Medical Specialties - Dermatology (1 Jul 2026)

SPEAKER_00 0:00

If you enjoy listening to career conversations, why not become a member of the Royal College of Physicians of Edinburgh? Our membership provides you with access to the RCPE educational portal, the live evening medical updates, and you have options to view the symposia both in person or online. If you would like to learn more about this, please go to the Royal College of Physicians of Edinburgh website.

SPEAKER_01 0:32

Hello and welcome to this episode of Career Conversations, brought to you by the Trainees and Members Committee of the Royal College of Physicians of Edinburgh. I'm Dr. Heather Kennedy and I'm a member of the Trainees and Members Committee. Today I'm delighted to be joined by Dr. Amy Perkins, Consultant Dermatologist at NHS Fourth Valley and honorary clinical lecturer at the University of Glasgow. Welcome, Amy, and thank you for joining me today. Thank you so much for having me. It's a true pleasure. So today we'll be talking about your specialty dermatology. Can I start by asking why you chose this specialty?

SPEAKER_02 1:07

Of course. So I am one of those slightly maybe unusual people who always wanted to do dermatology. And even in my yearbook, it actually says, you know, most likely to be found swanning around dermatology clinics in heels. And that's actually what ended up happening. So I think right from the start, I remember being, you know, on the wards and looking in textbooks in Edinburgh Medical School, where we actually went together and seeing that the skin was often the first sign of internal disease. And I remember being on the wards and these dermatologists would arrive and just look at the skin, to me at least, seemingly without the need for loads and loads of fancy tests. They seemed to be able to make a diagnosis. And I remember this just blew my mind. And that's when I knew I wanted to get into it.

SPEAKER_01 1:53

That's really interesting to hear. Thank you. And can you talk us through your typical week as a dermatologist?

SPEAKER_02 1:59

Of course. Yeah. So my clinical career is a huge part of obviously what I do, but I'm also doing lots of other bits and pieces at the moment. And I'll get into that later. But clinically, I work in NHS Force Valley. So I'm actually employed as a specialty doctor, but just last week I was made consultant, which is very exciting. So at the moment I do six clinics a week and I do a biopsy list as well. So clinics comprise all ages. You see everyone from babies from just maybe being a few hours to a few days old, right up until the most elderly in our population. So it truly is the most diverse, probably of most specialties, actually. And I really love that for it. You know, it's so interesting. You see people from absolutely every stage, every walk, and every demographic of life. And a huge part of what we do also is lesions. So specifically moles, precancerous things, and of course skin cancers. And a huge part of what drives me in my non-clinical work is skin cancer prevention. So in the day-to-day week, as well as clinics, we do biopsy lists, and that incorporates often cutting out skin cancers, taking biopsies of rashes, and also other things. So it's kind of removing troublesome, very large warts that might be impinging on people's day-to-day life. For example, if you have a large wart catching in your glasses. So not everything is sort of skin cancer-based when we're biopsying, but it is a big part. Apart from that, there's lots of kind of team meetings. In dermatology, I think about 20% of our patients have rare diseases. And dermatology is some of the broadest number of diagnoses in any specialty, as far as I understand. We've got over 3,000 various conditions to memorize. So there's no way I'm remembering all that, consultant or not. So we often have team meetings to discuss very complicated cases and so on. So every Thursday afternoon we get together as a department and do that. We also meet with the pathologists and the rheumatologists to discuss more complex inflammatory cases. Too. We also cover on call. So one of the kind of unrecognized maybe parts of dermatology is that we're frequently contacted by the wards for people who come in with rashes, maybe the doctors who've spotted a lesion that needs to be assessed. So every Friday I'm on call for Forth Valley Hospital and go around, do the rounds, and brings me back to my ward doctor days.

SPEAKER_01 4:16

Oh, that sounds like you've got quite a spread of work, as well as those mainly outpatient clinic-based, you have that day of inpatient inreach and like you mentioned, such a collaborative approach with your colleagues and having those team meetings. So it sounds like a really exciting specialty to work in. I absolutely love it.

SPEAKER_02 4:32

And you know, I feel so lucky because uh all over the world and even in medicine, I think many people don't like their job anymore. But I truly feel so lucky to love it. It's a true joy.

SPEAKER_01 4:43

Amazing. And so what advice would you give to medical students or resident doctors who are interested in getting involved in a specialty?

