More than skin deep

Cate Swannell
Med J Aust || doi: 10.5694/mja16.0108C1
Published online: 1 August 2016

Passion, hard work and patience … that’s what it takes to be a dermatologist

Talk to dermatology registrars and a common theme soon becomes apparent. Dermatology is hard to get in to, and enormously satisfying to practice.

It is, in short, worth the sacrifices made along the way.

For one group of registrars training at the Royal Prince Alfred (RPA) Hospital in Sydney, those sacrifices have been significant and ongoing, not that that is deterring any of them from their chosen career path.

The numbers are daunting for those wanting to make dermatology their life. The Australasian College of Dermatologists (ACD) has 490 practicing Fellows across the country. This year there are just 29 first-year trainees, and only 114 overall.

Dr Margit Polcz is a second-year trainee at RPA. Her husband Dave is a second-year orthopaedics trainee … in Townsville in far north Queensland. Every fortnight or so they manage to end up in the same city. They’ve been doing that commute for 2 years, with 2 more to go.

“I feel so lucky,” Dr Polcz tells the MJA. “My husband understands exactly what is needed and we support each other.

“It’s worth it.”

Dr Polcz was on track to become a general practitioner, but once she completed the GP trainee program she realised that “somewhere along the way” she had fallen in love with dermatology.

“Because it’s so hard to get into, it seems quite a closed [shop],” she says. “It was overwhelming just to even apply, but once you’re there you realise that everyone is very motivated and passionate about what they do, and receptive to hard work and dedication.

“It’s a really good culture.”

Dr Alicia O’Connor, another RPA registrar, is in her first year of training. But she’s no novice.

She was a physiotherapist with 3 years of full-time practice under her belt at RPA before she decided to take on a medical degree, and continued to work one day a week as a physio while she studied. After graduating from Notre Dame University in 2011 she interned at St Vincent’s Hospital, did her registrar year in 2013, and a year’s critical care training in 2014, learning anaesthetics, intensive care and emergency medicine.

Then followed a year as an unaccredited dermatology registrar at St Vincent’s until she finally made it to the ACD’s specialist training program this year.

Dr O’Connor flies in to Dubbo in central New South Wales for 2 days a week on rotation. Married to a country boy (and another physiotherapist), she says rural practice is “tempting”.

“You see so many different patients, and because the resources are limited you have to do a lot of problem-solving. People drive for 3 or 4 hours to come see you. They’re the salt of the earth and you have the opportunity to substantially improve their quality of life.”

The training program has so far proven to be “lovely, and supportive”.

“The aim is to make you a fabulous clinician,” says Dr O’Connor. “Yes, it’s hard work, but as the saying goes, if you enjoy your work, it’s not work. It’s fun to come to work.”

After the long path to dermatology, Dr O’Connor can at least see the end of the tunnel now, even if it is 3.5 years away.

“It’s getting closer,” she says. “It’s been a moving target for so long but finally it’s still.”

Dr Deshan Sebaratnam is so close he can almost reach out and touch the daylight at the end of the 4-year tunnel. At the time of writing he was just days away from his final exam — “the last exam of my life”.

“I fell into dermatology by accident,” he tells the MJA.

“It doesn’t have a particularly good reputation because there’s a preconception that it’s very easy, and that the work is simple.

“But dermatology spans the entire breadth of medicine, and I don’t know many dermatologists who do the same thing every day.”

Dr Sebaratnam has his sights set on paediatric dermatology.

“There’s something about making kids feel better,” he says. “They bring out the best in people, and makes them want to go the extra mile. Interacting with little kids makes me happy.”

So what is it about dermatology that makes these young doctors put themselves through so much?

Dr Patricia Lowe, who supervises the RPA registrars, was made a Fellow of the ACD in 1997.

“I never get bored,” she tells the MJA. “Dermatology is a wonderful mix of skills — medical, cerebral, surgical, academic — across the whole spectrum of medicine.

“You often have to be a bit of detective. The skin is a window to the rest of the body. It can tell you a lot about what is inside. It can show the outer manifestations of internal problems, often before other signs show up.

“People don’t realise the breadth of our specialty. It’s not just skin — it’s hair, nails, mucosa, including the inside of the mouth, and the genitals. We do have an overlap with many other specialties.

“We get to make a lot of diagnoses with an immediate impact.”

On a day when Dr Lowe and her registrars saw a case of scurvy, another of scabies and one suspected case of arsenic poisoning, variety is clearly key to the passion and enthusiasm of dermatologists. Just ask the registrars.

Dr Sebaratnam: “You can make a big difference and that makes me really happy.”

Dr Polcz: “I’m very passionate about it. Apart from general practice, only dermatology offers the variety that I love.”

Dr O’Connor: “I’m naturally a very visual person and that’s dermatology. It’s such a mix of medical and surgical, and there’s lots of patient contact. It’s a lovely job.”

The last word goes to Dr Lowe.

“I always wanted to do dermatology but people were always telling me how hard it would be, so I was put off. But then I realised that everything is hard, and I wondered why I listened to those people.

“The moral of the story is come and do the experience of dermatology when you get the chance. The beauty of derm is that there are so many subspecialties.

“It’s so much more than skin checks. You’ll never be bored.”

  • Cate Swannell



remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.