Pediatric dermatology training requirements evolve

Key Points

National report - With interest in the new subspecialty of pediatric dermatology still less than robust, leaders in the field are looking at training requirements to see how they might be impacting recruiting.

Meanwhile, the window is closing for a small but well-qualified group of physicians to be "grandfathered" into board certification.

And experts say that despite other options, approved one-year residency programs offer the broadest training in dealing with pediatric cases.

Currently, dermatologists who want to be certified by the American Board of Medical Specialties must complete a dermatology residency. Then they must finish a one-year fellowship at one of 21 American Board of Dermatology-approved pediatric dermatology fellowship programs.

Still, the "grandfather" path was employed by a good portion of the 162 pediatric dermatologists certified since the exam was first offered in 2004.

"There are people, like myself, who were fellowship-trained before board certification and before (today's programs) were set up. And even though we did not come through one of these programs, we were allowed to take the test," says Fairfax, Va., pediatric dermatologist Robert Silverman, M.D., who is on the board of the American Board of Dermatology and has an academic appointment in the department of pediatrics at Georgetown University Hospital, Washington.

That option will soon close. After this year's certifying examination in October, candidates must complete fellowship training in pediatric dermatology, according to Dr. Silverman.

Other options

Board-certified dermatologists can say they have special interests in pediatric dermatology, even without going through fellowship training. And there are fellowship opportunities that aren't recognized by the American Board of Dermatology, but dermatologists who complete those programs aren't eligible for the board examination.

Those options often don't give dermatologists the exposure to rare cases that they need to be able to treat the most severely affected pediatric dermatology patients, experts say.

James Treat, M.D., a pediatric dermatologist who completed his training by doing dermatology first and then a pediatric dermatology fellowship, says his one-year fellowship gave him the clinical time he needed with rare cases.

"I was (the only) fellow ... for 350 out of 355 days, roughly. I got to see a ton of pediatric dermatology. I would say basically that the breadth of clinical dermatology here (at Children's Hospital of Philadelphia) is really phenomenal; so, I did feel very prepared," says Dr. Treat, who today is assistant professor of pediatrics and dermatology at Children's Hospital of Philadelphia.

Fellowships 'optimal'

The standard one-year fellowship is optimal, according to Lawrence F. Eichenfield, M.D., chief, pediatric and adolescent dermatology and professor of pediatrics and medicine (dermatology), at Rady Children's Hospital, San Diego, University of California, San Diego School of Medicine.

Dr. Eichenfield says his program in pediatric dermatology has two to four fellows a year.

"For several years, the fellowship required two years, and that created problems," he says. "It greatly decreased the number of individuals who were willing to do the fellowship, because all the other fellowships in dermatology are one year."

Encouraging fellows

Still, many pediatric dermatology fellowship programs in the United States are struggling to fill their slots. There are 21 approved fellowship programs, but only 13 fellows for the 2010/2011 year - although that is five more than in 2009/2010.

Some programs report a full quota. Ilona J. Frieden, M.D., professor of dermatology and pediatrics, University of California, San Francisco, says UCSF's one-year pediatric dermatology fellowship has been filled every year.

"We take at least one or two people who are interested in pediatric dermatology into the dermatology residency program. ... There are a lot of pediatricians who are interested in pediatric dermatology, but not all can get dermatology residencies, because it is so competitive," she says.