There is more to dermatology than just Botox and face lifts. In fact, if you’re getting onboard for the right reasons, it can be an extremely fun and fulfilling career choice. In this episode Dr. Richard Marn talks with Dr. Kevin Dawson, a dermatologist in Honolulu, Hawaii. A general dermatologist whose practice involves mostly medical cases, Dr. Kevin is not your stereotypical image of a cosmetic dermatologist (although he does do some of that on the side). In this conversation, he dispels many of the myths around his profession and explains what keeps dermatologists like him on a daily basis. You will learn what it is really like to work in dermatology and why it can be a rewarding, albeit highly-competitive space that you might want to consider.

It’s all done in your office.

When I say surgery, we’re not going deep. We’re taking out a piece of skin. We’re going down to the fat, depending on where that is. It’s generally less than 2 to 3 centimeters deep. Unless it’s a lipoma, then it can get pretty nasty, but never bigger than baseball or softball size. If it gets bigger than that, then I send them somewhere because you risk running into more problems that require being in the operating room.

You’re not cutting down to the bone.

Not intentionally.

When does your day usually end?

We’re usually done by 5:30. It’s a pretty reasonable day. I take some time in the middle of the day to do calls and paperwork. We take lunch, although I’m eating my lunch as I’m working. It’s a relatively normal day.

Are you working often occasionally leading into the evening or on the weekends?

I work on weekends. We have a Saturday clinic. A lot of people appreciate being able to have access on Saturdays because of work and everything. I work into the evenings a lot and most of that is paperwork, not seeing patients. The clinic is done at 5:00, 5:30, but I’m usually done by 7:00, 7:30.

Would you say the work-life balance as a dermatologist is good?

I would say it’s pretty good. Most dermatologists don’t work as much as I do. I have been busy in my career. Most dermatologists are working 3 to 4 days a week.

Are you saying that some dermatologists have a better work-life balance than you?

I would say so, especially if they do cosmetics. The cosmetic stuff is a lot more lucrative than the medical stuff, but it’s not nearly as fun or interesting or rewarding for that matter.

What is the best or the most rewarding or your favorite parts of your day?

There are a lot of skin problems that are either relatively serious or are troubling for patients. Being able to take care of those or fix those is the reason why I do medical dermatology and not cosmetic stuff. For example, something as simple as bad acne in a teenager. For them, that’s disastrous and it can be scarring. That goes on for years. That’s a simple case where you take care of somebody’s acne and get them clear over the course of 4, 5, 6 months. Having them and the parents being grateful that the kid is more confident and they don’t have any of the scarring left. It’s something simple like that. Skin cancers are rewarding because a lot of people will come in for skin checks. They’re worried about something that is nothing.

As we look around, we find something that potentially could have been life-threatening for them. Being able to catch those things put a lot of satisfaction in the job. I’ve had several patients that had they not come in when they did for something other than their skin cancer, they could have died from skin cancer. That’s helpful. The most rewarding ones are a lot of rashes because those can be miserable and life-threatening. For example, something like a medication reaction can cause enough blistering were you’re losing skin. Your body doesn’t function properly anymore. There are some autoimmune diseases like bullous pemphigoid. Those are usually the patients that are the most difficult. It’s common enough that I see it probably 6 to 10 times a year, but that’s uncommon enough that most other doctors don’t know what it is. It’s itchy but they are losing a lot of skin. You’ve got these open raw areas. They can get infected and then they’re losing a lot of fluids.

Are they often admitted to the hospital because of that?

Some of them are. It depends on how long it takes for a doctor to send them away or for them to go to a dermatologist because everybody always thinks it’s an infection. They had been on antibiotics. They think that blistering is a medication reaction. They go down the wrong trail. Sometimes by the time I get called, they’re in the hospital and they’ve lost a lot of skin. It’s to get those people under control. They’re usually older patients and some of them are borderline suicidal by the time. They’ve lost the will to live because they can’t imagine living like this forever and it’s been going on for such a long time. I had one woman who went back home to Korea because none of the doctors here knew what that was. The doctors in Korea told her there’s nothing they could do for her and that she was going to have to live like that.

