Careers in Dermatology: Specializations

Key Takeaways:

Dermatologists need extensive education and training, including medical school and residency.
Specializations within dermatology include pediatric dermatology, cosmetic dermatology, and Mohs surgery.
Dermatologists earn an average of $383,500 annually. However, salaries can be more or less depending on location and experience.

Dermatology is the study of the skin, and there are a number of career specialties in dermatology that most people may not know about. A dermatologist is a type of medical doctor.

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Doctors in the dermatology field are primarily responsible for the diagnosis and management of conditions, disorders, and diseases that impact the skin, nails, hair, mucus membranes, and genitalia. A dermatologist’s career path may vary, depending on one’s academic interests and career objectives. There are no simple “dermatologist dermatologists.” Like other medical careers, dermatology careers can span many fields, from cosmetic surgery and laser treatment to reconstructive surgery. Dermatology professionals may work with pediatric patients, the elderly, cancer patients, and more.

What Kind of Education Does a Dermatologist Need?

Students interested in one of the specialties and fields of dermatology will first typically be required to complete a dozen years of education and professional training. These requirements apply to those jobs in the dermatology field in the United States and other western nations.

Note – Students who are interested in careers in dermatology without med school will find job opportunities that will be more of a supportive or business-oriented role.

The Education Phase I – Undergraduate Pre-Medical Degree Program (3 – 4 years)

To be accepted into medical school, students must complete a pre-medical undergraduate program. This usually includes a Bachelor of Science degree in one of the foundational science topics like biology, calculus, chemistry, physics, or statistics. Depending on the chosen undergraduate degree program, students may need to supplement their studies with classes and medical-related coursework that includes human anatomy or medical terminology, among others.

Taking the MCAT (Medical College Admissions Test)

The Medical College Admissions Test is an 8-hour, computer-based exam that gauges an aspiring physician’s medical school preparedness. The MCAT is required for admission into any U.S. medical school as it assesses the test-taker’s analytical skills and conceptual understanding of the skills necessary to succeed in medical school.

The Education Phase II – Medical or Osteopathic Degree Program (4 years)

To become a registered or licensed doctor in the U.S., one must complete a doctoral-level medical (or osteopathic) degree program. These academic programs set forth a physician’s foundational knowledge and take at least four years to complete. Within this degree, aspiring physicians –

Study Theoretical Coursework
Observe Medical Environments, Settings, and Procedures
Receive Hands-On Training
Complete Clinical Rotations

Following graduation from an M.D. program, a candidate must complete an internship or residency programs in a general medical practice. This helps graduates acquire the practical skills and experience that are needed to practice as a general practitioner.

The Training Phase – Internship and Residency (1 + 3 years)

When a registered doctor has completed the above-noted education, the next step is to choose a training program in one of the available fields in dermatology. The AAD (American Academy of Dermatology) offers a set of modules that offer aspiring doctors a taste of dermatology related careers and a more in-depth perspective of this medical discipline.

Those interested in dermatologist careers will then complete a 3-year residency. During this time, aspiring dermatologists learn how to apply their education, knowledge, and training in a practical medical setting. Under the supervision of experienced medical practitioners, interns are tasked with the responsibility of diagnosing and managing dermatological conditions. When completed, the medical resident is now eligible to sit for board certification, the final step to becoming a board-certified dermatologist.

A Word About Board Certification

It is noted that obtaining board certification as a dermatologist is not required to become a medical doctor or hold a medical license; the board certification is a highly desirable credential and is indicative of one’s expertise and dermatological knowledge, and experience.

Most clinics, schools, and hospitals require physicians to be board-certified to be eligible for employment as a dermatological specialists.

Dermatologic certification is available through several oversight organizations. These governing bodies include –

The American Board of Dermatology (ABD)
The American Osteopathic Board of Dermatology

How Does a Dermatologist Specialize?

