Intergenerational Dermatology Practice: Two Generations of Dermatologists Reflect on the Field

Although many children follow their parents’ paths to medical school, the specialty of dermatology seems to have distinctive family appeal. Practical Dermatology® reached out to several parent/child dermatologists for some intergenerational insights and reflections on the field. In this segment, Joel Schlessinger, MD, and his son, Daniel Schlessinger, MD, share their perspectives.

Practical Dermatology: What inspired you to pursue a career in dermatology?

Joel Schlessinger, MD: A career in dermatology wasn’t something I initially considered. I was board-certified as a pediatrician, something I had as a goal from the age of 4, but after I took an elective in dermatology with Barry Ginsburg, MD, from Birmingham, Alabama, I realized how amazing dermatology was.

PD: How much, if at all, did you encourage your son to pursue a medical career in general and dermatology in particular?

Dr. Joel Schlessinger: I can’t think of any time that we didn’t encourage Daniel to go into dermatology, but he was genuinely interested in science and medicine from a very young age. The challenge, of course, is wondering if your child has the aptitude and determination to be a doctor or dermatologist. Clearly, Daniel had what it takes, but it is important to explain the preparation and challenge not only of getting into medical school, but achieving the level of success needed for a chance at a dermatology residency slot. This process has become magnitudes more challenging since I applied in the late 1980s.

PD: What do you think are some of the greatest changes in dermatology since the time you began your career?

Dr. Joel Schlessinger: When I entered the field, I had the idea that I was going to specialize in pediatric dermatology because I was double-boarded in dermatology and pediatrics. Instead, I shifted to focus on cosmetics, starting with sclerotherapy. However, over time I invested in lasers and focused on Mohs surgery, recently sitting for and passing the Mohs certification exam. Changes such as Mohs certification and the incredible advances in fillers, neurotoxins, biologic drugs for eczema/psoriasis, advertising methods, social media emergence, patient ratings, and so many other aspects of the field have been both remarkable and terrifying at times.

As far as work-life balance, I have always tried to have the ability to not focus on the practice so much that I forgot my family duties and the joys of being a father. This often meant taking time off for performances and other activities or leaving national meetings early, but I wouldn’t have changed it for the world. Fortunately, one of the benefits of dermatology is the ability to make your own schedule if you own your own practice, as I did. Owning your destiny is one of the few things that allows you to change your style of practice, who you work with, and how hard you want to work.

PD: What advice do you have for your son? Any potential pitfalls that you wish you had known about on entering the field? Or have some of your early challenges been erased by technology and other changes?

Dr. Joel Schlessinger: My advice is to be confident in your ability to own a practice, but whether you do so or not, to find ways to engage with colleagues. I have been a member of an online listserv group of dermatologists, Dermchat and RxDerm, since 2002 and that has provided so much joy and collegiality to me, while making me a better dermatologist. Through Dermchat, I have a network of friends and have been privileged to know some of the greats in dermatology, including Haines Ely, Bill Danby, Skee Smith, Alan Wirtzer, and so many others. While there are new forms of chat groups out there, the friendships I have made and the discussions I have had on Dermchat and RxDerm seem impossible to recreate. Daniel has joined it now and I am proud of his contributions to the various discussions.

As far as pitfalls, the biggest one I see is that of spending too much time chasing fame. We all want to be the best in our field. Most dermatologists work incredibly hard to get to where they are, but some dermatologists exchange notoriety as a TikTok performer and a quick chance at fame for their professional reputation. That doesn’t mean that we shouldn’t have fun and engage in social media, but it always pays to think of how a particular video, Tweet, or Instagram will look later in your career.

Some practice challenges in dermatology have improved with technology over the past decades, such as electronic medical records, dermoscopy, artificial intelligence, and new drugs, while challenges have been magnified by the same technology. We are judged every day of our practice by ratings systems such as Google, Yelp, and RateMD, but we can also look up a patient and their medications on an iPhone from a theater or halfway around the world if necessary.

It is incredibly rewarding to see my son follow in my path, though I wouldn’t say he will follow in my footsteps as he will certainly blaze his own path. That’s what we should all want for our children.

Daniel Schlessinger, MD, chief dermatology resident at Washington University in St. Louis and incoming Mohs and cosmetic surgery fellow at Northwestern, added his perspective in an interview with Practical Dermatology.

