2 NEW Dermatology PGY-2 slots starting July 2022

[UCF/HCA.Dermatology.Coord]

Hello! Our newly accredited UCF/HCA Dermatology Residency Program is accepting applications for two PGY-2 slots starting July 2022. We are based in Tallahassee, FL. Must have PGY-1 completed by June 30, 2022. Please apply through ERAS by January 31st, as we will be screening all applicants through there!

Program Code: 0801100001
NRMP Code: Derm Reserve Track 2022 start – 1587080R0

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[Taurus]

HCA residency program? Is this another sign of corporate takeover of dermatology? First, EM. Now, derm? Say it ain’t so!

 

[Dral]

HCA residency program? Is this another sign of corporate takeover of dermatology? First, EM. Now, derm? Say it ain’t so!

There are a few around already unfortunately.

 

[doctalaughs]

There are a few around already unfortunately.

And the r*ape of American medicine (and patients) by corporate greed continues.

Flood the market with low-quality poorly trained physicians so their practices can decrease labor costs and return more money to the overlords. Gotta give them credit for playing the long-game. Look at emergency medicine to see a detailed playbook. Who cares about quality and patients when we can give that lip service- that’s what they pay the PR department for.

No doubt they will have no trouble filling by a few medical students who couldn’t quite make the normal derm cut. Too bad the ACGME allows accreditation of these programs — but I’m sure the HCA lobbying is a well-oiled machine too.

 

[bronx43]

HCA derm residency?? Wow, it truly is over.

 

[Taurus]

How hard is it to create a derm residency? I’m a rad so I don’t know. Creating a radiology residency is not easy because many different sections have to be represented and you need the appropriate teaching staff and volume. For a derm residency, do you just need a clinic and teaching staff? If so, corporate entities can easily replicate the primary care and EM model and apply it to derm.

 

[Dral]

ACGME requirements include dermpath, surgery, cosmetics, peds, Mohs, and inpatient exposure.

I suppose those can be interpreted differently though. So it's not super easy to put one together, but depending on the definition of 'exposure' it might not be too difficult. Those types of exposures help make a residency worth while though.

But due to the competitive nature of derm, there will always be people who will take residency spots, even if they are at a subpar (to use a 'nice' word) program.

 

[doctalaughs]

ACGME requirements include dermpath, surgery, cosmetics, peds, Mohs, and inpatient exposure.

I suppose those can be interpreted differently though. So it's not super easy to put one together, but depending on the definition of 'exposure' it might not be too difficult. Those types of exposures help make a residency worth while though.

But due to the competitive nature of derm, there will always be people who will take residency spots, even if they are at a subpar (to use a 'nice' word) program.

I don’t know the specific requirements — but there should be a minimum number of expert faculty in each area, and a minimum number of hours they are providing didactics (cannot count teaching while doing clinic).

I don’t consider learning on-the-job from 10 random dermatologists who are running their practice and have clinical affiliations with XYZ program to be a real residency. Which is what I suspect some of these HCA residencies are.

Although I suppose it’s better than getting “expert” care from a PA/NP which is another topic.

It’s truly a race to the bottom.

 

[Rekt]

I was scrolling to EM and saw "2 NEW PGY2.." underneath the derm header. Before I even got to the thread I knew it was HCA.

Sad times. And familiar ones. Get to FIRE while you can.

 

[Dral]

I was scrolling to EM and saw "2 NEW PGY2.." underneath the derm header. Before I even got to the thread I knew it was HCA.

Sad times. And familiar ones. Get to FIRE while you can.

Yep, meanwhile I'll bet the OP has a junk ton of messages in their inbox. Sad times indeed.

 

[qwerty89]

HCA residency program? Is this another sign of corporate takeover of dermatology? First, EM. Now, derm? Say it ain’t so!

