Specialty Spotlight Podcast, Episode 15: Dermatology

Introduction to the Podcast and Episode Overview

[00:00] Welcome to the WMed Specialty Spotlight Podcast, your virtual mentor for choosing a medical specialty and planning a career in medicine. On this podcast, we probe practicing physicians with questions about their specialty, the decision algorithm

[00:20] that helped them determine that the specialty was right for them and then for advice about long-term career planning, irrespective of the field they went into. I'm your host, Dr. Brenshaw, learning with you all about the various specialties in medicine. Just a quick reminder that the show notes for this episode and all episodes can be found on our website.

[00:40] site at wmed.edu forward slash specialty spotlight. If you'd like to help support this podcast by sponsoring an episode, or are a physician willing to volunteer for an interview to talk about your specialty, please email the Career Development Team at career.development at wmed.edu.

Guest Introduction: Dr. Diana Westgate’s Background

[01:00] The specialty of today's show is dermatology and the physician here to tell us all about it is Dr. Diana Westgate. Dr. Diana Westgate is a dermatologist and is a clinical assistant professor in the Department of Medical Education and the Department of

[01:20] Family Medicine and Community Medicine at Western Michigan University, Homer Stryker, MD, School of Medicine. She is a graduate of the University of Michigan Medical School in Ann Arbor, Michigan. Dr. Westgate completed her transitional year internship at Grand Rapids Medical Education and Research Center

[01:40] in Grand Rapids, Michigan, and her dermatology residency at Harvard Medical School Department of Dermatology. Her postgraduate work has included a medical directorship at LACS Cancer Center Skin Cancer Clinic, an appointment as an associate

[02:00] clinical professor at Michigan State University College of Human Medicine ran rampant campus where she hosted medical students and residents during dermatology clerkships and provided didactic medical students and residents during dermatology clerkships and provided didactic lectures.

[02:20] She has also served as case-based learning facilitator at the Indiana School of Medicine, Fort Wayne, Indiana, and has been a guest lecturer at numerous venues from WMed to the Indiana Academy of Dermatology. While Dr. Wesk

[02:40] practices complex medical dermatology and forefront dermatology. Her specific clinical interests include GI derm and skin-gut access diseases and cutaneous manifestations of allergic diseases. She is an expert in the use of biologics and other high-risk medications.

[03:00] medications. From a medical education perspective, she is interested in the equity and diversity in the house of dermatology and expanding the footprint of dermatology education in western Michigan. So without further ado, Dr. Diana Westgate. Dr. Westgate, welcome to the show.

Journey to Medicine: Why Dr. Westgate Chose a Medical Career

[03:20] Thank you so much for having me. Well, I'm excited to have you here and for you to share with our listeners about the field of dermatology. So you heard me read your bio. Was there anything that you'd like to add? My particular interest in dermatology are complex

[03:40] medical derms. So I do not do cosmetic dermatology. So I do have to kind of bring that up. That is a large portion or at least a large portion in some practicing dermatologist's career is to do cosmetic dermatology. So I won't speak as much to the cosmetic portion of dermatology. While I was trained in that

[04:00] it's not my area of focus. So I just want to make that clear for listeners. Right. Great. And when I have guests that come on, I usually ask them to put their hat on of a general specialty physician in that specialty because I know many of you have subspecialty interests

[04:20] throughout the podcast if you could more look at it from a perspective of general dermatology. Would you be able to take us back in time before medical school and walk us through your decision to go to medical school in the

[04:40] first place? Oh, that's a great question. So when I was young, actually, I had interest in multiple different things. And one thing that I wanted to do was to be a lawyer, actually. I told my parents that I thought the law would be a good place

[05:00] for me because I was one who really liked to speak and really liked to debate. I was a debater in high school. And then I went and shadowed a lawyer and knowing yourself and then being able to shadow firsthand in a career is so important at figuring out whether there's a good fit. And when I went to go shadow and realized that it was mostly paperwork, that

[05:20] was the disconnect for me. I was like, okay, not everything is going to be FaceTime in a courtroom or kind of person to person contact with debating style. That is like a very small portion of the process to becoming an attorney as well as the process of practicing law. And so I realized that that wasn't really maybe the best fit

[05:40] for me. But I really do love people and I love the interactions with people. My father was working in hospital as a maintenance mechanic. That's what he did for his career. And he was like, you know, I really think you should consider nursing. It's like, I think you're good with people and nursing might be a really good career for you.

[06:00] And so I did some shadowing at the hospital where my father worked and I shadowed the nurses. And as I was shadowing the nurses, I was like, you know, I think this job is really important and what they do with patients is important. But I kept my eye on the physicians in the room and I was like, you know, I think I would actually prefer that job.

