Name: 所以你想成為......皮膚科醫生 [第 52 集］ (So You Want to Be… DERMATOLOGIST [Ep. 52])
Uploaded: 2025-09-27T18:17:14.000Z
Duration: 21 min 41 s

所以你想成為一名皮膚科醫生。

You love the idea of popping pimples by day and curing skin cancer by night.

你喜歡白天爆痘，晚上治療皮膚癌的想法。

Let's debunk the public perception myths of dermatology and give it to you straight.

讓我們來揭開公眾對皮膚病學的認識誤區，為您一一道來。

This is the reality of being a dermatologist.

Welcome to our So You Want to Be series, where we highlight a specific specialty within medicine to help you decide if it's a good fit for you.

歡迎來到我們的 "你想成為這樣的人 "系列，在這裡我們將重點介紹醫學中的某一專業，以幫助您決定該專業是否適合您。

For this episode, we're bringing our insider expert to you.

在本期節目中，我們將為您請來內行專家。

Dermatologist Dr. Austin Johnson will join me to give you a glimpse into the world of dermatology.

皮膚科醫生奧斯汀-約翰遜博士（Dr. Austin Johnson）將與我一起帶您領略皮膚科的世界。

Dermatology is the specialty that manages diseases of the skin, hair, and nails, combining both medical and procedural aspects.

皮膚科是治療皮膚、頭髮和指甲疾病的專科，集醫療和手術於一體。

Many think skin is relatively straightforward, but it's far more complicated than it seems.

許多人認為皮膚問題相對簡單，但其實遠比想象中複雜。

A dermatologist can identify and treat more than 3,000 conditions, including eczema, psoriasis, and skin cancer, among others.

皮膚科醫生可以識別和治療 3,000 多種疾病，包括溼疹、牛皮癬和皮膚癌等。

How might you describe dermatology to a five-year-old?

您如何向一個五歲的孩子描述皮膚科？

Think of your skin like a superhero suit covering the whole body.

把皮膚想象成覆蓋全身的超級英雄戰衣。

It keeps the germs out, helps you feel things like hugs, and keeps you warm or cool.

它能防止病菌侵入，幫助你感受擁抱，保持溫暖或涼爽。

You might get an itchy spot, a rash, a bug bite, or even pimples.

你可能會出現癢點、皮疹、蟲咬，甚至丘疹。

這就是皮膚科醫生的作用所在。

Dermatologists examine your skin closely, much like detectives.

皮膚科醫生會像偵探一樣仔細檢查您的皮膚。

They might use a special magnifying glass or a tiny flashlight to get a better look.

他們可能會使用特殊的放大鏡或微型手電筒來觀察。

They may even take a little sample to look under the microscope.

他們甚至會取一點樣本在顯微鏡下觀察。

Your skin can often reveal how your body is functioning on the inside, and dermatologists can use that as a form of x-ray vision to help diagnose more than just skin conditions.

皮膚通常可以揭示身體內部的運作情況，皮膚科醫生可以將其作為一種 X 光透視技術，幫助診斷皮膚病以外的其他疾病。

Dermatology falls within four main categories.

First up is medical dermatology, which deals with general dermatologic concerns such as skin cancer, viral warts, acne, rosacea, hair loss, and various rashes.

首先是內科皮膚科，主要治療一般皮膚病，如皮膚癌、病毒性疣、痤瘡、酒渣鼻、脫髮和各種皮疹。

It also includes minor in-office procedures like injections, skin biopsies, and excisions.

它還包括注射、皮膚活檢和切除等小型診室手術。

General dermatology offers a predictable schedule and cases, combining fast-paced office visits with longitudinal patient continuity.

普通皮膚科提供可預測的時間安排和病例，將快節奏的門診與病人的長期連續性結合起來。

At academic institutions, you can also expect to manage more complex skin diseases, and there are often entire clinics dedicated to certain conditions or categories of disease, such as melanoma, cutaneous oncology, and vascular anomalies to name a few.

