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Factors Affecting Academic Leadership in Dermatology

Cutis. 2015 February;95(2):98-102

Although prior studies have examined methods by which to recruit and retain academic dermatologists, few have examined factors that are important for developing academic leaders in dermatology. This study sought to examine characteristics of dermatology residency programs that affect the odds of producing department or division chairs/chiefs and program directors (PDs). Data regarding program size, faculty, grants, alumni residency program attended, lectures, and publications for all accredited US dermatology residency programs were collected. Of the 103 programs examined, 46% had graduated at least 1 chair/chief, and 53% had graduated at least 1 PD. Results emphasize that faculty guidance and research may represent modifiable factors by which a dermatology residency program can increase its graduation of academic leaders.

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Practice Points

Leadership in dermatology is key to the future of academics.
Opportunity for mentorship and research are the most important residency program factors leading to the graduation of future chairs/chiefs and program directors.
The retention of residents and young faculty in academics can be aided by research and scholarly activity.

References

1. Wood LD, Miller JJ, Marks JG Jr. The need for leadership: how can we better train the next generation of dermatologists? J Am Acad Dermatol. 2008;58:715-717.

2. Resneck JS Jr, Tierney EP, Kimball AB. Challenges facing academic dermatology: survey data on the faculty workforce. J Am Acad Dermatol. 2006;54:211-216.

3. Wu JJ, Ramirez CC, Alonso CA, et al. Dermatology residency program characteristics that correlate with graduates selecting an academic dermatology career. Arch Dermatol. 2006;142:845-850.

4. Loo DS, Liu CL, Geller AC, et al. Academic dermatology manpower: issues of recruitment and retention. Arch Dermatol. 2007;143:341-347.

5. Donovan JC. A survey of dermatology residency program directors’ views on mentorship. Dermatol Online J. 2009;15:1.

6. Sambunjak D, Straus SE, Marusi´c A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296:1103-1115.

7. Rubenstein DS, Blauvelt A, Chen SC, et al. The future of academic dermatology in the United States: report on the resident retreat for future physician-scientists, June 15-17, 2001. J Am Acad Dermatol. 2002;47:300-303.

8. Reck SJ, Stratman EJ, Vogel C, et al. Assessment of residents’ loss of interest in academic careers and identification of correctable factors. Arch Dermatol. 2006;142:855-858.

9. Clark RA. Teacher, supervisor, adviser, or mentor? J Invest Dermatol. 2011;131:1779-1780.

10. Wu JJ. Current strategies to address the ongoing shortage of academic dermatologists. J Am Acad Dermatol. 2007;56:1065-1066.

11. Culton DA, Rubenstein DS, Diaz LA. The resident retreat for future academicians. J Invest Dermatol. 2010;130:1775-1777.

12. Wu JJ, Tyring SK. The academic strength of current dermatology residency applicants. Dermatol Online J. 2003;9:22.

13. Kia KF, Gielczyk RA, Ellis CN. Academia is the life for me, I’m sure. Arch Dermatol. 2006;142:911-913.

14. Miller CJ, Wood GC, Miller JJ, et al. Academics or private practice? the future of dermatologic surgery education. Dermatol Surg. 2006;32:70-75, discussion 76-78.

15. Wu JJ, Davis KF, Ramirez CC, et al. Graduates-of-foreign-dermatology residencies and military dermatology residencies and women in academic dermatology. Dermatol Online J. 2009;15:2.

16. Wu JJ, Davis KF, Ramirez CC, et al. MD/PhDs are more likely than MDs to choose a career in academic dermatology. Dermatol Online J. 2008;14:27.