[06:20] So I told my father that and my dad was like, well, he's like, that's, you know, that will take a lot of schooling and this and that. And he's like, well, he's like, I really think that this other job might could be a good fit for you. But I set my sights a little bit higher than I think my father did and decided to kind of, you know, go on

Understanding Dermatology: Overview of the Specialty

[06:40] pursuing a career in medicine and I think my dad is proud that I did. Great that's a wonderful story. Thank you for sharing that. I think it's a good opportunity to transition to the first part of the interview where I basically ask you to tell us everything

[07:00] There is about dermatology. And the way I like to start off this section is by reading the description of your field from the Association of American Medical Colleges' Careers in Medicine website and the American Academy of Dermatology.

[07:20] And then I'll ask you what you think and we'll take it from there. So here it goes. Dermatology. A dermatologist is a physician with training and expertise in the diagnosis and medical-slash-surgical management of diseases of the skin, hair, and nails

[07:40] and mucus membranes. Dermatologists recognize symptoms that appear on your skin which may indicate problems inside your body like organ disease or failure. Dermatologists often perform specialized diagnostic procedures related to skin conditions. They use

[08:00] treatments including externally applied or injected medicines, ultraviolet light therapy, a range of dermatologic surgical procedures such as mole removal and skin biopsies, cosmetic procedures such as chemical peels,

[08:20] therapy, and laser treatments. How much of that do you agree with? What would you add or subtract to ensure that anyone listening was well informed of the practice of dermatology? I actually think it's quite a good description of the practice of dermatology. Sometimes I think

[08:40] The knowledge about dermatology is a little bit of a black box in the house of medicine. So I think a lot of people are not fully equipped to describe what a dermatologist does and it gets boiled down to something that's as simple as if it's wet, dry it, if it's dry, wet it. And people don't really understand the complexity of the field.

[09:00] I think that description actually does speak to the complexity of the field. With dermatology, seeing skin as a window to the internal systems of the body, that can help us to diagnose even more complex diseases. I also think that it speaks to the breadth of dermatology not just being skinned, but also involving mucus membranes, nails, and

[09:20] hair and sometimes people miss that those are organ systems that we examine as well. In addition, it also talks a little bit about the diversity of dermatology in terms of the clinical aspects of dermatology, in terms of diagnostics, the procedural aspects of dermatology with either injectables or

[09:40] surgical procedures that we perform as well as the cosmetic aspects, the lasers and other cosmetic procedures that we do. I actually think it's a fairly well-rounded description of the field. That's great. What would you say is a typical daily

A Day in the Life of a Dermatologist: Work Routine and Patient Care

[10:00] or weekly routine and you can change it to whatever frame fits to your answer. What are the typical series of patients that you typically see and what is the typical outcome of these patients? So dermatology is a really diverse field.

[10:20] I always tell my clinic that I see the patients until the patients stop coming. So I don't usually police my schedule because if I do, then sometimes it's hard to kind of just be adaptable in the day. So usually a typical day in dermatology is fast paced. We see patients every day

[10:40] 10 minutes and we see every patient's every 10 minutes regardless of the clinical complaint. So someone could be coming in for something as simple as you know a new patient or a follow-up acne visit or they could be coming in for something as complex as scleroderma and they still are seen in a 10-minute slot. So there's a lot

[11:00] There's a lot of mobility and adaptability and a lot of thought processes that have to happen kind of in rapid fire succession in order to be able to be efficient and see our patients and take really good care of our patients. There has to be some flex in the schedule where, you know, one patient visit might only take you a few minutes and then you give the allowed an extra time to that patient that was a little bit more comfortable.

[11:20] complex and there's some ebbs and flows that happen. The day is going to be very diverse. There's going to be procedures that happen right at the fly at the bedside. So patients are sometimes surprised. You know, they'll come in for a spot that they're like, oh, I have this mold that's irritating me and it's catching. And then I say, okay, would you like to have that removed today? And they're like, today?

[11:40] surprised that we would do it right on the fly. How long is that going to take? Just a couple of minutes here at the bedside. We describe the procedure and then proceed with that. There are some things that obviously are going to take more time and we schedule those out differently, but a lot of what happens in dermatology is happening right at the bedside. And so

[12:00] You have to be prepared for it all. You're going to see everything from acne, rheasiness, skin checks, psoriasis, eczema, scleroderma lupus all in a given day. That's great. It makes an interesting day. That's nice. No one day is the same, I guess.

[12:20] is generally considered most exciting about dermatology and conversely, what is generally considered most mundane about the specialty that physicians tolerate to experience more exciting aspects of it? What I think is most exciting about dermatology

[12:40] is that dermatologists really get to be true diagnosticians. When a patient comes in for an evaluation, you have to rely on a really good physical exam and you have to rely on your knowledge base of patterns of disease, visual acuity, all of the things that you need

[13:00] need in order to make a diagnosis. And what gets really fun is that when you're good at it, when you really have kind of honed your skill set, you get to make what are called doorway diagnoses. The patient comes in, they've had a rash for either months, years, whoever knows how long. They come in, you walk in the door, they've tried a whole handful of things and you

[13:20] basically go, oh, this is, and you get to tell them exactly what the problem is and give them a targeted treatment for it and then make the problem go away in many instances or at least remit in some way. So that's the fun of dermatology is that there is really no replacement for a good physical exam.

