For Residents

Factors Affecting the Pursuit of Academic Careers Among Dermatology Residents

Cutis. 2015 April;95(4):231-236

References

1. Wheeler CE Jr, Briggaman RA, Lynch PJ, et al. Shortage of full-time faculty in dermatology. Arch Dermatol. 1973;107:529-532.

2. Wheeler CE Jr, Briggaman RA, Caro I. Shortage of full-time faculty in dermatology. Arch Dermatol. 1977;113:297-301.

3. Resneck J. Too few or too many academic dermatologists? difficulties in assessing optimal workforce size. Arch Dermatol. 2001;137:1295-1301.

4. Kia KF, Gielczyk RA, Ellis CN. Academia is the life for me, I’m sure. Arch Dermatol. 2006;142:911-913.

5. Wu JJ, Ramirez CC, Alonso CA, et al. Dermatology residency program characteristics that correlate with graduates selecting an academic dermatology career. Arch Dermatol. 2006;142:845-850.

6. Wu JJ, Tyring SK. The academic strength of current dermatology residency applicants. Dermatol Online J. 2003;9:22.

7. Hinchman KF, Wu JJ. Decisions in choosing a career in academic dermatology. Cutis. 2008;82:368-371.

8. Resneck JS Jr, Tierney EP, Kimball AB. Challenges facing academic dermatology: survey data on the faculty workforce. J Am Acad Dermatol. 2006;54:211-216.

9. Rubenstein DS, Blauvelt A, Chen SC, et al. The future of academic dermatology in the United States: report on the resident retreat for future physician-scientists, June 15-17, 2001. J Am Acad Dermatol. 2002;47:300-303.

10. Reck SJ, Stratman EJ, Vogel C, et al. Assessment of residents’ loss of interest in academic careers and identification of correctable factors. Arch Dermatol. 2006;142:855-858.

11. Olerud JE. Academic workforce in dermatology. Arch Dermatol. 2007;143:409-410.

12. Singer N. More doctors turning to the business of beauty. New York Times. November 30, 2006:A1.

13. Dogra S. Fate of medical dermatology in the era of cosmetic dermatology and dermatosurgery. Indian J Dermatol Venereol Leprol. 2009;75:4-7.

14. Donovan JC. A survey of dermatology residency program directors’ views on mentorship. Dermatol Online J. 2009;15:1.

15. Lim JL, Kimball AB. Residency applications and identification of factors associated with residents’ ultimate career decisions. Arch Dermatol. 2009;145:943-944.

16. Wu JJ, Davis KF, Ramirez CC, et al. MD/PhDs are more likely than MDs to choose a career in academics. Dermatol Online J. 2008;14:27.

17. Wu JJ. Current strategies to address the ongoing shortage of academic dermatologists. J Am Acad Dermatol. 2007;56:1065-1066.

18. Loo DS, Liu CL, Geller AC, et al. Academic dermatology manpower. Arch Dermatol. 2007;143:341-347.

19. Turner E, Yoo J, Salter S, et al. Leadership workforce in academic dermatology. Arch Dermatol. 2007;143:948-949.

Comment

Although this study focused on US dermatology residency programs, a shortage of academic dermatologists has been noted worldwide.^11-13 By determining residency program variables associated with the pursuit of academic careers, individual programs may be able to make changes that would encourage residents to pursue careers in academia following graduation.

The factor most strongly correlated with graduates pursuing a career in academics was the ratio of faculty to residents in 2008. Also highly correlated was total number of full-time faculty members. We hypothesize that programs with more faculty members may provide better mentorship for residents. A study by Reck et al¹⁰ demonstrated that a lack of mentorship was associated with residents’ loss of interest in academics. A survey of residency program directors demonstrated that mentorship played a role in career development and that it was important for residents to have mentors.¹⁴ Given the shortage of academic faculty, increasing the number of faculty may not be feasible for individual programs; however, assuming that more faculty members is a marker for mentorship, there are many ways that individual programs may improve mentorship. There are ample opportunities in clinics to demonstrate to residents the value of research to patient care.¹³ Residency programs also could establish mentorship programs, pairing residents with individual faculty members who share similar interests. Some programs currently have such mentorship programs but many do not.

