A s we approach the 21st century, specialty training programs in dermatology are feeling increasing pressures that have begun to erode clinical teaching. Full-time faculty members are being asked to spend more time in patient care to support an increasing portion of their income or are spending more time to develop laboratory data and write grant applications to survive in a brutally competitive academic world. Other faculty members are leaving academic medicine for private practice having decided that the risk-reward ratio is no longer acceptable. In California, the state government has implemented a plan that decreases specialty residency positions and their funding in favor of primary care positions. Third-party payers are becoming more restrictive in paying for inpatient and outpatient dermatologic services. Dermatologic inpatient services in some university teaching programs have been eliminated. Third-party payers are also balking at subsidizing teaching and research activities at teaching hospitals.
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