What is a dermatologist? 

Dermatologists are specialist physicians who diagnose and treat diseases of the skin, hair and nails. All dermatologists are medically qualified, and undertake the same undergraduate training as other doctors. After qualification, they spend a number of years training in general (internal) medicine, and this gives them a wide experience of other medical specialties (e.g. emergency medicine, rheumatology, cardiology etc.).  During this time, dermatologists must pass the exams enabling them to become a Member of the Royal College of Physicians (MRCP). Failure to pass this exam effectively prevents doctors from following a specialist career.

Once this hurdle has been cleared, the budding dermatologist needs to find a post which will provide training in the chosen specialty. These posts are either at Senior House Officer level, or more usually, at the higher grade of Specialist Registrar, and competition for places on these schemes is usually intense.  Training posts are usually based in teaching hospitals, although each ‘rotation’ will include a period at a district general hospital to provide broader experience.  Most training posts are for a 4 year period, but this is frequently extended, often by 2 or more years, to allow a period of time in research and to develop expertise in one of the dermatological subspecialties (e.g. dermatological surgery, paediatric dermatology, contact allergy, photobiology etc.) .  It is expected that trainee dermatologists will develop a research interest and they are expected to publish papers in scientific journals.

Once training is completed, dermatologists are awarded a Certificate of Completion of Specialist Training (CCST), and can then apply for consultant posts in either teaching or district general hospitals. Once appointed to a consultant post, the dermatologist will generally join a department where there are usually at least one or two other dermatologists; some departments, especially in teaching hospitals, may be much larger. In the UK , one dermatologist will serve a population of approximately 125000. Consultant dermatologists are a relatively scarce resource in the NHS, especially when you consider that 10 – 15% of consultations with a General Practitioner are related to skin disease.

What does a dermatologist treat? 

The range of patients seen by dermatologists is wide and extends from cradle to grave. There are over 2000 skin diseases described but about 20 of these account for 90% of the workload. Inflammatory skin diseases such as eczema and psoriasis are common and without treatment produce significant disability. Severe acne in teenagers is also a common reason for referral.

In the last few years, skin cancer has assumed almost epidemic proportion in the UK population, at least in part to the easy availability of holidays overseas and a (mistaken) belief that tanned skin is healthy skin. Dermatologists are at the centre of both research into, and treatment of, skin cancer and this now comprises up to 40% of the workload. Many dermatologists now spend a significant part of their time operating surgically to remove tumours.  

How do I see a dermatologist?

Access to consultant dermatologists is, by convention, by referral from a General Practitioner.  Patients may be referred for a number of reasons; there may be diagnostic doubt, the treatment may require special expertise or the patient may request to see a specialist.
Recent Government initiatives are having profound effects on these pathways such that patients referred on by their General Practitioner (GP) for ‘expert’ help can no longer expect to always see a fully trained and accredited dermatologist. You can ask about the qualifications of the individual to whom you are being referred, as, if you are being referred to an 'intermediate clinic' (sometimes called a Clinical Assessment and Treatments Service [CATS] or a referral management centre) it is most unlikely that you will be seeing a specialist consultant dermatologist. However well set up and supported these new services may be, most are NOT provided by fully trained, accredited NHS dermatologists.

You can exercise your rights and demand to see a specialist the first time to get the correct diagnosis and a treatment plan, after which your GP or a doctor in an intermediate clinic may be able to continue your care.

Be aware of the current ‘healthcare climate’ and exercise your right to expert care if your GP cannot diagnose or adequately treat your skin condition. For more information about access to care, please click here.

Specialist registrar (SpR)  in Dermatology. He or she will have already qualified as a doctor and then worked for about 3 years as a general hospital doctor. In this post they are undergoing 4 years specialist dermatology training. There are approximately 200 dermatology SpRs in the UK.  

A senior house officer (SHO) or F2 post holder. This person will have qualified as a doctor and already worked for at least a year in a hospital post. During their training they will be spending some specific time in dermatology

A pre-registration house officer (PRHO) will have qualified as a doctor and be in the first year  of working as a  hospital doctor.

An associate specialist in Dermatology will be a doctor who must have been qualified for at least 10 years before starting this post, with a proportion of this prior experience being in dermatology either as a registrar or as a Staff Grade doctor (see below). For one reason or another, the doctor cannot fulfil all of the requirements for entry into the Specialist Register of the General Medical Council (see Consultant dermatologist, above) and so cannot be called a consultant. However, these doctors usually devote the whole of their time to dermatology and are usually one of the most experienced members of the hospital team. As such, they are allowed to work independently, although patients are still always the ultimate responsibility of the consultant dermatologist.

A staff grade dermatologist is a doctor who has qualified as a doctor and worked for some years as a hospital doctor before training in dermatology.  For one reason or another, the doctor cannot fulfil all of the requirements for entry into the Specialist Register of the General Medical Council (see Consultant dermatologist, above) and so cannot be called a consultant.  A staff grade doctor may have many years of experience in dermatology. 

A hospital practitioner (HP) is a doctor who has qualified as a doctor, trained to be a general practitioner and then generally become a principal in his or her practice.  A hospital practitioner will have had considerable experience in dermatology, having worked for at least two years full time in a dermatology department or part time as a clinical assistant (see below) for at least 5 years. A hospital practitioner will work in a hospital department under the supervision of a consultant.

A clinical assistant (CA) is a qualified doctor who is working in a dermatology department but not in training to be a consultant. Many clinical assistants are fully qualified and trained general practitioners.  Most clinical assistants spend most of the week as a GP, but choose to spend one or more half days a week in the hospital dermatology department. A small proportion of clinical assistants are not GP’s and spend most of the week in the hospital dermatology clinic. 

A general practitioner with a specialist interest (GPwSI) is a relatively new classification of doctor.  A GPwSI will have qualified as a doctor and then trained as a general practitioner.  They may have worked for several years as a CA or HP (see above), gaining experience in dermatology and ideally also done one of the dermatology diplomas.. A GpwSI is not employed by a hospital but by primary care to care for people with skin disease who do not necessarily need to go to hospital. All GpwSI’s spend some of their time as a General practitioner and some time linked with the local dermatology department to ensure optimal patient care.

A specialist nurse  has trained as a nurse and been promoted to the level of sister or charge nurse.  She/He will have worked in Dermatology for several years and may run specific clinics for patients with psoriasis or eczema, phototherapy sessions, leg ulcer clinics etc.  In addition, some specialist nurses will have gained extra qualifications and can prescribe medicines, or carry out simple operations.