360 Derm spots in 2010.

407 Derm spots in 2015

451 Derm spots in 2018

507 Derm spots in 2021

I understand Dermatology has more things going for it with more elastic demand, cosmetics, more women (i.e. more part-timers), etc.

But those numbers are starting to look like Rad Onc...

Its getting worse at a faster and faster rate too.

Increase in 47 spots in 5 years between 2010 and 2015. Then 44 spots in just 3 years. Then 56 spots in just another 3 years.

 

[deleted941485]

360 Derm spots in 2010.

407 Derm spots in 2015

451 Derm spots in 2018

507 Derm spots in 2021

I understand Dermatology has more things going for it with more elastic demand, cosmetics, more women (i.e. more part-timers), etc.

But those numbers are starting to look like Rad Onc...

Its getting worse at a faster and faster rate too.

Increase in 47 spots in 5 years between 2010 and 2015. Then 44 spots in just 3 years. Then 56 spots in just another 3 years.

I’m in rad onc this problem unfortunately is persistent and will remain unaddressed

Your only saving grace here is that the ceiling of demand for Derm is likely much higher but it’s only a matter of time.

Don’t expect AAD to do anything about it except maybe suggest lengthening the residency tacking on some BS fellowships or just shaming anybody who brings up the topic.

People will then start complaining about the difficulty of getting a job in the city then the suburbs then rural areas. Employers will then start getting 20-40 applicants for desirable locales. Trainees will try to beef up their credentials doing fellowships but it will be in vain.

Unfortunately the situation is hopeless.

 

[Taurus]

The AAD needs to ramp up the accreditation criteria to create and maintain residencies. Make it difficult and unprofitable for corporations like HCA to try to manipulate the market by drastically increasing the supply of derms. This applies to all fields. The flip side is that HCA may respond by supporting non-physician alternatives like derm NP’s, similar to using CRNA’s as a wedge against anesthesiologists, ie, the enemy of my enemy is my friend.

 

[deleted941485]

The AAD needs to ramp up the accreditation criteria to create and maintain residencies. Make it difficult and unprofitable for corporations like HCA to try to manipulate the market by drastically increasing the supply of derms. This applies to all fields. The flip side is that HCA may respond by supporting non-physician alternatives like derm NP’s, similar to using CRNA’s as a wedge against anesthesiologists, ie, the enemy of my enemy is my friend.

It’s already happening. It doesn’t matter if you pump them out or not NPs are literally everywhere. My hospital if you call a consult to any service you get an APN.

 

[doctalaughs]

I don’t have a big horse in the race since I’m mid career, likely to mostly retire in about 10 years and co-own a fairly large practice.

That being said, I do feel sad for physicians (of all specialties) for their futures, not to mention feel bad for patients about what the quality of medicine in the USA going forward will be.

I am optimistic in that I think **overall** derm leadership are good people who want to do the right thing. And we do have some politically savvy people in positions of power. I have a few friends in National leadership positions and mean to speak to them about these issues. Everyone else should as well, regularly.

 

[qwerty89]

It's a race to the bottom.

 

[deleted941485]

It's a race to the bottom.

So basically an inpatient consult your billing maybe a 99223 which is what $100? That’s the highest you’ll get. Honestly a patient walks into a hospital these days if they need anything as an inpatient it’s basically free. Literally every inpatient service is a NP at this point.

There was a time where an inpatient consult was $200 before the new rules took hold in 2010.

 

[Dral]

In terms of the residency spot numbers, don't forget that recent merger. I believe there were a good number of AOA residencies not included in the official NRMP numbers who now are after their programs were approved during the merger. The spots where there before and people were being trained, but it looks like the number of spots is blowing up because they are now officially included in the NRMP data.

I'm just pointing that out. I'm not arguing against the fact that there is a looming issue with a glut of training spots.

 

[Rekt]

In terms of the residency spot numbers, don't forget that recent merger. I believe there were a good number of AOA residencies not included in the official NRMP numbers who now are after their programs were approved during the merger. The spots where there before and people were being trained, but it looks like the number of spots is blowing up because they are now officially included in the NRMP data.