She was miserable and itchy and losing everywhere. Everywhere it’s healed. There was this horrible dark spot. The daughter told me that she was talking about ending everything. It took about 3 or 4 months to get her under control. That was a rewarding situation there. It happens a lot where these people are miserable. She was borderline suicidal. Some of the other patients lose their will to live because they can’t imagine living like that. They’ve been told there’s nothing that can be done. Picking up a case like that and doing something about it is one of the things that make your whole month and keeps you going into the office every day.

Kevin, what is the name of that disease that this woman had?

She had a disease called bullous pemphigoid. It’s an autoimmune disease. It usually happens in older people. The immune system decides that it doesn’t like a part of the skin and it starts attacking it. It causes the upper layer of skin to start to peel off and blister.

Are dermatologists often going into the hospital to see patients in these situations, or is that a rare thing?

It’s not common. Most dermatologists avoid the hospital like a plague. As a medical dermatologist, the older you get and the more referring doctors you get, the more often you’ll be called to go into the hospital. Even so, I go into the hospital on average 3 to 4 times a month. Usually, less than once a week so it’s not common. A lot of it is because the doctors in the hospital don’t expect a dermatologist will come in. Sometimes it can be difficult to find somebody who wants to come in because you’ve got to get home by 5:00. A lot of dermatologists live that lifestyle. They want to go home and do their job. You can still have a rewarding career without having to be there late and stay late and go into the hospital.

Is there a part of your job that you find is your least favorite?

Any doctor is going to tell you that the least favorite part of the job is the paperwork. Except for the paper works and the reason why I’m not a big cosmetic guy and making tons of money is because I get bothered by people that come in and are overly dramatic about small things that shouldn’t bother them, like a small sunspot that won’t go away or a little bump under their skin. Somebody who is 80 is complaining that their skin is sagging like, “I never used to be like this. How come it’s like this?” Those things bother me a little bit. I wouldn’t say that I don’t like that part of the job. I don’t like it when I try to explain to people what’s happening and they don’t accept it. They want me to be able to do something about it or to cure their problem of getting older, which we all know is there is no real cure for it.

Those are people who are unrealistic about minor things. I do have some serious patients. Sometimes on a long day, when I’m a little backed up and somebody’s complaining and won’t let me leave the room because they want me to fix the wrinkling that’s on the inside of their arms, that bothers me a little bit. For the most part, while I’m seeing patients in the rooms and interacting with my staff, those are all enjoyable parts of the day. I rarely have issues with those.

What misconceptions do people have about dermatologists?

The biggest misconception is that it’s all superficial cosmetic stuff. That’s what most people think of. They think of Botox and acne.

Do you do more than that?

There’s a Seinfeld episode where he was going out with a dermatologist. He got upset with her and he says, “You’re just a pimple popper. That’s all you do.” Somebody in the restaurant came up and said, “Doctor, you saved my life from my skin cancer.” The biggest misconception is that it’s all cosmetic, superficial and it’s easy. A lot of times, the referring docs realize that not a lot of rashes are the same. It’s a lot of ciphering. It’s like any specialty. Once you start to get into things that look alike, then you have to start to do your detective work. That’s where the training comes in.

I agree that there are some misconceptions where all you’re doing is looking at acne, giving Botox and steroids.

You put a little cortisone on it and it’ll go away.

You’ve got to have a trained eye to know how to decipher the different skin lesions that you’re looking at.

It’s all patterns. A lot of it is red and scaly, and it all looks like a rash. You have to know patterns and you have to ask the history of how did it start, when did it start, how fast it had spread, and what are the symptoms? You put all of those together and some of it is easy after a while. Sometimes at least 3 or 4 times a day, there’s something I am trying to figure out that I have to do a lot of digging. I do a lot of asking questions, go back and look at medication history, and try to figure out what’s going on. Sometimes there’s a lot of testing involved. As I get older, it becomes easier to figure it out without having to do a lot of biopsies and tests.

You become more of an expert in your field. Do you recommend this career for students?

Dermatology is a very competitive field. If you’re looking at it as a career option, you have to be prepared to be top of your class.

 

I love dermatology. I wouldn’t have it any other way. The biggest shortcoming of getting into dermatology is because people perceive it as such a great lifestyle and it is, it’s become competitive. I see a lot of young people in medical school that are stressed out and doing work that’s above and beyond what they need to be doing so they can try to get into residency, which was the antithesis. Most people know that dermatologists are laid back. They’re happy because they get some sleep. The field itself is not competitive, collaborative, and a wonderful field to be in as far as the colleagues and the comradery.

