To the Editor:
Bandiera and colleagues1 have presented a framework for residency selection that suggests that programs and institutions identify “their social mandates and establish selection criteria based on these mandates.” In this way, aligning program focus with social accountability in different programs’ selection practices will lead to an appropriately diverse physician workforce. However, simply selecting program-relevant trainees will not be sufficient to meet the needs of patients or demands on the physician workforce.
With a shortage of physicians looming in our future,2 we have become increasingly concerned about reductions in the available pool of clinician–educators to train larger numbers of future physicians. In dermatology, for example, 6% of physicians practice in an academic environment. Economic factors and issues in recruitment and retention have been identified as sources of declining numbers of dermatologists within academia.3,4 Dermatology is not alone in this. Medicine in general has experienced a reduction in the number of physicians in academic practice due to similar underlying issues.5 These problems create unwelcomed fluctuations in faculty numbers and ability to teach.
To address this critical gap in academic educators, we have proposed and are implementing a unique residency program model that emphasizes support in the transition from trainee to junior faculty member. In such a program, residency is linked to a faculty appointment at the same institution upon completion of training. Junior faculty will be provided with career development courses and structured mentorship. While this model is not feasible for every program, there will be programs in many specialties that identify with a mandate to create academic leaders and educators. This setup facilitates selection of residency candidates with similar goals.
We are piloting such a model within our residency program with the first class to begin their three years of dermatology training in July 2016, followed by a (minimum) three-year term on faculty.6,7 We plan to provide our trainees with the tools they need to succeed as strong academic leaders and educators and, in so doing, fill a much-needed gap in the physician workforce. Such a program might similarly serve the institutional or regional needs of other specialties.
Rhoda M. Alani, MD
Herbert Mescon Endowed Professor and Chair, Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts; firstname.lastname@example.org.
Allison Larson, MD
Assistant dean of academic affairs and assistant professor in dermatology, Boston University School of Medicine, Boston, Massachusetts.
Vincent Falanga, MD
Professor of dermatology and residency program director, Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts.
1. Bandiera G, Abrahams C, Ruetalo M, Hanson MD, Nickell L, Spadafora S. Identifying and promoting best practices in residency application and selection in a complex academic health network. Acad Med. 2015;90:15941601.
2. Dall T, West T, Chakrabarti R, Iacobucci W. The Complexities of Physician Supply and Demand: Projections From 2013 to 2025. 2015. Washington, DC: Association of American Medical Colleges/IHS Inc.https://www.aamc.org/download/426248/data/thecomplexitiesofphysiciansupply anddemand projectionsfrom2013to2.pdf
. Accessed April 19, 2016.
3. Resneck JS Jr, Tierney EP, Kimball AB. Challenges facing academic dermatology: Survey data on the faculty workforce. J Am Acad Dermatol. 2006;54:211216.
4. Loo DS, Liu CL, Geller AC, Gilchrest BA. Academic dermatology manpower: Issues of recruitment and retention. Arch Dermatol. 2007;143:341347.
5. Kubiak NT, Guidot DM, Trimm RF, Kamen DL, Roman J. Recruitment and retention in academic medicine—what junior faculty and trainees want department chairs to know. Am J Med Sci. 2012;344:2427.