Melinda Dang

Current World Issues 1

Chemistry 2

English 3

Dermatologists

Imagine people who wake up and wash their faces everyday with different cleansers like

Neutrogena and Clinique, they turn on the faucet and let the water run when they really
shouldn’t,

after vigorously scrubbing for one to two minutes, they rinse off their face, pat dry their skin and

go on to moisturize it. With peoples daily routines to protect and maintain their skin, only

someone who is a skin specialist would really know what those routines are doing to our faces.

Dermatology is a medical branch that focuses on one’s skin. It takes years of medical school and

residencies to become a dermatologist. Doctors who studied dermatology put forth a lot of effort

into keeping ones skin healthy and their pores clear. Contrary to the literal definition of a

dermatologist, this career isn’t just skin deep. The anatomy of one’s skin can be researched and

treated scientifically in this rewarding field.

There isn’t only one kind of dermatologist that someone can choose to be, dermatology is

a broad field of medicine and has a large range of different areas where one can decide to

specialize in. The generic definition of a dermatologist is someone who is a physician that

diagnoses and treats conditions and diseases of the skin (Dermatologists). To name a few, other

kinds of dermatologists include derma pathologists, dermatologic surgeons, and pediatric

dermatologists (American Academy of Dermatology). A derma pathologist studies the tissue

structure and features of skin diseases while dermatologic surgeons perform micrographic

surgery and cosmetic procedures. A pediatric dermatologist specializes in treating the skin of

children (American Academy of Dermatology). Dr. Birkby is an experienced dermatologist who

practices general dermatologic treatments but also specializes in skin cancer surgery (Birkby 10

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Nov 2007). He currently owns his private practice at the Seattle Skin Cancer center near the

Swedish Medical hospital (Birkby 10 Nov 2007). Dr. Birkby has been working for twenty five

years and is one of the nation’s top rated skin surgeons and is a highly recommended

dermatologist by his patients (Staff 25 Nov 2007). Dr. Birkby says that even though every single

part of dermatology requires a lot of training and experience, there are different parts of

dermatology suited towards different people (Birkby 10 Nov 2007). “People skills are very

important for my job while other areas of dermatology are research based like laboratory and

epidemiology study. You can find a match with any personality type. Some people do best with

patients, some with numbers. As long as there is a desire, there’s a place in dermatology for

them” (Birkby 10 Nov 2007). General dermatologists are able to treat certain types of eczema,

psoriasis, acne, and impetigo (American Academy of Dermatology). Eczema is commonly

referred to as dermatitis and is an itchy rash found on young children (Eczema). Psoriasis affects

the joints and skin of a person, acne affects young adults, and impetigo is a bacterial skin

infection that can cause blisters to form on ones skin and creates an itch (About Psoriasis)

(Impetigo). A dermatologist is usually able to prescribe different creams, ointments, or oral

medications that can help treat the patient’s skin (American Academy of Dermatology). Through

different aspects of ones character, a dermatologist can explore many different branches of

dermatology to find more ways to treat people’s skin.

All symptoms of skin afflictions can be treated by dermatologists but a dermatologist

must be able to treat the emotional aspects of a patient as well. A dermatologist can be a

huge influence on someone’s life. “Dermatology deals with a lot of disfigurement, disability, and

both those things affect a person’s quality of life” (Birkby 10 Nov 2007). Acne, for example, is a

well known skin problem among many teenagers. Even though acne is common and a natural
part of puberty, some people may be deeply affected emotionally because of what acne does to

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their physical appearance. In cases of severe acne, Dermatologists are able to help prescribe

different medications such as Accutane to help someone overcome their difficulties with acne.

Being able to help change someone emotionally, “dermatology is more than treating a number

like cholesterol” (Birkby 10 Nov 2007). Dr. Birkby sees the deeper side of dermatology and how

a doctor is able to help change the person’s perspective on both their skin and their self esteem.

“The whole career is very rewarding. You’re able to get a lot of positive feedback” (Birkby 10

Nov 2007). The daily interaction that Dr. Birkby is able to have with each and every one of his

patients is one of the greatest advantages of his (Birkby 10 Nov 2007). Treating each patient with

care is one of the many benefits in the field of dermatology.

