Factors Influencing Post-Graduate Career Decisions of Ophthalmology Residents

Background: To identify factors that influence ophthalmology residents’ decisions to pursue fellowship training or to practice comprehensive ophthalmology after residency. Methods: An anonymous survey was sent to ophthalmology residents in the U.S. from the graduating Class of 2018 and Class of 2019. The main outcome measure was the decision on whether to seek fellowship training or to practice comprehensive ophthalmology. Information on demographics, residency program characteristics and factors influencing career choices were collected. Results: The overall response rate was 16.4% (153/931). Among the 153 respondents, 117 (76.5%) matched into subspecialty training. Residents pursuing fellowships had more first-author publications (4.4 vs. 1.2, P < 0.001), were more likely to plan to practice in an academic setting (47.0% vs. 8.3%, P < 0.001) and in an urban location (48.7% vs. 25.0%, P < 0.001). In a multivariable analysis, factors predictive of fellowship training included a desire to acquire special skills (OR=3.01; 95% CI, 1.34–6.77), working with new technology (OR=2.67; 95% CI, 1.14-6.24) and mentorship (OR=2.30; 95% CI, 1.02-5.17). Factors that predicted a career in comprehensive ophthalmology were being married (OR=0.11; 95% CI, 0.02-0.74), lifestyle considerations (OR=0.19; 95% CI, 0.07-0.56), educational debt (OR=0.31; 95% CI, 0.15-0.68) and a decreased interest in an academic career (OR=0.38; 95% CI, 0.17-0.86). Gender, prestige or perceived favorable job market were not significant factors. Conclusions: The majority of U.S. ophthalmology residents responding to this survey matched into fellowships. Various factors including mentorship, lifestyle considerations, educational debt and interest in an academic career influenced the post-graduate career choices.