Brain drain: Dermatologists shunning, leaving academia

July 1, 2008

While schools known for academic dermatology produce and retain a relatively high proportion of academic dermatologists, the career path on the whole suffers from low interest among recent graduates - and high attrition rates over time, experts say.

Key Points

At the University of California, San Francisco (UCSF), Bruce Wintroub, M.D., professor and chairman of dermatology, says, "We've had a pretty constant interest in doing research in academics, but we select people for that reason, and we're able to attract them."

Similarly, Harvard's dermatology residency program has placed 80 percent of its trainees into academic positions, and even more over the past four to five years, program director Joseph Kvedar, M.D., says.

Dr. Kvedar says his predecessors typically considered laboratory science the highest calling. Now, he says, academicians are finding other ways to advance the specialty.

Examples include taking clinician-teacher jobs, pursuing dermatoepidemiology and performing clinical or translational research.

Nevertheless, only 5 percent to 10 percent of graduating dermatology residents at the University of California, Davis, enter academic careers, says Peter J. Lynch, the residency program's director.

And wherever academic dermatologists come from, retaining them long-term proves challenging, sources say.

Choosing an academic career "makes sense early on, because residents are exposed to many role models who do this. But they don't all make it, and you cannot expect that they would," Dr. Wintroub says.

UCSF keeps at least half of its academic dermatologists long-term, he says.

However, Dr. Wintroub says, "If you don't enjoy spending a lot of your time teaching people and developing new information, then academics doesn't quite fit."

Dollars and sense

"But we can't (attract) the people who want to go out and do procedural work," which in California can command an annual income of around $450,000 for Mohs surgery or cosmetic dermatology.

"The financial disparities between what one can make in private practice compared to an academic setting can make a big difference for young physicians who are coming out of medical school with $200,000-plus loans that they have to start paying off as soon as they finish their residencies," says Deborah Goddard, M.D., a second-year dermatology resident at UCSF.

Nationally, around 7 percent of graduating dermatology residents enter academic careers (Wu JJ. Arch Dermatol. 2006 Dec;142(12):1650-1651), he says. However, Dr. Wu says nobody has studied academic dermatology's attrition rate, largely because such a study would span decades.

As for residents who initially express interest in academics but lose interest before graduating, reasons include bureaucracy, salaries and lack of mentorship (Reck SJ, Stratman EJ, Vogel C, Mukesh BN. Arch Dermatol. 2006 Jul;142(7):855-858).

Although academic dermatologists can't change university bureaucracies or salary structures, Dr. Wu says, "These findings suggest that perhaps academic dermatologists need to do a better job of stimulating interest among these residents."

For more information: http://www.uci.edu/