Dermatology Online Journal

Kaiser Permanente: A new model for academic dermatology
Jashin J Wu MD
Dermatology Online Journal 15 (11): 13

Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. jashinwu@hotmail.com

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Abstract

Kaiser Permanente can be seen as a new model for academic dermatology. We describe this model from within Kaiser Permanente Los Angeles Medical Center.

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Introduction

The interest in academic dermatology has been dwindling amongst graduating residents [1]. Some of the main reasons have been cited as salary differential/financial issues, bureaucracy, and location or practice environment [2]. Various methods have been recruited to boost interest in academics, such as joint 5-year programs for dermatology and internal medicine or pediatrics [3]. I wish to describe another model for academic dermatology: Kaiser Permanente (Table 1 and Table 2).

Kaiser Permanente

Founded in 1945, Kaiser Permanente is comprised of 3 components: Kaiser Foundation Hospitals (non-profit), Kaiser Permanente Health Plan (non-profit), and the Southern California Permanente Medical Group (SCPMG) (for-profit). The Kaiser Permanente Health Plan is the nation's largest non-profit health plan, serving almost 9 million members over 8 regions in the country: Southern California, Northern California, Colorado, Georgia, Hawaii, Mid-Atlantic, Northwest, and Ohio. Although Kaiser Permanente is most known as a health maintenance organization (HMO), it is also the world's largest integrated clinical research organization. At Kaiser Permanente Los Angeles Medical Center (LAMC), the academic tertiary center for all of Kaiser Permanente Southern California, there are over 300 Kaiser Permanente-institutional review board (IRB)-approved studies. The Graduate Medical Education office oversees 9 other residencies and 11 post-residency fellowships at Kaiser Permanente LAMC.

New dermatology residency

Effective July 1, 2009, the Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) granted initial accreditation to the Kaiser Permanente Southern California (Los Angeles) Program (Program 0800512144), which will be based at Kaiser Permanente LAMC. Starting in July 2010, we plan on having a total of 6 residents over 3 years of training.

Research opportunities

Large population-based research can be most efficiently performed by a few large U.S. institutions that have extensive electronic medical records (or by the Mayo Clinic which has well-categorized paper charts). Only 1.5 percent of U.S. hospitals have comprehensive electronic health records [4]. The Department of Veterans Affairs (VA) is divided into 22 independent Veterans Integrated Service Networks (VISNs) based on geography. The study population at the VA is mostly elderly men with many risk factors; for many conditions, results from this study population might not be generalize to the rest of the U.S. population.

The large patient base and electronic medical records at Kaiser Permanente allows the possibility of population-based research, a resource that is largely untapped, especially in dermatology. Each of the 8 regions of Kaiser Permanente functions as an independent unit. The regions do not routinely share databases unless there is an agreed-upon research project linking the various databases. The 2 largest in terms of patient population are Southern California and Northern California with around 3.3 million each as of December 31, 2008. Each of the two California regions have sufficient numbers of patients for large population-based research, and results from studies on this patient population could generalize to the rest of the U.S. population because it includes a diverse group of patients of all ages.

The dermatologists at Kaiser Permanente Southern California and at Kaiser Permanente LAMC in particular look forward to help train the next generations of dermatologists and to contribute population-based research to the academic community.

References

1. Wu JJ. Observations on the ongoing shortage of academic dermatologists. Cutis 2006; 78:229-30. [PubMed]

2. Reck SJ, Stratman EJ, Vogel C, Mukesh BN. Assessment of residents' loss of interest in academic careers and identification of correctable factors. Arch Dermatol 2006; 142:855-8. [PubMed]

3. Wu JJ. Current strategies to address the ongoing shortage of academic dermatologists. J Am Acad Dermatol 2007; 56:1065-6. [PubMed]

4. Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, et al. Use of electronic health records in U.S. hospitals. N Engl J Med 2009; 360:1628-38. [PubMed]

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