I'm just pointing that out. I'm not arguing against the fact that there is a looming issue with a glut of training spots.

This exact same thing was said for EM and ended up being a completely nearly insignificant number and everything was really just new CMG residencies.

 

[dermie1985]

The AAD needs to ramp up the accreditation criteria to create and maintain residencies. Make it difficult and unprofitable for corporations like HCA to try to manipulate the market by drastically increasing the supply of derms. This applies to all fields. The flip side is that HCA may respond by supporting non-physician alternatives like derm NP’s, similar to using CRNA’s as a wedge against anesthesiologists, ie, the enemy of my enemy is my friend.

Accreditation is done by the ACGME not the AAD.

 

[Taurus]

Accreditation is done by the ACGME not the AAD.

But who sets or heavily influences the accreditation criteria? I would think each medical society does.

 

[dermie1985]

But who sets or heavily influences the accreditation criteria? I would think each medical society does.

ACGME decides on criteria and accreditation, not AAD. This does include a ACGME review committee and outside peer review by dermatologists who are likely also AAD members, but the AAD isn't directly involved in this.

 

[droliver]

I’m confused by some of the sentiment expressed here. There are MASSIVE backlogs in primary Dermatology services in most metropolitan areas, and wide areas of non-coverage outside them. The expansion in residency programs has been a good thing in ramping up the workforce to meet public health needs.

 

[OraclePL]

I’m confused by some of the sentiment expressed here. There are MASSIVE backlogs in primary Dermatology services in most metropolitan areas, and wide areas of non-coverage outside them. The expansion in residency programs has been a good thing in ramping up the workforce to meet public health needs.

That has not been the case in any major metropolitan city that I am aware of. New York, Chicago, and AFAIK the California and Texas metros, are all saturated.

Churning out more dermatologists generally does not ensure people will go rural. It just creates more of a glut in the desirable areas.

 

[jambro]

That has not been the case in any major metropolitan city that I am aware of. New York, Chicago, and AFAIK the California and Texas metros, are all saturated.

Churning out more dermatologists generally does not ensure people will go rural. It just creates more of a glut in the desirable areas.

socal doesnt seem saturated. takes weeks to months to get an appointment at most places

 

[doctalaughs]

I’m confused by some of the sentiment expressed here. There are MASSIVE backlogs in primary Dermatology services in most metropolitan areas, and wide areas of non-coverage outside them. The expansion in residency programs has been a good thing in ramping up the workforce to meet public health needs.

There is not a derm shortage any more than most medical specialties.

In America our indirect-fee-for-service (funneled through multiple middle-men) and “customer is always right” culture has led to a massive amounts of unnecessary medical care.

The answer is not to dumb-down the training and create a bunch of corporate-run residencies that feed “widget producing” doctors into their mills to maximize profit for corporate dbags.

The answer is to encourage physician-led efficient practices, direct transparent physician payment, and get rid of administrative red tape, while incentivizing for physician-created quality metrics (not metrics made-up by administrators).

The USA has plenty of doctors. We just have artificially generated and highly inefficient care.

 

[droliver]

That has not been the case in any major metropolitan city that I am aware of. New York, Chicago, and AFAIK the California and Texas metros, are all saturated.

That's just untrue. The best metric of saturation is time until appointment for general dermatology consultation, and that was over 30 days when this was studied in the late 2010's and is now 2+ months in some markets in more recent survey. That is inconsistent with the "oversaturation" idea to say the least

"According to Merritt Hawkins’ Survey of Physician Appointment Wait Times, it takes an average of 78 days to schedule a new patient appointment with a dermatologist in Philadelphia. The average is 52 days in Boston, 51 days in Denver, 42 days in Seattle and 35 days in Los Angeles. The average in 15 top metro areas included in the survey is over one month – 32 days."

