Dermatology Online Journal

The Increased Competitiveness of Mohs Micrographic Surgery Training
Jashin J. Wu, Ramsey F. Markus, and Ida F. Orengo
Dermatology Online Journal 8(2): 24

From the Department of Dermatology, Baylor College of Medicine, Houston, Texas

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We have noticed a markedly increased interest in the field of Mohs Micrographic Surgery as a potential career. At least 3 of 9 dermatology residents at Baylor College of Medicine have expressed enthusiasm for the field or are in the process of applying for a fellowship position. It appears that this anecdotal observation is a nation-wide phenomenon, as applicants are facing stiffer competition and a larger applicant pool for a limited number of positions.

In 1995, the Fellowship Match for Mohs Micrographic Surgery was established, and it is provided for the benefit of members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. Its goal is to relieve the pressure of uncoordinated appointments and forced early choices by coordinating fellowship appointments between applicants and programs.

The Fellowship Match for Mohs Micrographic Surgery has kept statistics about the Fellowship Match. More programs have utilized the Fellowship Match from 25 programs with 25 positions in 1995 to 39 programs with 39 positions in 2000. There were 43 applicants in 1995 compared to 65 applicants in 2000. There were 4 unmatched applicants compared to 18 unmatched applicants, respectively. The complete statistical table can be found at www.sfmatch.org.

There are many factors as to why this field is becoming more competitive. With a rapidly expanding burst of knowledge in dermatology and dermatologic surgery, there is less time to devote to both aspects of dermatology. Many graduating residents may feel inadequately trained in surgical procedures that they may encounter in their practices and would prefer additional training.

Some dermatologists believe that the time spent in residency for medical dermatology and dermatologic surgery should be split evenly in half.[1] However, the majority of dermatologists and these authors believe that dermatology residency should provide the basis of the diagnosis of skin disease, as this is the feature that distinguishes the dermatologist from other specialists, and that additional surgical training is best attained through fellowships.[2]

For those who unfortunately do not match, there are less formalized avenues to obtain more extensive surgical training. Preceptorships and other postgraduate instruction and education are some of the other ways available for attaining additional surgical skills. These methods can help one gain practical knowledge and experience in new techniques not available during residency. Other specialists such as ophthalmologists, otolaryngologists, and plastic surgeons often use these methods to further their repertoire of skills. It is the way in which all specialists who completed residencies before 1982 have learned liposuction and in which many dermatologists have learned laser surgery.

Although there is less interest among the Baylor residents for cosmetic or laser fellowship training, we suspect that both fellowships are becoming tougher to enter as well. Since there is no centralized matching service for these fellowships such as the Fellowship Match for Mohs Micrographic Surgery, there is no way to objectively gauge the absolute competitiveness of these fellowships.

References

1. Alam M. Dermatologic surgery training during residency: room for improvement. Dermatol Surgery 2001;27:508-509.

2. Callen JP. Should dermatologic surgery training in residency be expanded? Dermatol Surgery 2001;27:509-510.

© 2002 Dermatology Online Journal