Category Archive: Dermatology

Which Residents Work the Hardest?

No one will ever agree on which residency is the hardest, or which residents work the most. However, with some new data from the FREIDA website, we get a better idea than ever before.  (For more information about the FREIDA website, read my previous article) FREIDA reports diverse variables about each specialty including the average of numbers worked per week, the average number of days off per week, and the average vacation time of each specialty.  I have compiled these into one database so that for THE FIRST TIME EVER you can compare objectively which residencies work the hardest.  (Well, at least you can compare which work the longest).

The first figure demonstrates the average number of hours worked by each specialty. As expected, the surgical sub-specialties work the longest hours with neurosurgery leading the pack and general surgery following closely in second.  Of the medical specialties, suprisingly, neurology works the most hours, with pediatrics and internal medicine following close behind. And at the bottom of the list… you guessed it, Dermatology. I wish I loved skin!

The results of the average number of days off per week and the average vacation time during residency follows closely with the trend seen in the graph above. For your viewing pleasure I have the entire compiled dataset posted below.  






Hours worked per week

Days off per week

Vacation weeks per year





Nuclear Medicine




Medical Genetics




Radiation Oncology
























Emergency Medicine




Transitional Year




Colon and Rectal Surgery








Family Medicine




Internal Medicine




















Orthopaedic Surgery




Obstetrics and Gynecology




Plastic Surgery




Vascular Surgery




Thoracic Surgery




General Surgery




Neurological Surgery






Spotlight Interviews: What is a Transitional Year Residency?


A Transitional Year Resident's Perspective: An interview with a transitional year resident from the Ann Arbor, Michigan.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty. See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.


  • What is a transitional year residency?

Transitional Year (TY) residencies might be the least well known residency option after medical school. The TY is a one year residency with a general focus which prepares recent graduates for advanced residencies. To understand where a TY fits in, you must understand that there are a number of residency programs that do not start specialty training until the 2nd year after medical school graduation (i.e. PGY2). These specialties include anesthesia, dermatology, neurology, physical medicine and rehabilitation, radiology, radiation oncology, and ophthalmology.

Each of these residencies begin their specialty training after a resident's intern year. Many of these residency programs will combine the intern year (PGY1) with the advanced specialty training. In these cases, the resident will remain in the same residency throughout their training and there is no need to complete a transition year residency. However, there are programs in each of these specialties that do not start training their residents until the second year after medical school (PGY2). These programs require their residents to complete an approved intern year prior to beginning specialty training. Approved intern years include a year of preliminary medicine, preliminary surgery, preliminary pediatrics, or a transitional year residency.


  • How is a transitional year residency different from other intern years?

The goals of training are basically the same among all intern years; we all learn hospital based patient care. Surgical interns take care of patients before and after surgery in the hospital, medicine interns take care of medical patients in the hospital, pediatric interns take care of kids in the hospital. A transitional year resident will take care of all of the above. The transitional year aims to be a broad hospital-based training. TY residents will spend various months working on medicine, surgical, OB, pediatric, outpatient, ED, ICU, and elective rotations. The great asset of a TY is that it provides more flexibility, allowing residents to focus on their interests. I am interested in research and was able to complete two months of intense research during my intern year: something no one from an internal medicine, surgery, or any other residency could say.


  • Are Transitional Year Residencies easy?

Not all TYs are made equally. It is a well known fact that there are some pretty cush TY residencies out there. However, there are also some very difficult TYs. To illustrate this fact, last year I interviewed at a number of TY residencies of varying difficulties. The easiest one had 4 required inpatient months, one outpatient month, one ED month, and 6 electives. Sign out during inpatient months was 3pm. When you were in the ICU you covered 2-3 patients, and you were NEVER on call the entire year. In contrast, I interviewed at a big hospital TY where there were two MICU months where you covered 15 patients, 6 required inpatient medicine months, 2 surgery months, a busy ED month, terrible call, and three 'electives' which were all time consuming. In general, however, the answer to this question is yes. Transitional years are FAR easier than prelim surg residencies and quite a bit easier than prelim medicine residencies as well.


  • Is the training as good at a Transitional Year Residency?

