Dermatology Online Journal

Graduates of foreign dermatology residencies and military dermatology residencies and women in academic dermatology
Jashin J Wu MD¹, Kristy F Davis², Claudia C Ramirez MD³, Carol A Alonso MD⁴, Brian Berman MD PhD⁵, Stephen K Tyring MD PhD MBA⁴
Dermatology Online Journal 15 (5): 2

1. Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. jashinwu@hotmail.com
2. Department of Dermatology, University of California, Irvine, Irvine, California.
3. Department of Dermatology, University of Chile School of Medicine, Santiago, Chile
4. Department of Dermatology, University of Texas Health Science Center, Houston, Houston, Texas
5. Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida

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Abstract

Background: It is well known that there is a growing shortage of academic dermatologists in the U.S. The number of graduates of foreign dermatology residencies (GFDR) and graduates of military dermatology residencies (GMDR) who take full-time academic dermatology positions are currently unknown. It is likely that a higher proportion of GFDRs and GMDRs are more likely to enter academics and practice medical dermatology. The percentage of women in academic dermatology has not been reported since 1994. Objective: To determine the total number of GFDRs, GMDRs, and women who are full-time faculty members at U.S. dermatology residency programs. Methods: The educational background of all full-time faculty members of the 107 U.S. dermatology residency programs that were active as of December 2004 were determined through extensive Internet searches, telephone, and email correspondences with residency coordinators and faculty members. Pure PhDs, physicians who did not complete a dermatology residency program at an allopathic school, PharmDs, DDSs, and FNPs were excluded. The University of Puerto Rico was not considered a foreign residency program. Results: As of December 2004, there were 988 full-time dermatology faculty members in the US, 813 of which met our inclusion criteria. There were 30 GFDRs, accounting for 3.7 percent of full-time academic dermatologists. There were 29 GMDRs, accounting for 3.6 percent of all full-time academic dermatologists. Women accounted for 44.42 percent of academic dermatologists and 15.9 percent (14/107) of dermatology chairs/chiefs. Conclusion: GFDRs, GMDRs, and women comprise important proportions of full-time faculty members at U.S. dermatology residency programs.

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Introduction

Residency positions in dermatology continue to be highly coveted year after year. The academic strength and research accomplishments of applicants are more extraordinary with each passing year, which should translate into intellectually curious dermatology residents and thus more academicians. Unfortunately, this scenario is not occurring; there is a growing shortage of academic dermatologists in the U.S [1, 2, 3].

As a result, many program directors actively seek applicants who express a desire to enter academics. However, a recent study showed only 8 percent of such applicants end up employed by a university [4]. This percentage is remarkably similar to our prior finding that 7.89 percent of all graduating residents between 1970-2004 became full-time faculty members [5].

One strategy is that academic centers could recruit full-time faculty members from overseas. Recent evidence suggests the amount of dermatology literature produced by international authors is rapidly increasing [6]. This rise in international dermatology literature may suggest a greater emphasis on academics in the international community. However, whether this leads to a greater number of graduates of foreign dermatology residencies (GFDR) pursuing careers in academic dermatology in the U.S. is unclear. The number of GFDRs who hold full-time faculty positions in the U.S. is also currently unknown.

The relationship between training in a military dermatology residency and pursuance of a career in civilian academic dermatology has yet to be examined. The number of graduates of a military dermatology residency (GMDR) who take full-time academic positions is currently unknown.

The value of military medical education to the field of dermatology academia was first appreciated with the publication of the Manual of Dermatology in 1942. This was an outline of the basics of skin diseases and their treatments for military medical generalists on the front lines, which left a lasting impact on the practice of dermatology in the United States [7].

Most graduates of a military dermatology residency (GMDR) complete one or two tours of duty, then separate from the service to enter either private practice or civilian academia, whereas others remain in the military throughout their career [8].

There are currently three military dermatology residency programs: the Naval Medical Center San Diego; the National Capital Consortium consisting of the National Naval Medical Center in Bethesda, Maryland and the Walter Reed Army Medical Center in Washington, DC; and the San Antonio Uniformed Services Health Education Consortium (SAUSHEC). SAUSHEC, the largest military dermatology residency, was formed in 1996 when Brooke Army Medical Center and Wilford Hall Medical Center merged their programs [8].

In the past, there were also military dermatology programs located in San Francisco (Letterman Army Hospital), Denver (Fitzsimmons Army Hospital), and Philadelphia (Naval Hospital Philadelphia).

Women have been making greater and greater strides in academic dermatology [9] and gender was one of the characteristics we decided to focus on as well.

It is imperative that academic dermatology programs discover characteristics in residency applicants that may be correlated with entrance into academics after graduating.

Methods

The names of all full-time faculty members of 107 U.S. dermatology residency programs, active as of December 2004, were collected as described in the past [5]. The total number of faculty in 2004 was calculated. We determined the training of these faculty members through extensive Internet searches, telephone, and email correspondences with dermatology residency coordinators and faculty members.

Pure PhDs, physicians who did not complete a dermatology residency program, D.O.s who completed a dermatology residency at an osteopathic school (D.O.s who completed an allopathic dermatology residency were included), PharmDs, DDSs, and FNPs were excluded. The University of Puerto Rico was not considered a foreign residency program.

