During the last 5 years, numerous residency training programs in dermatology have undergone significant structural changes. Programs have been disbanded entirely, separated into their component parts, or have merged with nearby programs. The motive force appears to be declining reimbursement flows associated with the ascendancy of contracted managed care, increased government oversight of entitlement programs, and the limiting of patients' access to specialists. In metropolitan areas with multiple training programs, there has been particular pressure to consolidate these programs into more efficient and economically competitive units.1