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The "brain drain" of academic dermatologists leaving teaching positions may be slowing, but individual institutions still report long wait times for patient appointments, and many physicians worry about who will teach future generations.
EDITOR'S NOTE: While some studies show that the rate of recruitment into academic posts is outpacing the rate of departure, instructors of dermatology are still in short supply. In this issue, we look at some of the reasons why physicians choose to leave - or to remain in - teaching positions. We also explore what they value in academia, and we look at the unique challenge pediatric dermatologists face.
National report - The "brain drain" of academic dermatologists leaving teaching positions may be slowing, but individual institutions still report long wait times for patient appointments, and many physicians worry about who will teach future generations.
Recruitment and retention are ongoing challenges, experts say.
"Fewer people are entering academics," says Donald V. Belsito, M.D., a private practitioner in Shawnee, Kan.
He says that as director of the University of Kansas Medical Center's dermatology division between 1994 and 2005, "I spent most of my time trying to recruit faculty members, often with very little success.
"I believe that's true in all areas - particularly parts of the country where there are extreme shortages of dermatologists," he says, as doctors can leave residency and have full practices within months.
More dermatologists and more instructors are needed, says David S. Pezen, M.D., an Elmhurst, Ill., private practitioner who left an assistant professorship in dermatology at the University of Chicago in 2002.
He says that with rising melanoma rates and new healthcare reform, there aren't enough academicians to boost the dermatology workforce as required.
Wait times are even longer in academic practices than in private practices.
American Academy of Dermatology (AAD) data show that in 2002, the average wait for new patient appointments in academic practices was 56 days (versus 31 for solo practices; Resneck JS, Tierney EP, Kimball AB. J Am Acad Dermatol. 2006;54(2):211-216).
Still, the number of full-time academic dermatologists grew from 781 in 2001 to 969 in 2009, according to the Association of American Medical Colleges.
Similarly, a survey of academic dermatology departments showed that between academic years 2004 and 2008, the recruitment rate increased 5.4 percent, while the departure rate increased only 1.1 percent, resulting in a 4.3 percent growth rate increase (Loo DS. Association of Professors of Dermatology/APD Annual Meeting. September 26, 2009. Chicago).
Dermatologists who have left academia blame factors ranging from financial pressures to university politics and bureaucracies.
Dr. Pezen says he enjoyed teaching immensely. "But it was very difficult to be the clinician, teacher and researcher I wanted to be, all at the same time," he says, especially when his department and university were pressuring him to see more patients at the expense of teaching hours - a trend he says impacts all medical schools.
"The final straw was the monetary compensation," he says. "I was putting in many more hours than I would in private practice, yet the compensation was 20 to 25 percent lower than a starting private-practice salary."
A Medical Group Management Association (MGMA) survey indicates that in 2009, academic dermatologists' salaries averaged $240,319, versus $385,088 for private practitioners.
Nevertheless, Dr. Belsito says, "I always ask residents, 'How much money do you really need?' Even academic dermatologists live very well."
Similarly, David G. Brodland, M.D., says money is rarely the main reason for a decision to leave academia.
Along with the availability of a great private-practice opportunity, he says his biggest reason for leaving was "a lack of control over my practice and personnel." For example, he says he had no authority to hire nurses when he needed more.