Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

Gender Disparities in Mentorship and Career Outcomes in Ophthalmology

Background: Gender disparities in the field of ophthalmology have been increasingly recognized. Although mentorship has been proposed as a contributing factor, there are limited data on the differences in mentorship experiences by gender among ophthalmologists. Objective: The purpose of this study was to evaluate gender disparities in mentorship experiences among ophthalmologists, and the impact of mentorship disparities on career outcomes. Design: Prospective, cross-sectional study. Setting: Web-based survey distributed through ophthalmology listservs. Participants: Ophthalmologists and ophthalmologists-in-training who completed the survey. Exposure: Training and practicing in the field of ophthalmology. Main Outcome Measures: Mentorship score based on 10 items from a previously published scale of mentorship quality and self-reported career outcomes (income, job satisfaction, achievement of career goals, and support to achieve future career goals). Results: We received survey responses from 202 male and 245 female ophthalmologists. Female ophthalmologists reported significantly lower mentorship satisfaction and worse quality of mentorship (p < 0.03). Female ophthalmologists also reported significantly lower income, worse job satisfaction, and lower rates of goal achievement and support to achieve future goals; all of these career outcomes, except income level, were partly mediated by mentorship score (mediation effect ranged from 29% to 68%, p < 0.014). Conclusions and Relevance: Gender-based inequities in achievement of career goals and job satisfaction are partly mediated by disparities in mentorship. Therefore, focused mentorship of women in ophthalmology at all career stages is imperative to reduce these inequities.

Gender Representation Among Ophthalmology Fellowship Directors in 2022

PURPOSE

Women are underrepresented in several medical specialties, including ophthalmology. Reducing disparities is critical in diversifying perspectives and increasing equity within ophthalmology, both of which can ultimately improve care delivery. We examined ophthalmic fellowship programs directors in the United States to investigate gender disparities by subspecialty.

DESIGN

Cross-sectional study.

METHODS

This was a retrospective cross-sectional study of ophthalmology fellowship program directors in academic medical centers. The primary outcome measure was a descriptive analysis of current fellowship directors in 2022 when stratified by subspecialty and demographic features.

RESULTS

Analysis was conducted on 358 fellowship directors in the United States. Twenty-nine percent of directors were women. Female directors had significantly fewer years since residency graduation compared with male peers (17 vs 24; P < .001); however, no differences were observed by program type (P = .896) or location (P = 0.104). Differences in female director representation were observed by subspecialty (P < .001), with the greatest percentage of women in pediatric ophthalmology (54%), other (oncology and pathology) fellowships (50%), and medical retina (40%). The subspecialties with the lowest percentage of female directors were oculoplastic and reconstructive surgery (13%) surgical retina and vitreous (16%).

CONCLUSION

There are disparities in female representation in academic leadership positions across ophthalmic subspecialties. Addressing this difference may have critical impacts on career advancement and opportunities available for marginalized groups in medicine.

Gender Distribution and Trends of Ophthalmology Subspecialties, 1992-2020

PURPOSE

To describe the gender trends in ophthalmology primary practice areas using the American Board of Ophthalmology (ABO) diplomates.

DESIGN

A trend study plus a cross-sectional study of the ABO's database.

METHODS

The de-identified records of all (N = 12,844) ABO-certified ophthalmologists between 1992 and 2020 were obtained. The year of certification, gender, and self-reported primary practice for each ophthalmologist was recorded. Subspecialty was defined as the self-reported primary practice emphasis. Practice trends of the entire population and the subpopulation of subspecialists were explored based on gender and were then visualized using tables and graphs and analyzed using the χ2 or Fisher exact test.

RESULTS

A total of 12,844 board-certified ophthalmologists were included. Nearly half (47%) reported a subspecialty as their primary practice area (n = 6042), of whom the majority were male (65%, n = 3940). In the first decade, men outnumbered women reporting subspecialty practices by more than 2:1. Over time, the number of women subspecialists increased whereas the number of men remained stable, such that by 2020 women comprised almost half of new ABO diplomates reporting subspecialty practice. When all subspecialists were compared within gender, there was not a significant difference (P = .15) between the percentage of male (46%) and female (48%) ophthalmologist reporting a subspecialty practice. However, a significantly greater proportion of women than men reported primary practice in pediatrics (20.1% vs 7.9%, P < .001) and glaucoma (21.8% vs 16.0%, P < .0001). Alternatively, a significantly greater proportion of men reported primary practice in vitreoretinal surgery (47.2% vs 22.0%, P < .0001). There was no significant difference between the proportion of men and women reporting cornea (P = .15) or oculoplastics (P = .31).

CONCLUSIONS

The number of women in ophthalmology subspecialty practice has increased steadily over the past 30 years. Men and women subspecialize at the same rate, but significant differences exist between the types of ophthalmology practiced by each gender.

Ophthalmologist Turnover in the United States: Analysis of Workforce Changes from 2014 through 2021

PURPOSE

Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover.

DESIGN

Retrospective cross-sectional study.

PARTICIPANTS

Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021.

METHODS

We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic.

MAIN OUTCOME MEASURES

Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next.

RESULTS

Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and ≥ 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021).