It seems almost that getting into dermatology has become the opposite. That’s the only thing that is the shortcoming of it. You do have to prepare, be at the top of your class, do well and want to do well. I’m not saying that I would not recommend dermatology because of that, you just have to be prepared for that. If it’s something that you want to do, then you have to get on your game. Start doing those extra things and start taking those AP classes. Start doing community service and the things that make you stand out.

What do you think the future outlook is for your profession?

I think the future for dermatology is stable. We always worry that computers and artificial intelligence are going to take over. We found out with COVID, we’ve had to do a lot of tele-dermatology where we’re trying to do things over the internet and through pictures. People are finding out quickly that there is a three-dimensionality about the skin that you need to be able to see in person to make that diagnosis. I don’t think that we’re going to be having computers take over our stuff anytime soon. People are always going to have skin problems. A lot of dermatologists are going into cosmetics. In my particular field of medical dermatology, there seems to be a shortage of dermatologists because of the few spots that are there. Some people are going into cosmetic dermatology and it leaves fewer people to be able to tackle the real skin problems.

Are people doing cosmetic dermatology because it’s more lucrative or it’s a lot more exciting?

It depends on your personality. I wouldn’t say it’s more exciting. There are some rewards to it. It’s neat to have somebody who is in their 30s and starting to sag a little bit, and leave looking a little better and being happy with it. There are some rewards to it but it’s not the same. It’s definitely much more of a burden. Per patient, you end up making a lot more money if you turn it into a business and ignore some of the medicine. You start getting a lot of assistants and nurses doing procedures versus medical practice or you’re using the patient and doing the work. You put your name on it, walk-in and give your blessing to whatever else that somebody else is doing. You can make some good money with that.

That part of it ends up not being as rewarding after a few years, the job part anyways. When you’re looking at a career, you have to look at what you’re going to be doing not just 2 to 3 years down the road, but what you’re going to be doing ten years down the road. I’m sixteen years in my career and there are different things that are rewarding about it. After a couple of years, you start to figure out some of the things like the diagnostic issues. How do you communicate? How do you make patients understand what’s going to happen? The cosmetic end of it, I feel like that’s a short reward curve. It stops quickly. With medical dermatology, the older you get, the more people will start to send difficult cases to you. I get dermatologists in the community, the younger ones that will send me stuff because they can’t figure it out. That’s the rewarding part of it.

Kevin, I’m going to change gears here a little bit. You met my dad before we even met each other in medical school because you had a career before medicine. I’m in my mid-40s, but you’re a little bit older than that because you started medical school later. I’m wondering, you started because you were in computers at the time. Even before that, you went to college in Colorado. Did you think about medicine in high school and in college? What happened there?

I was in a career in business. I double majored in Marketing and Finance. I had no medical background. I’m from a blue-collar family. Nobody in my family was a doctor. I was the first one in my immediate family to go to college. It was never on the radar because I didn’t grow up around people who were doctors. I never considered it as a career. When I moved to Hawaii, I started working for a computer business and I ended up being a general manager in a computer store. Cop-USA was the one who put everybody out of business. When the big-box guys came into town, I realized that I was paying my salesmen what they were paying their general manager who’s one step above me. I saw the writing on the wall. I was like, “This career’s not going to last me very long.” I started thinking about alternative careers. My wife was the one who suggested that I consider going to medical school.

You and Bev met in college. She was from Hawaii. Bev and I went to the same high school. You guys moved to Hawaii. You started working in Hawaii and that’s when you’ve seen the writing on the wall. Bev then said maybe you should consider another career.

I was saying, “I need to start another career.” I had started doing an MBA at one point, then she suggested I consider medicine and that took off from there. I was in business for eight years and a couple more years while I was trying to do all my pre-med classes. When you get a business degree, you don’t have any of the science. I have to go back and do freshmen Biology, Physics and Chemistry, and do all that. I did that here at the University of Hawaii. It was the first time in my life that I started to feel old because here I am ten years later. I’m always the youngest guy in my position trying to present. I feel like I’m older walking into a college campus for the first time in ten years. I realized that life has not been standing still and I’m getting older.

You’re 28 and you’re taking these pre-requisite courses.

