“I’d love to do dermatology but it’s too competitive.”

“I haven’t got enough publications to get in.”

“It’s too late for me to develop a CV for dermatology.”

“My brother’s friend came top of his year and still didn’t get in.”

These are all real quotes that I heard when I was a student, an SHO and still hear today. The first thing I need to convey is that this is utter nonsense. If you’ve read this blog, you’ll know that your cup need not overfloweth with prizes and publications to get into dermatology. If you’ve fallen into the trap of believing this stuff, you need to snap out of it. NOW.

Is dermatology competitive? In a nutshell, yes – but someone has to get the job: why can’t it be you?

In Freudian psychoanalysis, the pleasure principle refers to the instinctive seeking of pleasure and the avoiding of pain to satisfy our psychological and biological needs. I hypothesise that the reason why junior doctors lean so heavily on the competitive nature of dermatology is that we are naturally inclined to be pain avoidant. After all, no-one likes to confront the reality that we weren’t smart enough and/or didn’t have the work ethic to make it happen. It’s easier to dodge the issue than to face up and deal with it. 

Medics are a competitive bunch. We have to jump through numerous competitive hoops to get to the end goal. First, you have to do well enough in secondary education to secure a post in medical school. Once you’re there, you need to compete for the pick of the available Foundation Programme jobs. After that, you need to secure a place in Internal Medicine (or paediatric) training in order to be eligible to apply for a Specialist Registrar (ST3) post. If this weren’t enough of a headache, we need to balance training commitments against scoring enough points to secure a place in our specialty of choice. 

I assume that most of the people reading this will, at least, have managed to secure a place at medical school. If so, you’ve already competed and succeeded amongst hard-working competition. There is nothing special about navigating your way into a dermatology registrar post – it’s just another hoop, albeit with more highly selected competition. 

Lessons from The Tortoise and the Hare

When I think back to my first year of medical school, the super-competitive sorts (“gunners”) openly professed their future career as Consultant Plastic Surgeons and how they planned to be a professor before the age of 40. It’s always interesting to check back on some of these characters years later to see what they actually got up to. Some quit training to work in industry while some of the brightest stars didn’t complete their undergraduate degree. 

This reminds me of one of the most famous of Aesop’s Fables: the tale of The Tortoise and the Hare. I can tell you from personal observation that it is often not the most gifted undergraduates who end up getting to their end goal. I’ve encountered some incredibly smart people while a student at Cambridge – people who can digest an entire lecture, recall it perfectly and can apply nuanced concepts featured within it to novel problems immediately. I remember feeling wholly outgunned when in such company, with my imposter syndrome consequently running rampant. To borrow a motoring analogy, these individuals were finely-tuned performance vehicles that could effortlessly glide from 0 – 60 mph without so much as a grunt. On the other hand, I was the 1.0 litre Nissan Micra that would be revving ferociously just to keep pace. Looking through LinkedIn, I can tell you that many of the Ferraris in my year didn’t go on to achieve ‘greatness’ (using the definition that their younger selves espoused). Maybe their priorities changed? Perhaps life intervened? Who knows. 

In my opinion, one of the most underrated and important determinants of achieving your goals is not natural ability, but rather pure unadulterated work ethic. A person who demonstrates sheer doggedness to achieve their goals is hard to keep down. The Nissan Micra who won’t give up on his or her goals despite everything else telling them they can’t make it will get there – it will simply require a different magnitude of effort as compared to the Ferrari. A Ferrari who has been able to ease through every academic hoop with natural ability may not have built the coping strategies to deal with adversity. Since they’ve never had to shift into third gear or beyond, not being able to excel amongst able and driven peers can be a jarring experience for the fragile ego. As my dear friend Dr. Faisal Qureshi would say, what use is having a Ferrari if you only drive it in Sainsbury’s car park? 

Becoming a dermatology consultant won’t solve all of your life’s problems

Don’t make the mistake of putting life on hold until you jump through the next hoop. When a student, I told myself that life would be much better when I qualified. When I was a foundation doctor, I thought that things would become easier when I was a CT1. Predictably, once there, I figured that, at last, when I do make it into dermatology, people will respect me and I’ll be a proper doctor. As a senior registrar overburdened with ward referrals and calls from angry consultants, finally, FINALLY, I thought that making it to consultant would give me the validation I needed. 

Guess what? It didn’t. Sure, people are nicer to you because you’re higher up the food chain and you don’t get paged quite so often. Yes, you make considerably more money than an FY1 but that’s about it. Becoming a consultant won’t suddenly make you happy.

Get into the field for the right reasons. Live life in parallel with pursuing your academic and career goals. Make time for family and friends. When it’s all said and done, all the plaudits in the world won’t matter on your deathbed. Getting into dermatology is a worthy goal – but not at the cost of all else.