The Role Of A Dermatologist
Dermatologists are physicians that investigate, manage and treat skin conditions as well as problems with hair and nails. Dermatology is a speciality that involves a wide age range of patients and a mix of inflammatory, inherited, environmental and malignant diseases.
Although dermatology is a medical speciality, most dermatologists are also skin surgeons due to the prevalence of skin cancer in society. Interventional work ensuring adequate patient adherence to prescribed management is needed to reduce disease progression and treatment failure.
Outpatient clinics in secondary care are the predominant patient interface in dermatology. Some patients with acute and severe diseases may be admitted due to facility and specialist nursing requirements.
Multidisciplinary teams are a key component in dermatology as patients with comorbidities often require dual management with another speciality. Due to prevalence of skin cancer, dermatologists work closely with oncologists, plastic surgeons and maxillofacial surgeons.
Wider job opportunities in dermatology include managerial roles for consultants such as clinical leads, clinical directors and medical directors. Opportunities at a non-consultant level include working as a SAS doctor, trust grade and a clinical fellow. (1)
In the 2014 census for UK consultants and higher speciality trainees, it was found that for consultants aged 49 and below, there were more female dermatologists than male. (2)
Laser development and continued use is something to look out for in the future of dermatology. Lasers have been used in the past, but devices are being adapted and created to become more effective and treat a wider range of conditions.
Dermatologists must be dexterous, good communicators, capable of clinical diagnoses and be committed to providing high standards of care.
A Typical Week
A standard contract for a full time NHS consultant is 10 PAs (programmed activities) per week. This is typically divided into 7.5 PAs for direct patient care and 2.5 SPAs (supporting activities). These are tailored to each doctors’ interest. (3)
PAs includes direct patient contact such as ward rounds, theatre and outpatient clinics. SPAs can include teaching, appraisal, audit and research.
Below is an example of a typical day in the life of a dermatologist registrar/consultant:
Table 1- day in the life of a Registrar/Consultant (4)
Around 15% of consultants are routinely on-call during the weekend. (1)
The Route To Becoming A Dermatologist
Entry to dermatology training is possible after completion of a foundation programme and a core training programme. Core training programmes for dermatology include: CMT (Core Medical Training), IMT (Internal Medicine Training), ACCS-AM (Acute Care Common Stem- Acute Medicine) and Level 1 Paediatric training + CMT (If required). (5)
CMT and ACCS run parallel to each other with ACCS being particularly suited for trainees interested in paediatrics and acute medicine.
Candidates need to obtain MRCP(UK) Diploma to meet the entry requirements for dermatology speciality training.
Higher speciality training in dermatology is normally a four-year programme beginning after completion of IMT stage 1 training. There are no entry requirements for the Speciality Certificate Examination (SCE) but candidates often opt to sit in their penultimate year of speciality training.
There will be the option for some trainees to complete the training sooner than four years. However, clinical exposure is a fundamental aspect of dermatology. A small number of trainees may also develop more slowly and require an extension in their training period.
This curriculum also allows for less than full time training should trainees opt for that.
A new curriculum for Dermatology Training will be implemented in 2021 subject to GMC approval. The information above is extracted from the latest draft provided.
Dermatology is a competitive speciality with 172 applications for 55 posts in the UK 2018. This makes the competition ratio 3.13 for ST3 dermatology. (6)
The North Western Deanery dermatology training programme is one of the largest in the UK with its academic department linked with The University of Manchester. St John’s Institute of Dermatology is world renowned for its’ MSc in clinical dermatology. (7)
Dermatology is competitive, as a marker of your interest in the speciality, clinical experience before higher specialist training is desirable. For undergraduates, this can be in the form of Student Selected Components, Special Study Modules and electives. During foundation and core training, rotations in dermatology or related specialities such as rheumatology, paediatrics, infectious diseases and haematology can be undertaken.
Getting involved in research and audit projects in the scope of dermatology during undergraduate and postgraduate training is also helpful.
Subspecialities include cosmetic dermatology, dermatopathology, immunodermatology, Mohs surgery and paediatric dermatology.
