Access to pediatric derm services can be improved with more mentorship support

Just over four decades have passed since the first International Symposium of Pediatric Dermatology in Mexico City ushered in a formal beginning to this subspecialty field in October 1972 (Ruiz-Maldonado R. Arch Dermatol. 2000;136(1):84).

When the Society for Pediatric Dermatology (SPD) was formed in 1972 with 21 founding members, those identified as pediatric dermatologists came from a mixture of backgrounds, with training in pediatrics, dermatology, and often both (Weston WL. Curr Probl Dermatol. 2000;12(3):109-111).  A survey of pediatric and dermatology residency programs indicated that in 1986, although half of pediatric dermatologists were board-certified in both pediatrics and dermatology, only 14 percent of pediatric dermatologists saw children exclusively (Honig PJ, Burke L. J Am Acad Dermatol. 1986;15(1):123-126). Today, although many pediatric dermatologists work in blended practices seeing adults and children, larger numbers now work at dedicated children’s hospitals.

The establishment of formal board certification of pediatric dermatology by the American Board of Dermatology in 2004, and a formal fellowship match process in 2009, has helped to spur interest in the subspecialty. In 2004, despite the availability of 11 advertised fellowship programs, only six pediatric dermatology fellows were in training (Hester EJ, McNealy KM, Kelloff JN, et al. J Am Acad Dermatol. 2004;50(3):431-434). This number had increased modestly to eight fellows in 2006 (Craiglow BG, Resneck JS, Lucky AW. J Am Acad Dermatol. 2008;59(6):986-989). By 2012, however, there were 20 participating fellowship programs that had successfully matched 21 fellowship applicants (Match data from Society for Pediatric Dermatology).

Growth, but not enough

The Society for Pediatric Dermatology has likewise seen tremendous growth in its membership, from 250 in 1985, to 325 in 1988, 650 in 2000, and the society inducted its one-thousandth member in 2012. In July 2013, the SPD will be hosting its 39th annual meeting in Milwaukee.

Despite burgeoning interest in the field, the demand for pediatric dermatology services continues to remain high and outstrip existing supply. Surveys of dermatology institutions have shown an increasing number of training programs seeking to fill open positions in pediatric dermatology. In 2004, 24 programs were actively recruiting for a pediatric dermatologist, and by 2008, this had grown to 34.

At my own institution, our wait times for new pediatric dermatology patients with two full-time clinicians on staff was as long as 15 months back in 2004. Now that we have been fortunate to recruit six full-time attending clinicians and one physician assistant, our wait times for new patient visits have diminished to a more reasonable three to four months.

Challenges also exist within the field of pediatric dermatology as a result of increasing pressure for sub-specialization as a response to the growing complexity and sophistication of the diseases managed by pediatric dermatologists. As areas such as pediatric procedural dermatology, pediatric dermatopathology, pediatric contact dermatology, and inpatient consultative dermatology mature, the demand for subspecialists in this field will likely only increase over time.

Seeking solutions

Exactly how to appropriately address the pediatric dermatology work force shortage remains an active area of interest among my colleagues. Some of this could be accomplished by making pediatric dermatology a training priority of dermatology residency programs and stimulating interest among medical students through available rotations and research opportunities in pediatric dermatology. Doing so at pediatric training programs and encouraging the hiring of new pediatric dermatology faculty would also stimulate a career interest among pediatric trainees.

Perhaps most important is increasing mentorship opportunities for pediatric dermatologists to interact with trainees early on in their training among medical students, dermatology residents and pediatric residents, especially in light of research that the number of residents pursuing careers in pediatric dermatology is directly influenced by the number of pediatric dermatologists on faculty at their institution.

Existing opportunities for mentorship and pediatric dermatology outreach, sponsored by organizations such as the American Academy of Dermatology, the Society for Pediatric Dermatology, the Women’s Dermatology Society, the American Dermatological Association, the American Academy of Pediatrics, and the Society for Pediatric Research (American Pediatric Societies), should be further encouraged and supported. If access to pediatric dermatology services cannot be improved through measures such as these, training programs to support pediatricians to train in pediatric dermatology via a pathway outside of conventional dermatology residencies may need to be seriously considered. DT

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