To understand how a dermatologist may specialize, it is first important to understand the most common conditions and issues they may treat professionally –

Acne –typically happens in the teenage years and includes a skin condition caused by hair follicles becoming filled with dead skin cells or oil.
Psoriasis – a skin disease characterized by scaly, itchy patches.
Eczema – a skin condition that causes inflamed, itchy, and dry skin.
Hair Loss – which can happen for genetic and non-genetic reasons.
Nail Fungus – a common infection in the nail bed.
Skin Cancer – abnormal skin cell growth.
Rosacea – a skin condition that tends to be chronic but is treatable.

Standard dermatological procedures include –

Electrosurgery – involves a high-frequency electric current that is used to surgically cut or destroy tissue.
Cryosurgery – involves extreme cold to surgically freeze and destroy tissue.
Laser Surgery – involves special light beams to treat skin disorders.
Excision Surgery – involves removing (excising) tissue.
Mohs Surgery – involves removing skin cancer cells – layer-by-layer.
Mole Removal – involves partial or total mole removal. The mole is then sent to a lab to determine if it is malignant or benign.
Vein Treatment – dermatologists are trained to treat problematic veins with sclerotherapy or laser therapies.

Dermatology Careers and Dermatological Specializations

Dermatologists who wish to specialize and reach for specific jobs in dermatology have the option to pursue additional training in a number of dermatology fields and subspecialties. For instance, the following are available dermatology sub-specializations –

Dermatopathology – A One-Year Fellowship.

The dermatopathology fellowship builds upon the foundations of clinical and theoretical knowledge. Through examinations and clinical correlations, fellows interpret dermatopathological material. A dermatopathology resident –

Must be able to recognize patterns of skin diseases and disorders
Determine the differential diagnosis potentials. Techniques used in dermatopathology diagnosis include –
- Immunofluorescence – is a medical technique that allows for the visualization of many components in a cell or tissue sample.
- Electron Microscopy – a technique that obtains high-res images for research into the cell’s structure, function, and disease.
- Immunophenotyping – to aid or clarify a leukemia or lymphoma diagnosis. This technique also helps in treating and evaluating the condition after treatment.
- Molecular Diagnosis – The process of studying molecules, such as proteins, DNA, and RNA, in a tissue or fluid in the identification of diseases.
Determine a final diagnosis and treatment plan.

Pediatric Dermatology – A One-to-Three Year Fellowship.

A pediatric dermatologist, as its name suggests, involves dermatologic (common and rare) disorders in the pediatric population. Within the pediatric derm specialty, there are more refined subspecialties. These include –

Pediatric residents/fellows may be on-call and need to evaluate and treat patients in an affiliated hospital.

Note – Fellows who have successfully completed training in Dermatopathology, or Pediatric Dermatology become eligible to take a subspecialty examination in those fields to become a pediatric dermatologist.

Mohs Micrographic Surgery & Dermatologic Oncology – A One-Year Fellowship.

The Mohs and Dermatologic Surgery program focuses on the medical management of skin cancer. The procedure is done in several steps. Fellows are trained in excisional surgery that includes complex flap and graft closures.

Cosmetic Dermatology – A One-Year Program.

This one-year cosmetic program is not technically recognized as a subspeciality of the dermatology field, although it is quite a popular career choice for dermatologists. A cosmetic dermatologist treats a patient in ways that impact their appearance. A cosmetic dermatologist may treat issues related to acne, for example. They also offer cosmetic solutions to counter the impact of aging, reducing age spots or wrinkles.

What Does a Dermatologist’s Career Path Look Like?

Aside from the traditional medical education path, aspiring doctors may want to understand what and how a dermatologist’s career path may look like beyond the years of education and training.

The field of dermatology tends to be a bit different from other medical specialties. For the most part, dermatological patients require ongoing treatment. As a result, dermatologists – especially those medical professionals working in a private or group practice, usually have long-term professional relationships with many of their patients.

And because skin issues are often visible, these skin disorders may cause the patient to suffer a social stigma which ultimately impacts the patient’s self-esteem. These emotional challenges accompany physical issues and can be part of the most challenging yet rewarding parts of being a dermatologist.