在學術機構，你還可以治療更復雜的皮膚病，通常會有專門針對某些疾病或疾病類別的整個診所，如黑色素瘤、皮膚腫瘤學和血管異常等等。

But general dermatology is about much more than just acne.

但普通皮膚病學的內容遠不止痤瘡。

The conditions medical dermatologists treat are wide-ranging, including psoriasis, eczema, and various inflammatory, ulcerative, or blistering diseases that may require systemic medications or lifelong management.

皮膚科醫生治療的疾病範圍很廣，包括牛皮癬、溼疹以及各種炎症性、潰瘍性或水皰性疾病，這些疾病可能需要系統用藥或終身治療。

Aesthetic dermatology primarily focuses on cosmetic concerns, including ritids and wrinkles, volume loss, hyperpigmentation, textural changes, scar revisions, and redness, all through advanced cosmetic procedures and laser technologies.

美容皮膚科主要通過先進的美容手術和脈衝光技術，重點解決美容問題，包括皺紋、容積損失、色素沉著、紋理變化、疤痕修復和發紅等。

This is also clinic-based with in-office procedures.

這也是以診所為基礎的診療程序。

Procedures include laser and chemical resurfacing, microdermabrasion, collagen fillers, Botox, sclerotherapy, body contouring, and scar revision.

療程包括脈衝光和化學換膚、磨皮、膠原蛋白填充、肉毒桿菌毒素、硬化劑注射、塑身和疤痕修復。

Surgical dermatology centers on Mohs Micrographic Surgery, a precise technique used to treat skin cancer that involves examining the tissue under the microscope at intervals to determine if the cancer is entirely removed.

皮膚外科以莫氏顯微外科為中心，這是一種用於治療皮膚癌的精確技術，包括每隔一段時間在顯微鏡下檢查組織，以確定癌症是否被完全切除。

Mohs surgeons don't just do Mohs surgery, though.

不過，莫氏外科醫生並不只做莫氏手術。

They often also perform simple excisions, as you would in general dermatology, as well as cosmetic dermatology procedures.

他們通常也會像普通皮膚科一樣進行簡單的切除手術，以及皮膚美容手術。

While this is as surgical as dermatology gets, it's essential to understand that these are still clinic-based in-office procedures.

雖然這是皮膚科的外科手術，但我們必須明白，這些仍然是在診所進行的診室手術。

This doesn't happen in the operating room.

Patients generally only need local anesthetics, and the surgeons often interact with the patient throughout the surgery.

患者一般只需局部麻醉，外科醫生通常會在整個手術過程中與患者互動。

You're also more likely to have repeat customers.

Not only do these patients need follow-up monitoring for their excised skin cancers, but once you get skin cancer, you're also at a higher risk of it recurring somewhere else, which means Mohs surgeons work closely with medical dermatologists to screen patients and biopsy anything worrisome.

這些患者不僅需要對切除的皮膚癌進行後續監測，而且一旦患上皮膚癌，在其他地方復發的風險也會更高，這意味著莫氏外科醫生要與皮膚內科醫生密切合作，篩查患者並對任何令人擔憂的情況進行活檢。

Inpatient dermatologists work as primary services in the hospital, such as internal medicine, pediatrics, or surgery, which often manage hospitalized patients with primary or comorbid dermatologic conditions.

住院皮膚科醫生是醫院的主要服務部門，如內科、兒科或外科，他們通常負責管理患有原發性或合併皮膚病的住院病人。

These dermatologists function in various capacities, maintaining their own clinical practices while also being on-call for the hospital.

這些皮膚科醫生的職能各不相同，既要維持自己的臨床實踐，又要為醫院隨時待命。

There is a short list of dermatologic emergencies, and while there aren't many, these are the dermatologists who would provide recommendations to the managing service.

皮膚科急診有一份簡短的清單，雖然數量不多，但這些皮膚科醫生會向管理服務部門提出建議。

Patients in this category can be very sick and develop skin diseases concurrently, or the skin disease can be a manifestation of a systemic disease revealing the story of other underlying disease processes.