Absolutely, if you choose the right place. Many months this year I have more free time than I did in medical school. I have found that with the free time I am actually reading and studying a ton. I think that you MUST take call to learn how to be a doctor during your intern year. I am not sure how you can become a 'well trained' doctor if you never take call during your intern year. Being on call at night is when you really have to make decisions and you really learn a ton. You don't need 11 months of inpatient work to become a great radiologist or a great ophthalmologist. However, 6 solid months of medicine/surgery will certainly prepare you for your next level of training. Then you can spend the other half of the year becoming great at something else: research, pediatrics, surgery, golf, sleeping, etc etc


  • Describe a typical transitional year schedule?

Everyone must do: 1 month in the ICU, 1 month ED, 1 month outpatient, 2 months general medicine. I believe the rest is up to the residency program. Most programs end up giving 3-5 months of electives.


  • What are the potential downsides of a Transitional Year?

Not many! More free time, less stress, more fun…what's not to like. I guess one downside is that it closes some doors if you choose to switch specialties. For example, if you were doing a preliminary medicine year at an academic center and decided you wanted to do medicine instead of anesthesia, the switch would be easier. After completing a TY year you can only go into the specialties I listed above.


  • How competitive is the Transitional Year match?

It is actually very competitive. There are not many spots, and they are all coveted because they represent less work, more free time, more electives, and a much easier year. Also, imagine all the applicants trying to get spots: future radiologists, ophthalmologists, radiation oncologists, dermatologists. This is not a list of ordinary applicants. Matching into a TY is about as hard as matching into radiology or ophthalmology.


  • What are residencies looking for in a Transitional Year applicant?

I asked my TY program director this exact question and this was his response: "We know we will only have you for one year. However, during that year the TY class will take care of about 50% of all the patients in this hospital. So, it is in the hospitals best interest to have someone who 1- will work hard without being asked, and 2- will maintain the great patient care that we have at the hospital." I think those two things are exactly what all programs want. I think item #2 may touch on competency a little bit, but is mostly referring to your interpersonal skills.


  • What should students look for in a Transitional Year residency?

Whatever you want to look for in a TY year. That sounds cliche, but as I said above, not all TYs are made equally. Do you want a chill year at the risk of missing out on training? You can find that. Do you want to do pediatrics as well as medicine and surgery? You can find that.


  • Is there anything you wish you knew before application season?

I interviewed at a few places that had both TY years as well as preliminary medicine years but the curriculum was exactly the same. In other words, if you match into the preliminary medicine year, you still have the flexibility that the TY residents at the same program have. All of these programs will let you apply to both the TY and the prelim med year after your single interview. These are great programs to find because even though there is no difference at all in the curriculum, the preliminary medicine years are a bit easier to get into.


  • What other advice to you have for students applying to a Transitional Year?

Good luck, intern year is exhilarating, fantastically rewarding, difficult, and very very short. Enjoy it. Read The House of God (amazon link), there is no better time than intern year. Also, watch the first season of Scrubs where the characters are interns…it is incredibly realistic!



Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


Physician Satisfaction by Specialty

The most recent installment of the Medscape Physician Compensation Report was recently published. Along with some of the best information on the web about physician salaries by specialty, the new Medscape report also reports which specialties are the most satisfied with their jobs (click here to view the entire Medscape Report). The results may surprise you. There is no correlation with salary and satisfaction.  The highest paid specialties (orthopedics and anesthesia for example) are found in the middle of the list while pediatrics, ID/HIV, and pathology are all found at the top of the list.  Interestingly, plastic surgery is–by far–the least satisfying specialty. So, the most competitive specialty is by far the least satisfying…that’s odd!


From the 2012 Medscape Compensation Report


My conclusions from the Physician Satisfaction Survey:

  1. The age old adage is correct: Money does NOT buy happiness.
  2. Just because a specialty is desirable to match into does not mean it is desirable to practice in [plastics].
  3. I can find only one thing that links the most satisfying specialties: LIFESTYLE.  If you look at dermatology, psychiatry, emergency medicine, infectious disease, pathology, and ophthalmology they have a great lifestyle in common. They all have minimal call, good salary (but they are not the big earners), and few emergencies.  They all lend themselves well to family, recreation, and other hobbies outside of medicine.


