Recently a student who was interested in dermatology asked me what they should do if they do not score high enough on Step 1 to be competitive for it. First, I asked them to consider if their heart was really set on derm. Then, we discussed the many ways they could still get in to derm without stellar scores. Research is one. Connections at your home institution help. So does going to conferences, networking.
I knew a guy who wanted to do derm but didn’t match. He applied and ranked pathology as back-ups, did a year of pathology at a prestigious research institution in the North East, and re-applied derm the next year and got it. Because, if it’s the rest of your life we are talking about here, what difference does a year make in the bigger picture?
If you want to pursue derm because you have a passion for the subject itself, then I think my above point holds water. If your primary motivation is not derm but the lifestyle associated with derm, I could see that person not being thrilled to take an extra year doing resident work for resident pay. If it’s a light work week you are after, I’d encourage you to consider, well, pathology. Or psychiatry. (I am a psychiatrist). If it’s a big paycheck you’re after, anesthesia, surgical specialties, or any of the procedural subspecialties of IM (especially cards and GI) are good options. But, if you’re interested in derm for any reason other than a pure interest in the subject, I would gently challenge: are you sure that those reasons will be as important as loving your job in 30 years? I chose psychiatry because I know I can do this for the rest of my life and be excited to show up every day to work. Compare that to someone who resents their job, and in my mind, there’s no question.
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