這類患者可能病得很重，同時患上皮膚病，或者皮膚病可能是全身性疾病的一種表現，揭示了其他潛在疾病的過程。

Thus, inpatient dermatologists are well-versed in internal medicine, as well as unique or complex skin conditions.

是以，住院皮膚科醫生精通內科以及特殊或複雜的皮膚病。

Dermatology is not all acne, eczema, and skin cancer, and it's certainly not Dr. Pimple Popper.

皮膚科不全是痤瘡、溼疹和皮膚癌，當然也不是痘痘醫生。

While it can be extremely gratifying to extract milia and laser-away dispigmentation, dermatologists don't go into the field to get away from medicine.

雖然拔除粟粒疹和脈衝光祛除色素沉著會讓人非常高興，但皮膚科醫生並不是為了遠離醫學而進入這一領域的。

That dermatologist you see for dark spots?

They just got out of another room with a distraught family after sharing that their loved one has metastatic melanoma.

他們剛剛從另一個房間出來，與一個心急如焚的家庭分享了他們的親人患有轉移性黑色素瘤的消息。

The cosmetic dermatologist who just resurfaced your skin?

剛剛為您重塑肌膚的美容皮膚科醫生？

Last week, they had to excise an invasive skin cancer that chewed all the way through the nose.

上週，他們不得不切除一個侵入性皮膚癌，癌細胞一直咬到鼻子。

Dermatologists love what they do, but not every patient story ends in a triumphant cure.

皮膚科醫生熱愛他們的工作，但並不是每個病人的故事都以治癒為結局。

While a solid work-life balance is one of the reasons why dermatology is one of the most competitive specialties out there, it's not easy.

工作與生活的平衡是皮膚科成為競爭最激烈的專業之一的原因之一，但這並不容易。

At most, dermatologists are taught two weeks of dermatology in their four-plus years of medical school, and they're lucky to get more than that in a typical intern year.

皮膚科醫生在四年多的醫學院學習中，最多隻能學到兩週的皮膚病學知識，而在典型的實習年中，他們能學到比這更多的知識就已經很幸運了。

That means your so-called 9-5, which is really more like an 8-5, is followed by a 5-9 of reading, researching, and practicing procedures, which extends beyond residency.

這意味著你所謂的朝九晚五，實際上更像是朝八晚五，接下來的朝五晚九是閱讀、研究和實踐程序，這已經超出了住院實習的範疇。

It seems that a new biologic medication is being introduced every year, which requires constant review of immunology, clinical trials, and attendance at academic conferences to stay up to date.

似乎每年都有一種新的生物藥物問世，這就要求我們不斷複習免疫學、臨床試驗，並參加學術會議，以瞭解最新情況。

You know all those drug commercials that comprise roughly 80% of ad revenue on cable and satellite TV?

你知道那些佔有線電視和衛星電視廣告收入 80% 左右的藥品廣告嗎？

Rheumatologists and dermatologists are often the ones sifting through those results to determine whether X or Y is right for you.

風溼病學家和皮膚病學家通常會對這些結果進行篩選，以確定 X 或 Y 是否適合您。

All that to say, dermatology is wonderful, but it is far from easy.

綜上所述，皮膚病學固然精彩，但絕非易事。

You don't always get the answer in dermatology, even after dermoscopy, multiple skin biopsies, and an extensive laboratory workup.

在皮膚科，即使進行了皮膚鏡檢查、多次皮膚活檢和廣泛的實驗室檢查，也不一定能找到答案。

The art of dermatology is being comfortable with broad differential diagnoses characterized by subtle clinical and histologic differences, and more importantly, developing a therapeutic relationship with patients that can sustain multiple iterations of therapies over weeks, months, or even years.

皮膚病學的藝術在於能夠從容應對以微妙的臨床和組織學差異為特徵的廣泛鑑別診斷，更重要的是與患者建立一種治療關係，這種關係能夠維持數週、數月甚至數年的多次反覆治療。

While there are times when they can walk into a room and immediately diagnose a condition from 6 feet away, it's when you dive headfirst into a holistic evaluation of the patient and critically appraise the literature to clinch a diagnosis that often drives a dermatologist.