Unfortunately, there is currently a shortage of dermatologists in the world. The

employment outlook for dermatologists is excellent (Dermatologists). It is predicted that the

occupation will grow faster than average and will be in high demand globally (Dermatologists).

Dr. Birkby agrees with this fact and says that, “there is more and more of a demand for

dermatologists. You can get a sense of this demand; see how long it takes to get an appointment

with a dermatologist. They’re that busy” ((Birkby 10 Nov 2007). The demand for dermatologists

is high and the demand for dermatologists who specialize in cosmetic surgery is even greater. As

the baby boomers begin to age, procedures such as Botox, collagen injections, and micro

dermabrasion are becoming ever more popular and require a lot more certified professionals to

administer them. The changes that are taking place now will continue to change throughout the

next twenty years (Birkby 10 Nov 2007). Dr. Birkby agrees that since a lot of treatments are

getting better and increasing dramatically, the employment outlook is currently and will continue

to be excellent (Birkby 10 Nov 2007). This sustained high demand will create many job

opportunities for the next generation of dermatologists.

 The high demand for dermatologists is also being proved by the salary that they make.

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The AMA (American Medical Association) reports that the median salary for Dermatology was

175,000 dollars in the year 2000 (Dermatologists). Dermatologists can make 250,000 dollars and

above but their salary is constantly affected by their location, specialties, experience, personal

skills, and the amount of hours they work (Dermatologists). Some people may frequently

associate salary with success. But for Dr. Birkby, being a successful dermatologist boils down to

two things: “they need to enjoy what they do and they need to be able to give good care to their

patients” (Birkby 10 Nov 2007). Despite the very high paying salary, Dr. Birkby wasn’t

attracted to the money aspect of his job all. He contradicts those who say they will work for the

money by saying he doesn’t believe that “the lure of money will sustain someone throughout

their training” (Birkby 10 Nov 2007). The tedious training and schooling one must receive prior

to becoming a dermatologist is one of the main factors that show why dermatologists receive

such a high salary.

In order to become a dermatologist, one is required to go through post secondary training,

years in medical school, complete residencies, and get certified and licensed (Dermatologists).

Unlike some students who find passion in careers through a “life changing experience,” Dr.

Birkby said that “there wasn’t a direct influence in my life that made me pursue this career”

(Birkby 10 Nov 2007). There also isn’t a history of doctors or dermatologists in Dr.Birkby’s

family history (Birkby 10 Nov 2007). So how is it that one decides to take on the exiting career

of dermatology? “I decided it when I was in my medical school training. There were many

different areas I enjoyed and liked. I was especially interested in internal medicine or surgical

procedures” (Birkby 10 Nov 2007). For students who know they are planning on studying

dermatology or any other medical branch early on should consider taking classes such as
Biology,
Chemistry, Physics, and Anatomy (Dermatologists). It is also recommended that students try and

continue with four years of math by completing the basics of algebra and geometry but also learn

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other formulas in higher math levels (Dermatologists). Experimenting with numbers and other

parts of mathematics will be important to have in the future. Students who plan on working one

on one with patients should also consider taking psychology because dealing with patients will

also mean understanding them and what is going through their minds. After high school,

students will move on to college for further training in this field.

In his college years, Dr. Birkby majored in both biology and chemistry and had a minor

in mathematics; his major in the sciences is one of the requirements to apply for medical school

(Dermatologists). The two sciences are highly recommended and will definitely help better the

students understanding of any kind of occupation involving sciences and medicine. Students

shouldn’t only consider taking basic classes but should concentrate on the sciences all together.

Classes like Physics, Organic Chemistry, and Inorganic Chemistry would also be useful assets

for students in the near future (Dermatologists). Dr. Birkby found his passion for the medical

field during the summer between his junior and senior year (Birkby 10 Nov 2007). “I had done

some research work in microbiology, but even though I enjoyed the science, I really wanted to

work with people so I thought to myself ‘How do I combine my love of science and love of

working with people?’ and that’s when I began thinking about going to medical school (Birkby

10 Nov 2007). After his decision on going to medical school, Dr. Birkby applied to take the

MCAT (Medical College Admission Test). Like all medical bound students, one who is

considering medical school should apply for MCAT after their second or third year in college

(Dermatologists). A high score an excellent academic background helps the students get into top

medical schools and that will help the student build a strong resume.