[13:40] for honing your skill set with being able to tailor your eye to looking for very subtle differences among different eruptions and different lesions so that you can make a clear diagnosis at the bedside. So I think that's really fun. Patients are usually wowed by it. Wow, you know exactly what this

[14:00] is and that only took you a couple of minutes, but now I'm going to be better in a couple of weeks. So that's part of the fun of dermatology. Part of the mundane of dermatology is that we also do a lot of things repetitively. So you and some of the counseling that you do for patients because of the repetitive complaints

[14:20] become sort of robotic. You know, you see patients for a full skin check, you describe the ABCDs of melanoma a thousand times a day, and you talk about how to use sunscreens properly a thousand times a day. And you also talk about, you know, skin care concerns a thousand times a day. So

[14:40] You find that there's a lot of repetition that happens, which in some aspects is really good for the delivery of care by your team because your nurses get really good at being able to also give some of that counseling and to be able to answer phone calls. But it does sometimes become mundane. What is one thing

[15:00] that you would have wished you would have known before entering your specialty? And what would you encourage a medical student to think about in earnest before committing to going into dermatology? I would say dermatology is a really high-paced field. So I

[15:20] I think knowing yourself, how your brain works, how your body works, and what kind of stamina you might have for repetitive patient interactions at a very high pace is important for students to be aware of. You know, some specialties have a new patient visit that lasts an hour. You know, you pour over the records, you have

[15:40] time to process. In dermatology, the pace makes it that you have to have a quick processing speed. You have to be able to process the data very quickly and give patients the education that they need and then be able to move on and switch from one patient to the next.

Challenges and Rewards in Dermatology

[16:00] processes that you have to do, the thinking that you have to be able to get through. The other thing that I would say is that because of that, because of the high level of interactions that you have during the day, you also will start to get a little bit of person-to-person

[16:20] fatigue, where you're like, man, I have seen so many patients today. Now I just like want to sit for my lunch hour and not have anyone speak to me. Or you want to at the end of the day, drive around the block maybe once or twice before you head home and have your kids kind of attack. And they're like, mom, mom, mom, because you've just had so much

[16:40] into person interaction. So I think that that's really important. You have to love people. You have to love educating people. And you have to have the stamina to do it repetitively at a very fast pace. And on that note, how many patients do you typically see in a day?

[17:00] So it depends on the day, but I would say because we see about six patients per hour if you work a full day you can see you know 40-45 patients. But we do a lot additional time for things like surgical procedures. So if you have like a you know surgery mixed in there then usually

[17:20] give yourself a half an hour, 45 minutes for surgery. Or if you have several surgeries stacked together, you might have fewer patients in that day. It depends on how you make your schedule. One of the beautiful things about dermatology though is that you do have a lot of autonomy for how you build your schedule. So that if you feel like, okay, I'm starting to get my patient to patient interaction 15

[17:40] by about the third day of patient interaction, you might build in a half day of surgery and then you have like a much slower pace moving from patient to patient for that half day. Gives you a chance to kind of reset and that autonomy is actually a really beautiful thing about the field. Okay and do most dermatologists

[18:00] do they not work weekends or are they on call for the hospital? Great question. So dermatology has a really nice work-life balance. We work usually during the week. Most dermatologists, I would say, who are full-time work

[18:20] Some will work five shorter days, some will work five full days. It just depends as well in terms of productivity and what you're interested in doing. But the majority, I would say, four full days a week for direct patient interaction. Weekends are usually not worked.

[18:40] Unless you add a clinic because you wanted to take a day off somewhere else because again that autonomy kind of plays in You don't work holidays and call is relatively minimal There are some dermatologists that do take hospital call, but the majority I would say don't so usually call

[19:00] is just patients calling for a concern and that's usually shared among all the dermatologists that are in a given practice. So then mostly what you're doing on call is just answering phone calls and not necessarily having to go back into clinic. So that would be a significant rarity for a

[19:20] dermatologist to have to go back into clinic while on call. So it is a nice work-life balance, usually four full days a week, no holidays, no weekends, and minimal call responsibilities. Okay and how does the practice of dermatology change based on setting like

[19:40] inpatient versus outpatient, academic versus private versus public, urban, suburban, rural, maybe civilian versus military, and even maybe talking about international. Yeah. So what I've described as that kind of basic schedule is really the

[20:00] majority of dermatologists who probably are mostly in private practice settings. If you're kind of teasing out the different settings where dermatology can be practiced like an academic center or inpatient dermatology or a rural setting, those responsibilities may change them. Like I said,

[20:20] dermatologists are there there's the field of dermatology that is actually essentially like a dermatology hospitalist. There are basically dermatologists who take inpatient call as kind of their primary activity in the field. That usually happens at academic centers more so than that would happen in private practice.