SPEAKER_02 4:51

So the thing I ask everyone to do is reply to every email you get. And this sounds odd, but in dermatology and indeed in every specialty, of obviously we can all be bombarded with emails. And some of them are very important, for example, relating to emergency cases, and others might seem irrelevant even from pharmaceutical companies or other things that maybe aren't maybe seeming directly related to what we're interested in or what we're doing. But from an early stage, I have always been inquisitive and always kind of wanted to know what people are up to. And I genuinely think that that stood me in such good stead. So I've always replied to emails that people weren't expecting responses to. So what I'm talking about is kind of, you know, if you're invited to a meeting. So say for example, you historically had signed up to some mailing list and you get a sent-all email to your work address inviting you to something that you might not be interested in. Obviously, some of the times it's not of interest, but sometimes they might have a wee hankering and think, oh, I might want to do that one day. So I often respond and say, Oh, thanks so much. I'm not interested at the moment, but you know, I'd like to be kits on your list. And people remember that. And, you know, people come back to you years down the line because you're the only one who speaks to them. And honestly, that opens doors. And so that might seem like an odd example, but if you relay that across every single email you get, oh my goodness, the amount of opportunities it has paid off for in the long run has been enormous. Things like pharmaceutical representatives, like they can be so sick of not getting responses to any of their emails. I know them all on a first-name basis. Many of them are turned into friends. You know, I respond to all the people from labs whenever they contact me with any unusual responses. I know them all. That sent me in such good stead for kind of inter-team collaboration. So I think that's the first thing. Like if you're interested in any specialty, just respond, be involved, turn up. And of course, just in life, we need to be bold. We need to put ourselves out there and you know, just ask. People like when you're interested in their specialty. I love when people are interested in dermatology because to me, sometimes it feels that many people aren't. So when I get an enthusiastic resident doctor keen to shadow me, I jump at the chance. Not everyone does, of course, but there are doctors out there who will. So just put yourself out there and contact.

SPEAKER_01 7:06

And are there any societies or forums that medical students or resident doctors can get involved in to learn more about the specialty and develop their interests?

SPEAKER_02 7:15

Oh, absolutely. There's actually so many things now. This always makes me laugh because when I was in Edinburgh Medical School, we didn't have an undergraduate dermatology society, but there were a few others, including myself, who set one up, the Edinburgh Undergraduate Dermatology Society. And I think, you know, now it is this incredible, thriving society. They run so many events. But I think we set it up pretty much just to put it on our CV. We didn't do anything. But now there are societies everywhere and they're so active. I am so impressed. So I frequently speak at various undergraduate societies' events, they run conferences to encourage people to gain an interest and network. Pretty much every medical school now seems to have an undergraduate dermatology society. So absolutely look into these. And I think also they're not just relevant to undergraduates. Many of the events I've spoken at, despite being undergraduate sort of you know, directed, they have now expanded to be invited to resident doctors too. So it's absolutely not just for students, they're very open arms.

SPEAKER_01 8:22

And for anyone that's in foundation or internal medicine training, is there anything that they can be doing to bolster their portfolio and application to dermatology?

SPEAKER_02 8:32

Of course. So the first thing to say is do a taster week. Taster weeks are typically done in FY2. They involve where you reach out to a senior clinician in the department of your choice and shadow them for a week. And it's basically being a medical student again. I loved my taste or week in dermatology when I was in FY2. So that's a really good thing to do. There are other sort of more resident doctor-specific conferences, including Derm School. So Derm School is run by the British Association of Dermatology, and it is typically in the day before the main BAD, that's the British Association of Dermatologists, annual meeting every summer. And I've spoken at it a few times, and I also attended before I started dermatology. It's basically aimed at residents, and of course, medical students do, but it gives you a really good introduction into what a career in dermatology looks like. It's amazing for networking. And for me, it was my first experience in a dermatology academic environment. And that was the first time I really had that fire lit for me when I went to derma school. So I'd always recommend it to everyone.

SPEAKER_01 9:37

Great. And we can put a link to that in our show notes for this episode so people can check it out. And I think, like you say, it really demonstrated to you how engaged and interested you were. And then for our listeners, if they're thinking of applying for dermatology, they can use these experiences to demonstrate their commitment to the specialty. So that's something to definitely think about.

SPEAKER_02 9:56

Oh, totally. And also, I think for me, going to dermal school was the first time I really met loads of people with the same interests as me. Because I mean, I'm sure many people listening to this will feel passionately about dermatology, but they might not know others who feel the same. But actually, going to this environment where there are literally hundreds of people who you can talk to, share experiences with, it's so empowering and it's exciting and it really drives you to, you know, learn more and network and just get part of the community.

SPEAKER_01 10:23

Yeah, fantastic. And I'd be interested to know what route did you take into dermatology and what advice would you have for others trying to get into the career in the specialty?