All medical colleges in the United States require students to complete the MCAT. The
MCAT is highly competitive and the score that someone receives in addition to the requested

recommendation will strongly determine which medical school students will be accepted to.

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Some of the best Medical Schools for dermatology are: Harvard University, John Hopkins

University, University of Pennsylvania, Washington University in St. Louis, University of

California, University of Washington, and Stanford University (US News). After being admitted

to medical school, the courses in the first two years include anatomy, biochemistry,

pharmacology, psychology, microbiology, pathology, medical ethics, and laws governing

medicine (Dermatologists). Students will then go on to work in hospitals and clinics during their

third and forth years to perform examinations and recognize symptoms with actual patients

(Dermatologists). Each student goes through a rotation of different branches in the medical field

such as rotating from internal medicine to pediatrics or to surgery (Dermatologists). After going

through medical school the physicians must pass an examination given by the national board of

medial examiners in over to receive a license from the state in which they intend to open their

practice or work (Dermatologists). In order to become a Dermatologist, physicians need to get

into a residency program in the United States that is highly competitive (Dermatologists). The

years in residency tanning enable physicians to start specializing in the medical field of their

choice.

Residency training lasts a minimum of four years and three are left to specialize in

Dermatology (Dermatologist). During the first year in a clinical residency, students are able to

participate in a program concerning internal medicine, family medicine, general surgery, or

pediatrics (Dermatologists). Other fields like skin pathology, bacteriology, radiology, and

immunology and also be explored through one’s residency (Dermatologists). The physician is

closely supervised within the whole time span of the residency (Dermatologists). After one is

done with his residency training they have the option to become certified. Being citified is the
one thing that is voluntary in order to be a Dermatologist (Dermatologists). Certification is

strongly recommended and is given by the American Board of Dermatology and it includes a

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rigorous course of studies and examinations (Dermatologists). Dermatologists must continue

their studies to maintain their certification (Dermatologists). Completing all the necessary

requirements in this field is an important factor that influences the future success of each

dermatologist.

Once someone finishes their residency program there are several options which one can

choose to go to. They can work in a hospital, take over someone else’s practice, work in

someone else’s practice, or open their own practice. “Some people start off by worrying only

about the medical aspect of dermatology and work in large groups. After awhile, they might ask

themselves if they want to open their own practice. Others can also start off by teaching or

researching. “You have lost of different pathways to different options and it just depends on what

your interests and strengths are. The career opportunity depends entirely on the person pursuing

it” (Birkby 10 Nov 2007). With all these different choices, Dr. Birkby decided to establish his

own practice because he was able to see the benefits. Since Dr. Birkby is in private practice, one

of the greatest advantages, he says, is that he can decide what he wants to do in his practice

(Birkby 10 Nov 2007). Dr. Birkby hires other staff like nurses and bookkeepers but he needs to

be in his office for the whole practice to run smoothly (Birkby 10 Nov 2007). One member of Dr.

Birkby’s staff, Jessica, takes care of bookkeeping, interacts with patients through the phone, and

helps plan out the routines and patient appointments at Dr. Birkby’s practice. Jessica has worked

with Dr. Birkby since the opening of his practice and says that only in the recent years has Dr.

Birkby been able to trust his whole staff and go on vacation for a longer period of time (Staff).

Like all practitioners, Dr. Birkby has worked very hard to maintain an excellent practice and

deserves his success.

 The one thing that Dr. Birkby would suggest be a disadvantage of his career is the

paperwork (Staff 25 Nov 2007). Dr. Birkby needs to fill out different forms for various insurance

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companies (Birkby 10 Nov 2007). He thinks these things are disadvantages because they are

things that distract you from the care of the person (Birkby 10 Nov 2007). If one starts his own

practice, their schedule can be quite flexible. This is an advantage for people who have an

important family life. For Dr. Birkby: “personally, for seeing patients, I work Monday, Tuesday,

Wednesday, and Thursday. I take off Friday for family time. Sometimes I do have to work on