[20:40] If someone in private practice were taking hospital call, they would do it more as a kind of a courtesy on the as an added service and a value added not necessarily as a primary job. But at academic centers, there are people whose primary job is to deal with inpatient hospital consults. And then in the rural setting,

[21:00] A lot of times you will find that dermatologists have to wear a lot more hats, you know, and they might have to do a lot more pediatric derm than someone who's in a more academic setting or have to do a lot more surgery than someone who's in a more academic or private setting. So it can vary depending on

[21:20] where you are if you have access to a team of doctors because you're in a more urban setting. For example, I have a MOS surgeon in my office, so I send him all of the MOS surgery cases and he takes care of that and I just do general excisions and general dermatology and then I have someone in my office who does some cosmetics so

[21:40] If that's not an interest of mine, I don't have to. All of that might flex a little bit if you are out on your own. Okay. Okay. And do most residents that graduate from dermatology residency do a fellowship?

[22:00] Is it very variable is it is it a vast majority that do a fellowship or there could be a small my you know minority that do a fellowship. So there are several fellowships that you can do after a dermatology residency you can do a dermatopythology you can do pediatric dermatology you can do

[22:20] do cosmetics and like aesthetics and laser fellowships. And you can also do MOS fellowships, which is a surgical subspecialty of dermatology. I wouldn't say the majority of dermatologists do a fellowship. I would actually say it would be a lesser percentage of residents that actually go on to do a fellowship.

Career Path and Future of Dermatology

[22:40] But there are lots of fellowship opportunities for people who have more of a niche interest in the field. Okay. What do you think is the biggest challenge facing dermatology and where do you predict your specialty to be in 10 or 20 years from now?

[23:00] I think probably there are probably two, maybe three big hurdles that dermatology is facing currently. One is diversity in the field. Dermatology has been slated to be one of the least diverse fields and as a Mexican American that is something that is near and dear to my heart that hopefully

[23:20] will change within our specialty. So I think that there will be, there's certainly a concerted effort and a push toward trying to diversify our field to try to better represent the community of patients that we serve. So I think that's something that is an overarching goal for the field. The second thing that I'd

[23:40] would say is a challenge facing dermatology is access. So dermatologists, there are certainly not enough of us and so access is really a challenge for patients and the challenge that we face as a specialty is trying to garner enough

[24:00] enough of an important place in the house of medicine to gain more residency slots to train more dermatologists. So right now one of the access attempts for dermatologists is to hire providers who kind of serve with us

[24:20] whether they're physician assistants or nurse practitioners that we can train to treat some of the more routine aspects of dermatology. But that also raises some concerns about people truly seeing the specialist when they come into our office

[24:40] So access becomes another major issue that we have in dermatology and so we really do need to gain more residency spots that could be available. The other thing that I would say is a challenge in dermatology is our understanding of

[25:00] our field, the importance of our field in the House of Medicine entirely, I think that dermatology is sometimes undervalued as an important and complex specialty. And so I think the more that we interact with our colleagues, the more that they see us as specialists who can contribute to

[25:20] management of complex medical conditions and can work in concert with our colleagues, the more that we will be able to provide better care for patients. Sometimes I think dermatology becomes sort of an afterthought for patients who are dealing with complex disease. They're like, oh, and they have this thing

[25:40] on the skin, whereas sometimes that thing on the skin can inform the other systems. And so I think that that's also a challenge in our field. Great. Thank you for that information. And I'd like to ask as far as what resources, websites, books, etc.

[26:00] Would you recommend students to use to learn more about the specialty? There are tons of resources for students. I usually tell people a couple of things. One, it's a good idea to try to establish a mentor. If you have a mentor in your community,

[26:20] community that can give you more information about the field and some shadowing experiences and maybe connect you with someone who's affiliated with a program that is very helpful to students. If you don't have someone who can within your own community that can act as a mentor, there are also resources where you can find mentors

[26:40] prepared with mentors. So there is the Dermatology Interest Group Association that is a student-run organization and that you can, if you have an interest group within your medical school, you can actually affiliate with a larger group that's recognized

[27:00] in this association and they have resources for mentor matching that can be really helpful for students. That group also has some available resources to help people with volunteer experiences, with research opportunities. They have a spreadsheet that goes over research opportunities that might be available for students that are available on their

[27:20] website. So that might be a really good resource. And then also the American Academy of Dermatology has some resources available as well. They have a pathways program that gives targeted information about the specialty as a whole. They also have a diversity mentorship program.