Dermatopathology is the speciality where the origin of skin diseases is investigated. It is primarily based in the laboratory with minimal patient contact.
Paediatric Dermatology is for dermatologists who have been trained in children’s skin conditions. This is because children require different treatments from adults.
Immunodermatology looks at the relationship between the immune system and the skin. This includes diseases such as contact dermatitis and eczema. The bulk of their work is performed in the laboratory.
Cosmetic Dermatology is the primary patient interface in dermatology. Services range from laser hair removal, treatment of severe acne and skin tightening procedures.
The nature of a career and training in dermatology is there is flexibility to allow for research. (8)
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
As with any speciality, there is potential to enhance NHS earnings by private practice. JRSM reported in 2008 that the total income of consultant dermatologists was £126,733 with NHS income earning £72,787 and private income earning £53,946 making the ratio 0.74.
This ratio sits roughly at the same threshold as ophthalmology (0.75) and medical oncology (0.70) and is superseded by cardiology (0.90) and plastic surgery (1.90). (9)
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
The British Association of Dermatologists publishes two world-renowned dermatology journals. The British Journal of Dermatology contains papers on biology and pathology of the skin and covers experimental and clinical research. Clinical and Experimental Dermatology primarily serves clinical dermatologists. The Community Skin Health is published by the International League of Dermatological Societies and is aimed at healthcare workers in low resource environments.
DermNet New Zealand is an online resource that has been HON (Health-on-The-Net) certified since 1996. It contains information about a myriad of skin conditions including images, a glossary and quizzes.
The British Society for Dermatological Surgery (BSDS) is the UK leader in dermatological surgery. The British Association of Dermatologists (BAD) is a charity dedicated to the teaching, training and research of dermatology. It is a useful resource for dermatological diseases as well as information about available services in the UK and any changes applicable to them.
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(1) Dermatology [Internet]. Health Careers. 2020 [cited 3 May 2020]. Available from: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles- doctors/medicine/dermatology
(2) 2014–15 census (UK consultants and higher specialty trainees) [Internet]. RCP London. 2020 [cited 6 May 2020]. Available from: https://www.rcplondon.ac.uk/projects/outputs/2014-15-census-uk-consultants-and- higher-specialty-trainees
(3) 4. Levell N, Jones S, Bunker C. Dermatology [Internet]. 2020 [cited 5 May 2020]. Available from: https://www.bad.org.uk/library- media/documents/consultant%20physicians%20working%20with%20patients%20201 3.pdf
(4) Dermatology (2) | Royal College of Physicians of Edinburgh [Internet]. Rcpe.ac.uk. 2020 [cited 4 May 2020]. Available from: https://www.rcpe.ac.uk/careers- training/dermatology-2
(5) Dermatology [Internet]. JRCPTB. 2020 [cited 3 May 2020]. Available from: https://www.jrcptb.org.uk/specialties/dermatology
(6) 2018 Competition Ratios [Internet]. 2020 [cited 4 May 2020]. Available from: https://specialtytraining.hee.nhs.uk/Portals/1/Content/Resource%20Bank/Competition %20Ratio%27s/Competition%20Ratios%202018.pdf
(7) St John's Institute of Dermatology | School of Basic & Medical Biosciences | King’s College London [Internet]. Kcl.ac.uk. 2020 [cited 4 May 2020]. Available from: https://www.kcl.ac.uk/bmb/our-departments/st-johns-institute-of-dermatology
(8) British Association of Dermatologists - Why do research in dermatology? [Internet]. Bad.org.uk. 2020 [cited 5 May 2020]. Available from: https://www.bad.org.uk/healthcare-professionals/research/why-do-research-in- dermatology
(9) Morris S, Elliott B, Ma A, McConnachie A, Rice N, Skåtun D et al. Analysis of consultants' NHS and private incomes in England in 2003/4. Journal of the Royal Society of Medicine [Internet]. 2008 [cited 6 May 2020];101(7):372-380. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442143/table/tbl3/#tf3-1