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During the last 5 years, numerous residency training programs in dermatology have undergone significant structural changes. Programs have been disbanded entirely, separated into their component parts, or have merged with nearby programs. The motive force appears to be declining reimbursement flows associated with the ascendancy of contracted managed care, increased government oversight of entitlement programs, and the limiting of patients' access to specialists. In metropolitan areas with multiple training programs, there has been particular pressure to consolidate these programs into more efficient and economically competitive units.¹

Obviously, changes in residency training programs can affect the quality of resident education and the morale of residents.^2-5 Given the fiscal inevitability of mergers and consolidations, it is more realistic to attempt to mitigate the negative consequences rather than avoid change. Unanticipated windfalls for resident training also can occur during times of transition.

In the future, more dermatology programs are likely to face major . . . [Full Text of this Article]

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