department of health policy at their affiliated medical school (45, 48%).
Presence of dermatology faculty with health policy expertise was significantly associated with increased health policy research (OR 2.41, 95%CI 1.05–5.54), elective (OR 2.40, 95%CI 1.01–5.72), and enrichment opportunities in health policy (OR 4.55, 95%CI 1.91–10.83). Presence of affiliated health policy department or division was also significantly associated with health policy research opportunities (OR 2.58, 95%CI 1.12–5.93). Programs that had faculty with health policy expertise (OR 3.49, 95%CI 1.49–8.19) and non-medical graduate schools at their affiliated institution (OR 4.15, 95%CI 1.39–12.39) were significantly more likely to have had residents participate in health policy or advocacy work within the past five years.
Programs with health policy curricula provided significantly more frequent instruction on all policy-related topics surveyed except drug pricing, billing, and coding, and physician reimbursement (Table 2). The most common self-reported barriers (n=80) to health policy instruction included lack of time and/or curricular space (n=44, 55%), lack of faculty with relevant expertise (n=40, 50%), lack of resources and funding (n=22, 28%), and lack of interest (n=19, 24%). Nevertheless, the majority of respondents recognized that health policy knowledge is important to residents’ future success (n=82, 87%) and that residents are more likely to engage in health policy in the future if exposed in residency (n=80, 85%).
Presence of dermatology faculty with health policy expertise was significantly associated with increased health policy research (OR 2.41, 95%CI 1.05–5.54), elective (OR 2.40, 95%CI 1.01–5.72), and enrichment opportunities in health policy (OR 4.55, 95%CI 1.91–10.83). Presence of affiliated health policy department or division was also significantly associated with health policy research opportunities (OR 2.58, 95%CI 1.12–5.93). Programs that had faculty with health policy expertise (OR 3.49, 95%CI 1.49–8.19) and non-medical graduate schools at their affiliated institution (OR 4.15, 95%CI 1.39–12.39) were significantly more likely to have had residents participate in health policy or advocacy work within the past five years.
Programs with health policy curricula provided significantly more frequent instruction on all policy-related topics surveyed except drug pricing, billing, and coding, and physician reimbursement (Table 2). The most common self-reported barriers (n=80) to health policy instruction included lack of time and/or curricular space (n=44, 55%), lack of faculty with relevant expertise (n=40, 50%), lack of resources and funding (n=22, 28%), and lack of interest (n=19, 24%). Nevertheless, the majority of respondents recognized that health policy knowledge is important to residents’ future success (n=82, 87%) and that residents are more likely to engage in health policy in the future if exposed in residency (n=80, 85%).
DISCUSSION
Our results reveal a paucity of health policy and advocacy education within dermatology residency programs across the U.S. While practice management topics like drug pricing, billing and coding, and physician reimbursement are covered more widely across dermatology residency programs, other specific policy topics and concepts are given less attention in the absence of formal health policy curricula.
Our results show that elective, research, and other enrichment activities in health policy and advocacy are also uncommon, particularly at institutions lacking faculty with relevant expertise or affiliated departments or divisions of health policy. These resource gaps may be filled through inter-institutional partnerships and American Academy of Dermatology initiatives such as the American Academy of Dermatology Association’s annual legislative conference and health policy curricula developed by AAD State Society Committees. Many respondents indicated a willingness to include standardized materials and lectures within their curricula if they were available. Limitations include survey response bias and incomplete characterization of programs.
Our results show that elective, research, and other enrichment activities in health policy and advocacy are also uncommon, particularly at institutions lacking faculty with relevant expertise or affiliated departments or divisions of health policy. These resource gaps may be filled through inter-institutional partnerships and American Academy of Dermatology initiatives such as the American Academy of Dermatology Association’s annual legislative conference and health policy curricula developed by AAD State Society Committees. Many respondents indicated a willingness to include standardized materials and lectures within their curricula if they were available. Limitations include survey response bias and incomplete characterization of programs.
CONCLUSION
Nevertheless, our study calls to attention the need to improve
health policy education to equip future dermatologists with
the skills and tools to engage with the complex political and
legislative landscape locally and nationally.
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2. Chuang E. Expanding medical student and resident knowledge of health economics, policy, and management. Acad Med. 2011. doi:10.1097/ ACM.0b013e318231e122
3. Nijhawan RI, Smith LA, Rohrer TE, Mariwalla K. Are dermatology residents adequately prepared for the business of medicine? J Am Acad Dermatol. 2013. doi:10.1016/j.jaad.2012.07.017
4. Garg M, Tseng Z, Baird GL, Egan P, McGarry K. Attitudes Toward Advocacy Do Not Match Actions: A Cross-sectional Survey of Residents and Fellows. R I Med J (2013). 2019.
5. Horner ME, Kourosh AS, Menter MA. Awareness and engagement in political advocacy among dermatology residents: A needs assessment. J Am Acad Dermatol. 2015. doi:10.1016/j.jaad.2014.12.011
AUTHOR CORRESPONDENCE
Avery H. LaChance MD MPH alachance@bwh.harvard.edu
