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An evaluation of educational debt levels in dermatology residents and effects on career choices
J AM ACAD DERMATOL VOLUME 70, NUMBER 6
2. Raison-Peyron N, Meunier L, Acevedo M, Meynadier J. Notalgia paresthetica: clinical, physiopathological and therapeutic aspects. A study of 12 cases. J Eur Acad Dermatol Venereol 1999;12:215-21. 3. Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology 2005;26:785-93. 4. Welch MJ, Purkiss JR, Foster KA. Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon 2000;38:245-58. 5. Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol 2007;143: 980-2. http://dx.doi.org/10.1016/j.jaad.2013.12.006
An evaluation of educational debt levels in dermatology residents and effects on career choices To the Editor: Educational debt for medical students continues to rise: alarmingly, the median cost of attendance at public and private schools has grown at a rate 2 and 1.8 times that of inflation, respectively, during the last 13 years. Not surprisingly, the median educational debt for indebted private medical graduates grew from $110,000 to $180,000 ( public $80,000-$155,000) during the same time period.1 In 2006, under Stanford Institutional Review Board approval, Salter and Kimball2 showed that the career choices of graduating dermatology
Letters 1141
residents from 1999 through 2004 were unaffected by debt levels. The purpose of this letter is to re-evaluate the effect of debt costs on the career choices of dermatology residents despite continually increasing debt levels. Under Partners Human Research Committee Institutional Review Board approval in 2005, anonymous surveys were given to dermatology residents participating in the Galderma Board Review course from 2005 through 2011. The surveys included questions about age, gender, marital status, student debt, and future career goals. Adjustments for inflation were performed using the Consumer Price Index to convert debt levels to 2005 values. We used 2 to determine the relationship between the presence of educational debt and future career goals. In total, 817 surveys were collected, 768 (94%) of which contained data regarding debt. Yearly response rates varied from 34% to 75%. The proportion of residents reporting debt ranged from 47% to 76% annually. Mean debt levels for dermatology residents with debt increased from $104,794 in 2005 to $139,919 in 2011 ($120,868 in 2005 dollars), a 34% increase (Fig 1). In general, the presence of student loan debt did not seem to significantly impact the initial practice setting of graduating dermatology residents. However, in 2009 residents with debt were significantly more likely to pursue private
Fig 1. Mean debt levels over time, 1999 to 2011, as adapted from Salter and Kimball.2 *Debt was adjusted for 2005 dollars using the Consumer Price Index.
J AM ACAD DERMATOL
1142 Letters
JUNE 2014
Fig 2. Fellowships pursued by graduating dermatology residents over time.
practice postgraduate settings than their colleagues without debt (60% vs 14%, P ¼ .01). From 2005 to 2011, the percentage of surveyed residents selected for fellowships ranged from 21% to 30% with 51% to 73% of fellows reporting debt annually. The percentage of surveyed residents pursuing either Mohs or procedural fellowships varied from 33% in 2005 to 40% in 2010 (Fig 2). The presence of student loan debt did not seem to significantly impact whether or not residents chose to pursue fellowship training as a whole, or a fellowship in Mohs or procedural dermatology. However, a notable exception occurred in 2007 in which Mohs and procedural fellows were significantly more likely to report a lack of debt than their nonfellowship-trained counterparts (44% vs 34%, P \.05). During the 7 years surveyed, debt increased relatively consistently, with an increase in mean debt levels of 34%. The 4.9% average annual increase in debt levels always outpaced inflation with Consumer Price Index ranging from 0.34% to 3.85% annually. Despite increasing debt levels, resident choices to pursue fellowship remained largely unaffected, as did their choice of primary practice setting. These findings are consistent with data reported in 2006 by Salter and Kimball.2 However, as debt levels continue to increase, and other specialties report notable changes in postgraduate practice settings in relation to debt,3,4 these trends will need to be continually monitored. Sarah Sung, MD, and Alexa B. Kimball, MD, MPH Massachusetts General Hospital, Department of Dermatology, Boston
Galderma and the American Academy of Dermatology provided administrative support for the conduction of this study. Disclosure: Dr Sung is currently a research fellow with partial fellowship funding from the National Psoriasis Foundation and by Janssen. Dr Kimball has no conflicts of interest to declare. Correspondence to: Alexa B. Kimball, MD, MPH, Clinical Unit for Research Trials and Outcomes in Skin, Massachusetts General Hospital, 50 Staniford St, Suite 240, Boston, MA 02141 E-mail: [email protected] REFERENCES 1. Youngclaus J, Fresne J. Trends in cost and debt at US medical schools using a new measure of medical school cost attendance; Association of American Medical Colleges: analysis in brief 2012;12(2). Available from: URL:https://www.aamc.org/ download/296002/data/aibvol12_no2.pdf. Accessed January 30, 2013. 2. Salter SA, Kimball AB. Rising educational debt levels in recent dermatology trainees and effects on career choices. J Am Acad Dermatol 2006;54:329-31. 3. Frintner MP, Mulvey HJ, Pletcher BA, Olson LM. Pediatric resident debt and career intentions. Pediatrics 2013;131:1-7. 4. Doherty MJ, Schneider AT, Tirschwell DL. Will neurology residents with large student loan debts become academicians? Neurology 2002;58:495-7. http://dx.doi.org/10.1016/j.jaad.2013.09.060
Plasmacytoid dendritic cell involvement in the host response against keratoacanthoma To the Editor: Plasmacytoid dendritic cells (PDC) are specialized DCs that express CD123, blood-derived DC antigen-2 (BDCA-2), and Toll-like receptor (TLR)
