"True, the Board should move with care and caution before taking away a doctor's primary means of support. However, the Board also must consider the risk to consumers, whose health and very existence could be at stake. If there is doubt, deference should be made to safeguarding the life and limb of patients......
.....The Board's mission is to protect consumers by licensing and regulating doctors and other healthcare providers. This means putting consumers first, not doctors.
Dear Friend and Colleagues:
Attached a Miami Herald editorial regarding a Miami doctor whose legal trouble received wide exposure in the local media.
I personally know the doctor and deeply regret his professional trouble and struggle. I am also a volunteer expert witness for the Florida Department of Health, have attended Board meetings and have no doubt that each and every Board member diligently considers the merits of each and every case that is being presented for review.
The Boards mission is to " protect health care consumers by licensing qualified health providers ..[and] .. establishing and enforcing health care standards.."
Doing so the Board often has to navigate the narrow course between Scylla (the physicians right to privacy and guarantee of due process ) and Charybdis ( the consumers protection).
In this process the Board is often accused to be either too hard or too soft on doctors. I can empathize with Board members who feel that that they are damned if they do, damned if they don't.
We need to support the efforts of the Board by being proactive in regulating OURSELVES and not to ignore or tolerate the wrongdoing of a FEW doctors. We should not shy away from either talking to those doctors or utilizing the established channels of notifying the Board of any behavior that violate the high health standards in our community.
I would prefer proactive self-regulation to legal actions imposed on our profession by third parties.
The choice is ours and the reported case in question could have been addressed and resolved before hitting the headlines of a local news paper.
Lets remember that each of us or our family members are healthcare consumers too and may have been or will be harmed by actions or inactions of a fellow doctor who does not abide to the same health care standards that we do. Would we keep our mouth shut? I don't think so. Therefore we should learn from this tragic case in question and draw our own conclusions on how to act in the future.
Yours
Bernd
Posted on Fri, Mar. 21, 2008
Troubled doctor puts patients at risk
It is hard to understand why Miami doctor Alex Zakharia, after facing a string of legal and professional setbacks, still has approval from the state of Florida to practice medicine. Dr. Zakharia, 70, has admitted to suffering memory problems and possible strokes. He has pleaded guilty to lying about his credentials as a heart surgeon and was suspended by a Miami hospital after several of his patients died.
Yet the state Board of Medicine says Dr. Zakharia's license is still good and lists his status as ''clear/active'' on its website.
Dr. Zakharia's travails have been chronicled in news stories for more than a year, and the Board is expected to issue a final order on his status next month. Still, the Board's handling of the case raises the question of whose interest takes precedence, a troubled doctor's or the well-being of unsuspecting healthcare consumers.
When asked about Dr. Zakharia's well-documented troubles, Department of Health spokeswoman Eulinda Jackson told Miami Herald reporter John Dorschner that the Board must follow due process. ''That's the way it works, and for good reason,'' she said.
True, the Board should move with care and caution before taking away a doctor's primary means of support. However, the Board also must consider the risk to consumers, whose health and very existence could be at stake. If there is doubt, deference should be made to safeguarding the life and limb of patients.
In this case, the Board had every reason to be aware of Zakharia's troubles, including his legal problems, and could have issued an emergency suspension. A nurse who worked with the doctor said she complained and sent copies of Miami Herald stories about the doctor's problem to the Board.
Regulating doctors
Florida voters wanted to make sure patients' rights are protected when they passed a constitutional amendment in 2004 that allows disclosure to patients about ''adverse medical events'' in hospitals. The amendment had been tied up in court since passage, but the Florida Supreme Court recently settled matters by affirming that patients have a right to know about mistakes made by doctors and hospitals.
The Board's mission is to protect consumers by licensing and regulating doctors and other healthcare providers. This means putting consumers first, not doctors.
Monday, March 24, 2008
Thursday, March 20, 2008
Florida Plans To Restrict Access For IMGs from Cuba
Dear Friends and Colleagues;
Again, Florida is leading the field in "innovative thinking" regarding International Medical Graduates (IMGs) .