Also strongly correlated with the number of graduates pursuing careers in academia was the number of full-time faculty publications. It is presumed that these programs also have published extensively in the past, which may have positively influenced the programs’ residents toward academics. This factor can be easily addressed among individual residency programs, and in fact many residency programs do encourage or require residents to publish during their residency. Exposure to the process of collecting data and writing manuscripts can bolster a resident’s interest in academics. In a prior study by Wu et al,⁵ publications were counted multiple times if multiple faculty members were authors. This limitation was addressed by only counting each manuscript once.

Other variables correlated with the number of graduates pursuing academic careers included number of lectures from full-time faculty members at annual society meetings, number of full-time faculty on editorial boards, and amount of NIH and DF funding received. All of these variables represent the importance of establishing an academic environment and promoting dermatology research. A 2009 study by Lim and Kimball,¹⁵ which also evaluated factors associated with pursuing a career in academics, demonstrated that the number of publications prior to residency and volunteerism were associated with an academic career choice. Residents with an MD/PhD were more likely to pursue a career in academics, which also was demonstrated by a similar study in 2008.¹⁶

Wu et al⁵ demonstrated similar results using data from 2001 to 2004; however, amount of NIH and DF funding received was found to be negatively correlated with graduates pursuing a career in academics in the original study. This finding was surprising but was not replicated in the current study. In the current study, the amount of funding (in dollars) rather than number of grants was analyzed because it was felt that the amount of funding received was a better reflection of the quantity of research being conducted. The prior study examined the relationship between the number of grants received and the number of graduates pursuing a career in academics. It is unclear why results varied in the 2 studies, but the most recent data are consistent with our hypothesis that increased research funding is associated with more residents pursuing careers in academia.

The current study also has some limitations. It is a retrospective observational study looking at data from 2008. Choosing data from another study period may have provided different results; however, it is reassuring that the data from the current study were very similar to a prior study looking at data from 2001 to 2004.⁵

It is assumed that residency program characteristics remained constant over time. It was also assumed that the number of residents in a program remained constant over time. These assumptions were necessary to draw conclusions about the data. It may be that some programs have changed substantially over time, which was not accounted for in the current study. To estimate the total number of graduates, it was assumed that faculty did not practice for more than 35 years, which may not have been true; if the faculty member practiced more than 35 years, it would have altered our estimates. It is also assumed that data on residency programs’ Web sites at time of data collection were updated and accurate. It is likely that data were not 100% accurate on all Web sites at the time of data collection. However, verification of accuracy of data would have been cumbersome, and it would have been difficult to get participation from all programs.

This study does not differentiate the total number of new faculty members who join a residency program and those who are retained for many years. Encouraging residents to pursue a career in academics may increase the number of academic faculty.¹⁷ However, efforts must also be placed on retention of faculty members because many of the newly graduated residents who enter academics ultimately leave.^18,19

Conclusion

In conclusion, our data suggest that programs with more faculty members may encourage residents to enter careers in academia following graduation. Additionally, the number of publications increases the likelihood of residents pursuing academic careers. By providing mentorship and research opportunities to residents, perhaps residency programs can encourage their graduates to become academic dermatologists. A program’s overall academic environment, including faculty lectures at annual society meetings, faculty on editorial boards, and increased research funding are all associated with graduates pursuing careers in academics.

Ackowledgements—We thank all of the program coordinators, full-time faculty members, program directors, chairs, and chiefs who were kind enough to field our questions if we had any missing data about their programs. We would like to thank Mary H. Black, PhD (Los Angeles, California), for her contribution to the analytical plan.