Dermatology Online Journal

The academic strength of current dermatology residency applicants
Jashin J Wu MD¹, Stephen K Tyring MD PhD²
Dermatology Online Journal 9(3): 22

1. Department of Internal Medicine, Baylor College of Medicine2. Departments of Microbiology and Immunology, Dermatology, and Internal Medicine, University of Texas Medical Branch,Galveston, Texas 77555. jashinwu@hotmail.com

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This essay is in regards to the Dermatology Residency Board located at http://pub50.ezboard.com/bdermatology, an anonymous website where dermatology applicants can vote in polls, some of which inquire into academic statistics. Some tables is this essay were taken from the website. However, it is noted that the polls depend on self-reporting and should only be used as a rough indicator.

Twenty-five years ago, many United States medical schools did not have a dermatology department or division.[1] Dermatology has quickly become one of the most popular fields of medicine. The field attracts the most outstanding medical students each year and has been the most competitive of all specialties for at least the last 5-6 years as seen by results published by the Electronic Residency Application Service (ERAS).

As a result of the limited number of residency spots in dermatology, applicants are finding stiffer and stiffer competition. No longer is simply scoring over the mean a desirable achievement, as can be seen in Tables 1 and 2. These USMLE Step 1 scores of the Classes of 2001 and 2002 indicate that the majority of dermatology applicants are above the 90^th percentile, and 25-30 percent are at the 99^th percentile. These statistics are a small indication of what a stellar applicant pool dermatology enjoys.

Table 1

Class of 2002: (total responses=161) What did you score on the USMLE Step 1?
score	responses	percent
<230	40	24.8%
230–239	43	26.7%
240–249	38	23.6%
250–259	24	14.9%
260+	16	9.9%

Table 2

Class of 2002: (total responses=80) What did you score on the USMLE Step 1?
score	responses	percent
<229	21	26.3%
230–239	11	13.8%
240–249	26	32.5%
250–259	14	17.5%
260+	8	10.0%

Many applicants use their AOA status to help boost their chances. Most medical schools have an AOA chapter, and they elect the top 16-20 percent of each class. Approximately 40 percent of all dermatology applicants are AOA, another indication of the strength of this applicant pool (Table 3).

Table 3

Class of 2002: (total responses=97) What is your AOA status?
choice	responses	percent
Junior Year	19	19.6%
Senior Year	20	20.6%
Not AOA	48	49.5%
Our School Does Not Have AOA	10	10.3%

Studies have reported that a controllable lifestyle was becoming an increasingly important factor in choosing a specialty by medical students over the past three decades.[2, 3, 4] Specialties with a controllable lifestyle such as anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry, radiation oncology, and radiology, have enjoyed a surge in the quantity and quality of their applicants.

Top students have traditionally been attracted to internal medicine and general surgery, neither of which offers regular hours, but now many students are turning away from primary care fields, especially internal medicine and family practice.[4] The number of certificates issued by the American Board of Medical Specialties since 1970 has decreased significantly in primary care specialties, decreased slightly in general surgery, and increased sharply in specialties with a controllable lifestyle.[5] Anecdotally, match day has been referred to by internal medicine program directors as black Wednesday because of their inability to attract top students and to fill their residency positions.

One study tracked the careers of graduates who entered primary care specialties and found that 13 percent eventually entered a field with more regular hours.[6] This change in lifestyle was deemed as the most important factor for pursuing a new professional direction. In addition, the public is increasingly concerned about high working hours per week, sleep deprivation, and error-inducing fatigue inherent to primary care and general surgery. No doubt this has helped fields such as dermatology become more desirable.

Schwartz et al. have also noticed that procedure-oriented residencies have become increasingly popular for top medical students.[4] With managed care's shift of focus to increasing reimbursements for doing rather than thinking, students are picking fields where financial benefits would be greater. Fields with both a controllable lifestyle and a multitude of procedures tend to be the most competitive, such as dermatology, ophthalmology, and otolaryngology.

Dermatology will likely continue to attract the strongest applicant pool and remain the most competitive of all specialties for several years. With the brightest minds entering dermatology, the field will hopefully progress further with new discoveries in basic and clinical research, medical treatments, and surgical techniques.

References

1. Eaglstein WH. Why train residents and teach students in dermatology. J Am Acad Dermatol 1995;33:138.

2. McCarty DJ. Why are today's medical students choosing high-technology specialties over internal medicine? N Eng J Med 1987;317:567-9.

3. Graettinger JG. Internal medicine in the National Matching Program 1987: the Ides of March. Ann Intern Med 1988;108:101-15.

4. Schwartz RW, Jarecky RK, Strodel WE, Haley JV, Young B, Griffen WO Jr. Controllable lifestyle: a new factor in career choice by medical students. Acad Med 1989;64:606-9.

5. Boggs RJ. Trends in specialty certification. Bull Am Coll Surg 1988;73:14-39.

6. Tardiff K, Cella D, Seiferth C, Perry S. Selection and change of specialties by medical school graduates. J Med Educ 1986;61:790-6.

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