2. Raison-Peyron N, Meunier L, Acevedo M, Meynadier J. Notalgia paresthetica: clinical, physiopathological and therapeutic aspects. A study of 12 cases. J Eur Acad Dermatol Venereol 1999;12:215-21. 3. Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology 2005;26:785-93. 4. Welch MJ, Purkiss JR, Foster KA. Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon 2000;38:245-58. 5. Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol 2007;143: 980-2. http://dx.doi.org/10.1016/j.jaad.2013.12.006
An evaluation of educational debt levels in dermatology residents and effects on career choices To the Editor: Educational debt for medical students continues to rise: alarmingly, the median cost of attendance at public and private schools has grown at a rate 2 and 1.8 times that of inflation, respectively, during the last 13 years. Not surprisingly, the median educational debt for indebted private medical graduates grew from $110,000 to $180,000 ( public $80,000-$155,000) during the same time period.1 In 2006, under Stanford Institutional Review Board approval, Salter and Kimball2 showed that the career choices of graduating dermatology
Letters 1141
residents from 1999 through 2004 were unaffected by debt levels. The purpose of this letter is to re-evaluate the effect of debt costs on the career choices of dermatology residents despite continually increasing debt levels. Under Partners Human Research Committee Institutional Review Board approval in 2005, anonymous surveys were given to dermatology residents participating in the Galderma Board Review course from 2005 through 2011. The surveys included questions about age, gender, marital status, student debt, and future career goals. Adjustments for inflation were performed using the Consumer Price Index to convert debt levels to 2005 values. We used 2 to determine the relationship between the presence of educational debt and future career goals. In total, 817 surveys were collected, 768 (94%) of which contained data regarding debt. Yearly response rates varied from 34% to 75%. The proportion of residents reporting debt ranged from 47% to 76% annually. Mean debt levels for dermatology residents with debt increased from $104,794 in 2005 to $139,919 in 2011 ($120,868 in 2005 dollars), a 34% increase (Fig 1). In general, the presence of student loan debt did not seem to significantly impact the initial practice setting of graduating dermatology residents. However, in 2009 residents with debt were significantly more likely to pursue private
Fig 1. Mean debt levels over time, 1999 to 2011, as adapted from Salter and Kimball.2 *Debt was adjusted for 2005 dollars using the Consumer Price Index.
J AM ACAD DERMATOL
1142 Letters
JUNE 2014
Fig 2. Fellowships pursued by graduating dermatology residents over time.
practice postgraduate settings than their colleagues without debt (60% vs 14%, P ¼ .01). From 2005 to 2011, the percentage of surveyed residents selected for fellowships ranged from 21% to 30% with 51% to 73% of fellows reporting debt annually. The percentage of surveyed residents pursuing either Mohs or procedural fellowships varied from 33% in 2005 to 40% in 2010 (Fig 2). The presence of student loan debt did not seem to significantly impact whether or not residents chose to pursue fellowship training as a whole, or a fellowship in Mohs or procedural dermatology. However, a notable exception occurred in 2007 in which Mohs and procedural fellows were significantly more likely to report a lack of debt than their nonfellowship-trained counterparts (44% vs 34%, P \.05). During the 7 years surveyed, debt increased relatively consistently, with an increase in mean debt levels of 34%. The 4.9% average annual increase in debt levels always outpaced inflation with Consumer Price Index ranging from 0.34% to 3.85% annually. Despite increasing debt levels, resident choices to pursue fellowship remained largely unaffected, as did their choice of primary practice setting. These findings are consistent with data reported in 2006 by Salter and Kimball.2 However, as debt levels continue to increase, and other specialties report notable changes in postgraduate practice settings in relation to debt,3,4 these trends will need to be continually monitored. Sarah Sung, MD, and Alexa B. Kimball, MD, MPH Massachusetts General Hospital, Department of Dermatology, Boston
Galderma and the American Academy of Dermatology provided administrative support for the conduction of this study. Disclosure: Dr Sung is currently a research fellow with partial fellowship funding from the National Psoriasis Foundation and by Janssen. Dr Kimball has no conflicts of interest to declare. Correspondence to: Alexa B. Kimball, MD, MPH, Clinical Unit for Research Trials and Outcomes in Skin, Massachusetts General Hospital, 50 Staniford St, Suite 240, Boston, MA 02141 E-mail: [email protected] REFERENCES 1. Youngclaus J, Fresne J. Trends in cost and debt at US medical schools using a new measure of medical school cost attendance; Association of American Medical Colleges: analysis in brief 2012;12(2). Available from: URL:https://www.aamc.org/ download/296002/data/aibvol12_no2.pdf. Accessed January 30, 2013. 2. Salter SA, Kimball AB. Rising educational debt levels in recent dermatology trainees and effects on career choices. J Am Acad Dermatol 2006;54:329-31. 3. Frintner MP, Mulvey HJ, Pletcher BA, Olson LM. Pediatric resident debt and career intentions. Pediatrics 2013;131:1-7. 4. Doherty MJ, Schneider AT, Tirschwell DL. Will neurology residents with large student loan debts become academicians? Neurology 2002;58:495-7. http://dx.doi.org/10.1016/j.jaad.2013.09.060
Plasmacytoid dendritic cell involvement in the host response against keratoacanthoma To the Editor: Plasmacytoid dendritic cells (PDC) are specialized DCs that express CD123, blood-derived DC antigen-2 (BDCA-2), and Toll-like receptor (TLR)