Dermatology residency is a four-year training program that combines a preliminary intern year with three years of specialized dermatology training. Compared to many surgical or internal medicine residencies, the lifestyle is more predictable, with most clinical work happening in outpatient clinics during standard business hours. But the path to get there is among the most competitive in medicine, and the training itself covers far more ground than most people expect, from reading biopsy slides under a microscope to managing life-threatening skin reactions in the ICU.
How the Four Years Break Down
The first year (PGY-1) is a preliminary or transitional year, not spent in dermatology at all. Most residents complete this in internal medicine, surgery, or a transitional program, building broad clinical skills before specializing. Dermatology-specific training begins in the second year (PGY-2) and runs through PGY-4.
During PGY-2, residents start seeing patients in general dermatology clinics and begin learning procedural skills like biopsies and excisions. They also typically get dedicated research time. At University Hospitals in Cleveland, for example, second-year residents have two full months set aside for research projects. By PGY-3, responsibilities expand significantly. At Mayo Clinic, second-year dermatology residents (PGY-3 overall) spend roughly two months on inpatient hospital service, providing consultations across medical, surgical, and intensive care units, plus the emergency room. Cases range from routine lesion evaluations to rare, serious conditions like toxic epidermal necrolysis, a potentially fatal drug reaction that causes the skin to blister and peel off. PGY-4 residents function with considerable independence, often supervising junior residents and refining subspecialty interests.
A Typical Day in Clinic
Most dermatology training happens in outpatient settings, which makes the daily schedule more regular than in hospital-heavy specialties. At NYU Langone, residents start with a 45-minute didactic session at 8:00 AM, then transition to clinic or procedural rotations. Twice a week, there are midday clinical conferences where faculty lead case-based discussions on interesting patients from the week. The rest of the day is spent seeing patients, which in dermatology means high volume. It’s common for residents to evaluate 20 to 30 patients in a clinic session, each visit lasting 10 to 20 minutes. You learn to make visual diagnoses quickly, a skill that takes time to develop but becomes second nature.
Residents rotate through a variety of clinical environments. At USC’s Keck School of Medicine, trainees work at the county hospital, a children’s hospital, a VA medical center, a cancer center, and university-affiliated private clinics. This diversity matters because the patient populations differ dramatically. County hospitals tend to see more advanced disease and infectious conditions, while VA clinics skew toward older patients with sun-damaged skin and skin cancers. Pediatric rotations expose residents to birthmarks, genetic skin disorders, and eczema presentations unique to children.
Procedural and Surgical Training
Dermatology is more surgical than many people realize. The ACGME requires residents to perform at least 50 excisions of benign or malignant lesions as the primary surgeon before graduating. They must also observe a minimum of 15 Mohs micrographic surgery cases (a precise technique for removing skin cancer layer by layer) and 15 laser procedures spanning ablative, non-ablative, and vascular treatments.
These are minimums. Most programs exceed them substantially, and residents interested in procedural dermatology pursue additional surgical rotations. During surgical blocks, residents are expected to take call for urgent cases, which can include complex wound closures, flap repairs after cancer removal, or managing surgical complications. Some programs also offer exposure to cosmetic procedures like injectable fillers and chemical peels, though this varies widely.
On-Call Responsibilities
Call in dermatology is lighter than in most residencies, but it exists. Dermatology residents typically take home call rather than staying overnight in the hospital. At Mayo Clinic, residents on inpatient service care for an average of four patients and field after-hours pages for new admissions or consultations. The consultations range widely: sometimes it’s a quick evaluation of an incidental skin lesion found during surgery, and other times it’s a critically ill transplant patient with severe graft-versus-host disease or an oncology patient with a dangerous drug reaction.
Call frequency varies by rotation and program. Programs follow ACGME duty-hour guidelines, and because most dermatology work is outpatient, the overnight burden is generally manageable. The inpatient months, especially during PGY-3, are the most demanding stretches of training.
Board Certification During Training
Unlike many specialties where board exams come after residency, dermatology residents begin their certification process while still in training. The American Board of Dermatology’s CORE Exam has four modules: medical dermatology, pediatric dermatology, surgical dermatology, and dermatopathology. Residents become eligible to start taking modules in February of their second dermatology year, after completing at least 18 months of training, though they’re limited to two modules at that sitting. During the third year, the exam is offered three times (typically July, October, and February), and residents can take as many remaining modules as they want at each sitting.
This staggered approach means board prep is woven into the residency experience rather than crammed into a single post-graduation study period. Most residents spend significant time studying dermatopathology (reading skin biopsy slides) throughout training, as this module requires pattern recognition skills that take years to build.
Research Expectations
Nearly all dermatology programs expect residents to produce scholarly work. Dedicated research blocks are common, typically one to two months during the second year of dermatology training. Some programs offer an extended academic track for residents with serious research ambitions. University Hospitals, for instance, has a 2+2 track: two clinically focused years and two research-focused years, designed for residents pursuing academic careers.
Even outside of dedicated research time, residents are generally expected to present at conferences, publish case reports, and contribute to ongoing faculty research projects. The specialty’s competitiveness means most incoming residents already have substantial research experience, and programs expect them to continue building on it.
Compensation and Benefits
Dermatology residents earn the same salary as other residents at their institution, determined by post-graduate year level rather than specialty. At UT Health San Antonio, PGY-2 residents (the first year of dermatology training) earn about $70,085 for the 2025-2026 academic year. Benefits typically include health, dental, life, and disability insurance, plus professional liability coverage. Most programs provide three weeks of paid vacation, around 10 days of sick leave, free parking, and meal stipends for extended call shifts.
The salary feels modest given the workload, but it’s worth noting that dermatologists in practice earn among the highest physician salaries, making the residency years a temporary financial bottleneck rather than a long-term concern.
Fellowship Options After Residency
Most dermatology graduates go directly into practice, but several ACGME-accredited fellowship paths exist for those who want to subspecialize. The three main options are Mohs micrographic surgery and dermatologic oncology (a one- to two-year procedural fellowship), dermatopathology (typically one year, focused on microscopic diagnosis of skin disease), and pediatric dermatology (one to two years, now accredited through the ACGME rather than the American Board of Dermatology, which transferred that responsibility in 2021). Less common paths include research-focused fellowships, teledermatology, and wound care.
Mohs surgery fellowships are particularly competitive, often requiring strong procedural case logs and recommendation letters from fellowship-trained Mohs surgeons. Residents interested in this path typically begin building their surgical experience and mentorship networks early in PGY-2.