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Residency Applications and Identification of Factors Associated With Residents’ Ultimate Career Decisions
Jean L. Lim, MD;
Alexandra B. Kimball, MD, MPH
Arch Dermatol. 2009;145(8):943-944.
Dermatology is fortunate to attract the most accomplished residency applicants.1 Given the small workforce size and relative shortage of academic dermatologists, it is important to study the residency selection processes to better understand the factors that influence a resident's eventual career choice.2
Methods
This study is a retrospective review of the application files of former residents from the Harvard Combined Dermatology Residency Program, which graduates the greatest proportion of academic dermatologists in the country.3 The study was approved by the institutional review board of Massachusetts General Hospital. Included were all graduates who had completed their residencies between 1991 and 2005 and had residency applications on file in the department records.
The graduates were divided into 2 groups based on their workplaces as of August 2008: (1) those working in academic settings, defined as research-based or clinician-educator–based positions; and (2) those working in nonacademic settings, defined as full-time private practice, private practice with part-time academic teaching, or industry. Numerous factors were recorded in a deidentified manner from each applicant's file (Table 1).
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Table 1. Results of Univariate Analysisa
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The study was powered to show a difference in proportions that exceeded a delta of 0.4 and a difference in continuous variables that exceeded a delta of 2.2, with a power of 0.8 and P = .05. The  2 and t tests were used to analyze the appropriate variables. Stated career interest and black race were factors excluded from the multivariate analysis because the frequency of their occurrence was insufficient for adequate analysis.
Results
Eighty-nine individuals graduated from the residency program between 1991 and 2005. Three graduates had missing applications, and 1 graduate's workplace could not be determined. Of the 85 eligible graduates, 31 worked in an academic setting (37%) and 54 worked in a nonacademic setting (64%).
In univariate analyses, the number of publications, number of months spent doing full-time research activities, number of volunteer experiences, attainment of an advanced degree, and being of Asian ancestry were significantly associated with working in an academic setting after residency (Table 1).
In the multivariate model (Table 2), after adjusting for all factors found to have P < .10 in the univariate analysis as well as age and sex, we found that the number of research publications, the number of volunteer experiences, and possession of an advanced degree in addition to a medical degree were significantly associated with a current career in academia. Graduates in the academic group published an average of 5.2 articles per person at the time of application compared with 1.9 articles per person in the nonacademic group.
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Table 2. Results of Multivariate Analysisa
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Comment
Thirty-seven percent of the residents evaluated in this study were pursuing an academic career (n = 31), a substantially higher proportion than the approximately 6% to 9% of US dermatologists currently in academia.2-3 Our findings corroborate those of other studies suggesting that dermatology residents with an MD and a PhD degree are more likely to enter academia.4 However, the number of publications prior to residency, independent of advanced degree status, was also associated with an academic career choice. The graduates in academia were also more likely to have extensive volunteer experiences prior to residency. We defined volunteer activities as community service–oriented activities that were not financially compensated. Individuals who choose a career in academia may place less importance on monetary compensation, though the nonmonetary rewards in academia are often perceived to be greater.5
This study has several limitations. The data are from a single institution and may not be generalizable. Changes in workplaces over time could not be determined. The data were based on each graduate's application and curriculum vitae, and were not always uniform in presentation or detail. Finally, there is no way to determine the equivalence of various research, leadership, and volunteer experiences in terms of quality or content.
We believe that many factors are involved in a career decision, including many variables that are not available or easily measurable in a residency application. However, our data suggest that individuals with a strong research background and a commitment to volunteerism may be more likely to choose an academic career. By creating an environment during residency that supports these types of pursuits, dermatology residency programs might be better equipped to address the shortage of dermatologists in academic dermatology.
AUTHOR INFORMATION
Correspondence: Dr Lim, 330 Brookline Ave, Second Floor, Boston, MA 02215 (jlim1{at}bidmc.harvard.edu).
Author Contributions: Drs Lim and Kimball had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Lim and Kimball. Acquisition of data: Lim. Analysis and interpretation of data: Lim and Kimball. Drafting of the manuscript: Lim. Critical revision of the manuscript for important intellectual content: Lim and Kimball. Statistical analysis: Lim and Kimball. Administrative, technical, and material support: Lim and Kimball. Study supervision: Kimball.
Financial Disclosure: None reported.
Funding/Support: This study was supported in part by the Harvard Dermatology Residency Program and the Clinical Unit in Research Trials in Skin (CURTIS), Massachusetts General Hospital and Brigham and Women's Hospital.
Role of the Sponsors: The sponsors had no role in the design or conduct of the study; in the collection, analysis, or interpretation of data; or in the preparation, review, or approval of the manuscript.
Additional Contributions: Diane Kovacev and Mary Jane Arenberg gave administrative assistance in providing access to the relevant department records.
REFERENCES
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1. Jolly P. Charting outcomes in the match: characteristics of applicants who matched in their preferred specialty in the 2005 NMRP main residency match. http://www.nrmp.org/data/matchoutcomes2006.pdf. Accessed March 14, 2009.
2. Resneck JS Jr, Tierney EP, Kimball AB. Challenges facing academic dermatology: survey data on the faculty workforce. J Am Acad Dermatol. 2006;54(2):211-216.
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3. Wu JJ, Ramirez CC, Alonso CA, Mendoza N, Berman B, Tyring SK. Dermatology residency program characteristics that correlate with graduates selecting an academic dermatology career. Arch Dermatol. 2006;142(7):845-850.
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4. Wu JJ, Davis KF, Ramirez CC, Alonso CA, Berman B, Tyring SK. MD/PhDs are more likely than MDs to choose a career in academic dermatology. Dermatol Online J. 2008;14(1):27.
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5. Olerud JE. Academic workforce in dermatology. Arch Dermatol. 2007;143(3):409-410.
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