Friday to attend to paperwork and administrative things” (Birkby 10 Nov 2007). Dr. Birkby’s

daily office hours are from 7:30 to 4:30 (Birkby 10 Nov 2007). When Dr. Birkby isn’t present,

another dermatologist is available at the practice (Birkby 10 Nov 2007). Becoming a

dermatologist offers a very free schedule and shouldn’t affect one’s life, personally. The career

choice of dermatology has directly affected Dr. Birkby’s work routine and lifestyle choices

(Birkby 10 Nov 2007). But Dr. Birkby says that becoming a dermatologist is a “piece of the

puzzle” of who he is and that he “wouldn’t change his career choice now or in the future”

(Birkby 10 Nov 2007). Seeing the small disadvantages of opening ones own practice, the greater

advantages that come along with it make the whole experience worthwhile.

Being able to be part of a career that incorporates Dr. Birkby’s love of science and love

of people, he is able to use the scientific method each day to treat his patients. Whenever

Dr. Birkby meets a new patient, he needs to become better acquainted with them and make

observations about the history and current health status of the patient. Dr. Birkby says it is very

important to “know the person before you treat them, you need to remember the you’re treating

the person not just the disease (Birkby 10 Nov 2007).” For any kind of doctor, it’s useful to ask

questions that deal with the patients history, family health history, and how the patient feels that

the doctor and patient can work together. Questions of the patients history are very important to
ask because the patients health history can tell Dr. Birkby what the patient is allergic to, or if any

kind of health condition is causing the patient to see different symptoms of a disease. Knowing

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the patients family history is important because the patient may have a skin disease that runs in

the family or something may affect the patient more or less due to their genetic background.

“You need to be able to treat the patient and support them throughout the entire treatment

(Birkby 10 Nov 2007).” Once he becomes better acquainted with the patient, Dr. Birkby will

start to try and figure out what kind of problem the patient is having (Birkby 10 Nov 2007). The

patient will explain different symptoms that are related to any area of their skin (Birkby 10 Nov

2007). Examples of some questions might be whether or not the patient has been feeling any

irritation or seen any rashes, patients might also be asked about what they have been doing lately

or whether or not they have been eating anything new in their diet (Birkby 10 Nov 2007). Dr.

Birkby says, “I pay careful attention to the cause and effect and timing of things. If a patient

came in with a rash and were out in the woods three days earlier, they might have been bitten

with an infectious insect. Or maybe they traveled down to Brazil and sat on the beach, they

might have contracted a type of parasite (Birkby 10 Nov 2007).” If a woman walks in with a rash

all over her body, Dr. Birkby will probably ask questions about when the rashes started to occur,

what the patient has been eating, where the patient has been, and how irritation the rash is and if

the patient has experienced any other symptoms such as fatigue or a fever. If the woman

responds and tells Dr. Birkby that she recently received a flu vaccination and is constantly

itching her skin, Dr. Birkby might infer that the rashes on her skin have resulted from hives. The

woman may have had an allergic reaction to something that was used in order to create the flu

vaccine. The different questions that Dr. Birkby asked were able to help him make observations

about the woman’s condition and ask himself what possible diseases have symptoms that match

hers.
 After hypothesizing about the disease that the patient might have, Dr. Birkby will

diagnose the disease and advise the patient to purchase an over the counter antihistamines such as

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Benadryl. With a small case of mild hives, the woman doesn’t require an entire procedure to be planned

out in order to find a treatment on her skin condition. However, if Dr. Birkby were to diagnose a woman

with skin cancer he would need to perform various tests to ensure that his prediction about a forming skin

cancer was correct and create a procedure for an effective treatment plan for the patient. In order to

check his hypothesis in a case of diagnosing skin cancer, Dr. Birkby would take a small section

of the infected skin from the man and observe it under a wood’s light (Dermatologists). A

wood’s light is a bright light that shines ultraviolet light on the skin sample to serve as a

diagnostic tool in diagnosing the disease (Dermatologists). By using a wood’s light, anything

that is fluorescent will show onto the wood’s light and thus serves as evidence of a skin disease

(Dermatologists). Another tool that can be used by dermatologists is the dermatoscope, the

dermatoscope serves as a magnifier that contains either cross polarized or non polarized light that

helps a dermatologist further investigate the disease (Dermatologists). By using the tools

mentioned and other tools that may be involved, a dermatologist can perform lab procedures in

his practice to make sure that the treatment for each patient will be correct and effective.

