At the 2022 ODAC Dermatology, Aesthetic & Surgical Conference, a resident directed series included a panel on choosing your next steps after dermatology residency – Fellowship, Academics, or Private Practice, It’s Decision Time. The panel had an impressive group of dermatologists who answered a series of questions about paving our future paths in dermatology. Here are our panel members, including their relevant previous and current roles:
William Hanke, MD (Mohs surgery, academic medicine)
- Previous role: Professor of Dermatology, Pathology, and Otolaryngology at Indiana University School of Medicine
- Current role: Program Director for Micrographic Surgery/Dermatologic Oncology Fellowship Training at Ascension St. Vincent Hospital, Indianapolis
Yasmine Kirkorian, MD (pediatric dermatology, academic medicine)
- Current role: Chief, Division of Dermatology, Children’s National Medical Center & Associate Professor of Dermatology and Pediatrics, George Washington University School of Medicine and Health Sciences
Omar Qutub, MD (general dermatology, personally owned private practice)
- Current role: medical, surgical, and cosmetic dermatology at his own private practice, Defining Dermatology in Portland, Oregon
Adam Friedman, MD (general dermatology, academic medicine)
- Current role: Professor and Chair of Dermatology at George Washington University School of Medicine and Health Sciences
James Spencer, MD (Mohs surgery, private equity)
- Previous role: Assistant Professor and Director of Mohs Surgery at University of Miami Miller School of Medicine
- Previous role: Associate Professor and Vice Chair of Department of Dermatology at Mount Sinai School of Medicine
- Current role: Professor of Clinical Dermatology at Mount Sinai & private practice in St. Petersburg, Florida (private equity)
We will tackle a range of questions regarding career choices, hearing opinions from our panel of speakers with a wide range of careers. I hope it helps other residents as you ponder future career choices, especially those who did not have the fortune of attending the panel in person!
Is it possible to go back to fellowship after years in practice? Does this give the applicant an edge or is it looked down upon?
Dr. Hanke summarized this by saying yes, you can return to a fellowship later in practice. He thinks later applicants may even have an edge given the experience they gained in practice. However, early applicants also seem more purposeful in their decision compared to later applicants. So there are pros and cons of both approaches, but both are feasible options!
Is it possible to switch from academics and private practice and vice versa? Everyone agreed this is a common path, especially from academics to private practice. Dr. Friedman stressed that dermatology is flexible – you do not need to pick only academics or private practice. For instance, you can teach or lead a resident clinic while remaining in private practice. He gave a plug for academics as well, stating that it is nice to have the extra support in academics, especially after residency, and that there are opportunities to supplement an academic salary outside of clinic, if desired.
I want to do cosmetics in my future practice – is a cosmetics fellowship necessary?
Dr. Spencer feels that a fellowship is not necessary but it is more efficient given how much you will pick up in one year (compared to learning more slowly at meetings). Dr. Qutub added that this question really depends on your residency, however, given the amount of cosmetic exposure varies between programs. But if you are looking for a niche in cosmetics, a fellowship that emphasizes that niche is more necessary.
What are the pros and cons of an academic practice?
For pros, collegiality is the biggest benefit. Dr. Kirkorian expressed how she loves to build relationships with residents and colleagues, with residents especially, as she is able to see their future successes as dermatologists. Another pro discussed by both Dr. Kirkorian and Dr. Friedman is that you can be a leader and expert in your field and as an expert, you are referred challenging, complex cases. Leading into cons, Dr. Friedman discussed that the field is changing, especially with the pandemic, so there is a greater focus on revenue, even in academics. Dr. Hanke finished by stressing the importance of your chair – this can be a pro, if your chair supports you, or a con, if the chair does not want to build your career.
What are the pros and cons of a private practice?
Dr. Qutub, who has experience in both a larger private practice and his own practice, said the biggest pro is autonomy – this can be intimidating, yes, but also liberating and satisfying. Along the same vein, this autonomy can lead to uncertainty, both with medical decisions and financial security. You need to plan for downturns, like the pandemic, and make sure you have financial backing to keep the practice going. Dr. Spencer reiterated the benefit of independence; you can make all decisions and buy whatever tools you would like (although, purchasing new equipment may be more challenging in private equity compared to a personally-owned practices). Being the boss comes with cons too. As the boss, you are in charge of hiring and firing. Although he believes in all of us, stating “If you make it through medical school, you can make it through a private practice.” Finally, Dr. Spencer also stressed that private practice is the most lucrative, especially if you expand your practice and hire other physicians and physician assistants.