Dermatological Salary Expectations

Dermatologists are in high demand and are well paid. Their annual median salary is approximately $383,500. Most dermatologists work in physician offices. And while dermatologists may have busy and hectic days, these types of doctors tend to keep regular work schedules and have few, if any, emergency calls. The states with the highest dermatologist employment levels include –

State	Median Annual Salary
Texas	$ 321,600
Minnesota	$ 349,710
Florida	$ 219,580
Ohio	$ 242,600
Arizona	$ 316,380

Source– BLS

United States Metropolitan areas with the highest employment levels for dermatologists include –

State	Median Annual Salary
Minneapolis-St Paul, MN	$ 337,900
Nashville-Franklin, TN	$ 328,520
Phoenix-Scottsdale, AZ	$ 349,550

Source – BLS

According to an IQVIA research report, 30% of dermatologists work as solo practitioners. These types of medical professionals maintain a relatively high rate of business ownership.

Compared to other medical specialties, dermatologists are typically affiliated with fewer hospitals or medical systems. Nearly 36% of these medical specialists have no affiliation with a hospital for admitting patients and surgical care.

It’s common for dermatological professionals to manage patients without a need for a hospital setting. Most have an office staffed and equipped to handle routine procedures and treatments.

A Closer Look at Some Dermatology Specializations

Dermatology is the study of the skin, and there are a number of career specialties in dermatology that people may not know about. Many simply know that a dermatologist is a doctor that takes care of the skin, hair, and nails. However, the types of specializations within this field are actually quite vast. Let’s take a closer look at some of these subspecialties.

Dermatopathology

The pathology of the skin is the area of expertise for a dermatopathologist. These highly trained medical professionals are most concerned with the causes and effects of skin diseases. Much of their work is done in the laboratory, where they study samples to diagnose specific conditions. A year of specialized fellowship training is required for this position.

Pediatric Dermatology

Another specialty in dermatology is pediatrics. Pediatrics is a specialization in meeting the medical needs of children. Dermatologists within this subspecialty frequently come across conditions such as birthmarks, warts, genetic skin diseases, and acne. In order to become a pediatric dermatologist, one must complete residencies in both dermatology and pediatrics or complete a fellowship post-residency, according to the American Academy of Dermatology.

Teledermatology

Teledermatology is an innovative specialization in which dermatologists use various media to assist other medical professionals in identification and diagnosis of hair, skin, and nail conditions. Technologies such as audio, visual and data use are employed to share information between providers. It allows a second opinion to be given without requiring the patient to make a special trip and allows off-site dermatologists to weigh in on patient cases with their specialized knowledge.

Mohs Surgery

Mohs surgery is the removal of skin cancers. This is a very specific type of surgical procedure that allows practitioners to make a complete assessment of tumor margins peripherally. It was named after its developer, Frederic E. Mohs, who discovered the technique in the 1930s. Dermatologists who choose to enter this specialty must commit to becoming proficient in both surgery and pathology during their time in residency. In addition, it’s possible to obtain training during a fellowship in Mohs Surgery.

Cosmetic Dermatology

A popular specialization within the dermatological field is cosmetic dermatology. This subspecialty focuses on procedures that are aesthetic involving the skin, hair, and nails. They help to improve their patients’ appearance. Common treatments performed by cosmetic dermatologists are fillers, laser surgery, liposuction, botox, and skin resurfacing. Most of the procedures undertaken by these professionals are minimally invasive, rather than extensive surgery. Specialized fellowships are required for this specialization.

These are five common specializations within the field of dermatology that future medical professionals can consider. While dermatology is itself a specialization within the medical field, there is a wide assortment of subspecialties available to study. Patients benefit from seeing these specialists because of the peace of mind that’s provided in knowing their doctor is specifically and extensively trained in the types of medical issues the patient is experiencing. These specializations require additional training in residencies or fellowships, but these experiences provide professionals the knowledge and experience required to properly treat very particular skin, hair, and nail conditions. These career specialties in dermatology are necessary within the profession.

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