[27:40] which is available to students who are underrepresented minority groups to try to gain a mentor and then also to gain a clerkship opportunity. So usually with the Diversity Mentorship Program, students who are in,

[28:00] Usually in the fourth year, I believe, we'll be able to apply for the mentorship program where they then pair them with someone where they can go and do a four-week, 40 hours a week mentorship, clerkship essentially, and they give them a stipend to try to help with living expenses.

[28:20] and other expenses while they are there. So that's a process that students could apply for on the American Academy of Dermatology website. So those are a couple of really good things. There's also some publications that can be helpful. There's Dermatology World Weekly.

[28:40] That usually has some things available for students plus some kind of more basic information about dermatology and dermatology cases  and then for residents, there's a dermatology cases and some dermatology cases and some dermatology cases and it might be good for students to peruse it too because it might be good for students to peruse it too because it

[29:00] give some timelines for residents when they should be doing certain things and also some basic term knowledge. So there's tons of resources that students should be able to use to try to gain more access in the field. Right. I appreciate that and we'll definitely add that into the show notes.

[29:20] for our listeners to go to for that information. I'd like to now transition to our second part where I asked to tell us about how you decided to go into dermatology and how you came to the decision that it was right for you.

Advice for Medical Students: Choosing Dermatology as a Specialty

[29:40] My question to you is how did you come to the realization you wanted to go into dermatology what. Did you have any struggles in making that decision what factors did you weigh into your decision and deciding and was there any head on head decision.

[30:00] between another specialty. Yeah, so my process in kind of coming to a decision to pursue dermatology as my residency field was a long one and my aha moment actually came late. So I'll give some encouragement to

[30:20] about how maybe to avoid that pitfall as we kind of go forward. But for me, I actually was not familiar with the field of dermatology. You know, my access to, you know, medicine was relatively limited. Like I said, I did some shadowing experiences before I decided to go into medicine.

[30:40] But I also went straight from college to medical school without any interim time. And I was also quite young in the process. I was barely 21 when I entered medical school. So I didn't really have a lot of life.

[31:00] life experience or experiences in medicine to kind of guide me. So what I was exposed to was, you know, the general medicine fields, internal medicine, pediatrics, OB-GYN. Like I was aware of those, but the subspecialty fields were totally foreign to me. When I was in medical school though, I was eager.

[31:20] And so I guess that's probably a good thing. But at the same time, it made my interests sort of like a bumpy path because every time I would rotate in something as a third year, I'd be like, oh yeah, I could do this. This just looks like a great job. And so I loved everything in medicine. I loved internal medicine and I was like, oh my gosh,

[31:40] able to solve some of these medical mysteries is so fun and interesting, but it was definitely a slower pace. And then I did pediatrics and I'm like, I love working with kids. This could be really great. And then you do OB and you're like working with moms and babies is really fun too. And then you do surgery and I really enjoyed

[32:00] the surgical aspects and I loved to sew and I loved learning the anatomy. But when I had to take it all together and I was like now what do I want to do? I've loved my experiences in all of these fields. For me it was like okay I love working with men and women and

[32:20] children and I love doing surgery, what puts it all together for me? And the other thing that I really liked is I liked the idea of being a specialist, not necessarily a jack of all trades, but a master of one and I didn't know what that would look like. So actually for

[32:40] For me, I was originally like, maybe I'll do med-peds and then I'll like transition into a subspecialty of medicine and that way I can see men, women, and kids. Kind of the specialist of the generalists was my thought process going kind of that route. And then I did a shadowing.

[33:00] experience with a derm and I was like, this is it. This is exactly what I was looking for because I get to see men, I get to see women, I get to see kids, I get to do surgeries and it happens at a fast pace. I get to talk to people, which is something I really enjoy and they're true diagnosticians and they're specialists.

[33:20] And so it was just the perfect aha moment. This is a fit for me. This is what I think I want to do and never looked back going forward from there. That's great. And this you may have already touched upon this. This is kind of like the third year question. If you were a third year medical

[33:40] student undecided on the specialty with limited time remaining before residency applications were to be submitted, what do you think would be the fastest, highest yield route to making the decision about going into dermatology? Yeah. So part of my bumpy ride

[34:00] was that when I had my aha moment, it was literally right before my fourth year. So I was already kind of in the throes of I'm planning to apply into med-peds. I had already met with the department head, I had already started down that path, and then I fell upon this

[34:20] oh man, I really think I want to do derm and then I hit the wall of man, this specialty is really competitive. What are you going to do now? And so then I had to go and meet with the derm department and come to find out that we didn't have any rotations left for me to take because I was so late in making that decision.

[34:40] that they're like, we don't have a general derm rotation to offer you at my home program at Michigan. And so I ended up doing a MOS rotation and then they got me a couple of away rotations, which were really helpful. And then with mentorship and just really providence, I was able to secure a spot in dermatology.

