Multiple roads to dermatologic practice: pathways, opportunities, and limitations in dermatology training

Dermatology is one of the most interdisciplinary specialties in medicine, yet the pathways through which physicians may enter dermatologic practice are not always clearly defined for trainees. Although dermatology residency remains the primary route to board certification, alternative pathways allow physicians from other specialties to participate in dermatologic care. These include fellowships and training opportunities in dermatopathology, pediatric dermatology, cosmetic dermatologic surgery, micrographic surgery and dermatologic oncology, and community-based dermatology fellowships for physicians trained in family medicine or internal medicine. This review outlines the major residency and fellowship routes that lead to dermatologic practice in the United States and highlights the evolving interdisciplinary structure of the dermatology workforce. The growing role of primary care providers in dermatologic care is also highlighted alongside emerging training opportunities to expand access while maintaining quality. While alternative pathways offer opportunities to expand access to dermatologic care and foster collaboration across specialties, they also present limitations related to variability in training exposure, procedural experience, and standardization of curriculum. Understanding these pathways is important for medical students, residents, and educators seeking to navigate career planning within dermatology and related specialties. A comprehensive overview of these routes may improve transparency in dermatology training and support a more collaborative, multidisciplinary approach to skin health.