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Day-to-day pace

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People always romanticize the 40 hour work week in Derm. My question is, how busy are those 40 hours for a dermatology attending (private practice)? Is it like surgery/IM specialties where you have quite a bit downtime between cases to mentally recharge or is it more like radiology, where it's a constant, exhausting grind where you have to be "on" the entire time?

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