What it’s like in cosmetic & laser dermatology: Shadowing Dr. Alster

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As a medical student, do you ever wonder what it’s like to specialize in cosmetic and laser dermatology? Meet Tina Alster, MD, a featured physician in the AMA Wire® “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in cosmetic dermatology and dermatologic laser surgery might be a good fit for you.

“Shadowing” Dr. Alster (@DrTinaAlster)

Specialty: Cosmetic and laser dermatology.

Practice setting: Group.

Employment type: Private practice.

Years in practice: 25.

A typical day and week in my practice: On a typical day, I arise at 7 a.m. to quickly scan the day’s news online prior to showering. By 8, I am in the office where I answer patients’ emails that have arrived overnight. I typically schedule staff and management meetings at 8:30 a.m. and begin seeing patients at 9. I frequently have dermatology or plastic surgery residents shadowing me while patients are being evaluated and treated. I schedule patients back to back until 4 or 5 p.m. and do not break for lunch, instead preferring to refuel with a cup of coffee midway through the day.

Following a brief recap of the day’s cases with the residents, I catch up on outstanding email correspondence and electronic medical records until 6 or 7 p.m. Twice a week, I go to the gym for a personal training session or Zumba class. At least two to three evenings a week, I attend special dinners or events in Washington, D.C., that reflect a wide variety of cultural or political interests. I am usually home by 10 p.m., at which time I check my emails (once again!) and (when necessary) prepare presentations for national and international professional meetings at which I lecture. I tend to do my best writing late at night, so most of my academic manuscripts are penned then.

Every week is unique depending on whether I’m seeing patients, teaching, traveling to lecture or responding to media queries. I spend 70 percent of my workday on patient care (including emails and charting), 10 percent on administrative duties and 20 percent on academic pursuits (e.g., preparing/delivering lectures and reviewing/editing/writing manuscripts). Email correspondence with patients and other physicians takes more time with each passing year—everyone expects immediate answers to their questions!

The most challenging and rewarding aspects of cosmetic and laser dermatology: The most challenging aspect of caring for cosmetic dermatology patients is managing their expectations. Patients often expect one treatment to reverse decades of cutaneous damage. They are frequently disappointed that optimal results require several in-office procedures at monthly (or longer) time intervals during which time they have “homework”—namely, to protect their skin from further damage (particularly, sun exposure).

The most rewarding aspect of my job is being able to give hope to children and adults with extensive birthmarks or who have suffered extensive scarring as a result of burns or other trauma. My longstanding interest in wound healing, nurtured as a medical student, led to my eventual completion of a specialized dermatologic laser surgery fellowship with a focus on laser scar revision. Techniques that I developed using laser technology are now being used around the world to treat scars. Another gratifying aspect of my professional life is having the opportunity to interact with medical students and residents across a wide spectrum. Mentoring has provided me with the opportunity to teach as well as to learn from my mentees.

Three adjectives to describe the typical cosmetic and laser dermatologist:  Visual, results-oriented and gratified.

How my lifestyle matches, or differs from, what I had envisioned: It was important for me to choose a specialty that would not only satisfy my desire to incorporate medicine and surgery, but also to provide me with time to nurture a home life and to pursue other interests outside of medicine.

I enjoy traveling and visual arts and have had many opportunities to explore a wide variety of international destinations and exhibitions with my family. I take great pride in meeting up with my son in far-flung locales as he pursues his university studies and I’ve always made it a priority to save a significant chunk of time in the Summer for family vacations.

While some people may conclude that the life of a cosmetic dermatologist is glamorous, hard work and dedication remain most important to success. I am extraordinarily fortunate to have chosen a career that is academically and professionally challenging as well as satisfying. The lack of life-threatening patient issues permits me to sleep peacefully most evenings. My penchant for working into the wee hours of the morning is borne out of my own desire to be academically active, yet I believe that I have achieved a reasonable balance of home and work life.

Skills every physician cosmetic and laser dermatologist should have but won’t be tested for on the board exam: Diplomatic and empathetic communication skills, as well as an appreciation for aesthetics, are important when dealing with patients with cosmetic concerns or disfigurements. Business skills such as practice management, public relations and marketing are not taught in medical school, but are crucial for private (and, increasingly, academic) practice. In addition, time-management skills are paramount to achieving a good life balance.

One question medical students should ask themselves before pursuing cosmetic and laser dermatology: I’m going to pick two questions: “Do I have an aesthetic eye?” and “Do I love looking at skin atlases?” In order to excel at cosmetic dermatology, a deep-rooted fascination with all things related to skin and aesthetics is paramount. An innate eye for beauty and proportion is critical since a “cookbook approach” to achieving optimal aesthetics requires an understanding of individual patient (and cultural) variables.

Books every medical student interested in cosmetic and laser dermatology should be reading:

  • I am certainly biased, but I recommend my book, Skin Savvy: The Essential Guide to Cosmetic Laser Surgery, because it provides a good, readable foundation about dermatologic lasers and the conditions that can be treated.
  • Good to Great, by James C. Collins, is helpful for those interested in building a medical practice.
  • The Golden Ratio: The Story of Phi, the Extraordinary Number of Nature, Art and Beauty, by Mario Livio, provides an interesting analysis of geometrical proportions shared in art, architecture, botany, biology and the human body.

One online resource students interested in cosmetic and laser dermatology should follow: There are numerous websites that cover cosmetic dermatology, but many of them are for the “lay” audience and are heavy on advertising and self-promotion. I recommend that interested students follow (and join) the American Society of Dermatologic Surgery for unbiased education by leaders in the field.

Additional advice you’d give to students who are considering cosmetic and laser dermatology: I would suggest that students who are considering cosmetic and laser dermatology speak with cosmetic dermatologists who work in different cities and practice settings. Practices in large cities that concentrate solely on cosmetic procedures are different than medical dermatology practices that dabble in cosmetic services. The fact that several states are considering passing legislation that permits non-physicians to perform cosmetic procedures without physician oversight will also affect the viability of the field in these geographic locations.

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Sep 19, 2018
September is the AMA’s Women in Medicine Month, which celebrates the accomplishments of—and showcases advocacy for—female physicians.