What do Dermatologists do?

Consultant performing Photodynamic Therapy on a patientDermatologists are specialist physicians who diagnose and treat diseases of the skin, hair and nails. All dermatologists are medically qualified, and undertake the same undergraduate training as other doctors. After qualification, they spend a number of years training in general (internal) medicine, and this gives them a wide experience of other medical specialties (e.g. emergency medicine, rheumatology, cardiology etc.). During this time, dermatologists must pass the exams enabling them to become a Member of the Royal College of Physicians (MRCP). Failure to pass this exam effectively prevents doctors from following a specialist career.

Once this hurdle has been cleared, the budding dermatologist needs to find a post which will provide training in the chosen specialty. These posts are either at Senior House Officer level, or more usually, at the higher grade of Specialist Registrar, and competition for places on these schemes is usually intense. Training posts are usually based in teaching hospitals, although each ‘rotation’ will include a period at a district general hospital to provide broader experience. Most training posts are for a 4 year period, but this is frequently extended, often by two or more years, to allow a period of time in research and to d eve lop expertise in one of the dermatological subspecialties (e.g. dermatological surgery, paediatric dermatology, contact allergy, photobiology etc.) . It is expected that trainee dermatologists will develop a research interest and they are expected to publish papers in scientific journals.

Once training is completed, dermatologists are awarded a Certificate of Completion of Specialist Training (CCST), and can then apply for consultant posts in either teaching or district general hospitals. Once appointed to a consultant post, the dermatologist will generally join a department where there are usually at least one or two other dermatologists. Consultant dermatologists are a relatively scarce resource in the NHS, especially when you consider that 10 – 15% of consultations with a General Practitioner are related to skin disease.

What does a dermatologist treat?

The range of patients seen by dermatologists is wide and extends from cradle to grave. There are over 2000 skin diseases described but about 20 of these account for 90% of the workload. Inflammatory skin diseases such as eczema and psoriasis are common and without treatment produce significant disability. Severe acne in teenagers is also a common reason for referral.

In the last few years, skin cancer has assumed almost epidemic proportion in the population, at least in part to the easy availability of holidays overseas and a (mistaken) belief that tanned skin is healthy skin. Dermatologists are at the centre of both research into, and treatment of, skin cancer and this now comprises up to 40% of the workload. Many dermatologists now spend a significant part of their time operating surgically to remove tumours.

[Source: British Association of Dermatology 2009]
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