How does a person become a dermatologist

Over the years, I’ve gotten used to complete strangers approaching me in a variety of different social settings after learning that I’m a dermatologist and partially disrobing to show me some problem they are having with their skin. A slightly different variation on that theme occurred recently while I was attending a very large wedding that included a number of attendees from all over the country, many of whom I did not know. I was somewhat surprised when one of the guests, a 17-year-old high school student, approached me (again after she learned I was a dermatologist) and asked point blank:  “How does someone become a dermatologist?” 

It seems she had developed a strong interest in skin diseases as she had long been under the care of a dermatologist for treatment of atopic dermatitis and she enjoyed those interactions very much. As a result, she wanted to know what she had to do to become a dermatologist and I was the “lucky person” she had chosen to answer her questions. After ascertaining that she was indeed serious about this, I agreed to help. I generally enjoy this type of interaction, just not at the exact time and venue she had selected for this discussion to take place. I was able to postpone our phone discussion for a few days later after she had returned home. This also gave me the advantage of some time to organize my thoughts and try to be a better mentor for her. 

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Over the next few days, I gave this subject a lot of thought, trying not to make the whole process seem too overwhelming to a high school senior. After all, I remember when I was a high school senior trying to decide if I even needed to go to college at all in order to become the “surfer dude” to which I was aspiring. I sat down and came up with the following suggestions.

Disclaimer:  Even though I have been chair of three different dermatology departments and a member of three others, these are my thoughts about preparing for a career in dermatology and while they are valid in my experience, there are certainly other points of view that are also valid.

Attend college

Yes, certainly go to the college of your choice, apply yourself and get the best grades you can without sacrificing the enjoyment of being in college, like participating in social activities, making new friends, joining clubs that interest you and volunteering for some worthwhile cause. If you don’t already play a musical instrument or sing or dance, take lessons! Do things that appeal to you but also help to make you a well-rounded individual. If you can find the time, get a part-time job so that you get to learn how to handle money and be at least partly responsible for your educational expenses or your extracurricular activities. This will also give you a chance to meet more people and also learn how to work effectively as a member of a team.

Choose your major

I’m not a believer that to get into medical school you must major in one of the sciences, but I do believe you should have a good foundation in the sciences, perhaps just as a minor. Remember, medical schools are trying to train doctors who can best care for their patients. In my opinion, that requires someone who can understand a patient’s concerns, effectively communicate information and answers to the questions being asked and do so without sounding like “Doc Martin” on PBS! In my experience, these physician qualities are found more commonly in an individual has a broad background and greater life experiences. 

Make a sincere effort to get to know your professors and teaching assistants. If they have office hours, go see them to learn if there are things you can do to assist them that also interest you, perhaps assisting in a research project or developing a public information pamphlet, brochure or a lecture that may be of interest to seniors or elementary school students. Your professors are the same people who will be asked to write you a letters of recommendation for medical school, but they can only do that if they know you.

Next: How to apply to medical school and what to do once you're there

Apply to medical school

This is the hardest question for me to answer and is very dependent upon a number of interrelated factors, including:  the quality of your college performance (if you did well in school, but not great, you might consider a state school over a private one), your family’s financial situation (medical school is expensive and you need to think about how you can pay for it), availability of scholarships for which you qualify (look around, there are a number of smaller clubs or organizations that offer special scholarships to top students and you might qualify for one of these), and where you have residence (theoretically, if you live in a state with multiple medical schools, like Ohio, Texas and California you might have an advantage getting accepted over someone who lives in a state with only a single medical school. 

However, it is also true that these states have large populations so the number of undergraduate students applying may also be greater, but I still believe there is an overall advantage when you have multiple schools to which you can apply.)

Be flexible in medical school

Many of the ideas I suggested be done while attending college are the same for medical school. Study hard, work to learn and not to just get grades, get to know your professors and volunteer for some worthwhile cause that is of interest to you. As you get further along, periodically reassess your interests.  Medical students often start with one goal in mind, but along the way they develop new and unexpected interests in something else. Be open to changing your mind about what you want to do with your life. There is nothing worse than seeing a physician who has become bored with what they had selected as their career choice but finds that it is too late to start over with another residency due to family, financial or job commitments.

Target dermatology

Most medical students don’t have much choice in the order of their junior year clinical rotations. However, if you have some flexibility, I believe it is beneficial to try and select a dermatology rotation as early in the third or fourth years of medical school as possible. This will not only confirm the validity of your career choice, but also give you an opportunity to get to interact with the dermatology residents and also to know the dermatology faculty members. Again, try to find a faculty member with whom you feel a connection, then set up an appointment with them to review your record and with their help try and find some project or other activity for which you can provide help. I think it can also be very beneficial to take an “away” rotation at another school that may be nearby or have some special interest for you. These types of rotations are often very hard to get, so start that planning process as early as possible.

Apply for dermatology residencies

It is important to understand that seeking a residency in the specialty of dermatology is extremely competitive. There used to be an inside joke that all one needed to get a dermatology residency position was to have “AOA” (Alpha Omega Alpha-a medical school honor society) on your resume. That isn’t quite true but, in my opinion, the successful dermatology residency candidate will be able to show evidence of scholarly achievement in college and medical school, present a number of letters of recommendations from former faculty members and perform well on residency department interviews. The one question I get asked more than any other is, to how many dermatology programs should I apply? Despite the high level of competition, I personally believe that there is no reason to apply to a huge number of residency programs. Choose the ones you are most interested in for geographic, curricular or personal reasons, but don’t overdo it.

I once had a medical student who applied to almost every dermatology program in the country. When she got invited for over forty interviews, she went to the bank and borrowed $40,000 specifically to cover the costs of going to all of these interviews! While she did obtain a residency position and is now a happy and successful practicing dermatologist, I personally think this was excessive.

I also believe the training programs are partly to blame for this situation. I don’t think it makes a training program any better when it has 200 or more applicants for every residency position. This not only wastes the time and money of the applicants, it also requires a huge commitment on the part of the training program director and faculty to review the applications and then conduct the interviews. More should be done to try to reduce these burdens on everyone by limiting the both number of applicants allowed to apply to a given program but also limiting the number of programs to which an applicant can apply. If a sufficient number of programs set these types of standards, the end result will be more equitable for all parties.

Summary

Assuming that one does all these things (and probably more) what can one expect from your profession as a dermatologist? In my opinion, you will be part of a fun, exciting, challenging and extraordinary profession, one in which you’ll be able to care for babies, toddlers, adolescents, young and middle-aged people and seniors. You’ll also have the chance to do research and treat your very grateful patients medically as well as surgically using conventional medications, targeted immunotherapy, chemotherapy, lasers and light therapy. You’ll be able to interpret your own biopsies histopathologically.  Also, to stay current with your knowledge, your colleagues will enthusiastically share their knowledge with you at some of the best and most comprehensive continuing education courses of any specialty. Lastly, you’ll have the chance to get to know your patients and enjoy them while helping them conquer the many complex skin diseases that affect humans. It will be a fun and enjoyable way to spend your life.  I hope you will have some of the same wonderful experiences that I have.