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With competition for dermatology residency slots keener than ever, some program directors worry that the application process weeds out potentially excellent dermatologists who didn't finish at the top of their classes.
EDITOR'S NOTE: In this issue, Dermatology Times looks at today's fierce competition for residency slots in the dermatology field. We examine the low interest in academia among recent dermatology graduates - and the high attrition rates over time (See story, "Brain drain: Dermatologists shunning, leaving academia"). And we look at the path to a derm residency through the eyes of two students who chose the specialty late in the game - during their fourth year of medical school (See story, "Strategies for success: Dermatology residents say planning, personality, flexibility are key ").
Even for stellar students, they say, educational choices are, increasingly, the result of early strategizing - not late-in-the-game decisions.
"We're looking at whether they're doing something unique, and how good their recommendations are," says Joseph Kvedar, M.D., residency program director and associate professor, department of dermatology, Harvard Medical School.
In 2007, dermatology was ranked the most competitive residency specialty, followed closely by plastic surgery, says Bethanee Schlosser, M.D., associate residency program director and assistant professor of dermatology, Northwestern University.
According to National Resident Matching Program data, the ratio of dermatology applicants to available slots is currently 1.8 - nearly two applicants for every opening - even though the number of residency slots offered nationally has risen from 262 in 2001 to 327 in 2008.
The ratio is 1.7 in plastic surgery, Dr. Schlosser says.
Numbers game: How do residency programs select derms?
Though the number of applicants to Harvard's program hasn't grown appreciably in more than 20 years, "The quality of the applicants keeps going up. We often joke as faculty that we wouldn't get in now," says Joseph Kvedar, M.D., residency program director and associate professor, department of dermatology, Harvard Medical School.
Although one would expect top-tier medical schools to attract the most applicants, "The competition level is about the same for the bottom-level programs as for the top programs," says Peter J. Lynch, M.D., dermatology training program director and chairman emeritus, University of California, Davis.
UC Davis ranks in the top 25 percent of dermatology programs, he says, "and competition for slots in our program is very similar to that which occurs all over."
Moreover, application totals don't entirely reflect the level of interest in dermatology.
"The number of people interested in dermatology has increased hugely. But students are being advised by their mentors that if they are not suitably qualified, don't even bother applying," Dr. Lynch tells Dermatology Times.
Relationships are key
Heightened competition for dermatology residencies means programs use broad criteria to winnow out many applicants, sources say.
However, he says, "I don't believe necessarily that the top 10 percent of the medical school class practices better medicine in the long run than the top 25 or 50 percent."
Still, the only way students in the 50th to 90th percentile of their classes can land a dermatology residency - which occasionally happens - is to become very well-known personally by one or more program directors, he says.