Abstract
This cohort study examines associations between demographic, academic, and publication factors and dermatology trainees’ initial choice of academic vs private practice careers.
Strengthening the academic dermatology workforce is an issue that faces challenges in both recruitment and retention of dermatologists.1 There has been considerable interest in identifying factors associated with dermatology trainees’ entry into academics.2,3 As research productivity and publications represent key elements in academia, these components may help assess trainees’ potential to pursue academic dermatology. We examined associations between demographic, academic, and publication factors and dermatology trainees’ initial choice of academic vs private practice careers.
Methods
We conducted a retrospective analysis of 416 graduates of US dermatology residencies certified by the American Board of Dermatology in 2015 and their career choices as of July 1, 2017. Graduates of military-affiliated residency programs (N = 19) were excluded, given possible military-specific postresidency trajectories; 5 individuals who did not hold attending-level positions as of July 1, 2017, were also excluded. Sex, graduate degree(s) obtained, medical school and residency attended, and postresidency fellowship(s) completed were identified from publicly available information. Publication records for each individual were obtained using comprehensive PubMed database searches (https://www.pubmed.gov). Preresidency publications (PRPs) were defined as publications indexed by PubMed before dermatology residency (prior to 2012) and in-residency publications were defined as publications indexed by PubMed during dermatology residency (2012-2015). PubMed searches were supplemented by internet searches identifying alternative names associated with each individual to ensure accurate authorship attribution. Academic dermatology career choice was defined as a staff position at an institution directly affiliated with a dermatology residency program. Statistical analysis was performed using SPSS (IBM Analytics); P < .05 (2-sided) was the threshold for statistical significance. This study was deemed exempt by the Partners Healthcare Institutional Review Board. The data were collected from publicly available information such as employer webpages and personal professional profiles; therefore, participant consent was not applicable to this study.
Results
Among the study cohort of 392 individuals, 133 (33.9%) held academic positions and 259 (66.1%) held private practice attending positions (Table 1). Sex was not statistically associated with choice of academic career (odds ratio [OR], 1.20; 95% CI, 0.77-1.87; P = .44). Completion of a PhD (OR, 2.81; 95% CI, 1.29-6.14; P = .009) and completion of another advanced degree (OR 1.98; 95% CI, 1.00-3.91; P = .05) were both associated with increased likelihood of entering academic careers (Table 1). Individuals who attended medical schools affiliated with a top 25 National Institutes of Health–funded institution were significantly more likely to choose academic careers (OR, 1.99; 95% CI, 1.24-3.18; P = .004), as were those who attended residency programs affiliated with a top 25 National Institutes of Health–funded institution (OR, 1.68; 95% CI, 1.09-2.59; P = .02). There was no association between fellowship completion and subsequent academic career choice.
Table 1. Demographic Characteristics and Choice of Academic Career.
| Characteristic | Individuals, No. (%) | Academic Career, OR (95% CI) | P Value | ||
|---|---|---|---|---|---|
| Individuals (% of Overall Cohort) | Academic Career (% of Category) | Private Practice (% of Category) | |||
| 2015 Dermatology residency graduates | 392 (100) | 133 (33.9) | 259 (66.1) | NA | NA |
| Sex | |||||
| Female | 261 (66.6) | 92 (35.2) | 169 (64.8) | 1.20 (0.77-1.87) | .44 |
| Male | 131 (33.4) | 41 (31.3) | 90 (68.7) | 1 [Reference] | |
| PhD | |||||
| Yes | 28 (7.1) | 16 (57.1) | 12 (42.9) | 2.81 (1.29-6.14) | .009 |
| No | 364 (92.9) | 117 (32.1) | 247 (67.9) | 1 [Reference] | |
| Other advanced degree | |||||
| Yes | 37 (9.4) | 18 (48.6) | 19 (51.4) | 1.98 (1.00-3.91) | .05 |
| No | 355 (90.6) | 115 (32.4) | 240 (67.6) | 1 [Reference] | |
| Medical school at top 25 NIH-funded institutiona | |||||
| Yes | 98 (25.0) | 45 (45.9) | 53 (54.1) | 1.99 (1.24-3.18) | .004 |
| No | 294 (75.0) | 88 (29.9) | 206 (70.1) | 1 [Reference] | |
| Residency at top 25 NIH-funded institutiona | |||||
| Yes | 137 (34.9) | 57 (41.6) | 80 (58.4) | 1.68 (1.09-2.59) | .02 |
| No | 255 (65.1) | 76 (29.8) | 179 (70.2) | 1 [Reference] | |
| Completed fellowship | |||||
| Yes | 100 (25.5) | 37 (37.0) | 63 (63.0) | 1.20 (0.75-1.93) | .45 |
| No | 292 (74.5) | 96 (32.9) | 196 (67.1) | 1 [Reference] | |
Abbreviations: NIH, National Institutes of Health; OR, odds ratio.
