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With increasing reports of dermatology patients waiting for three months or longer, some dermatologists feel that industry funding could at least make a dent in the shortage of skin specialists.
The American Academy of Dermatology recently decided not to accept funds from pharmaceutical companies, funds that would help to expand the number of residency slots for dermatologists.
On Call talked to dermatologists around the country about whether they see a shortage in their areas - and if they are relieved or disappointed that the slots won't be forthcoming from industry money.
Several dermatologists say the method of funding could be acceptable if it could be done in a manner where residents didn't know that they owed their careers to drug manufacturers.
Troy K. Richey, M.D., says he's fortunate in Eugene, Ore., that there isn't a drastic shortage of dermatology colleagues.
"I would say we're borderline. I don't think anybody's much more than maybe a month out in their scheduling. We've had three dermatologists settle here in the past nine years and we're all very busy, active, younger guys so that has filled the need a bit. We're not like some of those places where everyone is three, four or five months out in scheduling and are totally overwhelmed. At the same time, some of us have PAs working for us because we are busy."
"I feel that we already have too close a relationship with the drug companies that can influence the way doctors do things. Training should be kept out of that realm a little bit.
"I think all doctors feel pressure from the drug companies - you either ignore it or not. But they put the pressure on, that's their job. They're here to encourage you to use their products. If they were to fund residency slots, you would want to make sure young residents wouldn't be influenced, thinking they owed the companies something for picking up the cost of their training."
In Springfield, Ill., Judith P. Knox, M.D., says she does see a need for more residents.
"We definitely need more where I'm practicing and I don't know how we're going to get them if we don't have more training opportunities.
"We have to work through the powers-that-be to fund the residencies and to prove why we need more dermatologists. We're supposed to be putting our patients first and the way to do that is to give them better access to dermatology. But pharmaceutical companies are not the answer; in fact, that's just about the worst answer I can think of."
A practitioner for 12 years and a clinical faculty member of Southern Illinois University, she agrees with the decision not to use pharmaceutically funded training slots.
"We're way too closely tied to the drug companies as it is. There has to be a better way to fund residencies. I worry that we're not raising a group of independent thinkers in dermatology. The more industry funds residencies, the more of a problem there will be in dermatology.
"I was brought up (trained) so that if you even got caught talking to a drug rep, you'd get kicked out of the program."