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Posted this on the DIGA Forum but did not get any response from the faculty advisors, so I thought I'd post it here:

I was wondering what you guys thought about the recent surge in the number of new dermatology residency programs. Over the last 2 years, MetroHealth Cleveland, UTSW-Austin, Baylor-Dallas, Kaiser, and Tufts have opened new residency programs. And Arizona just announced that they will re-open their program this July. With these new spots PLUS the continued expansion of the residency classes of already-exisiting programs, one cannot help but wonder if we are overproducing dermatologists. In fact, in the just-realeased data gathered by the NRMP, ONLY dermatology and radiation oncology increased their available residency spots by more than 10% over the last 4 years (2006-2010). The PGY-2 dermatology spots increased from 276 to 329 in that period.

As everyone knows, one of the secrets to dermatology's success and "hotness" as a field has been the low supply to demand ratio compared to other specialties. With so many spots opening up recently, might dermatology lose its "edge?"
 
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MOHS_01

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I believe that there were 236 positions in 2001.... and yes, to answer your question, the expansion has been ill conceived. Many of us have argued this at specialty meetings; unfortunately for the specialty some real arrogant SOB's have been calling the shots.
 
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I believe that there were 236 positions in 2001.... and yes, to answer your question, the expansion has been ill conceived. Many of us have argued this at specialty meetings; unfortunately for the specialty some real arrogant SOB's have been calling the shots.
Very interesting... And here I thought the leaders in dermatology were the most protective of their specialty...

Dermatopathology is facing the same problem, in my opinion. There were about 61 spots in 2001, and now there are 91. I have talked to several dermatopathology fellows who told me that the job market has not been as good as it used to be.
 

MOHS_01

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Very interesting... And here I thought the leaders in dermatology were the most protective of their specialty...

Dermatopathology is facing the same problem, in my opinion. There were about 61 spots in 2001, and now there are 91. I have talked to several dermatopathology fellows who told me that the job market has not been as good as it used to be.
NO -- what you have in many instances parallels the perilous path that pathology programs have gone down. Many of the real power players are dermpath and MMS section heads who drive the cash wagon and call the shots. They enjoy the referral farm system that a residency provides. It's awful, really....
 

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my program uses residents to see about 50% of the clinical volume, which means we generate a TON of revenue. expanding the program would bring in way more money than hiring staff, while also ensuring a steady stream of biopsies and surgery referrals.
 

Unty

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It's about time...there are long waitlists for Dermatologists in this country...Dermatology has been a competitive field because of the limited number of residency spots and therefore, has been very lucrative. If you had good business sense, you could open a very lucrative practice by taking advantage of this shortage. If the leaders in the field open more residency programs to meet the demand, do you think there will still be tough competitition for Derm?

No way. I think more programs should open up so that patients don't have to wait months to see a dermatologist. Then, you will weed out those who went into Derm for the wrong reasons ($$$$) and keep those ppl who really do love skin.

Oversupply? You have got to be kidding!!!!!!!!!!!!!!! I think after opening up these programs, I still don't think supply would = demand!

I'd like to ask Derm residents this...if Derm paid 200K (typical family practice salary) a year...would you still do it?
 

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I'd like to ask Derm residents this...if Derm paid 200K (typical family practice salary) a year...would you still do it?
I know we are taught in grade school that there's no such thing as a stupid question but this one comes close.

Ask anyone (forget derm, forget medicine, anyone) whether they'd be OK doing the same work they're currently doing for a paycut and the answer you'll get back should be universal...
 

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NO -- what you have in many instances parallels the perilous path that pathology programs have gone down. Many of the real power players are dermpath and MMS section heads who drive the cash wagon and call the shots. They enjoy the referral farm system that a residency provides. It's awful, really....
anyone who alliterates that much in one post must have a point. the perilous path of pathology programs is a probably a precious pointer for people who would pursue the problematic predicament of pathologists.
 

Taurus

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Derm has to be careful as to not create such a huge imbalance in supply and demand that politicians notice the problem or other groups such as FM, IM, NP's want a piece of the derm pie. Let's face it, derm is not neurosurgery. It's no secret that most of what derms do in the clinic can be done 80% of the time by FM. If you can't meet the demands of the public, some other group will try to fill that void for you.
 

