There is a mad rush for dermatology and plastic surgery courses in the US.
So much is the craze for better physical appearance among Americans that those who specialize in the relevant disciplines have begun to have a roaring practice.
Naturally there is intense competition among medical students for admission to residential programs in dermatology and the like.
The vogue for such specialties has resulted in the migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours, says NATASHA SINGER, writing in the New York Times.
Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors.
Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties.
Only 61 percent of seniors at American medical schools whose first choice was dermatology received a residency in that field last year.
Whereas in internal medicine 98 per cent walked in and 99 percent in family medicine, according to a report by the Association of American Medical Colleges and the National Resident Matching Program, which pairs candidates and programs.
"It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time," said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.
"We have a shortage in America of primary-care or family-type doctors," said Dr. Joel M. Felner, a cardiology professor who is the associate dean for clinical education at Emory University School of Medicine in Atlanta. Last year, the school enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care, he said. "We do need dermatologists, but I am more worried about the really sick people and dermatologists aren't taking care of them," Dr. Felner said.
Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery. Not anymore.
At a time of increased discussion of enhancing beauty, as well as narrowing standards for skin perfection, the public has a newfound esteem for doctors who treat appearance.
"Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color," Meena Singh, aspiring for dermatology residential course this year, said. "Having something on your skin is not life or death for people, but it can be equally important for them emotionally as a life-threatening disease."
Indeed, dermatology can be a psychological lifeline for people with severe skin problems. At pools or the beach, some people shun those with psoriasis who have scaly skin, fearing the condition is contagious, doctors said. People with deep acne scars say it affects their personal and professional lives.
Then there is the growing popularity among otherwise healthy people of tweaking one's appearance with cosmetic treatments, from Botox injections to lip plumping and laser hair removal. Plastic surgeons, dermatologists and facial surgeons in the United States performed about 9.6 million such nonsurgical treatments in 2007, almost nine times the number a decade earlier, according to the American Society for Aesthetic Plastic Surgery.
Dermatology also attracts students like Thomas Hocker because of the potential for basic research on skin diseases that can lead to new treatments. Hocker said he plans to focus his career on researching the role of genetics in problems like skin cancer and abnormal scarring; he took a year off during medical school to conduct melanoma research.
While students like Mr. Hocker choose dermatology planning on research careers, others end up focusing on cosmetic treatments like skin tightening and resurfacing.
Half of the dermatology residents graduating over the last five years from the program at the Boston Medical Center have chosen postgraduate fellowships that teach a combination of skin-cancer operations and cosmetic procedures, according to Dr. Barbara A. Gilchrest, the chairwoman of dermatology at Boston University School of Medicine.
Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.
But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.
And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.