Factors Influencing Postgraduate Career Decisions of Ophthalmology Residents

Abstract Objective This study aims to identify factors that influence ophthalmology residents' decision to pursue fellowship training or to practice comprehensive ophthalmology after residency. Design This is a cross-sectional study. Methods An anonymous survey was sent to ophthalmology residents in the United States from the graduating class of 2018. The main outcome measure was the decision 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 24.0% (112/467). Among the 112 respondents, 88 (78.6%) matched into subspecialty training. Compared with residents entering comprehensive ophthalmology, there was a greater proportion of Asians (37.5 vs. 8.3%) and a smaller proportion of non-Hispanic whites (47.7 vs. 70.8%, p = 0.029) among residents pursuing fellowship training. Residents pursuing fellowships had fewer children (0.4 vs. 0.8, p = 0.049), had less debt (median debt ≤ $100,000 vs. > $200,000, p = 0.008), had more first-author publications (4.3 vs. 1.2, p< 0.001), decided on their postgraduate career path earlier (median time postgraduate second year [PGY2] versus postgraduate third year [PGY3], p = 0.016), and were more likely to plan to practice in an academic setting (51.1 vs. 29.2%, p< 0.001) and in an urban location (44.3 vs. 12.5%, p = 0.004). In a multiple logistic regression model, factors predictive of fellowship training included a desire to acquire special skills (odds ratio [OR] =4.39; 95% confidence intervals [CI]: 1.70–16.37) and work with new technology (OR = 2.92; 95% CI: 1.16–10.02). Factors that predicted a career in comprehensive ophthalmology were higher levels of educational debt (OR = 0.35; 95% CI: 0.12–0.77), a later timing of postgraduate decision (OR = 0.17; 95% CI: 0.02–0.65), and lifestyle considerations (OR = 0.13; 95% CI: 0.03–0.36). Gender, prestige, or perceived favorable job market was not significant factors. Conclusion The majority of U.S. ophthalmology residents matched into fellowships. A desire to gain special skills and a desire to work with new technology were major factors influencing residents to seek fellowship training. Lifestyle considerations and educational debt were more important in the decision to choose a comprehensive ophthalmology career. Future research that includes more trainees and programs may minimize the selection bias issues present in this study.