MOHS_01

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It's about time...there are long waitlists for Dermatologists in this country...Dermatology has been a competitive field because of the limited number of residency spots and therefore, has been very lucrative. If you had good business sense, you could open a very lucrative practice by taking advantage of this shortage. If the leaders in the field open more residency programs to meet the demand, do you think there will still be tough competitition for Derm?

No way. I think more programs should open up so that patients don't have to wait months to see a dermatologist. Then, you will weed out those who went into Derm for the wrong reasons ($$$$) and keep those ppl who really do love skin.

Oversupply? You have got to be kidding!!!!!!!!!!!!!!! I think after opening up these programs, I still don't think supply would = demand!

I'd like to ask Derm residents this...if Derm paid 200K (typical family practice salary) a year...would you still do it?
Ignorance has no modesty.....

Before you blather on about wait times, perhaps you should do a little research. What you would find, in fact, is that dermatology wait times are in line with other specialties studied. You can start with the Merritt Hawkins study and go from there.

You may also want to look at how reimbursement works in medicine, too -- as you clearly have no idea currently.
 

reno911

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I believe that there were 236 positions in 2001.... and yes, to answer your question, the expansion has been ill conceived. Many of us have argued this at specialty meetings; unfortunately for the specialty some real arrogant SOB's have been calling the shots.
I definitely think that the expansion hasn't been super well thought out. The problem is that there are areas of relative shortage. This is true in many parts of the country. There are places in West Texas or Wyoming that could really use dermatologists. Unfortunately training more dermatologist doesn't really do a ton to solve this problem. You can train more dermatologists, but you can't tell them where to practice (at least no one has come up with a good way to do this yet).

The other thing to consider is that the problem really starts at a more local level. I think that assigning all of the blame to the "leadership" (depending on how you define that) is unfair. I've met many colleagues who have the incongruous view that their program needs more residents or their community needs more dermatologists, but nationwide there are probably too many dermatologists.

When these programs fulfill the necessary requirements to be accredited for more residents or when medical schools open up new programs that meet all of the requirements, then you can't really not approve them without creating a whole bunch of other problems.
 

MOHS_01

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There is nothing unfair about the criticism; the decision upon whether to expand the number of training positions is made on a national level. Individual programs are accredited for a set number of trainees; they must make a formal request for an expansion.

Increasing the numbers does nothing to address distribution problems. This holds true regardless of whether we are discussing primary care and rural or inner city areas or subspecialty care. The simple fact of the matter is that there are real underlying causes for the maldistribution, and, despite all of the institutional efforts, they cannot be corrected via an increase in the ranks or through the wave of a magical hand.
 

sore eye asses

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There is nothing unfair about the criticism; the decision upon whether to expand the number of training positions is made on a national level. Individual programs are accredited for a set number of trainees; they must make a formal request for an expansion.

Increasing the numbers does nothing to address distribution problems. This holds true regardless of whether we are discussing primary care and rural or inner city areas or subspecialty care. The simple fact of the matter is that there are real underlying causes for the maldistribution, and, despite all of the institutional efforts, they cannot be corrected via an increase in the ranks or through the wave of a magical hand.
I'll show you "magical hand"
 

asmallchild

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There is nothing unfair about the criticism; the decision upon whether to expand the number of training positions is made on a national level. Individual programs are accredited for a set number of trainees; they must make a formal request for an expansion.

Increasing the numbers does nothing to address distribution problems. This holds true regardless of whether we are discussing primary care and rural or inner city areas or subspecialty care. The simple fact of the matter is that there are real underlying causes for the maldistribution, and, despite all of the institutional efforts, they cannot be corrected via an increase in the ranks or through the wave of a magical hand.
Agreed, tossing enough up to see what sticks isn't representative of a very well thought-out strategy
 

sore eye asses

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Funny thing...I said that same thing to your mom. She was very happy about that.
That wasn't my mom. It was me dressed as my mom. I was on a sting operation for people showing my mom magical hand. You did it so good that I didn't stop you.
 

reno911

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There is nothing unfair about the criticism; the decision upon whether to expand the number of training positions is made on a national level. Individual programs are accredited for a set number of trainees; they must make a formal request for an expansion.
This is true, but the requests for expansion are part of the problem as well. If a new program opens up and meets all of the requirements, then not accrediting them can result in a lawsuit (and "we've already got enough spots" is not a good enough reason to withhold accreditation).

The same is true for programs requesting to add a resident. Although it's easier to come up with a reason to not accredit a program for an additional spot if you simply don't want to.