[35:00] But knowing that that was a pitfall for me, that there was no rotation left, that I decided a little bit late, that that kind of made it difficult for me to kind of surmount some of the challenges with going into a competitive specialty. I would say third years should really early on in their third

[35:20] your start to explore. I think that's really important. The aha moment has to come sooner. Otherwise, you're going to run into some timeline challenges and some access challenges. So I feel like third year needs to make sure they're doing some shadowing experiences so that they can experience some different

[35:40] specialties within medicine that they call people up and just say, hey, I'm looking in dermatology. I mean, just look through the directory at WMS and someone in New York will say, I'm looking and trying to find out more about what specialty I might want to go into. Tell me a little bit more about yours. Podcasts like this are going to be a great way for people

[36:00] people to also have some insight into what other specialties look like. None of this really existed when I was a medical student. And so the amount of access you have to reach out I think is really important. And when you have those experiences, start to check off the things that check boxes for you.

[36:20] Like I said, you kind of have to know yourself, know what makes you tick, know what you do and don't like, and then just start checking off the boxes. You know, does this one meet my desires when it comes to X, Y, or Z? So like I said, I would encourage students to start exploring a lot sooner so that it's

Competitive Application Strategies for Dermatology

[36:40] less bumpy experience. That's great advice and thank you for that. Do you feel that for dermatology, are away electives necessary? So away rotations.

[37:00] In a medical school where you don't have a program, they're vital because if you have a home program like I did at Michigan, it's really important because they know you best in your home program for you to rotate and get to know the faculty in your home program, your odds of math

[37:20] with people who know you well are higher than your odds of matching from just a one-day interview somewhere. When you don't have a home program, you don't have a department of dermatology, you don't have maybe as many research opportunities, you don't have a residency program,

[37:40] Those clinical away rotations are basically an opportunity for someone to get to know you, to want to invest in you, and for you to get a kind of foot in beyond just a one-day interview and in order to try to garner a spot in dermatology. So I would say for W Med students in particular,

[38:00] I say this when I counsel and mentor them. You can come and shadow me. Don't rotate with me because I don't have a spot to offer you. Shadow me if you would like, but I want you to spend your time in a clinical rotation that is affiliated with a residency program so that you potentially could get it.

[38:20] a spot somewhere. That's great advice. How important, and this is really an important question because I get this a lot and this has come up, how important is research or scholarly productivity for matching into the specialty? Because what I

[38:40] What I've experienced with students is they're contemplating in terms of taking a research year. So taking time off to do a research year in dermatology to build their scholarly productivity in that field. And so be interested to get your take on

[39:00] that. So I will say the need for research publications, scholarly activities seems to be skyrocketing in every field, but particularly in dermatology there's a demand for that. The number of publications required for someone to, on average,

[39:20] to match in dermatology seems to be continuing to escalate. I saw one statistic that it might be upwards of 20 publications or presentations or case reports or whatever else. So the numbers keep going up. It wasn't the case when I was applying in Durham that it needed that much scholarly activity and thank the Lord that it didn't because I wouldn't have had them.

[39:40] deciding as late as I did. But I do tell students that doing scholarly work doesn't necessarily require a year off and a research year. I think if you look for opportunities to volunteer, to write case-reproxisting

[40:00] You get hooked up with a mentor who is hopefully somewhat prolific. They can give you little projects to do that you can tick off pretty easily during your time as a medical student that you can potentially get enough into your experience.

[40:20] resume that that will help you match in dermatology. If you can't, if you decide late and you haven't really done any research or scholarly activity, then maybe considering a research year is not a bad plan. But I don't think that if you are motivated and you decide early

[40:40] early that it's an absolute necessity. The other thing that I tell people who are interested in Derm is you don't have to only do research for scholarly activity in dermatology. I actually think it's great for a medical student to be able to expand their reach of scholarly activity

[41:00] to things that can maybe relate to dermatology, but also gives them additional insight into how dermatology fits in the house of medicine. So do a research project in ENT on skin cancer and do a research project in plastics on reconstructive

[41:20] if you want to and do a research project in rheumatology on maybe newer medicines for lupus. I think it's really important for students to not only cast their nut first fowler activity in the field they're interested in, but in fields that relate to the field that they're interested in. It will make them a better

[41:40] thinker in their own field. Yeah, thank you for that. That's wonderful. Is there anything else that a student can or should do to be a competitive applicant in dermatology?