I was doing that. I was running down during my lunch hour and my boss was kind enough to let me have an extra time for lunch. I’m going after work to take classes and take in all of these freshmen classes, and then getting ready to take the entrance exam, the MCAT or Medical College Admissions Test.

Did you get into medical school the first time you applied?

Yes, the first time I applied.

How did dermatology come up as a choice for you? Was that the first one you were thinking about?

No. When I decided to go into medical school, the intention was to be a primary care doctor. I want to do internal medicine. We didn’t want to leave Hawaii because at that time, we had a son who was born. We found out that my wife was pregnant about two weeks after I got my acceptance letter into medical school. He was born a few months before I started medical school. At that point, everything was, “We’re going to stay here. I was going to go to medical school here. I was going to do my residency here.” Somewhere around the end of my third year, my wife has a friend that is a dermatologist. She was at the time practicing here.

 

She was asking me why I didn’t want to do dermatology. I thought it’s boring and all the misconceptions that we talked about, it’s not an exciting work. She said, “You should come and spend a week with me.” There is something about dermatology that felt a little different. As a specialty, it’s much broader. Some specialties are dealing with the same thing 80% of the time. With dermatology statistically, my medical software where I take all my notes on tells me that the biggest problem that I deal with is acne, but it’s only about 15% of my patients. That’s the largest proportion of diseases that I see. Things are fragmented, which I like.

I’m seeing a lot of different things on a daily basis. It never gets boring. You never know what today’s going to bring up. I saw that when I was with her. There’s a lot of different stuff going on with dermatology that I didn’t realize. I started pursuing it and I’m fortunate that things fell into place for me. I didn’t realize how difficult it was going to be to get in. I assumed that if I decided to go to dermatology, I was going to get in. There was a point of no return where I started to realize, “This may not be as easy as I thought,” but then I’d already committed. I had spent most of my fourth year scrambling to get all the things that I needed to do to get into dermatology. I was fortunate that things landed in place. I got in the first time. I know people that were just as smart. I was interviewing with Harvard guys and out of the seven Harvard guys that I’m in on the interview trail, two of them didn’t get in. Things just started falling into place. They had to go try and get the next year.

I take it for granted, Kevin. We stayed and spent some time together because of medical school. Our medical school was set up where we would operate and learn as little pods. How hard was that? Here you are starting medical school, you have a new son, and you’re not working anymore. Was it as hard as I imagined for you to leave the working world after being there for eight-plus years, and now you’re back to school?

Psychologically, it wasn’t as difficult as I thought it was going to be. I did go from being somebody with somewhat status to being a student again. That didn’t bother me too much. What was stressful right away is the work and lifestyle balance comes into play. Most medical students at the time don’t have a lot of commitments. They can dive in and fully commit. That’s their whole life, but I couldn’t do that. In some ways, I’m grateful for that because it made me structure my life so that I did have time for family and myself right off the bat.

You thought I was studying so hard, it’s because I only had eight hours a day to study. I had to study while my son was with my mother-in-law and while my wife was at work. If I had to pick up my son and come home, then there’s no study to be done when you’ve got an infant. He was 1 to 4 years old when I was in medical school. There’s no studying when you got a child in the house and you got a wife that has to work to pay for your medical school. She can’t do all the housework so you have to do some of that. It was difficult, but my previous life as a businessman and being out in the real world for several years before I went to medical school prepared me for that.

I knew how to structure my time. I knew how to budget my time. I knew how to say, “I got to study. I can’t talk. I can’t go off and go to Barnes & Noble.” It was Barnes & Noble at the time, not Starbucks. There were these things called books where you open them up and there’s a piece of paper. You guys would say, “Let’s all study at Barnes & Noble tonight.” I’m like, “No, I’ve got to go home.” There was none of that pushing it off until later. When it’s time to study, you’ve got to study if you want to do well.

Kevin reflecting back, would you have done anything differently?

I don’t think I would have done anything differently. From the outside looking in, I didn’t think medical school was going to be as tough as it was. It didn’t seem like it was going to be that hard, but it is a lot harder than I thought. Getting into residency and doing residency didn’t seem like it was going to be hard, especially my internship here. That was a lot harder than I thought. I don’t know that I would change anything. Now that I’m older and have less energy, I would not have the energy to go and dive into that again. If you’re passionate about it and you’re going into it for the right reasons, you won’t need it for the rewards.