Results

Graduates of foreign dermatology residencies

As of December 2004, there were 988 full-time dermatology faculty members in the US. There were 813 full-time dermatology members who met our inclusion criteria (Table 1). Of these 813 dermatology faculty members, 30 (3.69%) graduated from a dermatology residency program outside of the United States. Only one program, Johns Hopkins University, had a GFDR serving as the department chair.

Programs with the highest numbers of GFDRs who were full-time faculty members were Boston University/Tufts University (5), Johns Hopkins University (4), Case Western Reserve University (3), and University of California, San Francisco (3) (Table 2A).

Programs with the highest percentage of GFDRs serving as full-time faculty members were State University of New York at Buffalo (50%), Boston University/Tufts University (21.8%), and University of Oklahoma (20%) (Table 2B).

Foreign dermatology residencies that have graduated the most GFDRs who became full-time faculty members in U.S. dermatology residency programs were McGill University (8), University of Toronto (2), and University of Wurzberg, Germany (2) (Table 3). Thus one-third of GFDRs came from Canada, which is expected considering the close proximity of the two nations.

Graduates of a military dermatology residency

Of the 813 full-time dermatology members who met our inclusion criteria, 29 (3.57%) were GMDR. Of these 29 GMDRs, 17.24 percent served as the dermatology chair/chief, accounting for 5.9 percent of all dermatology chairs/chiefs.

The programs with the highest number of GMDRs were the University of Colorado (3), the University of Pennsylvania (3), and the University of Texas, San Antonio (3) (Table 4A). The programs with the highest percentage of GMDRs were the University of Texas, San Antonio (100%), MCP Hahnemann University (50%), Texas A&M Scott and White Clinic (33%) (Table 4B). The most represented military dermatology residencies were Brooke Army Medical Center (7), Wilford Hall USAF Medical Center (5), and Walter Reed (4) (Table 5).

Women in academic dermatology

Of the 813 full-time dermatology members who met our inclusion criteria, women accounted for 44.42 percent of academic dermatologists and 15.9 percent (14/107) of dermatology chairs/chiefs.

The programs with the highest number of women as full-time dermatology faculty members were Boston University/Tufts University (11), University of Texas, Houston (10), and University Health Center of Pittsburgh (10) (Table 6A).

The programs with the highest percentage of women serving as full-time dermatology faculty members were George Washington University (100%), Georgetown University (100%), and UMDNJ-Robert Wood Johnson, New Brunswick (100%) (Table 6B).

Women held 17 positions of dermatology chair/chief, accounting for 15.9 percent of all positions.

Comment

This is the first study to establish data regarding GFDRs serving as full-time faculty in the U.S. Future studies could track this same population and determine whether GFDRs are taking a higher number or proportion of U.S. full-time faculty positions over time.

This raises the question of whether graduates from a non-US medical school who become U.S. dermatology residents are more likely to become full-time faculty. Generally, only a handful of such applicants are able to secure U.S. dermatology residency positions. This is usually after completing dermatology residencies in their own countries and then spending several years in research at their matched program. A recent study showed that the strongest factor that was correlated with dermatopathology fellows choosing an academic career was graduating from a non-US medical school [10].

Those who are trained in dermatology overseas may come from a background of more prevalent and more severe medical conditions and are more enthusiastic to treat difficult dermatology patients in a university setting. They may be accustomed to a lower standard of living and are satisfied with a lower academic salary [11].

This is the first descriptive study examining the number and percentages of GMDRs in academics. It is possible that those who trained in the military are exposed to more challenging medical dermatology conditions and wish to continue treating such diseases in a university setting. The leadership skills that they gained in the military may help explain the relatively high percentage of chairs/chiefs who are GMDRs.

In 1975, 10.4 percent of the faculty members in academic dermatology were female; in 1993, the percentage nearly tripled to 30.7 percent (both part-time and full-time) [9]. As of December 2004, the percentage had risen to 44.42 percent, nearly a 45 percent increase in 11 years. This data suggests that women were as likely as their male colleagues to be retained in academic dermatology. Women accounted for almost half of academic dermatologists, which was lower than the 57 percent of females graduating from dermatology residency in 2003 [12].

However, the percentage of female chairs/chiefs has not risen accordingly. Of the 94 dermatology departments who returned surveys in 1993, only two dermatology departments and one dermatology division with a residency training program were led by women (3.2%) [9]. Despite dermatology having high percentages of women, the proportion of female chairs was very similar to the average across the various fields of medicine [13]. A recent study showed that female chairs had shorter tenures (5.5 vs 12.0 years) compared to male chairs [13]. The reasons for this are not clear. However, with higher and higher numbers of residency positions being filled by women, it is possible that women may obtain more chair/chief positions in the future.

A limitation of this study is that it was not possible to determine the total number of GFDRs from all of the programs in the world. If this number could be estimated, then we would be able to determine the percentage of GFDRs who take a full-time faculty position in the U.S.

Another limitation of this study is that the total number of past GMDRs between 1970-2004 could not be estimated in order to determine the percentage of GMDRs who do enter academics. It would have been interesting to compare this number to the overall 7.89 percent of all graduating residents between 1970-2004 who did enter academics [5]. Future studies could delve further into these statistics.

In conclusion, GFDRs and GMDRs make up small but important proportions of full-time academicians in the U.S. Future studies could determine how likely they are to enter academics compared to graduates of U.S. civilian dermatology residencies. Women continue to comprise of a larger proportion of academic dermatologists, but the rise of female chairs/chiefs has been slower.

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