[42:00] I think it's really hard because some of these really competitive specialties, it used to be that you had to score really well on your board exams. Step one is now pass-fail and so now people are really putting a lot of pressure on themselves for step two. But at the end of the day, it's not a one

[42:20] test one day event to try to work your way into a complex or high demand specialty. I think if students really want to position themselves well to get into a good residency

[42:40] really across any specialty, I think that they have to commit themselves to doing their absolute best every single day. Like, show up every single day and do your best. You know, you have to have the can-do attitude that even if something is hard that I'm going to show up and keep trying until I can work

[43:00] my way through it because some of those things are what are going to make you a good doctor in the long run and will also make it so that you have depth of character to draw from your medical school experience in a way that someone who silos themselves into a one-track, I have to get the best test scores

[43:20] I need to focus on, laser focus on this one specialty will sometimes miss some of the other things that would make them a more well-developed, seasoned physician in the long run. So I think it's not a one-day event. It's not a

[43:40] not a single test that's going to make or break it. I really think that developing your whole story and your whole person is going to be the most important thing to really letting that shine when you're trying to seek out a residency. Great. Great. I want to move to our third part.

[44:00] part and that is giving advice for long term career planning irrespective of the choice of specialty and. If you I'm going to ask if you could go back and do it all again, what would you do differently and what would you do the same and why?

[44:20] Hmm, what would I do differently? I think I probably would have done some more exploration for other fields. I think I would have probably done more shadowing experiences to understand

Long-term Career Planning and Final Advice

[44:40] other fields because even as a physician now, and I've been practicing now for a while over a decade, and there are still some things that I learned from other specialties that I'm like, I never saw that in medical school. I didn't even know that existed. So I think take the opportunity

[45:00] opportunities that you have, the access that you have as being part of a medical community and make the most of it. Like really, you know, don't sit idly by and let the opportunities pass you to be able to just spend a little time with someone. No pressure, you know, no requirements, no, you know,

[45:20] exam to study for, but really just spend some time with a clinician just for the sake of learning what it is that they do and how all the physicians in medicine can work synergistically to take really good care of people. So I would say if I were counseling young me, I would be like, get out there, go see some different fields of

[45:40] medicine so you're not so surprised by some things down the line that you come across when you're actually in practice. So I think that that would be really important for students. Yeah, that great point, great point. There's so much out there and unfortunately in medical school you only get to see just a

[46:00] portion of medicine, not all the specialties. What would be a career mistake that you've seen other physicians make and what is something that you've seen another physician do well that you want to emulate it?

[46:20] I would say a mistake that I've seen people make. I have known people over the years who chose the wrong specialty, who they maybe chose it for the wrong reasons. They're like, oh, I'm going to go into this specialty because maybe it's highly competitive and I just thought that maybe it was better respected and that's why I didn't

[46:40] it, but it wasn't a great fit for me. Or maybe they choose a specialty and then realize that, you know, they have other draws in their life that make that specialty difficult to attain what they wanted out of it. So I think some advice that I would give would just be

[47:00] be to really evaluate your reasons for choosing a specialty and make sure it aligns with who you are and who you want to be as a physician to make sure that you have a really good fit because you know what they say you know if you love your job you don't work a day in your life and so for me I always say

[47:20] you know, I don't work any days except for when I'm charting. So, so that's just kind of, you know, I really love my job and I love what I do. And so only the, you know, kind of more mundane or administrative things kind of get you down. So, so I think that going into it for the right reasons, making sure it's a good fit for

[47:40] who you are as a person and who you want to be as a physician, that would be something that I would say so that you can avoid the mistake of having to backpedal because it's very, very hard to do. And I've seen that happen to people. I've also seen people burn out in the specialty they chose because it wasn't a good fit for their personality. So just

[48:00] kind of being aware of those pitfalls. And then things that I've seen people do well. When I was a first year Derm resident, I rotated with a doctor, his name was Art Savadra, at the Brigham and Women's Hospital. And I

[48:20] showed up for my first day of clinic and he had a case file that was in front of him he was seeing as a consultation and it was a patient who had a hand condition where her hands the skin was very thickened and red and inflamed and he showed me the pictures and he art is probably

[48:40] one of the most brilliant physicians I've ever worked with. But he's also triple-boarded in internal medicine and quadruple-boarded in critical care, dermatopathology, and DERMs. He's just a brilliant dude. But anyway, so he had this case file sitting in front

[49:00] of him. And I walked in and he said, okay, he's like, can you go check the room? We might need to do a pelvic exam. And I actually thought that I might be being punked. You know, I'm a first year resident, maybe he's just teasing, right? Is this the pathology talking about? And so I was like, you're kidding, right? And

[49:20] And then he just kind of smiled at me and was like, no, I'm not kidding. He's like, we just need to make sure the table's equipped. He's like, we don't have to do a speculum exam, but we might need to do a vimanual exam. He's like, this patient, I think she has palmar fibromatosis. And that can be associated with ovarian cancer. And when I was looking through her history, she's been seeing her doctor for back pain. And I said, okay.

[49:40] So I went and looked in the room and I'm like looking for like stirrups on the table and I found them and so I was like okay yeah this table has what we need. He's like okay. So the patient comes in and he talks to her about her hands and the symptoms that she's having and what he thinks is probably going on and he's like you know I just want to be strict.