As reported by the National Institutes of Health for calendar year 2015 (https://www.report.nih.gov/award/index.cfm [accessed September 7, 2017]).
A total of 1082 PRPs and 1229 in-residency publications were analyzed (Table 2). The study cohort had a mean of 2.6 PRPs (range, 0-26), including a mean of 1.7 dermatology-specific PRPs (range, 0-24). Individuals with PhDs had significantly more total PRPs than those without PhDs (7.1 vs 1.7; P < .001), but there was no significant difference between these 2 groups in dermatology-specific PRPs. The mean number of in-residency publications was 2.95 (range, 0-35), with no significant difference between individuals with and without PhDs.
Table 2. Preresidency and In-Residency Publications and Association With Choice of Academic Careera.
| No. of Publications | Residents, No. (%) | Academic Career, OR (95% CI) | P Value | |
|---|---|---|---|---|
| Who Chose Academic Career (n=133) | Who Chose Private Practice Career (n=259) | |||
| Preresidency publications | ||||
| ≥1 | 100 (75.2) | 180 (69.5) | 1.33 (0.83-2.14) | .24 |
| ≥2 | 80 (60.2) | 113 (43.6) | 1.95 (1.28-2.98) | .002 |
| ≥4 | 45 (33.8) | 53 (20.5) | 1.99 (1.23-3.18) | .004 |
| Dermatology-specific preresidency publicationsb | ||||
| ≥1 | 78 (58.6) | 149 (57.5) | 1.05 (0.69-1.60) | .84 |
| ≥2 | 54 (40.6) | 85 (32.8) | 1.40 (0.91-2.16) | .13 |
| ≥4 | 25 (18.8) | 29 (11.2) | 1.84 (1.03-3.29) | .04 |
| In-residency publications | ||||
| ≥1 | 112 (84.2) | 215 (83.0) | 1.09 (0.62-1.93) | .76 |
| ≥2 | 91 (68.4) | 153 (59.1) | 1.50 (0.97-2.33) | .07 |
| ≥4 | 63 (47.4) | 97 (37.5) | 1.61 (1.03-2.51) | .04 |
Abbreviation: OR, odds ratio.
Classification of preresidency and in-residency publications was determined by publication year; therefore in-residency publications may occasionally also reflect academic work completed prior to residency training.
Dermatology-specific preresidency publications were defined as publications examining a cutaneous condition or published in a dermatology journal.
Individuals with 2 or more PRPs were significantly more likely than those with 1 PRP or fewer to pursue an academic career (OR, 1.95; 95% CI, 1.28-2.98; P = .002). Individuals with 4 dermatology-specific PRPs or more were significantly more likely than individuals with 3 dermatology-specific PRPs or fewer to choose academics (OR, 1.84; 95% CI, 1.03-3.29; P = .04). Finally, having 4 in-residency publications or more was statistically associated with academic career choice (OR, 1.61; 95% CI, 1.03-2.51; P = .04).
Discussion
This study represents the first nationwide analysis of factors associated with dermatology trainees’ entrance into academic dermatology careers. Preresidency publications represent a significant factor in the residency selection process for dermatology trainees4; our analysis suggests that PRPs may be indicative of trainees’ interest in academic practice. Our findings regarding the association between preresidency and in-residency academic productivity and pursuit of academic careers are consistent with trends observed in several other specialties.5,6 Causes of this observed association warrant further investigation, but are likely multifactorial and may include trainees’ access to mentorship and skills training pertinent to academia such as study design and writing manuscripts. Overall, this study offers insights for identifying and encouraging trainee entry into academic dermatology.
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