This time a lawmaker introduced a bill that wouldn't allow Americans who get their medical degree in Cuba to practice medicine in Florida The bill is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
Obviously, this bill is based purely on ideological grounds and should be rejected. What's next? Physicians who study abroad at "Muslim schools" or obtained a medical degree from those countries belonging to the "axis of evil."
I call upon the AAFP and AMA to oppose such an action.
Yours
Bernd
Chair, Florida Medical Association IMG Section & Past Chair of the AMA IMG Governing Council
Posted on Tue, Mar. 18, 2008
Bill would make Cuban medical degree worthless
ASSOCIATED PRESS
Americans who get their medical degree in Cuba wouldn't be allowed to practice medicine in Florida under a bill discussed by the House Health Quality Committee.
The panel didn't vote on the bill (HB 685) but could as early as next week.
The measure is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
According to the information provided by Gonzalez, eight American students have graduated from the school and are currently practicing in the United States, but none are working in Florida. Since no graduates of the program have Florida medical licenses, the bill would only affect those graduates who try to become licensed here in the future.
The scholarship program, coordinated by an organization called the Interreligious Foundation for Community Organization, takes advantage of an exception in the U.S. embargo of Cuba for educational programs. The scholarships are open to Americans who go to Cuba for a 6-year medical school program and then agree to return to the United States to practice medicine in poor or underserved communities in the United States.
If the measure were to pass, Florida would be the first U.S. state to bar graduates of the program from practicing medicine here.
Again, Florida is leading the field in "innovative thinking" regarding International Medical Graduates (IMGs) .
This time a lawmaker introduced a bill that wouldn't allow Americans who get their medical degree in Cuba to practice medicine in Florida The bill is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
Obviously, this bill is based purely on ideological grounds and should be rejected. What's next? Physicians who study abroad at "Muslim schools" or obtained a medical degree from those countries belonging to the "axis of evil."
I call upon the AAFP and AMA to oppose such an action.
Yours
Bernd
Chair, Florida Medical Association IMG Section & Past Chair of the AMA IMG Governing Council
Posted on Tue, Mar. 18, 2008
Bill would make Cuban medical degree worthless
ASSOCIATED PRESS
Americans who get their medical degree in Cuba wouldn't be allowed to practice medicine in Florida under a bill discussed by the House Health Quality Committee.
The panel didn't vote on the bill (HB 685) but could as early as next week.
The measure is aimed at students who accept scholarships from the Cuban government to attend the Latin American School of Medical Sciences in Havana. About 150 American students are currently enrolled in the school and would be affected, according to information provided to the committee by the bill sponsor, Rep. Eddy Gonzalez, R-Hialeah.
According to the information provided by Gonzalez, eight American students have graduated from the school and are currently practicing in the United States, but none are working in Florida. Since no graduates of the program have Florida medical licenses, the bill would only affect those graduates who try to become licensed here in the future.
The scholarship program, coordinated by an organization called the Interreligious Foundation for Community Organization, takes advantage of an exception in the U.S. embargo of Cuba for educational programs. The scholarships are open to Americans who go to Cuba for a 6-year medical school program and then agree to return to the United States to practice medicine in poor or underserved communities in the United States.
If the measure were to pass, Florida would be the first U.S. state to bar graduates of the program from practicing medicine here.
Medical Students Vote With Their Feet
"Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors. Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said."
Dear Friends and Colleagues:
Attached an article from todays New York Times reporting about the preference of US medical students to seek out postgraduate training positions in lucrative specialties such as dermatology, ENT and plastic surgery.
I am not opposed to medical students choosing training positions in such specialties. What concerns me that the brightest minds seem to avoid primary care residency training positions which present complex challenges ( example: chronic disease management) that require input of the best and brightest in our profession.
Can we blame them to choose otherwise?According to the NEJM the prevalence of chronic conditions — most of which are handled in primary care settings — is increasing, as are requirements for their proper management. Not only has the number of primary care tasks grown exponentially, but physician performance is being measured and physicians are even being paid according to their ability to perform these tasks reliably and consistently. It has been estimated that it would take 10.6 hours per working day to deliver all recommended care for patients with chronic conditions, plus 7.4 hours per day to provide evidence-based preventive care, to an average panel of 2500 patients (the mean U.S. panel size is 2300)! A seemingly unsurmountable task that requires complex information management systems and the sophisticated staff to implement them. Such primary care experts should be reimbursement properly but they are not!
