How Important is Cosmetic Training in Residency?

[swaggy1090]

My residency program doesn't do a ton of cosmetic training, maybe a week or so each year of you actually doing it yourself. Would this greatly hamper your ability to find a private practice job? I'm not terribly interested in cosmetics, but I do want to be marketable, and I know most private practices offer cosmetics. Is this something that can easily be picked up / improved on after residency? My understanding is that cosmetic training is minimal at many residency programs, so I don't imagine this is a unique problem.

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[Skindoc83]

When I think of cosmetics I think of two things: injectibles and devices. Exposure to devices varies significantly across programs with some programs providing excellent hands on training and others offering close to zero. But if your program doesn’t have a lot of devices it’s easy enough to spend a few days, either as a resident or a new grad, at places that do, to get a feel for treatment endpoints etc. The rest you pick up in practice just by doing.

injectable are harder because the product itself is so expensive residents get almost no hands on experience treating patients Outside of treating occasional friends and family. You can do a cosmetic fellowship but even then you get minimal hands on Experience for the same reason. Injectables are something that you pick up in practice by doing. I would start by selecting easy going patients and see if you have an eye for it and like it. From a financial standpoint, unless you’re doing high volume or charging exorbitant rates, cosmetics does not generate a lot of money. And to be fair, I can’t imagine a lot of practices that would decline hiring you because you’re not interested in cosmetics and would rather just do medical derm

 

[swaggy1090]

Ok cool, yeah I'm not really interested in cosmetics, just would want to be fairly marketable for private practice, and it seems like most private practice offices offer cosmetics so that had me concerned. Glad to hear that not getting tons and tons of injectable experience is pretty typical.

 

[Dr. Doctor MD]

Also, there is no shortage of "providers" Derm/midlevel/RN/esthetician who are craving/eager to do all sorts of cosmetics, so if you are woking in any reasonable sized practice or group there will likely be at least one if not many colleagues who would be thrilled to take all your cosmetic patients. So I would imagine not doing any cosmetics would not hurt your marketability one bit in the majority of practices.

The only downside I can see is if you wanted to join a really small solo or old school office that was looking specifically for someone to branch out into cosmetics or take over cosmetic patients for a doctor who is leaving. Might not be the best fit in a specific situation such as that, but it's unlikely anyways.

 

[dermie1985]

My residency program doesn't do a ton of cosmetic training, maybe a week or so each year of you actually doing it yourself. Would this greatly hamper your ability to find a private practice job? I'm not terribly interested in cosmetics, but I do want to be marketable, and I know most private practices offer cosmetics. Is this something that can easily be picked up / improved on after residency? My understanding is that cosmetic training is minimal at many residency programs, so I don't imagine this is a unique problem.

I wouldn't worry too much. I think, contrary to popular misconception, most general dermatologists mainly practice....general dermatology. The cosmetic market is competitive and there is more limited "patient supply". While there are some dermatologists/plastic surgeons/ENTs, etc. who concentrate exclusively on that, most dermatologists do it as a "side-gig" (e.g. 10% of patients or less). There are also opportunities to get training on this after residency - either CME conferences, AAD Meetings, weekend courses, cosmetic fellowships, etc. You should also consider choosing a private practice where you feel other providers would be willing to teach you if you ask for it. For lasers, you can also always have a company rep come out to your clinic to teach you and practice on volunteer patients and/or nurses/MA. They want you to use their laser.

I personally recommend in your first year as an attending, especially if you haven't done a lot of cosmetics, to (1) not to do any cosmetics in the beginning (2) once you're adjusted to your work schedule, flow, patient-ramp up, have all your note templates, etc. and clinic is going well...then consider slowly adding in cosmetics - maybe start with botox first (easiest), then filler, then an easier laser like PDL. (3) Branch off to more advanced stuff (e.g. ablative / resurfacing lasers, tattoo lasers, etc.) if you feel so inclined.

Personally, I find cosmetic patients exhausting, and anything beyond the occasional PDL case and/or neuromodulator patient is more than I want to do. I also have seen enough patients with terrible filler complications from other providers, and know I don't have the personal will or desire to do enough of it in my practice to feel comfortable with the adequacy of volumes to maintain skills....that I don't do filler nor really want to. I actually got a lot of cosmetics training in residency (not sure about these comments about issues with product - Galderm/Allergan love donating botox/filler for residents to practice so they use their product once they're attendings). I'm sure other dermatologists will have a different perspective.