Financial decisions might impact whether people pursue fellowship or not. Do you think this should impact applicants’ decisions?
Overall, the emphasis was that finances should not be everything. Dr. Kirkorian encouraged us to consider, “What is your life about? What makes your life worthwhile?” If you love seeing complex pediatric patients every day, then the fellowship is worth it, regardless of the hit to your salary. Dr. Spencer also added that fellowships like Mohs surgery and dermatopathology completely direct your career path, so these fellowships are likely worth the extra year of training.
I am interested in pediatric dermatology, but I am not sure if I should pursue a fellowship. What are some of the pros and cons of pursuing a pediatric dermatology fellowship?
Dr. Kirkorian explained the pros and cons with a simple anecdote – you can’t be a pediatric dermatologist without the fellowship but you can be a dermatologist who takes care of kids. So for next level, complex care, you need a fellowship. Board certification also requires a fellowship.
If I want to work in private practice and do Mohs, do you recommend I do a fellowship? What would be the pros and cons?
Dr. Spencer discussed that the fellowship is absolutely needed if you want referrals for surgery and if you would like to be a board certified Mohs surgeon. If you only want to perform your own cases, then you can do this without a fellowship.
I am interested in reading my own permanent pathology slides, but I want to also see patients and do some surgeries. Is it worth it for me to do a dermatopathology fellowship?
Dr. Friedman stressed that having a dermatologist who does it all (dermpath and seeing patients) is very marketable and useful. In academics, a 50:50 split with pathology and clinic time is very common. Dr. Spencer and Dr. Hanke agreed that you can also read your own slides without a fellowship if you keep up with your skills. However, from a legality standpoint, this could be problematic. Regardless, if you are interested in dermpath, Dr. Qutub stressed the importance of continuing to study pathology after residency because if you do not, you won’t retain the same skillset.
I am interested in research, innovation, and contributing to the field of dermatology. What are some recommendations for how I can do this in private practice?
This can be done in two common ways – getting involved with your local residency program or participating in clinical research with pharmaceutical companies. Dr. Spencer and Dr. Friedman discussed that most clinical research is actually done in private practice. Private practices are more likely to have an appropriate set up for clinical trials and the institutional review board (IRB) can be easier to navigate through compared to a university’s IRB.
I am interested in leadership and teaching others. What are ways I can pursue this in the private practice setting?
The majority of dermatologists are in private practice, so you can certainly still be a leader in this setting. Dr. Qutub stressed that leadership and mentorship can be within your own private practice as well – four of his medical assistants have gone to medical school and three to physician assistant programs. Dr. Kirkorian also discussed that you can pursue leadership through your local dermatologic society. If you want to speak in the media, the AAD media training would also be a great place to start.
I would like to start my own clinic, but I am overwhelmed by the administration, HR, insurance, rules and regulations. Are there any companies that can help manage these services?
Consultant services do exist and can help you set up your practice, including a Mohs lab. However, Dr. Qutub hired one such consultant but did not continue with the service. He realized that he knew what he wanted for his practice so it made more sense to save money and invest more of his own time.
I am considering joining a private equity group, but I have heard negative things about it. What are your opinions on private equity?
Dr. Spencer, who works in private equity, kept it brief by stating that it is a job and the hours are fair (9am to 5pm). He described it as an “exit strategy” – you can make a good salary while working only a few years so consider this near retirement. Dr. Kirkorian also empowered women here by stating that if having reasonable and consistent work hours is appealing for your family, then no explanation is needed!
We will end with everyone’s one final thought:
- Hanke: Donate to SkinPAC to help the AAD advocate for us!
- Spencer: Academic dermatology is something to consider given it is the most interesting and stimulating, but unfortunately, the poor pay is a downside.
- Kirkorian: You can’t buy happiness and you can always change your mind.
- Qutub: Private practice allows a nice work-life balance.
- Friedman: After residency we are finally a commodity and can paint our own paths. Eighty percent of people leave their first job so remember jobs are flexible and never underestimate your value.
This information was presented at the 2022 ODAC Dermatology, Aesthetic and Surgical Conference by Drs. C. William Hanke, Adam Friedman, Yasmine Kirkorian, Omar Qutub, and James Spencer. The above highlights from their panel presentation were written and compiled by Dr. Emily Murphy.
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