Our reimbursement system is tilted towards non-primary care specialties.Thirty minutes spent performing a diagnostic, surgical, or imaging procedure often pays three times as much as a 30-minute visit with a patient with diabetes, heart failure, headache, and depression. The median income of specialists in 2004 was almost twice that of primary care physicians, a gap that is widening. In 2004 all visits to primary care physicians (FP,IM, Peds) accounted for almost half of the overall total of 967.3 million office visits but only 30 percent of the $152 billion spent on office-based care. The remaining 70 percent was spent on specialty care. This misalignment of reimbursement causes a shortage in primary care physicians and subsequently creating a population of medically disenfranchised individuals who lack access to medical homes. Fair reimbursement is the first step towards stopping the bleeding of primary care health care services.
Bernd
PS: Happy Purim holiday.
==============================================================================================================
New York Times - March 19, 2008
The Price of Beauty
For Top Medical Students, an Attractive Field
By NATASHA SINGER
BOSTON — March Madness has a different meaning for Thomas Hocker and Meena Singh, a married couple in their final year at the Harvard Medical School, who are waiting to learn Thursday if they have been accepted into their residency programs of choice.
Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.
Ms. Singh, pregnant during interview season, gave birth to their second daughter in early January. Three days later, she flew to Miami for an interview.
The search has been difficult not because they are mediocre students; indeed, each has a brand-name education, academic honors and published research on disease. No, it has been hard because they aspire to be dermatologists.
As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance — dermatology and plastic surgery — are among the most competitive.
Only 61 percent of seniors at American medical schools whose first choice was dermatology received a residency in that field last year, compared with 98 percent for those whose first choice was internal medicine and 99 percent for those seeking family medicine, according to a report by the Association of American Medical Colleges and the National Resident Matching Program, which pairs candidates and programs. Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors.
Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said.
The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours.
“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.
“We have a shortage in America of primary-care or family-type doctors,” said Dr. Joel M. Felner, a cardiology professor who is the associate dean for clinical education at Emory University School of Medicine in Atlanta. Last year, the school enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care, he said. “We do need dermatologists, but I am more worried about the really sick people and dermatologists aren’t taking care of them,” Dr. Felner said.
Until recently, saving skin did not have the cachet of saving lives. Doctors in other fields jokingly dismissed dermatology as a province of red-spot diseases that could not really be cured, but weren’t going to kill patients. Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery.
But dermatology’s status is rising, not just for the pay, hours and independence, but also because of the growing variety of treatments and devices in this fast-developing field that can help people in a looks-obsessed world. At a time of increased discussion of enhancing beauty, as well as narrowing standards for skin perfection, the public has a newfound esteem for doctors who treat appearance.
“People greatly value the skin because it is what is on the outside that is the face you present to the world,” Mr. Hocker said one evening last month after coming off a hospital shift in which he dealt with afflictions like heart failure and kidney failure. “Most dermatological diseases won’t kill you, but they can greatly affect your quality of life.”
Some dermatology professors said the growing allure of their field among medical students has raised the bar for applicants over the last decade. “Dermatology has always attracted bright students,” said Dr. Harley A. Haynes, a dermatology professor at the Harvard Medical School who has been mentoring medical students there since 1970. “But now we are getting more of the brightest and the best.”
Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today.
A Psychological Lifeline
For an idea of the competition facing dermatology aspirants, consider the application numbers. Last fall, 383 people applied for 6 places — an average of about 64 applicants per spot — in Harvard’s dermatology program. By comparison, Harvard College received an average of 11 applications per offer of admission in the class of 2010.
Mr. Hocker and Ms. Singh were well prepared for the Darwinian process of landing a dermatology residency when they met as classmates at the Harvard Medical School in 2003. Mr. Hocker, 27, holds a graduate degree from Cambridge University and an undergraduate degree in chemistry from Yale, where he was a champion hurdler. Ms. Singh, 26, was in several honor societies as a biomedical engineering student at the University of Southern California.
During her senior year, she competed on an MTV reality show called “Sorority Life,” but was ejected midseason for being too studious.