After correctly matching the symptoms of the disease with the different tests made to

validate Dr. Birkby’s hypothesis, Dr.Birkby needs to create a procedure like treatment plan to

treat his patients. In the incidence of the man being diagnosed with basal cell carcinoma, the most

common type of skin cancer, the treatment plan for the patient will include special needs for micrographic

surgery (Staff 25 Nov 2007). Since Dr. Birkby is both a general practitioner and a specialist in

dermatologic surgery, Dr.Birkby is certified to treat patients with Mohs surgery (Staff 25 Nov 2007). The

Mohs surgery is micro graphically controlled so it’s able to perform precise removal of cancerous tissue,

while keeping the healthy tissue in tact. Mohs surgery creates smaller possibilities of a surgical defect and

an improved cosmetic result compared to other surgical methods used to treat skin cancer (Mohs
Micrographic Surgery). In preparation for the dermatologist to treat the man with Mohs, they must first

take a look at all the paperwork and financial things needed to complete the payment for the procedure

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(Staff 25 Nov 2007). Then the workers at the clinic must set out a date and follow up in order for the

patient and doctor to know the timeline in which the procedure will occur (Staff 25 Nov 2007). After

carefully planning the whole procedure, Dr. Birkby can safely treat the patient.

On the day of the surgery, the general procedure for the surgery to take place is fairly similar for

all dermatologic surgeons like Dr. Birkby. The time of the operation is scheduled early in the

morning and once the patient arrives the surgeon will perform preliminary preparation of the skin (Mohs

Micrographic Surgery). In order to prepare the skin, the patient will have the area needed to be removed

and the table around it anesthetized. Once the patient’s skin is numbed, the doctor removes a small area of

tissue from your skin in order for the skin to be analyzed (Mohs Micrographic Surgery). The small piece

of tissue is processed into micrographic slides and takes about an hour to be studied by the doctor and his

assistants (Mohs Micrographic Surgery). During the time the slides are being studied, the patient will wait

in the waiting room or a designated area in the clinic (Mohs Micrographic Surgery). During the second

stage of the procedure, the patient needs to be re-anesthetized if they need another part of their skin

removed. The whole surgery usually takes three whole stages in order for the doctor to make sure that all

the cancer cells have been removed (Mohs Micrographic Surgery). The entire procedure that Dr. Birkby

follows is similar to the procedure that is followed in experimental design.

After the surgery is preformed, the doctor will make conclusions and offer different options that

the patient might choose to follow. These recommendations will often include how the patients will feel

within the next few weeks, how often the patient should check in, and different things the patient can do

to prevent complications (Mohs Micrographic Surgery). For example, a dermatologist may tell the patient

the different complications that might occur like pain, bleeding, or itchiness (Mohs Micrographic

Surgery). After the doctor is done consulting with the patient, he will usually ask the patient to come back

in a few weeks to check for any complications that might’ve occurred. By following the steps based on
the scientific method, dermatologists like Dr. Birkby are able to treat patients with care and success.

A successful dermatologist has to endure years of medial school, medical training, and complete

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different exams in order to treat their patients. But apart from all the hard work, the field of dermatology

is very rewarding because the dermatologist has the ability to conduct research and treat their patients

with the best care and best techniques possible. Being able to create an impact on the patient’s life

emotionally and physically is best delivery of satisfaction in this career and should inspire students who

plan on studying dermatology. With its high demand and broad spectrum of specialization, anyone who

considers the field of dermatology will be able to reap its benefits of a stable and rewarding career.

Despite the benefits in this career, I personally wouldn’t pursue a medical career in dermatology, I have a

greater interest in the career of optometry. I would like to become an optometrist because I find the

human eye more interesting than the human skin and because I feel there is a higher demand for eye

exams rather than skin complications. Apart from my decision about a career in optometry, skin: our

bodies largest organ can be researched and treated using the scientific method in the career of

dermatology.
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Bibliography

"America's Best Graduate Schools 2008: Top Medical Schools." US News. 16 Nov. 2007.

U.S.News & World Report. 06 Dec. 2007 <http://grad-

schools.usnews.rankingsandreviews.com/usnews/edu/grad/rankings/med/brief/md

rrank_bri>.

