Recent trends may forecast derm shortage in academia

New Orleans - Academic dermatology is not currently in crisis, although some recent trends suggest a more serious situation may emerge in the future, said Alexa Boer Kimball, M.D.A, M.P.H., at the 63rd Annual Meeting of the American Academy of Dermatology (AAD) here.

Her comments were based on analysis of the AAD 2002 Practice Profile survey. The survey was mailed to 4,090 physician members and returned by 1,425 (34.8 percent). The study included only 1,214 dermatologists who reported working >80 percent of their time in a single practice setting. Responses from dermatologists working in an academic setting (n=75) were compared to those in solo (n=603), dermatology group (n=415) or multispecialty group practices (n=121).

Findings on age distribution and dermatologist recruiting suggest there may be a problem retaining dermatologists in academia, says Dr. Boer Kimball, director, Dermatology Clinical Studies Unit, Massachusetts General and Brigham and Women's Hospitals, Boston.

"These data suggest that a significant percentage of dermatologists are entering academia soon after they complete their training, but then are leaving mid-career. This is a concerning trend that needs to be monitored carefully because of its implications for preserving the field," Dr. Kimball comments.

"It is great that academia is attracting junior faculty because they tend to be very energetic and enthusiastic. However, experienced dermatologists are the foundation for a successful teaching and research program, and we need to ask, if dermatologists are leaving academia before they reach the 45-to-50-year-old age bracket, who will be left to fill the leadership roles?" she tells Dermatology Times.

Gender analysis Gender analysis found that there were proportionally more women in academia (39 percent) than in any of the other categories (26 percent to 33 percent).

"Those data likely account for some of the age differences between the groups since younger cohorts include higher proportions of women than older cohorts," Dr. Boer Kimball notes.

Data on the time needed to fill a vacant position support the belief that any shortage of dermatologists in academia is due to a retention problem rather than a recruitment issue. The average time needed to hire a new dermatologist was only 12.7 months in academia compared with 16.9 months for solo practice.

"Even one year is a long time to be looking to fill a position, but those data are still consistent with the idea that it is not really difficulties with recruitment that underlie vacancies in academic dermatology, but rather that there is a revolving-door phenomenon," Dr. Boer Kimball says.

Patient care analysis Questions relating to patient care showed that the average academic dermatologist saw about 90 patients per week, which was 33 percent to 40 percent less than the number of patients seen by dermatologists across the other three practice categories.

"Those results were not surprising since the academic dermatologists are probably spending more time teaching and performing research than their colleagues in other practice settings," Dr. Boer Kimball observes.

The wait times were longest - 56.8 days - for patients to be seen in academia. Patients waited on average 48.9 days for an appointment with a dermatologist in a multispecialty group, but the wait time was <40 days for the other practice settings.

Parallel to those findings, the proportion of respondents reporting that their institution or practice was seeking new dermatologists was almost twice as high among the academic dermatologists compared with the private practitioners: 56 percent vs. 29.7 percent.