“In one scene, you see her all happy getting the acceptance letter from Harvard and in the next scene, you see her crying up a storm because she has been de-pledged from the sorority,” Mr. Hocker recalled fondly.
Neither student had planned to become a skin specialist.
Growing up in Kansas City, Kan., Ms. Singh loved visiting the hospital with her mother, an internist with long relationships with a diverse group of patients. Ms. Singh said she initially planned to emulate her mother, a physician who focuses on treating major adult diseases.
A lecture on skin-pigment conditions like vitiligo changed her mind.
“Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color,” Ms. Singh said. “Having something on your skin is not life or death for people, but it can be equally important for them emotionally as a life-threatening disease.”
Indeed, dermatology can be a psychological lifeline for people with severe skin problems. At pools or the beach, some people shun those with psoriasis who have scaly skin, fearing the condition is contagious, doctors said. People with deep acne scars say it affects their personal and professional lives.
Then there is the growing popularity among otherwise healthy people of tweaking one’s appearance with cosmetic treatments, from Botox injections to lip plumping and laser hair removal. Plastic surgeons, dermatologists and facial surgeons in the United States performed about 9.6 million such nonsurgical treatments in 2007, almost nine times the number a decade earlier, according to the American Society for Aesthetic Plastic Surgery.
‘Your Input Is Valued’
Mr. Hocker was finally sold on dermatology last year, while on a clinical rotation during which neurosurgeons called him and a dermatology resident to an intensive-care ward for a consultation. A patient, in a coma after surgery, was covered with mysterious red half-moon-shaped blisters. They could not determine the cause. Then Dr. Haynes of Harvard arrived.
“Dr. Haynes comes in and he is like a walking CAT scan, who eyeballs her from head to toe and has the diagnosis in 15 seconds,” Mr. Hocker said. The verdict: a rare blistering disorder caused by an allergy to an antibiotic.
Mr. Hocker said he liked the idea of drawing independent conclusions without tests or consultations with other doctors.
“The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol,” Mr. Hocker said. “But there is not a lot of respect for doctors who do that because anyone can get into it. But if you are an expert where no one else is, like the eye or the skin, your input is valued.”
Dermatology also attracts students like Mr. Hocker because of the potential for basic research on skin diseases that can lead to new treatments. Mr. Hocker said he plans to focus his career on researching the role of genetics in problems like skin cancer and abnormal scarring; he took a year off during medical school to conduct melanoma research.
While students like Mr. Hocker choose dermatology planning on research careers, others end up focusing on cosmetic treatments like skin tightening and resurfacing. Half of the dermatology residents graduating over the last five years from the program at the Boston Medical Center have chosen postgraduate fellowships that teach a combination of skin-cancer operations and cosmetic procedures, according to Dr. Barbara A. Gilchrest, the chairwoman of dermatology at Boston University School of Medicine.
Work Less, Earn More
Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.
But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.
And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.
For thousands of medical students nationwide, especially those trying to enter the most competitive fields, this week — when residency acceptances are announced — has been fraught with tension. The National Resident Matching Program uses an algorithm to pair applicants with the one program they have ranked highest that also preferred them, a system that leaves some applicants disappointed.
Mr. Hocker and Ms. Singh face even longer odds because they entered the match process as a couple, seeking positions at the same program, or at least in the same region.
On Monday, when applicants learned whether they had been paired with a program at all, Mr. Hocker and Ms. Singh found out they will each obtain a residency. Thursday, they find out where.
“My friends going into general medicine and general surgery pretty much have an idea that they are going to be at their No. 1 or No. 2 school,” Ms. Singh said. “But we really could be anywhere in the country, together or not together.”
She added: “We would have a better chance of winning ‘American Idol.’ ”
Dear Friends and Colleagues:
Attached an article from todays New York Times reporting about the preference of US medical students to seek out postgraduate training positions in lucrative specialties such as dermatology, ENT and plastic surgery.
I am not opposed to medical students choosing training positions in such specialties. What concerns me that the brightest minds seem to avoid primary care residency training positions which present complex challenges ( example: chronic disease management) that require input of the best and brightest in our profession.