有時，他們走進一個房間，在 6 英尺外就能立即診斷出病情，但當你一頭扎進對病人的整體評估中，批判性地評估文獻以得出診斷結果時，往往是皮膚科醫生的動力所在。

As with all specialties, you must enjoy the bread and butter of your field.

與所有專業一樣，你必須喜歡自己領域的麵包和黃油。

For dermatology, that means skin checks, also known as full body skin exams.

對於皮膚科來說，這意味著皮膚檢查，也稱為全身皮膚檢查。

If you enjoy pattern analysis and finding clues, you're going to love nevi and rashes.

如果你喜歡分析模式和尋找線索，那麼你一定會喜歡黑痣和皮疹。

What's something that surprised you about dermatology?

關於皮膚科，有什麼讓你感到驚訝的事情？

Looking back, I was initially nervous about the rapid fire visits, as one of my passions is spending enough time to make a genuine connection with someone who is often going through the scariest, most painful time in their life.

回想起來，我最初對這種快速的訪問感到緊張，因為我的愛好之一就是花足夠的時間與人建立真正的聯繫，而這些人往往正在經歷他們生命中最可怕、最痛苦的時刻。

Fortunately, the fact that both the patient and I can often see what's bothering them, as well as my ability to potentially diagnose and address it immediately, leads to a strong therapeutic bond that I felt was missing in other specialty contexts.

幸運的是，我和病人都能看到困擾他們的問題所在，而且我有能力立即診斷和解決這些問題，這讓我們之間建立了深厚的治療關係，而這正是我在其他專業領域所缺乏的。

Telling someone they don't have cancer, taking such a cancer off, or even just making someone confident in the organ that defines their social and biological interactions with the rest of the world, is often akin to lifting a visible and invisible weight off of those who need a win in life.

告訴某人他們沒有癌症，摘掉癌症的帽子，甚至只是讓某人對自己與世界其他地方進行社會和生理互動的器官充滿信心，往往就相當於為那些需要人生勝利的人卸下了有形和無形的重擔。

I believe that everyone has a gift to offer humanity, and I am proud to say that it is my job to give people the opportunity to share that gift, unshackled by judgment or pain.

我相信，每個人都能為人類提供一份禮物，而我可以自豪地說，我的工作就是讓人們有機會分享這份禮物，不受評判或痛苦的束縛。

What's better than a field where you can make such potential a reality for dozens of people a day?

有什麼比每天為數十人實現這種潛力的領域更好呢？

After finishing medical school, you'll complete a one-year preliminary or transitional year.

完成醫學院學業後，您將完成為期一年的預備年或過渡年。

Collectively, this first year is referred to as your intern year.

Oftentimes, prelims and TYs, as they are otherwise known, have little to no dedicated dermatology rotations, and instead are primarily cemented in the guise of what an intern in internal medicine would experience.

通常情況下，預科生和 TY（也就是我們常說的實習生）幾乎沒有專門的皮膚科輪轉，而是主要以內科實習生的經歷為幌子。

After that, the dermatology residency is three years.

While there are technically combined five-year internal medicine and dermatology programs, as of 2025, there are only a few in the entire country.

雖然從技術上講，有五年制內科和皮膚科聯合課程，但截至 2025 年，全國僅有幾個這樣的課程。

The 1 plus 3 model is much more typical, and while a few programs have linked prelims and dermatology program spots, with institutions such as Mayo boasting categorical programs in which all four years fall under the same dermatology program, expect to potentially move across the country after finishing your intern year.

1 加 3 的模式更為典型，雖然有少數項目將預考和皮膚病學項目名額掛鉤，但梅奧等機構擁有分類項目，所有四年都屬於同一個皮膚病學項目，是以在完成實習年後，你有可能會搬到全國各地。

In terms of competitiveness, dermatology is consistently the first or second most competitive specialty in medicine, switching off with plastic surgery depending on the year.

