I've mentioned on this blog before that I had good grades and scores in med school, although not freaking awesome. So it seems like the reason I didn't do dermatology should be obvious: I wasn't freaking awesome. And that's what you need to be to match in derm these days.
But between you and me, I actually did have a possible opportunity to do derm. My cousin is a big cheese dermatologist and assured me multiple times that he'd get me a residency spot if I wanted it. I don't know if this was a true offer, but needless to say, I didn't take him up on it. It was tempting, for sure. Dermatologists make good money and have a great lifestyle. I like procedures and dermatologist get to do lots of those. Part of the reason I didn't try was because of location (yet again), but there were some other reasons:
1) I looked at the people in my class who matched in derm and I thought about those people being my colleagues for the rest of my life, and I felt ill.
2) I felt that as a dermatologist, the pressure to have perfect skin would be too intense, and would cause me to break out.
3) I have a slight inherited tremor in my hands that I worry might get worse with age and keep me from doing really fine work.
4) I didn't like the idea of getting a spot through nepotism. Everything I've ever gotten in my life was earned through my own hard work and it didn't feel right to take a coveted spot just because of connections.
All that aside, I feel angry at the culture of dermatology. When I was in med school, a young girl came to talk to our class about her experience with bullous pemphygoid and how it inspired her to want to be a dermatologist, and all I could think was, "Good luck with that." Here was a person who was genuinely interested in skin conditions, yet she had very little chance of becoming a dermatologist because it's so damn competitive. Your dermatologists don't have a passion for skin, trust me.
I've heard that the number of dermatology spots are intentionally limited, so that it continues to stay competitive and salaries remain high. This is why we have to wait so long to see a dermatologist. Plus a lot of the females who go into the field do it for lifestyle, and the first thing they do after graduating is to cut back to parttime. I can't personally throw stones at that, but it kind of sucks to limit the number people going into a field, when many of those people don't intend to work full time.
In general, I don't think it says anything great about physicians that the most competitive fields are the ones with the highest pay and best lifestyle. But again, can't throw stones.