Can we blame them to choose otherwise?According to the NEJM the prevalence of chronic conditions — most of which are handled in primary care settings — is increasing, as are requirements for their proper management. Not only has the number of primary care tasks grown exponentially, but physician performance is being measured and physicians are even being paid according to their ability to perform these tasks reliably and consistently. It has been estimated that it would take 10.6 hours per working day to deliver all recommended care for patients with chronic conditions, plus 7.4 hours per day to provide evidence-based preventive care, to an average panel of 2500 patients (the mean U.S. panel size is 2300)! A seemingly unsurmountable task that requires complex information management systems and the sophisticated staff to implement them. Such primary care experts should be reimbursement properly but they are not!
Our reimbursement system is tilted towards non-primary care specialties.Thirty minutes spent performing a diagnostic, surgical, or imaging procedure often pays three times as much as a 30-minute visit with a patient with diabetes, heart failure, headache, and depression. The median income of specialists in 2004 was almost twice that of primary care physicians, a gap that is widening. In 2004 all visits to primary care physicians (FP,IM, Peds) accounted for almost half of the overall total of 967.3 million office visits but only 30 percent of the $152 billion spent on office-based care. The remaining 70 percent was spent on specialty care. This misalignment of reimbursement causes a shortage in primary care physicians and subsequently creating a population of medically disenfranchised individuals who lack access to medical homes. Fair reimbursement is the first step towards stopping the bleeding of primary care health care services.
Bernd
PS: Happy Purim holiday.
==============================================================================================================
New York Times - March 19, 2008
The Price of Beauty
For Top Medical Students, an Attractive Field
By NATASHA SINGER
BOSTON — March Madness has a different meaning for Thomas Hocker and Meena Singh, a married couple in their final year at the Harvard Medical School, who are waiting to learn Thursday if they have been accepted into their residency programs of choice.
Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.
Ms. Singh, pregnant during interview season, gave birth to their second daughter in early January. Three days later, she flew to Miami for an interview.
The search has been difficult not because they are mediocre students; indeed, each has a brand-name education, academic honors and published research on disease. No, it has been hard because they aspire to be dermatologists.
As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance — dermatology and plastic surgery — are among the most competitive.
Only 61 percent of seniors at American medical schools whose first choice was dermatology received a residency in that field last year, compared with 98 percent for those whose first choice was internal medicine and 99 percent for those seeking family medicine, according to a report by the Association of American Medical Colleges and the National Resident Matching Program, which pairs candidates and programs. Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors.
Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields — plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) — had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said.
The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients — and the lives of physicians, with better pay, more autonomy and more-controllable hours.
“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.
“We have a shortage in America of primary-care or family-type doctors,” said Dr. Joel M. Felner, a cardiology professor who is the associate dean for clinical education at Emory University School of Medicine in Atlanta. Last year, the school enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care, he said. “We do need dermatologists, but I am more worried about the really sick people and dermatologists aren’t taking care of them,” Dr. Felner said.
Until recently, saving skin did not have the cachet of saving lives. Doctors in other fields jokingly dismissed dermatology as a province of red-spot diseases that could not really be cured, but weren’t going to kill patients. Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery.
But dermatology’s status is rising, not just for the pay, hours and independence, but also because of the growing variety of treatments and devices in this fast-developing field that can help people in a looks-obsessed world. At a time of increased discussion of enhancing beauty, as well as narrowing standards for skin perfection, the public has a newfound esteem for doctors who treat appearance.
“People greatly value the skin because it is what is on the outside that is the face you present to the world,” Mr. Hocker said one evening last month after coming off a hospital shift in which he dealt with afflictions like heart failure and kidney failure. “Most dermatological diseases won’t kill you, but they can greatly affect your quality of life.”
Some dermatology professors said the growing allure of their field among medical students has raised the bar for applicants over the last decade. “Dermatology has always attracted bright students,” said Dr. Harley A. Haynes, a dermatology professor at the Harvard Medical School who has been mentoring medical students there since 1970. “But now we are getting more of the brightest and the best.”
Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today.
A Psychological Lifeline
For an idea of the competition facing dermatology aspirants, consider the application numbers. Last fall, 383 people applied for 6 places — an average of about 64 applicants per spot — in Harvard’s dermatology program. By comparison, Harvard College received an average of 11 applications per offer of admission in the class of 2010.