PD: As a child, and as a teenager, what did you think about your father’s job? Did that influence your decision to choose a medical career?

Daniel Schlessinger, MD: Dermatology has been a part of my life for as long as I can remember, but my original interest as a child was chemistry. My grandfather was a physical chemistry professor and during long walks together I remember discussing chemical nomenclature and the story of how Mendeleev formed the Periodic Table of Elements. Dermatology was a part of my everyday childhood, whether I was looking at pictures of rashes at the dinner table, attending dermatology conferences and ad-board meetings alongside my dad, or working in my parents’ clinic or dermatology e-commerce warehouse. When I was 12, I had the idea for a lip balm with 1% hydrocortisone to help my chapped fingers, and my dad, grandfather, and I perfected it together until several years later we had the right formulation, our patented FixMySkin line.

People always ask whether my dad pushed me to go into medicine or dermatology. He has always encouraged me to do whatever I want to do, but I think that when your greatest role model truly loves what they do, that impacts how you see the world. So many things make dermatology an appealing specialty–the independence, the diagnostic challenges, the medical and procedural duality, the ever-changing advancements–but in the end, it has always come down to the special connections we make with our patients and the joy of practicing dermatology. That was always clear growing up watching my dad.

PD: What are some differences about your dermatology training/medical school experience compared to your father’s experience? For example, what are some of the main technological advances that have affected not only how you learn the basics, but also how you interact with patients and manage administrative issues?

Dr. Daniel Schlessinger: I am lucky to be training at Washington University in St. Louis, the same institution for dermatology residency as my dad did. Although we are separated by 30-plus years, some things are still the same, including several attendings, nurses, and administrators. When I had COVID in the fall of 2022, I took the week off to digitize the dermatology division’s slide collections. One by one, I scanned each Kodachrome and labeled it with the correct diagnosis. I scanned staggering numbers of Kaposi’s sarcoma and AIDS-related opportunistic infections, diagnoses that we rarely see anymore. Some slides depicted disease entities which had not yet been named at the time, such as PASH and PAPASH syndromes. We are in the process of digitizing and categorizing all of these slides so they may serve as an educational resource for our residents.

Technology has changed the educational experience in several ways. Rather than sitting at the multiheaded scope, for example, our dermpath didactic lectures may now be held over Zoom using digital whole-slide images scanned into the digital pathology app, PathPresenter.com. I have also worked with colleagues at WashU to create the first-of-its-kind digital Mohs pathology textbook using the same process. Digital whole-slide images have allowed us to digitize entire Mohs cases start to finish so a trainee can pan, zoom, rotate, and click back-and-forth between cuts to track out the tumor and make their own Mohs map side-by-side next to an answer key. Our digital textbook is funded by an AAD Sulzberger Grant and has more than 100 cases and is growing. We plan to release it as a free resource for dermatology trainees. In a really special “full-circle” moment, my dad used some of our slides to review for the recent Mohs certification exam.

Administratively, technology has certainly shaped the way I practice as one of this year’s chief residents. Our entire schedule is digital, for example, and the app we use to determine each resident’s daily assignment even uses artificial intelligence (AI) to help sort residents equitably.

PD: What are you looking forward to most as you begin your dermatology career?

Dr. Daniel Schlessinger: Clinically, I am thrilled to return to Northwestern University in July 2023 to complete a dual Mohs surgery and cosmetics fellowship with my longtime mentor, Murad Alam, MD. My father began his practice in the 1990s just as “cosmetic surgery” was entering the common lexicon. He was one of the first in dermatology to work on pivotal clinical trials of cosmetic drugs and devices that shaped a huge part of our field. Similarly, we are at an inflection point for AI, and it has the potential to be a game-changer in medicine. I’m fascinated by AI, but I am more of an AI realist than an enthusiast. Too often, I read about devices, apps, or algorithms that are clearly not designed by dermatologists or with their input; these products miss the boat by trying to create solutions for problems that don’t exist. I can’t predict how exactly AI will integrate into our daily practice, but I am certain that we need dermatologists leading the integration process. Therefore, in addition to general dermatology, Mohs surgery, and cosmetic surgery, I would like to focus on AI in dermatology and help play a role in this rapidly changing field.