MD/PhDs are more likely than MDs to choose a career in academic dermatology1. Department of Dermatology, University of California, Irvine, Irvine, California, USA
Jashin J Wu MD1, Kristy F Davis BS1, Claudia C Ramirez MD2, Carol A Alonso MD3, Brian Berman MD PhD4, Stephen K Tyring MD PhD MBA3
Dermatology Online Journal 14 (1): 27
2. Department of Dermatology, University of Chile School of Medicine, Santiago, Chile
3. Department of Dermatology, University of Texas Health Science Center, Houston, Houston, Texas, USA
4. Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA
There are fewer dermatologists entering and being retained in academics. We investigated the hypothesis that MD/PhDs are more likely than MDs to enter a career in academic dermatology. This retrospective study of university dermatology departments and divisions studied MDs, DOs, and MD/PhDs who completed a dermatology program in the U.S. and were serving as full-time dermatology faculty members at a US dermatology program as of December 2004. The main outcome measures were percentage of MD/PhDs who chose a career in academics compared to the percentage of MDs who chose a career in academics; MDs, DOs, MD/PhDs and serving as full-time faculty members and the number serving as chair or chief of dermatology. The total number of MD/PhDs and percentage of MD/PhDs as full-time faculty in 107 U.S. dermatology programs were determined. As of December 2004, there were 782 full-time faculty MDs who completed a residency in the US, with 72 (9.2%) MD/PhDs who completed a US dermatology residency program. MD/PhDs were 1.63 times (p ≤0.001) more likely to go into academics compared to MDs. The programs with the highest number of MD/PhDs as full-time faculty and the programs with the highest percentage of MD/PhDs as full-time faculty were tabulated. Seven out of an eligible 101 dermatology chiefs/chairs were MD/PhDs. The assumption that 5.8 percent of dermatology residents who were MD/PhD during 2004-2007 could be extrapolated to the 35 year period of 1970-2004. MD/PhDs are an important source of physician-scientists in academic dermatology and were 1.63 times more likely compared to MDs to choose a career in academics and remain in academics.
Residency positions in dermatology continue to be highly coveted. Each year dermatology attracts the most competitive applicants with increasingly impressive statistics . In addition, many applicants have research experience and most have publications. It was found that 52.1 percent of US applicants had 1-5 research publications and 27.9 percent had more than 5 research publications at the time of the match . The academic strength and research accomplishments of applicants are more extraordinary with each passing year, which should translate into intellectually curious dermatology residents and thus more academicians. Unfortunately, this is not the case because there is a growing shortage of academic dermatologists in the U.S. [3, 4, 5]. As a result, many program directors actively seek applicants who profess a desire to enter academics in an effort to revitalize academic dermatology .
Many believe that MD/PhDs are more likely to pursue academic careers owing to their extensive research background and experience. MD/PhD applicants receive significantly more interviews than those with an MD degree alone . We sought to investigate the hypothesis that MD/PhDs are more likely to pursue careers in academic dermatology by determining the total number of MD/PhDs who are full-time faculty members at U.S. dermatology residency programs compared to the total number of MDs who are full-time faculty members. As a secondary end point, we determined the number of MD/PhDs serving as chairs/chiefs.
The names of all full-time faculty members of 107 U.S. dermatology residency programs that were active as of December 2004 were collected as described in the past . The total number of faculty in 2004 was calculated. We determined the degrees of these faculty members through extensive Internet searches, telephone, and email correspondences with dermatology residency coordinators and faculty members. Pure PhDs, physicians who did not complete a dermatology residency program, DOs who completed a dermatology residency at an osteopathic school (DOs who completed a dermatology residency at an allopathic school were included), PharmDs, DDSs, FNPs, and graduates of a foreign dermatology residency programs were excluded. The University of Puerto Rico was not considered a foreign residency program.
Data provided by the University of Alabama at Birmingham National MD/PhD Residency Data 2004-2007 and unpublished data from Wu et al.  were used to estimate the number of MD/PhDs in dermatology residency over the past 35 years. Chi-square analysis was used to compare the percentage of MD/PhDs in dermatology residency and the percentage of MD/PhDs in academic dermatology.