My unsolicited advice:

  • I am sure there are my internists and plastic surgeons who are very satisfied with their jobs. I would bet that they knew exactly what there were getting into before they choose their specialty. Satisfaction in the workplace has lots to do with managing your expectations (and the expectations of your family and friends!)  If you really love some of the specialties that do not have the best lifestyle, that is great, just make sure you know that this will be an issue before you go into he specialty. Once you have made that decision, you will not be shocked (and neither will your family/friends) when you work a lot more than those around you.

The Most Recruited Medical Specialties

Now that I am in the first year of residency I am beginning to think about landing that first real job.  As a Transitional Year resident I am heavily involved with the Internal Medicine residents at my hospital.  I found out very quickly that these internal medicine residents are HIGHLY sought after. In fact, many of them receive job offers on a weekly, or even daily basis.  The jobs that are in highest demand for internists are outpatient primary care and inpatient hospitality.  Many of my senior residents are being offered salaries between $200,000 and $300,000 along with many benefits including loan repayment. There are even some offers higher than $300,000 for less desirable locations! This is in a stark contrast to the ophthalmology job market that I will face, where starting salaries are low and it is terribly difficult to get your foot in the door.

Recently, I came across the Merritt Hawkins database.  Merritt Hawkins obtains information about starting salaries and benefits for newly graduated residents. I speak about their great physician salary database in my Ultimate Guide to Physician Salaries. However, their database also contains a list of the 20 most recruited specialties in medicine. The list may shock you!  The ability to find a well paying job right out of residency is NOT AT ALL correlated with the competitiveness of the specialty.  Case in point: family physicians and general internists are the two most highly recruited specialists in medicine!

From Merritt Hawkins


This list represents the Top 20 most ‘requested physician searches by medical specialty.’ The numbers represent the number of times Merritt Hawkins was used to recruit a person from the respective specialties (Merritt Hawkins full PDF including physician compensation data is available here for free). So, when you are deciding on a specialty, don’t forget that competitive does not equal good job placement.  In fact, many of the least competitive specialties are very high on this list (pediatrics, psychiatry, family medicine)

Spotlight Interview: Matching in Dermatology

A Dermatology Resident’s Perspective:

From an interview with a dermatology resident at Wayne State University in Detroit, Michigan

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.



  • How competitive is the dermatology match?

Very. There are not a lot of training programs as compared to otherspecialties. On top of that, each program may only have 2-3 spots yearly. As you can imagine, this creates a competitive atmosphere in the Dermatology match.


  • What are residencies looking for in a dermatology applicant?
There are rumors about Dermatology i.e. You must do research, you must have 250+ on Step 1, etc. Although these will help in the match, each applicant has their own characteristics that may impress a program (i.e leadership,Clinical experiences). In general, a well-rounded student will be very competitive. Honors in third year clerkships will be very helpful. Dermatology programs particularly look at the Internal Medicine clerkship as a strong indicator. 


  • What do you wish you knew before application/interview season?  

Since Dermatology is competitive, it is important to apply broadly across the country. The application and travel expenses can be costly so prepare wisely.


  • What should students look for in a dermatology residency?

Important aspects of Dermatology training include a diverse patient population, wide variety of training in all Dermatology subspecialties (Pathology, Pediatrics, Procedural, Mohs and Cosmetics) and learning environment (clinic vs. inpatient; large program vs small program)


  • What other advice do you have for students applying to dermatology residency?

It is important to immerse yourself in the field of Dermatology. Performing well in a Dermatology clerkship will be very helpful. Away rotations are helpful to show a program how well you can fit in at that program AND will give you the opportunity to get a strong letter of recommendation from  Program director at your away rotation.


Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


Spotlight Interview: Why Did You Choose Dermatology?


A Dermatology Resident’s Perspective: From an interview with a dermatology resident at Wayne State University in Detroit, Michigan

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.



  • What attracted you to Dermatology?

The variety of pathology seen in the field of Dermatology initially attracted me. The field allows your to be a clinician, a surgeon and a pathologist all in one day. This kind of variety seems to allow me to be entertained for the next 20+ years.


  • Describe a Dermatologist’s typical work day?