SPEAKER_02 10:33

Of course. So I had a bit of a weird one. And I actually just became a consultant dermatologist last week, as I mentioned. And this has possibly been even more of a celebration than many people who finally become a consultant because I've waited a long time for this moment. So my path into dermatology started pretty conventionally. I graduated from medical school, did my FY1, FY2, then I did my CMT, as it was at the time, so core medical training, which is now internal medical training. And I've always been very driven and as I said, always been very, very keen to go straight into dermatology. I think I was a bit of a problem trainee, not in maybe the way that people would expect, but basically because I was so driven to dermatology that I made a huge song and dance about finishing core medical training early. So instead of doing it in the usual two years that people conventionally do, I found a very small print clause that said, if you can do all your exams and finish all the competencies in advance, you can complete it in 18 months. So when I did it, it was a very unusual situation. And I think locally it hadn't really been done before. So it kicked off quite a furry, and of course you can imagine all the drama with rota gaps and so on. But I had all these plans, you know, I wanted to go and work internationally with dermatology. I had all these volunteering plans set up. So I managed to do it. I actually did all my Royal College of Physicians exams in FY2, and that stood me in such good stead going straight into CMT, having gained my membership. So I actually finished my CMT in February of 2020. And then of course I had all these grand plans. I'm going to go to India to be in this leprosy centre. So flew out to what's called the Guambei Leprosy Project, landed there, and then kind of vaguely was aware of some vague situation in Italy with some virus. And then, of course, two weeks later, I had to get an emergency flight home because COVID was kicking off. Then after that, of course, as with everyone else in the world, my world turned upside down. So I'd already got rid of my flat that I'd been living with at my partner at the time in Aberdeen. So moved back in with my parents at the ripe old age of 27, which felt a wee bit not the way my life was planning. And then I started locoming in the COVID words and so on in Dumfries from where parents are based. Did that for about six months, then moved to Glasgow. And over that time period, there's a lot of stuff going on in personal life as well. So initially I'd sort of planned to go straight into a dermatology clinical file, but that didn't happen. So I just carried on locoming. But in that time, I loved locoming. People can dismiss locoming as being lazy or not working hard enough. But I genuinely probably worked harder as a locum than I did in my formal training years. And I really used it as an opportunity to work in places that I'd never had the opportunity to. So for example, a job came up in the Neurological Disability Rehabilitation Unit in Glasgow. And I thought, that sounds so interesting. Because I just have no idea what that is. So I started working there, initially just signed up for a four-week locum, but I loved it so much I ended up staying for five months. And again, this part of medicine is just nothing to do with dermatology. If you'd told me even a few months prior to me applying to the job that I would be applying to it, I would have thought you were crazy. But this is the joy of medicine. There are so many interesting parts, and we're just so lucky to be in a career that we don't just need to stick to our box. So after doing those jobs, I worked to do a bit in oncology, gastro, lots of different pieces that I just wanted to improve upon and kind of learn more about. And then after that, I thought, well, life seems a wee bit more normal now, coming out of lockdown and so on. So I'll apply for a clinical fellow post in dermatology. And then I thought, well, you know, I've got a good CV. I was feeling really arrogant about it. I was like, I'll sail into a dermatology training number. I genuinely thought that was the case because I had done everything that people tell you to do. I had publications, I had audits, I had done a diploma in medical education, I had all my exams, and I thought, surely, surely I'll get it. Well, you can guess what happened. I didn't even get an interview for a training number. And honestly, the day that happened, I felt like the stupidest person in the world. And it was mortifying because I was the girl who wanted to do dermatology since medical school. And everyone just expected me to do it. You know, it was honestly awful. I felt so, so, so silly. And telling people that felt like a failure. And then everyone kept saying to me, Oh, just try again, try again, you'll get it, you'll get it. And then I thought, well, you know, the people that have got a job this year, they're having to move across the country to somewhere that their partner isn't there, their family isn't there, they're having to uproot their entire life. And I thought, I don't really want to do that. You know, at this stage, I'm like 28, 29. And I was like, I just don't want to have to uproot my life because some person is telling me to do so. And then I thought, well, you know, I've heard about this thing called the portfolio pathway. It was formerly known as Caesar. And essentially it's an alternative way to become a consultant without the formal training. So at this stage, I was nearing the end of a clinical fellowship in dermatology in Glasgow. And then I saw an advert go up for another job as a clinical fellow in another hospital in Glasgow. And I thought, well, if I do this, I'll actually be following the same path as the training registrars. So I applied for that one. Then I did a second year in dermatology. And then I applied for another job in a different hospital. And by that point, I'd done my specialty certificate exam in dermatology. I was working as sort of mid to senior registrar level. And then before I knew it, I had most of the evidence required to become a consultant via the portfolio pathway. So after that, I applied for a specialty doctor post in Forest Valley, where I am at the moment. And I finally gathered enough evidence to submit to the General Medical Council to apply to be a consultant dermatologist. And that was in January 2025. And so now on the 26th, 27th of March 2026, I finally found out that it was approved. So here we are. And now I am a consultant. And so that's been my slightly unconventional pathway. So challenging, but for me, so worth it.