MD/PhDs as full-time faculty
At the end of 2004, there were 988 full-time dermatology faculty members in the U.S. The number and percentage of full-time faculty members and chiefs or chairs with MD/PhDs for each program were tabulated (Table 1). There were 782 full-time dermatology members with at least an MD who completed a US dermatology residency (Table 1). Of these 782 full-time faculty, 72 (9.2%) were MD/PhDs who completed a US dermatology residency, and 710 were MDs (90.8%). Of the 107 programs, 39 (36.4%) had at least one MD/PhD full-time faculty member.
The programs with the highest number of MD/PhDs as full-time faculty are presented in Table 2. The programs with the highest percentage of MD/PhDs as full-time faculty are presented in Table 3. A total of 101 dermatology chiefs/chairs met our inclusion criteria. Of these 101, 7 were MD/PhDs who served as the department chief/chair (Table 4).
Dermatology residency positions going to MD/PhDs
Data from the University of Alabama at Birmingham National MD/PhD Residency Data 2004-2007  showed that 72 MD/PhDs matched into dermatology residencies between 2004-2007. During this same time period, 1236 total dermatology residency spots were filled through the National Resident Matching Program . Thus, 5.8 percent of dermatology residency positions went to MD/PhDs during this 4-year period.
According to the National MD/PhD Residency Data 2004-2007, 72 MD/PhDs matched in dermatology over the last 4 years, representing 5.83 percent of the positions filled in the match . Unpublished data from our prior study  estimated that there had been 8797 total graduates from dermatology residencies over the past 35 years. We selected 35 years for our calculations in order to capture full-time faculty who started their careers in 1970 and afterwards up to a retirement age of 65 years. Using the percentage from the 2004-2007 study to extrapolate to the 35 year interval of 1970-2004, if 5.83 percent of these 8797 graduates were MD/PhDs, then roughly 513 MD/PhDs had graduated from dermatology residency over the last 35 years. Of these 513 MD/PhDs, 72 (14.0%) were full-time academic dermatologists as of December 2004.
Using the same calculations, if 94.2 percent of these 8797 total graduates from dermatology residencies over the past 35 years were MDs, then roughly 8284 MDs had graduated from dermatology residency over the last 35 years. Of these 8284 MDs, 710 (8.6%) were full-time academic dermatologists as of December 2004. A Chi-square analysis was performed to calculate the odds ratio. MD/PhDs were 1.63 times (p ≤0.001) or 62.8 percent more likely to go into academics compared to MDs.
Overall, 8.9 percent (782/8797) of all MDs or MD/PhDs who completed a US dermatology residency entered academics.
Of the 72 full-time MD/PhD academic dermatologists as of December 2004, 9.7 percent (7/72) were serving as the chair or chief. This is in comparison to 13.24 percent (94/710) full-time MD academic dermatologists who were serving as the chair/chief. Therefore, although MD/PhDs were more likely to stay in academics compared to MDs, there was no increased tendency for MD/PhDs to become the chair or chief.
Further, although 5.8 percent of matched dermatology residents were MD/PhDs, a statistically significant 9.2 percent of full-time dermatology faculty members are MD/PhDs (p ≤0.01). A Chi-square analysis was performed to calculate the odds ratio. MD/PhDs were 1.58 times (or 58.6%) more likely than MDs to stay in academics. This figure is similar to the prior 1.63 finding. Thus, a higher percentage of MD/PhDs were staying in full-time academics after graduating compared to the percentage of MD/PhDs entering residency.
The main limitation in this study is the assumption that 5.8 percent of dermatology residents who were MD/PhD who matched during 2004-2007 could be extrapolated to the 35 year period of 1970-2004. This true percentage may be lower or higher than 5.8 percent, which would affect our calculations. However, the true number and percentage of MD/PhD dermatology residents during this period is not known. The following six organizations were contacted, but none of them had a list of dermatology residents who were MD/PhD: Accreditation Council for Graduate Medical Education; American Academy of Dermatology; American Board of Dermatology; Association of American Medical Colleges; Dermatology Foundation; Society for Investigative Dermatology. Thus, the best way to estimate the percentage is through the figures from the University of Alabama at Birmingham National MD/PhD Residency Data 2004-2007  and the National Resident Matching Program" .
MD/PhDs are an important source of physician-scientists in academic dermatology and were 1.63 times more likely to choose a career in academics compared to MDs. It is imperative that academic dermatologists identify markers that can discern those who are truly interested in academics. The title of MD/PhD could be used as an instrument  by dermatology residency directors to choose dermatology applicants who are more dedicated to academics.
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