Birkby, Dr. Craig. Telephone interview. 10 Nov. 2007.

“Dermatologists.” Career Information Center. Ninth Ed.

“Dermatologists.” Encyclopedia of Careers and Vocational Guidance. Thirteenth Ed.

"Doctor QuickCheck Report From UCompareHealthCare." UCompareHealthCare.

04 Dec. 2007

<http://www.ucomparehealthcare.com/drs/report2.html?L=103941913151550135

048&R=xJw0JMWMhl72xS7BgR4od2mzn&I=1039419&page=1>.

Iowa Public Television. Career Profile:Dermatologist #1195. 08 Dec. 2006. Iowa Public

Televison. 06 Oct.

2007<http://www.careers.iptv.org/people_detail.cfm?pplID=439&occID=160>.

"Mohs Micrographic Surgery." The Skin Cancer Foundation. 31 Nov. 2007

<http://www.skincancer.org/skin-cancer/mohs-micrographic-

surgery.html?gclid=CM_Xip2rpZACFSa7iQodXlP>.

Neil, Swanson, Bar Anna, and Ken K. Lee. "Mohs Micrographic Surgery." OHSU. 12

Dec. 2007. OHSU. 30 Nov. 2007

<http://www.ohsu.edu/dermatology/patients/mohs.php?MOHS=G>.

Staff. Personal interview. 25 Nov. 2007.

UniXL. “Dermatology Jobs.” UniXL. 24 Oct. 2006. UniXL. 07 Oct

2007<http://www.unixl.com/dir/medical_sciences/dermatology/>.

Biographical Questions:

When you decided to become a dermatologists, was there any specific reason behind your

decision?

When you look at long term career choices, what is more important to you? Money or
enjoyment?

Did anyone, any moment, or any thing inspire you to become a dermatologist?

What other career choices, if any, did you consider before actually becoming a dermatologist?

Has becoming a dermatologist affected your personal life at all?

It’s recommended that students take courses in the sciences like Biology, Physics, Organic

Chemistry, & Inorganic Chemistry if they plan on becoming a dermatologist, would you

agree with these recommendations?

What courses did you take in college in order to prepare for your career?

If you could pick one class that you think is vital in order to become a successful dermatologist,

what class would it be and why?

Does a history of doctors or dermatologists run in your family history?

Do you think that your decision to become a dermatologist was a good one? If not, what would

you have changed?

Do you mind telling me some of your favorite hobbies?

Do you think that a career in dermatology is more suited for people who are single, people who

have family, or both and why?

Were there ever any times that you wanted to give up while pursuing your career in
dermatology?

If yes, would you mind explaining what that experience was like? Why didn’t you give

up?
Do you plan on changing your career in the future?

General Career Questions

Does your job offer a flexible schedule?

There is an excellent predicted outlook in careers concerning dermatology, would you agree or

disagree? Why?

What do you think is the greatest advantage of becoming a dermatologist? The greatest

disadvantage?

Are there any facts that you think students should know about becoming a dermatologist?

How many days does a dermatologists work each week? How many hours each day?

Is there a pivotal point for dermatologists when they change from amateurs to actual

dermatologists?

How many years of experience do you think is needed to become a successful dermatologist?

If someone was a dermatologists wanted to switch his/her careers and use most of their prior

knowledge learned while being a dermatologist, what jobs do you think they could

choose?

Many dermatologists open their own practices or work at hospitals, are there other ways a

dermatologists can work? Examples?

Do you think the large majority of current a future dermatologists will open their own practices

or work at hospitals? What do you see dermatologists doing in the future?

What are the advantages and disadvantages of having your own practice?

What is your definition for a “successful” dermatologist?

Scientific Method Questions:

What is an average workday like if someone was a dermatologist?

What are some problems that might occur in the clinic on a workday?

What questions do you ask the patient prior to treatment?

What observations do you make about the patients skin?

What do you need to know before you are able to create a treatment plan?

What do you base your hypothesis off of?

How many tests are needed to accurately diagnose the disease?

How do you act with the patient so that they can work together with you to treat the disease?

What treatment best serves as an example of scientific method?

How often do you test the patient’s skin?

Do you diagnose patients through tests more often or through visual observations? Both?