The majority of Dermatologist spend there days seeing patients in clinic. Common things are common so most days consist of diagnosis and treatment of skin cancer, acne, benign skin conditions, warts, etc. Some Dermatologists mix their day up with procedures such as benign or cancer excisions, aesthetic procedures, laser surgeries, etc. dermatopathologist spend their days viewing pathology slides to lead to the diagnosis of various skin conditions. Mohs micrographic surgeons use a special surgical technique to treat skin cancer at the microscopic level. Procedural and Cosmetic Dermatologists uses injections, chemicals, lasers and surgical techniques to improve the aesthetic appearance of their patients.


  • What type of lifestyle can a Dermatologist expect?  

Most Dermatologist work 5-6 days weekly. The majority of patients are seen between 8am and 5 pm. Dermatologist who are affiliated with hospitals may seen Dermatology consults throughout the day and occasionally on weekends. There are only a few Dermatological emergencies. Therefore, your evening and weekends are used to enjoy family or personal interest. Although the hours of a Dermatologist may be limited to 40-50 hours per week, most Dermatologist will tell you they spend a large amount of time reading new literature and review old text as the field is very vast. A good trained Dermatologist must stay up with current recommendations.


  • What is the earning potential of a Dermatologist?

Typically, a Dermatologist may earn roughly between $200,000 and $400,000. This depends on the setting of your practice (Academic vs. Private), location of your practice (Urban vs. Rural) and Volume of patients. With any specialty, there are always outliers. Dermatologist who see large volumes of patients, perform cosmetic or surgical procedures, may earn more income.


  • What is the job market like for Dermatology?

There is currently a shortage of trained Dermatologist across the United States. Therefore, the job market is pretty good.


  • What are the potential downsides of Dermatology that students should be aware of?

Many people (especially other physicians) comment about the awesome lifestyle of Dermatologist. Although generally dermatologist have great lifestyles, they work very hard for this lifestyle. If you are looking for a field that is “easy,” Dermatology is not for you. The training is an intense 3 years filled with countless hours of clinic and reading…Lots of reading. Life as an attending may be seen as glamorous but your earning potential is based on how hard you work. Due to the shortage of Dermatologist, many physicians have to “stretch themselves thin” in order to accommodate their patient population. Many Dermatologist work beyond normal business hours and even weekends to accommodate the patients they serve.


  • What else would you tell medical students who are considering Dermatology?

It will be very helpful to get a full Dermatology experience during your medical school training. The more you see, the better you will understand the field and if it is a good choice for you.


Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.


Morgellons: Real Skin Disease or Delusional Dermatology?

Morgellons Syndrome is described as a skin ‘infestation’ by small mites, or morgellons.  The ‘diagnosis’ is not accepted by mainstream medicine but has been widely publicized by media outlets and advocacy groups. Those who are believed to have morgellons complain of itchy skin, stinging and painful sensations, and the feeling of creeping and crawling underneath the skin. In many patients, there are persistent skin infections that do not heal properly. Some describe white plaques the form around chronic skin wounds. One of the unifying complaints, however, is the presence of small fibers erupting from the skin after the symptoms have been present for a few weeks.

Initial research into these complaints identified no unifying cause, no parasite, and no underlying cause. The lack of evidence for morgellons led most medical organizations, including the American Academy of Dermatology, to declare the the symptoms were not skin related at all, but were a delusion. The combination of symptoms, they say, follows a well known pattern that has been described in dermatology as Delusional Parasitosis: a disease that causes a healthy person to have a strong and incurable belief that their bodies are being overtaken by mites or bugs.  Interestingly, a PubMed search of all research that has been published on the subject (34 papers since 2006) identified no causative factor but did include titles with words such as: psychosis, hypnosis treatment, delusion, unexplained, antipsychotic-responsive, mysterious, web-based dissemination, contested, unknown etiology, and internet meme. [CLICK HERE TO SEE ALL 34 PAPERS]

Nevertheless, though the medical community has shunned the idea of morgellons, the diagnosis has lived on. A recent paper  published in PLoS One identified the epidemiology of 115 patients who were thought to have morgellons syndrome.  The paper found that 70% of these patients also complained of chronic fatigue, 59% had cognitive deficits, 50% tested positive for drugs, and 78% reported exposure to solvents. Quite the motley crew!  However, they did find some interesting results among this interesting group, see images below…

Microscopic image of a fiber taken from 'morgellons' patient

Skin lesions seen in patients enrolled in the PLoS One study

Something is certainly going on in those images.  Is it a delusion? Or is it a whole body infestation?