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    Starting a career in dermatology: 5 questions

    Veteran physicians advise residents on training, practice management

    Residency isn't forever, and young dermatologists on the verge of starting their careers must make big decisions. At the 2016 CalDerm Symposium, a continuing education seminar offered by the California Society of Dermatology & Dermatologic Surgery, a panel of experienced dermatologists offered insight and advice to dermatology residents about embracing their futures. They followed with more comments in interviews.

    Here's a look at how several of the panelists answered some of the biggest questions facing these young derms:

    How important are mentors?

    The University of California at Irvine's Patrick K. Lee, M.D., is a strong advocate for mentors since they can serve as guiding figures throughout a dermatologist's career.

    “Most of us get where we are thanks to brains, hard work and insecurity, which is really what drives a lot of us," he said to laughter.

    As a result, he said, "you may be a bit hesitant. A lot of times you’re not sure what you’re able to accomplish. I really believe that mentors can really help shape you and see your potential."

    Dr. Lee, professor and director of dermatologic surgery at UC Irvine Department of Dermatology, says residency is the perfect time to search for a mentor, especially since official mentor programs may be available.

    “Find the person who's living the life you want to live and see if they'll counsel you,” he advises.

    “The best type of mentor is someone you feel like you have a good vibe with. They can help you in the right direction even if they don't do what you want to do."

    Is a fellowship a good idea?

    Dr. Lee addressed the sentiment that most residents are just trying to finish training to start making money. He advised those who are thinking of careers in teaching to consider fellowships seriously.

    If you have any aspiration for academics, you will need a fellowship, he stressed. He recommended that everyone consider this option.

    “The issue is that you may not know you have academic aspirations until you are done. I've had several residents who weren't sure they wanted to go into fellowships at first and realized later they wanted to,” said Dr. Lee, who is the immediate past president of the California Society of Dermatology & Dermatologic Surgery.

    A fellowship can lead you to your mentors, too, he noted.  “Many of us are still very close to those who trained us.”

    He encouraged the audience: “If you have any inkling that you might want a fellowship, go for it.”

    What about a dermatopathology fellowship?

    Linda Wong, M.D., a Kaiser Permanente dermatologist in the Los Angeles area, is a fan of dermatopathology ("dermpath") fellowships.

    “I would encourage you to do dermpath. It helps you to at least know what you don't know, which is a very high level of knowledge to achieve,” she said.

    “And it helps you judge and assess the accuracy of some of the results you get back, which helps you with the patients.”

    However, in dermatopathology, "you're not directly working with the patients so they get to like and love you,” she noted. This can sometimes lead to a higher legal risk she cautioned. “A patient may say, 'I love my dermatologist,' but if you're just some name on a piece of paper, they may think, 'Who's that person? She must have been wrong.'”

    Dr. Wong serves on the Board of Directors for the California Society of Dermatology & Dermatologic Surgery.

    Should I go into private practice?

    Jerome Potozkin, M.D., a Walnut Creek, Calif., dermatologist, noted that private practice is getting a bad rap.

    “In general, people are afraid to go into private practice and feel they would be more protected by being in a large group,” he says. “People fear change whether it's the ACA or whatever the Trump Administration has in store for us.” 

    But, he told the young residents, “doom and gloom is good for you guys. It will scare people away from private practice so you’ll have a lot of opportunities," he says. “I’m really happy with what I do, and I love what I do."

    Should I hope to run the office myself?

    Dr. Potozkin cautioned the residents that being in charge has pluses and minuses.

    “As a dermatologist, you can somewhat control your schedule in terms of seeing patients. You probably won’t be there in the middle of the night. But if you own your own business, you have two jobs. You have the job of being the provider of services and then you have the job of running a business.

    "We don’t have the luxury of other fields where they can just leave work and not think about it. I have those days where I fantasize about what it would be like to be at Kaiser Permanente and not think about all those managerial things, staff and human resources.”

    Who's the best person to take charge of a clinic? “Someone who's brave, independent, creative and wants to run their own business,” he says.

    Dr. Potozkin also advises dermatologists to keep in mind three rules published in the Harvard Business Review:

    1. Better before cheaper.

    2. Revenue before cost.

    3. There are no other rules.

    Randy Dotinga
    Randy Dotinga is a medical writer based in San Diego, Calif.

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