CONCLUSIONS

One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Rates of Internal Hiring of Ophthalmology Faculty from their Institution of Training at Top Academic Medical Centers: A Cross-Sectional Study

Background  Throughout graduate and postgraduate education, trainees need to gauge the impact of training location on future institutions of practice. Objective  We assessed rates of internal hiring of ophthalmology faculty at academic institutions from their same institution of training. Methods  This was a cross-sectional study. We included 1,246 clinical ophthalmology faculty at the 13 top-ranked institutions listed in the 2021 U.S. News and World Report. Primary, emeritus, adjunct, and affiliate faculty were included. Publicly available information was collected from institutional websites and other online sources. Statistical analyses were conducted using t -tests or Mann-Whitney tests, chi-squared or Fisher's exact tests, and multivariate logistic regression. The main outcome measured was internal hires, defined as faculty who had completed residency and/or fellowship training at their current institution. Results  In total, 47.3% of faculty were internal hires who completed residency or fellowship at the same institution. Among externally trained faculty, 27.7% completed residency and 56.0% completed fellowship at another top 13 programs. Internal hires were more frequently fellowship-trained, had a greater number of publications, and practiced in smaller departments ( p  < 0.001, p  < 0.001, and p  = 0.002, respectively). A greater proportion of internal hires held leadership positions ( p  = 0.012). Faculty practicing in the Midwest or West and with more years since residency graduation were less likely (odds ratio [OR], 0.29, 95% confidence interval [CI], 0.18-0.48; OR, 0.49, 95% CI, 0.31-0.78; OR, 0.98, 95% CI, 0.97-0.99, respectively) to be internal hires. Faculty with non-R01 National Institutes of Health funding were more likely to be internal hires (OR, 1.82, 95% CI: 1.12-2.96). Conclusions  Training institution is key to determining the institution of practice. These results may be beneficial for trainees to consider when selecting a training program.

Association Between Preresidency Peer-reviewed Publications and Future Academic Productivity or Career Choice Among Ophthalmology Residency Applicants

Importance

Ophthalmology-residency selection committees require robust metrics to review applicants. Participation in research activities is a core component of the application process for its perceived association with future academic productivity.

Objective

To evaluate the correlation between the number of preresidency peer-reviewed publications (PPPs) and subsequent peer-reviewed publications or career choices of ophthalmology residency graduates.

Design, Setting, and Participants

In this cross-sectional study, names of ophthalmology residency graduates were obtained. PubMed-indexed publication records were generated and publications were categorized as preresidency, intraresidency, and postresidency. First author and journal publications with an impact factor (IF) score of 3 or more were recorded. Current academic and community-based career statuses were designated. Names were obtained from cohort and alumni lists on residency program websites or by emailing program directors. Participants included US Accreditation Council for Graduate Medical Education-accredited ophthalmology residency graduates from 2013 to 2016.

Main Outcomes and Measures

The primary outcome measure was association of PPPs with later publications, first authorship, and journal publications with an IF score of 3 or more. The secondary outcome measure was difference in characteristics associated with academic vs community-based ophthalmologist.

Results

A total of 964 ophthalmologists (52% of graduates) were studied and most (85.5%) had PubMed-indexed publications. First authorship (ρ = 0.71; 95% CI, 0.67-0.74; P < .001) had a strong positive correlation with intraresidency publications, while journal publications with an IF score of 3 or more (ρ = 0.56; 95% CI, 0.51-0.60; P < .001) and PPPs (ρ = 0.38; 95% CI, 0.32-0.43; P < .001) had moderate and weak positive correlations, respectively. For postresidency publications, journal publications with an IF score of 3 or more (ρ = 0.86; 95% CI, 0.84-0.87; P < .001) had the strongest positive correlation followed by first authorship (ρ = 0.77; 95% CI, 0.74-0.79; P < .001) and PPPs (ρ = 0.26; 95% CI, 0.20-0.31; P < .001). Preresidency (t = 3.3; P = .001), intraresidency (t = 4.1; P < .001), postresidency (t = 7.5; P < .001), first author (t = 6.6; P < .001), and journal publications with an IF score of 3 or more (t = 5.9; P < .001) were greater for academic ophthalmologists compared with community-based ophthalmologists.

Conclusions and Relevance

Preresidency publication history is at least weakly correlated with future publications or work in an academic setting among ophthalmologists. Multiple factors associated with academic productivity were evaluated; however, adjustment for multiple analyses was not done and further testing is required to prove whether these factors are predictive.

Obstacles and Challenges Facing Iraqi Women Ophthalmologists

PURPOSE

The purpose of this study was to address disparities between male and female Iraqi ophthalmologists in terms of personal circumstances, professional profiles, and attitudes toward work and family life.

METHODS

A Google Form-based questionnaire was released on a social media platform including 500 ophthalmologists between September 1, and December 1, 2021. The survey included three domains: (1) demographic characteristics, (2) clinical practice profile, and (3) career satisfaction and work/family balance.

RESULTS

The study included a total of 209 specialists, with a response rate of 45.5%. About 69.4% of them were 45 years and younger. The female-to-male ratio was 1:1.6, 188 (90%) were married and 186 (88.9%) had children. Women ophthalmologists worked fewer hours, days, and operations than male ophthalmologists (P = 0.091). Moreover, women ophthalmologists in private practice were considerably underrepresented. General ophthalmologists represented 77%. The number of women ophthalmologists with subspecialty degrees was far less 9 (11.5%) than males 38 (29.2%), P = 0.003, and they performed significantly fewer operations than male ophthalmologists (P = 0.001). Family duties were the biggest deterrent for female ophthalmologists. For males, the private clinic is an obstacle to acquiring a specialty degree in 45.6%, but for women, it is just 25.7%. Overall satisfaction was 65.1%. Women respondents were less satisfied with their practice (P = 0.009) and thought that they are facing more challenges (0.007). Men believed they had less time to spend with family, implying that women sacrifice working time/income to satisfy family obligations and expectations. Work-life balance is achieved by limiting work hours and including family members.

CONCLUSION

Women ophthalmologists in Iraq might be facing greater obstacles to their professional advancement than their male counterparts. Female doctors were working fewer hours and doing fewer surgical procedures, and they were less likely to pursue subspecialty certification.