ODEAR: Most-Favored Specialties

Hi, Dr. Elpern, I am contacting you in hopes that you may be able to assist me in attaining my goal of gaining acceptance to a Dermatology residency, and also to see if you had any advice on how to shine during my dermatology rotations, or any contacts at my away school who may assist me in research opportunities such as case reports/letters.

I receive emails like this with regularity.  In the 1960s when I was in medical school, dermatologists were at, or near, the bottom of the physician feeding chain.  Internists, with their haughty demeanors, were the self-proclaimed real brains of medicine and lorded it over most other practitioners.  Radiologists sat around in the dark, ophthalmologists were outsider-geeks, anesthesiologists servile gas passers, and ER docs were off the radar screen.  Dermatologists were the butt of jokes.

Today’s most sought after residency positions are ophthalmology, dermatology, ER, anesthesia and radiology: hence, the acronym O.D.E.A.R. I propose this as a replacement for the older acronym, R.O.A.D. These O.D.E.A.R. specialties, over the years, have undergone amazing transformations.  From pariah, low status to most-favored specialty status.

The ROAD specialties are specialties that are generally considered “lifestyle” specialties in medicine. Lifestyle specialties are those that offer good pay with minimum work hours, low patient loads, above average working conditions, and typically low on-call time.1

With its focus on often worthless skin screening2 and lucrative cosmetic procedures, dermatology has changed forever.  Today, there is no shortage of practitioners with evefr-ready cryospray guns, lasers and skills in Botox and fillers.  At the same time, patients with severe disabling skin diseases have a hard time finding skin doctors with the time and/or interest to spend with them.  It’s not uncommon for a patient with a changing mole to wait months for an appointment, while a cash-paying patient wanting Botox can get seen in a few days.3

We have met the enemy, and it is now us.

References:

1.  What Exactly are the ROAD Specialties:  Med School Hell blog.
2.  Skin Checks:  Australian Recommendations
3. Tsang MW, Resneck JS Jr.
Even patients with changing moles face long dermatology appointment wait-times: a study of simulated patient calls to dermatologists.  J Am Acad Dermatol. 2006 Jul;55(1):54-8. Epub 2006 May 6.

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