就競爭力而言，皮膚科一直是醫學界競爭最激烈的第一或第二大專業，與整形外科的競爭取決於年份。

The average Step 2CK score is 257, which is also the highest average Step 2 score of all categorical specialties.

第 2CK 步平均分為 257 分，也是所有分類專業中第 2 步平均分最高的。

Not only that, the average research items for newly christened derm residents is 27.7, the third highest of any specialty, falling just behind plastic surgery at 34.7 and neurosurgery at 37.4.

不僅如此，皮膚科新住院醫師的平均研究項目為 27.7 項，在所有專業中排名第三，僅次於整形外科的 34.7 項和神經外科的 37.4 項。

If that sounds like a lot of research, that's because it is.

如果這聽起來像大量的研究，那是因為確實如此。

Research item averages have been increasing steadily for years.

多年來，研究項目的平均值一直在穩步上升。

In 2020, the average research items for successful derm candidates was 19.

2020 年，皮膚科成功候選人的平均研究項目為 19 項。

Considering the 7.8 jump from 20.9 to 27.7 in research items between 2022 and 2024, it's not hard to imagine that number easily cracking 30 by 2026.

考慮到 2022 年至 2024 年間，研究項目從 20.9 個躍升至 27.7 個，增長了 7.8 倍，不難想象，到 2026 年，這一數字將輕鬆突破 30 個。

For competitive specialties, you have to think ahead.

對於競爭激烈的專業，你必須未雨綢繆。

That means making decisions early and determining what you need to do to become a competitive residency applicant.

這意味著要儘早做出決定，並確定自己需要做些什麼才能成為一名有競爭力的住院醫師申請者。

But you don't have to guess or wonder if you're on track.

但你不必猜測或懷疑自己是否走在正軌上。

The free tool at ResidencyPredictor.com shows you exactly where you stand compared to medical students who matched into your desired specialty.

ResidencyPredictor.com 網站上的免費工具可以準確地顯示您與符合您所需專業的醫學生相比所處的位置。

The prediction algorithm leverages the latest official match data to accurately predict your percentage odds of matching into that specialty.

預測算法利用最新的官方匹配數據，準確預測您匹配到該專業的機率。

It will even identify your relative weaknesses compared to the average person in that specialty, providing personal insights that will help you prepare before it's too late.

它甚至會找出你與該專業普通人相比的相對弱點，提供個人見解，幫助你未雨綢繆。

See how your stats stack up for the specialties you're most interested in.

查看您最感興趣的專業的統計結果。

Unlock your competitiveness at ResidencyPredictor.com.

在 ResidencyPredictor.com 釋放您的競爭力。

There are a handful of fellowships to choose from after residency, each lasting between 1 and 2 years.

住院實習結束後有多種研究金可供選擇，每種研究金為期 1 到 2 年。

Moe's Micrographic Surgery and Dermatology Oncology requires a 1 to 2 year fellowship.

莫氏顯微外科和皮膚腫瘤學需要 1 到 2 年的研究金。

The prevailing joke among med students and residents is that these people wanted to become surgeons but didn't want to sacrifice their work-life balance completely.

醫科學生和住院醫師之間流行的一個笑話是，這些人想成為外科醫生，但又不想完全犧牲工作與生活的平衡。

Compared to other dermatologists, the stereotype is that these physicians may have a lower tolerance for mistakes, work at a fast pace, and tend to be perfectionist with a similar attention to detail as plastic surgeons.

與其他皮膚科醫生相比，人們對這些醫生的刻板印象是：容錯率低、工作節奏快、傾向於完美主義，對細節的關注程度與整形外科醫生類似。

This is the specialty for dermatologists who enjoy constantly working with their hands and spending years fine-tuning a nuanced technique.

這是皮膚科醫生的專長，他們喜歡不斷地用雙手工作，並花費數年時間對微妙的技術進行微調。

For those who prefer excisions and biopsies over skin exams and topical steroids, Moe's surgery can be extremely appealing.

對於那些喜歡切除和活檢而不是皮膚檢查和外用類固醇的人來說，莫伊的手術極具吸引力。