Dermatology: Supply, Demand, Compensation and Recruiting Trends

This white paper explores recent trends and compensation data in the field of dermatology.

www.merritthawkins.com

 

[Skindoc83]

I don’t believe those results having practiced dermatology in some of the cities that you gave examples for.

 

[qwerty89]

360 Derm spots in 2010.

407 Derm spots in 2015

451 Derm spots in 2018

507 Derm spots in 2021

I understand Dermatology has more things going for it with more elastic demand, cosmetics, more women (i.e. more part-timers), etc.

But those numbers are starting to look like Rad Onc...

Its getting worse at a faster and faster rate too.

Increase in 47 spots in 5 years between 2010 and 2015. Then 44 spots in just 3 years. Then 56 spots in just another 3 years.

522 spots in 2022. 15 more spots than 2021. 115 more than 2015.

For comparison, DR/IR went from 1132 total DR spots in 2015 to 1297 total DR/IR spots in 2022 (no IR residency existed in 2015). That is an increase in 165 spots.

 

[Taurus]

115/407 = 28% increase over 7 years for derm
165/1132 = 15% increase over 7 years for rad

I’ve noticed that radiology and anesthesiology have done a really good job at keeping a lid on expanding total residency spots over the last 10 years.

At this rate, it won’t be long before the same issues afflicting EM and RadOnc hit derm. Derm needs to identify the root cause of the exploding residency spots and nip it in the bud or they will have serious issues in a few years. At this rate, 5-10 years?

 

[PhillyMed777]

115/407 = 28% increase over 7 years for derm
165/1132 = 15% increase over 7 years for rad

I’ve noticed that radiology and anesthesiology have done a really good job at keeping a lid on expanding total residency spots over the last 10 years.

At this rate, it won’t be long before the same issues afflicting EM and RadOnc hit derm. Derm needs to identify the root cause of the exploding residency spots and nip it in the bud or they will have serious issues in a few years. At this rate, 5-10 years?

I agree it is a negative early sign, and better to get ahead of it.

The job market seems good for now however.

 

[OraclePL]

That's just untrue. The best metric of saturation is time until appointment for general dermatology consultation, and that was over 30 days when this was studied in the late 2010's and is now 2+ months in some markets in more recent survey. That is inconsistent with the "oversaturation" idea to say the least

"According to Merritt Hawkins’ Survey of Physician Appointment Wait Times, it takes an average of 78 days to schedule a new patient appointment with a dermatologist in Philadelphia. The average is 52 days in Boston, 51 days in Denver, 42 days in Seattle and 35 days in Los Angeles. The average in 15 top metro areas included in the survey is over one month – 32 days."

Dermatology: Supply, Demand, Compensation and Recruiting Trends

This white paper explores recent trends and compensation data in the field of dermatology.

www.merritthawkins.com

I’ll take a look at that white paper later. It’ll depend on their methodology, were they looking across all insurances, just public insurance? How did they ensure they sampled enough derms in the area? I’ll take a look. I can tell you that a 30 day plus wait time just does not exist in my metro area, or the one I practiced in before this one. I’m lucky to now have my schedule booked out 10 days, and I know of several derms offering same day appointments in my area. I agree with skindoc. While I appreciate the reference, this is something that personal experience defies.

 

[droliver]

All I can say is that as someone whom deals with Derm practices all the time in a mid sized metro area >>1M people, it's 4-6 weeks for a medical dermatology appointment. That article is very consistent with what we see on the ground.

(Hell it's often that for internal medicine visits that aren't emergent now, and dentists here are telling people it will be June for routine cleaning visits)

 

[Solodyn]

ACGME Merger took place in 2015.

407 Derm spots in 2015

451 Derm spots in 2018

507 Derm spots in 2021

Can be easily explained by the conversion of ex-DO Derm Residency positions. There are roughly 75 DO spots per year pre-merger. If I have to guess, 60-70 positions survived.