The Millennials Are Here
With their long anticipated arrival into medicine now over, they have hit the ground running as a team-oriented, socially networked group, known for their confidence and drive to achieve.1-3 Born between 1980-2000, the Millennials have only recently joined the ranks of practicing dermatologists. Given their much anticipated arrival into the evolving medical work force, we aim to examine their initial impact on the trending career choices of graduating dermatology residents.
Methods
Upon obtaining approval from the Stanford and Partners Institutional Review Boards, anonymous surveys were given to dermatology residents participating in the Galderma Board Review course from 1999-2012. Data from 2001 was not collected, as previously described.4 The surveys included questions about age, gender, marital status, race, future career goals, and primary post-training practice setting. We used Excel (Redmond, Washington, 2003) to plot trends regarding primary practice setting changes over time, and Chi-squared analysis to determine the significance of these trends. In an effort to control for the changing demographics of the workforce over time, we also completed a multinomial logistic regression of a combined solo/private career setting and academia versus all other settings (fellowship, military, industry, etc.).
Results
In total, 1825 surveys were collected, 1657 (81%) of which contained data regarding future career goals. The mean age of respondents was 32 ± 4.2 years, 38% were male and 62% female. Yearly response rates varied from 34% to 82%. The proportion of dermatology residents pursuing private practice careers (47%-62%, mean =54%) was fairly constant over the last 13 years. However, the proportion of dermatology residents pursuing solo practice declined from a high of 12% in 2005 to 4% in 2011 (mean 8%). After a peak in 2005, the average percentage of graduating residents pursuing solo practice declined from over 9.5% to 8%, a decline that was not statistically significant (P=0.37). In contrast, the average percentage of residents pursuing academic careers (mean 17%) witnessed a significant increase after 2005, increasing from 13% to 19.5% (P<0.001).
In addition to temporal trends, demographic variables including marriage status, presence of children in the household, and race were evaluated (Table 1). While marital status did not significantly appear to affect the post-graduate career choice of graduating dermatology residents, parents tended to prefer solo practice. There also seemed to be a correlation between racial demographics and post-graduate career training as well, with Asians preferring academic practice, (Table 1, P<.01).
In order to adjust for the possibility that demographic factors influencing decisions may also have been changing over time, a multinomial regression model of the complete cases (non-missing values, n=1539) adjusting for gender and age showed that for each additional year, there was a 5% increase in the proportion pursuing private group and solo practice settings versus ‘other’ settings, and a 7% increase in those pursuing academic versus other settings [relative risk ratios (RRR): 1.04(P=0.02), 1.07(P=0.001), respectively].
Discussion
Our findings indicate that beginning several years prior to, and continuing with the arrival of the Millennials, there has been a modest decline in the proportion of graduating dermatology residents pursuing solo practice as their post-training practice setting, and a recent trend of a significant and increasing interest in academia. However, this trend does not appear to be necessarily true for parents, and is not consistent throughout all races of those surveyed over time.
Academic dermatology has previously faced periods of low recruitment. Surveys have identified reasons for not choosing
