Dermatoethics: Nepotism in dermatology residencies

Abstract

Dear Dr Dermatoethicist: I am an attending in a dermatology department and my daughter-in-law is applying for a dermatology residency. Can I use my influence to help her get accepted to our program? Dear Dr Dermatoethicist: I am an attending in a dermatology department and my daughter-in-law is applying for a dermatology residency. Can I use my influence to help her get accepted to our program? Dear Conflicted Attending: It is instinctive to help the people we know and care about; who you know matters. This practice is not new to medicine, and the physicians who have previously benefited from such relationships have still gone on to make significant contributions to our field. However, influencing the selection process to favor an applicant based solely on kinship is nepotism. Considering the competitive nature of matching, it is understandable that nepotism in dermatology sparks heated discussion.1Nepotism and family connections. Student Doctor Network. Published online January 2015.https://forums.studentdoctor.net/threads/nepotism-and-family-connections.1115890/Date accessed: December 10, 2021Google Scholar Those who successfully match are among the strongest performers in objective metrics (board scores, publications, and Alpha Omega Alpha status), creating a high barrier of entry.2Charting outcomes in the match: senior students of U.S. MD medical schools. National Resident Matching Program. Published online July 2020.https://www.nrmp.org/wp-content/uploads/2020/07/Charting-Outcomes-in-the-Match-2020_MD-Senior_final.pdfDate accessed: December 7, 2021Google Scholar The principle of justice supports a residency selection process that is fair for all applicants, particularly when the salaries for training residents are funded by taxpayers. Additionally, any interference with the integrity of the process would fundamentally undermine public trust and the common good; provide a meritless advantage for an individual seeking to care for patients, without regard for their ability to do so; and compromise patient safety and the ethical principle of nonmaleficence. Decision makers in graduate medical education have a duty to make choices that abide by their program’s mission and the needs of the community it serves.3ACGME common program requirements (residency). Accreditation Council for Graduate Medical Education. Published online July 2021.https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResidency2021.pdfDate accessed: December 7, 2021Google Scholar The National Resident Matching Program Code of Conduct stipulates that programs are expected to recruit with integrity and “fully disclose the criteria used for vetting applications so that applicants and their medical school advisors can effectively direct applications.”4Match code of conduct for programs. National Resident Matching Program. Published online 2021.https://www.nrmp.org/wp-content/uploads/2021/11/Match-Code-of-Conduct_Programs_2021.pdfDate accessed: December 10, 2021Google Scholar This call for transparency has been echoed by the Association of Professors of Dermatology.5Rosmarin D. Friedman A.J. Burkemper N.M. Nord K.M. Murina A.T. Huang J.T. The Association of Professors of Dermatology Program Directors Task Force and Residency Program Transparency Work Group guidelines on residency program transparency.J Drugs Dermatol. 2020; 19: 1117-1118https://doi.org/10.36849/JDD.2020.5600Crossref PubMed Scopus (2) Google Scholar Any program that weighs undisclosed extraneous factors, such as kinship, into its decision-making process is allowing a major disparity that defies justice and undercuts transparency for competing applicants who have unknowingly invested their resources into an inequitable process. With the surplus of qualified applicants and the shift toward more holistic review, qualitative factors and connections are likely to play a larger role in distinguishing candidates and should therefore be navigated with great care. If an attending supports an individual’s candidacy by communicating the applicant’s relevant qualities, characteristics, and overall “fit” for the program, this recommendation should be rooted in professional experiences rather than partisanship factors. Nepotism in resident selection should be discouraged; however, there are instances in which a highly qualified applicant with familial connections to a program may be appropriately considered if the faculty person in question is not in any way part of the selection process, National Resident Matching Program and graduate medical education regulations are followed, postinterview communication and guarantees are prohibited, and transparency is maintained. Importantly, a highly qualified candidate who is known or related to someone of influence should not be disadvantaged by this relationship but afforded full consideration. We should strive for the highest ethical and professional standards and transparency in the recruitment of patient caretakers. —Dr Dermatoethicist None disclosed.