SPEAKER_01 16:41

Thank you so much for sharing that. And like you say, the challenges that you experienced along the way and the moments of vulnerability that you had. And I think a lot of our listeners, that will resonate with them. The challenge of applying for higher specialty training, the recruitment issues at the moment, and feeling that they can not have options that they want to. So that's really heartening to hear that there's different ways of going into a specialty that you're passionate about. So thank you for that. And in contrast, can you just give us an overview of, I guess, the more traditional route into dermatology and how higher specialty training would work?

SPEAKER_02 17:14

Of course. So the standard route to becoming a dermatology consultant is much harder to get a job. As I said, I sort of apply for jobs every year and was, of course, successful. But to get a training job is very difficult, and unfortunately, it's probably going to become more difficult. But if you get a job, you basically pretty much just have to turn up to work and then you'll become a consultant after four years. So once you've got a training number, you're laughing pretty much, you. So standard dermatology training is typically done after core medical training. However, they've changed it in the past so well that you can also apply after doing core surgical training, and you can also do it if you've done pediatric training as well. So there's a few different routes, and I think that really reflects how broad dermatology is and just how diverse the dermatology community is. And one of the reasons I love it so much, honestly. So after you've done your sort of initial medical surgical pediatric training, whichever it is, you then do a four-year dermatology-specific training. And there are obviously multiple centres around the UK, and some of them are based mainly in one site. Many of them you're kind of expected to move around a little bit, kind of in a region over that four-year period. After the four years, you become a consultant and then that's you.

SPEAKER_01 18:26

Great. So that's been really helpful to hear about what attracted you to dermatology and the route that you've taken. And I wonder to finish, is there a particular case that has stayed with you and highlights how great your specialty is? Oh, that's a really good question.

SPEAKER_02 18:41

I don't know whether I have a specific case, but I think it's more representative of I think the power of dermatology and what really drives me. When I started in dermatology, I was really, really struck by how many people would come in specifically to skin cancer clinics, but also just to any dermatology clinic, you know, whether they had psoriasis, eczema, acne, whatever, and they were really tanned. And a lot of the time they would admit or, you know, talk about using sunbeds, being on holiday, obviously in summertime, often people would come in sunburnt with tan lines and so on. And the thing is for me, I was kind of struck by this because I was well aware, as many of us are, that a huge proportion of skin cancer is preventable. And sunbeds are a huge, huge driver for skin cancer. And we know that even just using a sunbed once in your lifetime can increase your risk of a lifelong melanoma by up to about 70%. So it's colossal. And I was just seeing these young people coming in with melanoma diagnoses, and almost unanimously they were sunbed users, especially those that were developing melanoma under the age of 30. And I was talking to my colleagues, and I said, you know, this is mad, isn't it? Like we don't need to kind of talk more about this. And the general consensus was, oh, you know, this uh well acknowledged. Of course, CV is a known trigger factor for cancer and so on, and yeah, it's a real problem. But, you know, it's obviously very culturally ingrained in the UK. Everyone associates being tanned with being healthy and so on, and it's a huge amount in decline. So I think that situation has really driven a huge part of what has motivated me in my non-clinical work. And I really now spend a huge amount of time when I'm not working in the NHS campaigning for skin cancer preventative measures. And I do spend a lot of time with my patients talking to them about how to protect their skin and the sun. And, you know, I've had so many experiences with multiple patients that have really taught me the importance of empathic communication, being supportive, not challenging. And I've learned so much from my patients through that. And, you know, I think for many years, I think I was probably in the cohort of doctor, whether I would have admitted it or not. I think I probably would have maybe, you know, dismissed people who were using slump beds as not being very sensible or not really thinking about the risk. I would maybe just have been frustrated with them. And I think that probably would have come across in my communication style. And I think it took me a long while to kind of realize the impact that that was having on my patients and also not only on that specific consultation, but also on their appreciation of healthcare in general. So, for example, if they go to a doctor like me who they feel they're being told off for using a sunbed, that's then probably going to make them hide away from other healthcare scenarios. So I think I've learned so much from these sort of situations and learning more about how to communicate with patients who are responding to natural situations in our culture that are telling them to tan. So I suppose it's not really a specific case that stays in the with dermatology. It's more that entire ecosystem of communication, how dermatology is so interlinked with the beauty industry and how we can navigate that as doctors.

SPEAKER_01 21:46

That's been really interesting. Thank you so much. And thank you just for sharing all of your experiences and advice with us, Amy. And for our listeners, you can check out our other episodes in our career conversations podcast that cover different medical specialties, like we discussed dermatology today. And we also have many interesting cases and clinical topics on our sister podcast, Clinical Conversations. So thank you so much, Amy, for joining us today. My pleasure. Thank you so much for having me. Good. And thanks everyone for listening.