>> Careers in UK Dermatology

A Career in Dermatology?

Skin disease is incredibly common, accounting for approximately 15% of GP consultations and it has a significant impact on quality of life. Dermatology is the study and treatment of skin disease and is fascinating, maintaining one’s interest throughout a lifetime’s career. Every clinic is different, the number of possible dermatological diagnoses has been estimated at 3000 and each can present in numerous ways. 

Although dermatologists see a certain amount of chronic disease, many conditions are curable and most are at least treatable (we have the largest formulary in the hospital ranging from ancient tar preparations to the latest immunomodulatory drugs). This, when considered with the enormous morbidity and social stigma caused by skin disease, results in a high level of job satisfaction.

Although we are one of the major outpatient-based specialities some of our patients require inpatient admission and we are often on the wards seeing patients from other departments. Surgery is an important part of our practice with most dermatologists having at least one theatre list per week. A surgical list can be just as varied as a clinic and will typically consist of excision of cutaneous malignancies, shave excision or curettage of benign tumours, cautery of vascular lesions and diagnostic biopsies of rashes.

Dermatology Subspecialties

Most dermatologists develop an interest in a particular subspecialty such as paediatric dermatology, contact dermatitis, photobiology, dermatological surgery, blistering diseases, eczema, psoriasis, acne, urticaria, vulval disease, skin cancer, or connective tissue disease (this list is by no means exhaustive). However it is unusual for more than one clinic to be devoted to this interest unless one works in a teaching hospital and even then general dermatology makes up much of the workload. Trainees generally rotate through the subspecialties available in their region and can either arrange clinical attachments in other areas or attend courses if there is a gap in their regional training programme.

Continuing Medical Education

Although relatively small in number, dermatologists form a sociable community and meet frequently. We have very well developed scientific, educational and training programmes with local, regional, national and international meetings playing an important part in our ongoing education. Most departments have regular local meetings with interesting cases for discussion; regional societies meet through the year; and the British Association of Dermatologists, the British Society for Investigative Dermatology, the American Academy of Dermatology and the European Academy of Dermatology meet annually. Add to this annual meetings for most of the sub-speciality groups and you can see that we are spoilt for choice when it comes to deciding where to spend our study leave.

Medical Staffing of a Dermatology Department

The mix of grades of medical staffing will vary from department to department but will be made up of consultants (NHS and academic), specialist registrars, research registrars, associate specialists, staff grades, clinical assistants and senior house officers. Dermatology is also practised by general practitioners with a special interest but this will generally be within primary care (within a health centre or primary care centre).

Specialist Dermatology nurses are also an important part of the team of most Dermatology departments.  Such nurses may run their own clinics alongside the doctors and will also have a major responsibility for day-time treatments of people with skin disease.

Training to be a consultant

Currently, there is much discussion about training within the medical specialities; the following is a description of the training programme as it stands at present. This may be subject to substantial change according to the response to JCHMT proposals to incorporate more training in general internal medicine with dermatology.

General professional training

At present as with the other medical specialities, at least 3 years of general professional training are required before entry into the specialist registrar grade. These must be in approved Foundation year 1, 2 and 3 posts and at least 12 months should involve acute unselected medical intake. MRCP is required and in practice, because entry to the specialist registrar grade is so competitive, at least 6 months and often more as an SHO (or Foundation year 3) or as a locum specialist registrar in dermatology is necessary, although no more than 6 months is allowable towards general professional training. Most trainees will try and become involved with some research at this stage to improve their chances of being awarded a national training number (NTN). Overseas and non-UK EU graduates who do not hold the MRCP and wish to apply for specialist registrar posts must provide evidence of equivalent knowledge, training and experience.

Higher medical training

The duration of higher medical training in dermatology is only 4 years at present. Many trainees feel that this is too short and there have been discussions regarding an extension to 5 years. At present no dermatology specialist registrar training programmes offer dual accreditation with general internal medicine, but few feel that this is a disadvantage. A period of supervised research is considered to be a desirable but not an essential part of higher medical training.

Research Opportunities

There is ample opportunity for both clinical and laboratory based research as many diseases are very common and skin samples are easily accessible. Dermatology is at the cutting edge of much immunological and molecular biological research.

Of those trainees who undertake higher degrees, most take time out from their training programmes. However the relatively non-acute nature of dermatology has allowed some to undertake this during their training. Funding can be obtained via the usual grant giving bodies, pharmaceutical companies and other charities. The British Association of Dermatologists, British Skin Foundation and The British Society for Investigative Dermatology offer a number of awards and grants to sponsor research and travel in the U.K. and abroad.

Associate Specialists and Staff Grade doctors (Non-Consultant Career Grade Doctors)

Both of these posts offer settled, permanent employment within the hospital based dermatology service. They have agreed work commitments and clinical responsibilities and may be full-time or part-time.

The Associate Specialist grade is for senior hospital doctors responsible to named Consultants. The posts are personal appointments for doctors committed to a career in the hospital service but who have been unable to complete Higher Medical Training or who prefer not to accept the full load of a Consultant post. Associate Specialists will:

a)       have completed 10 years’ medical work (either a continuous period or in aggregate) since obtaining a primary medical qualification;

b)       have served a minimum of 4 years in the Registrar, Specialist Registrar or Staff Grade, at least two of which should have been in the appropriate speciality.

Anyone aspiring to a Staff Grade post must have completed a minimum of three years’ full-time hospital service in SHO or higher grade since first obtaining full or limited registration, including adequate experience in the relevant speciality.

All NCCG posts should have adequate time for continuing professional development, audit and clinical governance. However, it must be remembered that there is no structured training towards the Certificate of Completion of Specialist Training (CCST) within these posts and at present it is not possible to apply for a consultant post without a CCST. Therefore, if your ultimate aim is a Consultant post you are strongly advised to complete General Professional Training and complete the MRCP before taking up any post in dermatology. The Royal College of Physicians currently  recommends that no more than a year be spent in one of the NCCG posts if you wish to apply for a specialist registrar training number.

Clinical Assistants and General Practitioners with a Special Interest

Many dermatology departments employ Clinical Assistants who work on a sessional basis in a fully supervised capacity. These doctors usually also work in general practice or have other affiliations, but some work exclusively in dermatology. Experience in the Clinical Assistant grade can sometimes lead to employment as a Staff Grade or Associate Specialist (see above).

General Practitioners with a Special Interest (GPSI) while usually affiliated to a local dermatology department work independently without direct consultant supervision. The recommended level of training for  GPSI is currently 1-2 years of appropriate experience in secondary care dermatology or equivalent and evidence of recognised training via courses, qualifications or a portfolio.  It is likely that accreditiation for this intermediate level of care delivery will become formalised in the near future.

Flexible training

As a well-structured outpatient based speciality with a relatively low on-call commitment dermatology is well suited to flexible training. In 2006, 13% of specialist registrars are training flexibly.

Career prospects

The demand for dermatological expertise will never diminish, there is a bottle neck at present as the popularity of the speciality means a substantial number of  SHOs usually apply for each NTN available. However efforts are being made to increase the number of NTNs as there are many unfilled consultant posts in the country. With relatively few NTNs compared with consultant posts, and many consultants taking early retirement this is unlikely to change in the near future.

For further information contact:

The British Association of Dermatology
BAD House
4 Fitzroy Square
London
W1T 5HQ

Tel: 020 7383 0266
Fax: 020 7388 5263
Email: admin@bad.org.uk

Joint Committee of Higher Medical Training
Royal College of Physicians of London
11 St Andrew's Place
Regent's Park
London
NW1 4LE

Tel: 020 7935 1174