Mr. Hocker and Ms. Singh were well prepared for the Darwinian process of landing a dermatology residency when they met as classmates at the Harvard Medical School in 2003. Mr. Hocker, 27, holds a graduate degree from Cambridge University and an undergraduate degree in chemistry from Yale, where he was a champion hurdler. Ms. Singh, 26, was in several honor societies as a biomedical engineering student at the University of Southern California.
During her senior year, she competed on an MTV reality show called “Sorority Life,” but was ejected midseason for being too studious.
“In one scene, you see her all happy getting the acceptance letter from Harvard and in the next scene, you see her crying up a storm because she has been de-pledged from the sorority,” Mr. Hocker recalled fondly.
Neither student had planned to become a skin specialist.
Growing up in Kansas City, Kan., Ms. Singh loved visiting the hospital with her mother, an internist with long relationships with a diverse group of patients. Ms. Singh said she initially planned to emulate her mother, a physician who focuses on treating major adult diseases.
A lecture on skin-pigment conditions like vitiligo changed her mind.
“Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color,” Ms. Singh said. “Having something on your skin is not life or death for people, but it can be equally important for them emotionally as a life-threatening disease.”
Indeed, dermatology can be a psychological lifeline for people with severe skin problems. At pools or the beach, some people shun those with psoriasis who have scaly skin, fearing the condition is contagious, doctors said. People with deep acne scars say it affects their personal and professional lives.
Then there is the growing popularity among otherwise healthy people of tweaking one’s appearance with cosmetic treatments, from Botox injections to lip plumping and laser hair removal. Plastic surgeons, dermatologists and facial surgeons in the United States performed about 9.6 million such nonsurgical treatments in 2007, almost nine times the number a decade earlier, according to the American Society for Aesthetic Plastic Surgery.
‘Your Input Is Valued’
Mr. Hocker was finally sold on dermatology last year, while on a clinical rotation during which neurosurgeons called him and a dermatology resident to an intensive-care ward for a consultation. A patient, in a coma after surgery, was covered with mysterious red half-moon-shaped blisters. They could not determine the cause. Then Dr. Haynes of Harvard arrived.
“Dr. Haynes comes in and he is like a walking CAT scan, who eyeballs her from head to toe and has the diagnosis in 15 seconds,” Mr. Hocker said. The verdict: a rare blistering disorder caused by an allergy to an antibiotic.
Mr. Hocker said he liked the idea of drawing independent conclusions without tests or consultations with other doctors.
“The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol,” Mr. Hocker said. “But there is not a lot of respect for doctors who do that because anyone can get into it. But if you are an expert where no one else is, like the eye or the skin, your input is valued.”
Dermatology also attracts students like Mr. Hocker because of the potential for basic research on skin diseases that can lead to new treatments. Mr. Hocker said he plans to focus his career on researching the role of genetics in problems like skin cancer and abnormal scarring; he took a year off during medical school to conduct melanoma research.
While students like Mr. Hocker choose dermatology planning on research careers, others end up focusing on cosmetic treatments like skin tightening and resurfacing. Half of the dermatology residents graduating over the last five years from the program at the Boston Medical Center have chosen postgraduate fellowships that teach a combination of skin-cancer operations and cosmetic procedures, according to Dr. Barbara A. Gilchrest, the chairwoman of dermatology at Boston University School of Medicine.
Work Less, Earn More
Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.
But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.
And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.
For thousands of medical students nationwide, especially those trying to enter the most competitive fields, this week — when residency acceptances are announced — has been fraught with tension. The National Resident Matching Program uses an algorithm to pair applicants with the one program they have ranked highest that also preferred them, a system that leaves some applicants disappointed.
Mr. Hocker and Ms. Singh face even longer odds because they entered the match process as a couple, seeking positions at the same program, or at least in the same region.
On Monday, when applicants learned whether they had been paired with a program at all, Mr. Hocker and Ms. Singh found out they will each obtain a residency. Thursday, they find out where.
“My friends going into general medicine and general surgery pretty much have an idea that they are going to be at their No. 1 or No. 2 school,” Ms. Singh said. “But we really could be anywhere in the country, together or not together.”
She added: “We would have a better chance of winning ‘American Idol.’ ”
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