The times of the rich doctors are coming to an end. My son is in medical school now, and none of those people are in it for the money. They’re in it knowing that they’re not going to make as much as some of their architect friends and some of their people in other fields, but they love medicine, helping people and love doing what they’re doing. It makes me feel a lot better about the field as a whole. Everybody says, “Medicine is terrible now.” Those are the guys that went into it for the wrong reasons. Those reasons aren’t there anymore. The guys are in it for the right reasons. I see it as a great field now. I see that there are many advances. There are many new things going on, new tools to help people, finding things out about the human body that we didn’t know existed.

They have technology where they can take your blood and train it to kill cancer cells, and put it back in your body. It’s amazing stuff that’s going on. If you’re in it for those reasons, then you’re going to love it for the rest of your life. You’ll always find a new path to take when the computers take over one area, you go and research another area and focus on another area. If you’re passionate about that thing, you like the medical field, helping people, curing diseases, and solving those mysteries, medicine is a great field for you.

Kevin, if someone wants to learn more about you or reach out to you, how do they do that?

You can go to my website and can always contact me there. My website is www.DawsonDermatology.com. They can go there. There are multiple ways to contact me. There’s a phone and an email. It takes a couple of days for me sometimes to answer my emails.

Not at all or even texts, you’re responsive.

Think with all this social time, I’d be able to do that better.

I want to end with my final segment, which is called Marn’s Lightning Round. These questions need short answers, yes or no. The short answer to the question is fine too. It can’t be too hard, I hope not. On a scale of 1 to 10, how good of a driver are you?

Nine.

People say medicine is terrible now. The truth is that for those who went into it for the wrong reasons, those reasons aren’t there anymore.

TV shows or movies?

Movies.

Love or money?

Love.

When was the last time you stayed up past 4:00 in the morning?

Two weeks ago.

Who inspires you?

My family, my son and my wife inspire me.

What is your absolute number one biggest pet peeve?

Being asked if I’m sure about a diagnosis, “Are you sure? Do you think it could be something else?”

“I’m glad you asked me that question. I’m going to change my answer.” What is the most delightful word you can think of?

Delightful.

What is your greatest achievement?

Being able to start and maintain a successful practice.

Finally, if you could get a yacht, what would you call it?

Beverly.

She’s going to love this episode. Kevin, thank you for joining me on the show. I appreciate it.

It is a pleasure to talk to you.

-—

I enjoyed talking with Dr. Kevin Dawson, my old friend and buddy from medical school about his career as a dermatologist in Hawaii. I’m in New York and Kevin was in Hawaii when we were doing this interview through the internet. I especially like how he dealt with his struggles as he was trying to raise a family during his medical school training. To learn more about this guest and other past guests or if you like to reach out to me, visit HealthCareersWithDrMarn.com or HCWithDrMarn.com. I’ll catch you in the next episode.

 Important Links:

• @DrRichardMarn – Instagram

• www.DawsonDermatology.com

• https://www.Facebook.com/dawsondermatology

• https://Twitter.com/dawsonderm

About Kevin Dawson

Board Certified in Dermatology

• American Board of Dermatology, 2004

Chief of Dermatology Division, Queen’s Medical Center, Honolulu

• Appointed October 2015

Assistant Clinical Professor of Medicine

• University of Hawaii since 2005

Dermatology Residency:

• State University of New York (SUNY) at Buffalo 2001 to 2004

Internship: University of Hawaii

• Internal Medicine Residency Program, 2000 to 2001

Medical School: University of Hawaii

• John A. Burns School of Medicine, 1996 to 2000

Fellow – American Academy of Dermatology

• Since 2004

Hawaii Dermatological Society

• Member since 2004

• President 2007

• American Board of Dermatology, 2004

Chief of Dermatology Division, Queen’s Medical Center, Honolulu

• Appointed October 2015

Assistant Clinical Professor of Medicine

• University of Hawaii since 2005

Dermatology Residency:

• State University of New York (SUNY) at Buffalo 2001 to 2004

Internship: University of Hawaii

• Internal Medicine Residency Program, 2000 to 2001

Medical School: University of Hawaii

• John A. Burns School of Medicine, 1996 to 2000

Fellow – American Academy of Dermatology

• Since 2004

Hawaii Dermatological Society

• Member since 2004

• President 2007