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Reading Lisette Hilton's article concerning the dermatologist workforce in the United States (February 2005, "Today's dermatologist workforce,"p. 23) I can't help but think Dr. Butler's interpretation of much of the data that is mentioned is, in my humble opinion, self-serving.
He points out that the number of dermatology residencies was doubled to 300 from 1965 to 1983. He then states that "there is a reduced supply because the number of graduating residents has not increased in 20 years." How can the number be reduced if it has stayed the same? He goes on to state that there are 3.5 dermatologists per 100,000 population nationally, and 2.5 per 100,000 in Texas. Yet, he also admits that only 40 percent of Texas dermatologists surveyed feel that there are too few dermatologists. He interprets the increased use of "physician extenders" (although only 23 percent in his survey use such personnel) as additional evidence that there are too few dermatologists. In fact, there are other reasons why these personnel could be employed, including the need for staff to do tasks not requiringphysician training and the increasedrevenue realized by the employer physician.
I admit that there are many more applicants for the dermatology training positions each year, but that can also be explained by other factors. Dermatology is a specialty that allows patient care, but limited call. We care for all ages, and both sexes. We practice medically and surgically, and the specialty is one in which technological improvements are occurring rapidly. Many or all of these characteristics are valued by today's graduating medical students. Additionally, the compensation for dermatologists can be better than many other specialties such as internal medicine, pediatrics or family practice.
Dr. Butler responds:
In many respects, I agree with Dr. Poitras. The shortage of dermatologists is a regional matter, but many non-urban areas are really hurting, such as where I currently practice. My practice in central Texas has a five-month waiting time for new patients to be seen. We are so overbooked that working in "problem" patients has become a real problem. Many areas in the Midwest and South have similar waiting times.
Just because a slim majority of dermatologists in Texas don't think we have a shortage doesn't mean they're right. I think many dermatologists have an unwarranted financial concern that if we increase the graduating class of residents, that it will hurt their bottom line. These dermatologists are being shortsighted and are willing to let physician extenders and family practice physicians take over the specialty of dermatology.
The real issue is how do we get graduating residents to practice in areas where there is a shortage? I don't have an answer for this. The American Academy of Dermatology has decided to curtail the program of funding more dermatology residency positions and study this issue.
Hopefully we can find a mechanism to expand residency positions and supply the need for more dermatologists in the shortage areas of our country.
- David F. Butler, M.D., Temple, Texas