17. Olerud JE. Academic workforce in dermatology. Arch Dermatol. 2007;143:409-410.

18. Turner E, Yoo J, Salter S, et al. Leadership workforce in academic dermatology. Arch Dermatol. 2007;143:948-949.

Leadership is widely recognized as a key component in the role of a physician,¹ which is especially true in dermatology, a specialty that faces severe challenges in the recruitment and retention of academic faculty.² A study of the dermatology workforce found that academic institutions are more likely to be seeking to hire new faculty² and that many dermatology residency programs often are looking to replace chairpersons (chairs) and/or chiefs.³ Although fewer dermatology residents are pursuing academic careers than careers in private practice, full-time faculty members also are leaving their academic posts. This shift is demonstrated by the younger mean age of academic dermatologists² and the increased rate of departure from academia prior to pursuing more formalized leadership roles.⁴

It has been suggested that the number of full-time faculty and number of faculty publications positively influence graduates of dermatology residency programs to pursue academic careers; however, variables affecting the likelihood of graduates of dermatology residency programs becoming academic leaders later in their career have not been well studied.³ The purpose of this study is to determine the factors that influence the development of program chairs/chiefs and program directors (PDs) of dermatology residency programs.

Methods

Data were collected from all accredited dermatology residency programs in the United States as of December 31, 2008. Residency programs that were started after 2004 were excluded from the study, as it was thought that these programs may not have graduated a sufficient number of residents for assessment. Military residency programs also were excluded, as graduates from these programs often do not freely choose their careers after residency.

Primary end points were the number of chairs/chiefs and PDs who had graduated from each dermatology residency program. Variables included the number of years the program had been in existence, status of the program as a department or division, number of full-time faculty members, number of residents, National Institutes of Health funding received in 2008 (http://www.report.nih.gov/award/index.cfm), Dermatology Foundation (DF) funding received (http://www.dermatologyfoundation.org/rap/), number of publications from full-time faculty members in 2008 (http://www.ncbi.nlm.nih.gov/pubmed/), number of faculty lectures given at annual meetings of 5 societies in 2008 (American Academy of Dermatology, the Society for Investigative Dermatology, the American Society of Dermatopathology, the Society for Pediatric Dermatology, and American Society for Dermatologic Surgery), and the number of faculty members on the editorial boards of 6 major dermatology journals (Journal of the American Academy of Dermatology, Journal of Investigative Dermatology, Archives of Dermatology [currently known as JAMA Dermatology], Dermatologic Surgery, Pediatric Dermatology, and Journal of Cutaneous Pathology). Data regarding faculty and residents were obtained from program Web sites and inquiries from individual programs. The year 1974 was used as a cutoff for the number of years a program had been in existence. Years of existence of a program was controlled for in the analysis. The ratio of faculty to residents was calculated per year and categorized as 4 or more or less than 4 to minimize the effect of changing program size over the years. For faculty members who split time between 2 residency programs, each program was given credit for the duration of time spent at that program. Faculty members who hold a PhD only and those who completed their residencies in non-US dermatology residency programs were excluded from the outcome variables. To avoid duplicate faculty publications, collections for each residency program were created within PubMed (ie, if 2 authors from the same program coauthored an article, it was only counted once toward the total number of faculty publications from that program).

Because the data were skewed (ie, there were a large number of programs with 0 graduating chairs/chiefs and PDs), nonparametric analyses were utilized. Logistic regression was used to calculate the odds of producing chairs/chiefs or PDs (yes vs no). Multiple logistic regression helped to determine those variables that were most closely associated with odds of graduating a chair/chief or PD. Variables with a significance level of P<.10 were considered in the multiple logistic regression, and backward selection was used to determine a model. Multiple linear regression was used to determine correlation coefficients for each of the variables and the number of chairs/chiefs or PDs graduated, controlling for the estimated number of graduates from the program and number of years the program had been in existence. Analyses for graduating chairs/chiefs and PDs were conducted separately. The final significance level used was P<.05. Data were analyzed using SAS version 9.3. This study was approved by the institutional review board at Kaiser Permanente Southern California.

Results

Data from 103 dermatology residency programs were included in the analysis. Of these programs, 47 had graduated at least 1 chair/chief and 55 had graduated at least 1 PD. Among the programs graduating any chairs/chiefs, they produced an average of 2.04 chairs/chiefs and 1.86 PDs. The 5 dermatology residency programs that graduated the highest total number of chairs/chiefs and PDs were Harvard University (Cambridge, Massachusetts), the University of Michigan (Ann Arbor, Michigan), New York University (New York, New York), Yale-New Haven Hospital (New Haven, Connecticut), and the University of Minnesota (Minneapolis, Minnesota).