It is entirely institution dependent and there is a lot of variability. Some programs put you closer towards internal medicine-like schedules, while others are vastly more "chill", but still not in entirety as the hours tend to pick up towards PGY3/the first two years on service.

 

With approximately 18-22 english spots per year, it is difficult to aim and match to one specific program and you will need to be mentally willing to go anywhere in Canada.

Derm residency is as lifestyle as you're going to get in residency. minus off service rotations. Others include rad onc and physiatry. 

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8 hours ago, hero147 said:

Derm residency is as lifestyle as you're going to get in residency. minus off service rotations. Others include rad onc and physiatry. 

Hard to ignore off-service when it is 2 years, and can be very internal medicine heavy with call. While on service, derm residents do end up staying up to/past 6 PM routinely after clinics to review consults when on call (call is also usually 1 week at a time continuous, with no post call day), and can very often end up staying that long on normal days. At my institution, psych/urban family appear to have better hours, but I assume there will be natural variability between programs.  

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derm is neither low stress nor for the indecisive mind

like derm workflow is fast and consults are seen quickly. Decisions are usually made quickly. You don't get to spend 30 min doing a history and physical on someone lol. Have you been to a derm clinic? The dermatologist is usually in-and-out before you even blink lol.

I think you should do public health, basically a 9-5 office job

otherwise you are asking for a lot of pluses and seems you aren't willing to take many minuses. There aren't many specialties in medicine that give you all those pluses you want. You can pretty much rule out anything related to IM/peds, surgery, even radiology.

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So you just happen to like 2 of the most competitive specialities? Unfortunately you, many others do. The only difference is a lot of individuals would have been grinding to build a strong application since almost day one. Another point to mention is although research (which typically takes the most time to build on a CV) isn't a requirement to match, I'm willing to die on the hill that there is an extremely high correlation between it and the number of interviews applicants received (and then subsequently matched).

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On 3/8/2024 at 12:46 AM, attempt2 said:

Hard to ignore off-service when it is 2 years, and can be very internal medicine heavy with call. While on service, derm residents do end up staying up to/past 6 PM routinely after clinics to review consults when on call (call is also usually 1 week at a time continuous, with no post call day), and can very often end up staying that long on normal days. At my institution, psych/urban family appear to have better hours, but I assume there will be natural variability between programs.  

Oh no, I don't mean to say it is easy. Theres a lot to read and learn about for dermatology. But most other fields also have to do off service rotations. You could make an argument that fam med only has to do a year or so and thus is an easier residency, but amongst 5 year programs, I would still classify derm as more lifestyle than not. 

 

Calls and postcall days are super dependent on how busy you are. Most after hour consults I would imagine can wait till the morning. 

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12 hours ago, hero147 said:

Oh no, I don't mean to say it is easy. Theres a lot to read and learn about for dermatology. But most other fields also have to do off service rotations. You could make an argument that fam med only has to do a year or so and thus is an easier residency, but amongst 5 year programs, I would still classify derm as more lifestyle than not. 

 

Calls and postcall days are super dependent on how busy you are. Most after hour consults I would imagine can wait till the morning. 

That is fair. I am indeed in the boat that FM is a far "chiller" residency given the shorter program duration and shorter time needed on rotations with call.

I am also hoping to set the expectation to OP that even for "lifestyle" specialties, it is never simply 9-5.

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Thank you all for your insight- this is all helpful! Just to respond to some of the comments made, I am no way saying I am competitive for optho or derm, just trying to think about options that are best for my personality/interests so I can direct my efforts. I also understand medicine as a whole is not a lifestyle field and I am just trying to get the "best" lifestyle possible with an understanding that I may not get this. Although I believe public health is great, I definitely see myself in the acute setting!

Thanks again everyone :)

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I was interested in dermatology for but abandoned the idea this year. Everybody says do cosmetics, but the overhead is also immense. If you're not someone who is good at marketing a private service, patients are incredibly demanding and it can exhaust you. Talking to the medical derms in my province it seems like the medical community perception of dermatology is "great salary, great lifestyle". But, even if you go on the physicians financial Facebook group, some posts chat about the low salary (compared to other 5 year specialists) that medical derms make. I've shadowed clinics that fit in 80 patients a day and go from 8-6 not including all the admin.

Dermatology definitely has the perks of job security, flexibility to practice and no call. I think the disease is fascinating too. I think you should pursue it if you're competitive and like the content. I wouldn't say it's the lowest stress job ever though. Patients can be very demanding in this specialty and most run a practice that doesn't afford extensive time to counsel properly. I think there's certainly a stereotype that has been leant from the American system that dermatologists in Canada are out here regularly nabbing 1 million dollars for a 20 hour work week (hyperbole). 

I can imagine ophtho being the same, but the compensation and billing codes for ophtho are much better. They also run clinics that see patients every 3 minutes like derm. 

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