Diverse paths bring unique experience, perspective

Editor's note: Every month in Residents' Forum, a dermatologist in practice or academia discusses clinical and practice management issues affecting residents. If you're a resident and would like to see specific issues covered in this column, please e-mail the editor at mhrehocik@advanstar.com
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There are many different ways to achieve success in dermatology practice, and many different metrics by which to measure it.

However, personal fulfillment may be the most meaningful endpoint. Therefore, physicians need to define their interests and goals and aim to do what they love, so they can love what they do, agree Richard D. Sontheimer, M.D., and Phoebe Rich, M.D.

Off the beaten path

Dr. Sontheimer is professor and vice-chairman, department of dermatology, and Fleischaker Endowed Chair, dermatology residency program director at the University of Oklahoma Health Sciences Center, Oklahoma City, Okla.

After completing his internal medicine residency, he went on to a research fellowship in immunodermatology and then finished his clinical training in dermatology.

Since then, Dr. Sontheimer has spent his entire career as a dermatologist in the academic setting where he has also enjoyed the benefits of being an National Institutes of Health (NIH)-funded investigator until two years ago. As a result of partial salary support from those grants, he has been able to pursue his subspecialty interest in autoimmune connective tissue diseases and satisfy his "curiosity gene" as a patient-oriented, translational clinical investigator.

However, Dr. Sontheimer admits that young dermatologists today face many obstacles that make it very difficult for anyone interested in following a similar course.

"As a young physician with NIH funding, I had protected time to develop my research and focus on a particular group of patients. Now, however, as physicians in training look forward to what their career options might be, their decisions are being influenced by the need to pay back a high educational debt, challenges presented by increasingly tight NIH research budgets and reduced departmental financial reserves for research support," Dr. Sontheimer says.

While it might be within the realm of possibilities to develop educational payback systems that can allow young physicians to have a broader menu of options, expanded funding from the NIH or in academia cannot be anticipated in the short-run.

"In medical schools across the country, departments are down to the fascia and getting close to the bone in terms of what resources are available to help young people get started in a research-oriented career, and simultaneously there is more and more pressure for academicians to see more and more patients," Dr. Sontheimer says.

However, if success is defined by how well one is "paid," it is still possible for young dermatologists to gain accomplishment in an academic-based, medical dermatology-focused career.

"Pay is not only income, but rather at the professional level, there are multiple types of rewards, and in academia there is tremendous diversity and many ways to gain satisfaction. One can enjoy personal pride that comes from peer-recognition of your expertise and knowing you are able to help patients in a way that others can't, intellectual rewards of scholarship, and satisfaction from teaching, involvement in professional associations and travel opportunities. An academic career certainly has a benefit for avoiding professional burnout," Dr. Sontheimer says.

Despite the obstacles presented by the economic realities of contemporary medicine and the absence of simple solutions, Dr. Sontheimer encourages young physicians not to ignore their "curiosity gene."

"It is important to feel good about what you are going to be doing for the next 40 to 50 years. So, if you have a sense now that research is something you truly want to do, pursing that type of career may be challenging. However, it is worth trying to figure out a way to make it happen," he says.

Nailing her specialty

Dr. Rich is clinical associate professor of dermatology, Oregon Health Sciences University, Portland, Oreg., and works in private practice, where she combines medical, cosmetic and surgical dermatology services with clinical research.