[50:00] that there's not something internal happening here. And so he talked to her and he's like, would you be okay? He's like, I can send you to your gynecologist if you want. And he's like, but I'm also a trained internist. Would you be okay if we did a bimanual exam and tried to determine whether or not there's something ovarian that could be happening here? And so she was like, okay, so he did the

[50:20] exam and felt a mass and he was like, okay, I'm going to send you for a CT and he diagnosed that patient's ovarian cancer. And that was like a wow moment for me. I was like, oh my gosh, this is crazy. This person who could have just examined the

[50:40] woman's hands and fielded her off to other places for anything else that was in his thought process took the time to actually just do what needed to be done to make a diagnosis. And what that taught me in that moment was you have this depth of knowledge from medical school that goes far beyond the

[51:00] silo that you choose as your specialty and you should use it. You know, don't just think about, oh, someone else will handle that or someone else can think about that. I just have to like focus on just the skin that's in front of me, but rather you have to think about people holistically and how these things relate to one another and remember that you are

[51:20] trained physician that went through all of those other rotations long before you picked a specific specialty. So I think that that was something that was pivotal for me as a physician. What kind of physician do I want to be? I want to be one who thinks and uses the entire bag of tricks that I have, the entire

[51:40] depth of knowledge that I have for medical school, I want to be able to use that for the better of my patient and to deliver the best care. So I think seeing those physicians who go that extra mile really will help you to develop into the best doctor that you can be. Right. Thank you for sharing that. That's a wonderful story.

[52:00] Great advice too. What is one thing that you're struggling with or lamenting about your career today and what are you doing to remedy it and what would you encourage a medical student to do right now to help avoid this problem entirely later?

[52:20] Okay, so everybody has their Achilles heel. I always tell people I think I'm a good doctor because I really try to invest in being a good doctor, but I am a terrible administrator. So I still find that my Achilles heel is that I tend

[52:40] procrastinate on the paperwork side of things. Now there are some built-in things that try to help me with that. You know, like our company has a report that they run every week that I know I need to do a certain amount in order to make sure that we're not out of compliance or those types of things. So I have a nurse that gives me a list of you must sign these

[53:00] today before you leave because it needs a prior authorization so I can get those things done. And I have a wonderful husband who will tell me, I'm putting the kids to bed tonight, go do some charts. So I have some safeguards in my life to try to help me with my Achilles heel.

[53:20] But I will say it is really important though just to develop good habits early on and to try to sustain those good habits even when other things can distract you from them. So I usually say it's less stressful.

[53:40] to do a little at a time than it is for it all to pile up on you and then you have to get it done and then you're pulling an all nighter or taking away from something else that you have to do. Plan ahead, keep a calendar, have an accountability person who helps you with those types of things so that you can

[54:00] can just get the job done. Great, great invite and thank you for that. I'd like to end by asking you what is one book, medical or non-medical, that you think every person pursuing a career in medicine should read?

[54:20] Oh, gosh, I guess much along the lines of what I was just saying about trying to make really good habits and trying to do the best that you can for every patient that you see, I think the book that I would recommend is called Atomic Habits. It's by James Clear.

[54:40] And it's a book that talks about how making small incremental changes over time can have a big, big effect. So that can help you with things like productivity and it can help you with things like efficiency and it can help you with things like quality. You know, like if I just try to do a lot of work,

[55:00] little better for each person each time and those small incremental changes can make a big difference over time. I think that that's really important. So yeah, atomic habits is what I'd recommend. Okay and I will make sure that that is in our show notes that are listed

[55:20] listeners can read. So is there anything else, Dr. Westgate, that we haven't discussed that you want to make sure our listeners know about the field of dermatology? I would say the field of dermatology is really fun.

[55:40] It's really fun. So it's very diverse. It keeps you on your toes. If you're the type of person who thrives on speed and you can think quickly on your feet and you really like to kind of get your hands in on things, I think it's a really

[56:00] great choice for people. You know, it's been an honor to be a dermatologist. I would choose it again and again and again because it fits my personality so well. It's not for everyone, but when you find the field that fits you, it's just a joy to practice. So.

[56:20] Right. Well, Dr. Westgate, it's been a pleasure having you as a guest on the WMed specialty spotlight. For everyone listening, we'll wrap up the show with that. I hope that you enjoyed the conversation with Dr. Westgate. You can find the resources and additional insights mentioned

[56:40] mentioned in this episode in the show notes on the WMED website, wmed.edu forward slash specialty spotlight. If you found the episode helpful, please consider sharing it with your fellow medical students, especially those who may be feeling uncertain about their career path. Michael is

[57:00] that these discussions with experienced physicians will inspire and guide you as you navigate your own career decisions. If you have any questions, don't hesitate to reach out to the Career Development Team at career.developmentatwmed.edu. Until next time, take care.

[57:20] you