Factors Affecting the Decision to Pursue Vitreoretinal Fellowship Training
2008, Volume 1, Number 1 11 Introduction During the last decade, there has been a steady rise in the proportion of graduating ophthalmology residents pursuing subspecialty fellowship training. This trend is evident from data from the National Residency Match-ing Program for oculoplastics fellowships and the Oph-thalmology Fellowship Match Program for all other subspecialty fellowships (Figure 1). The trend toward increasing specialization has been observed in other fields of medicine and has major implications for future health care delivery. While there has been an overall increase in the percent-age of graduating ophthalmologists choosing fellowship training, the numbers are not growing evenly across all subspecialties. There has been an increase in the num-ber of ophthalmology residents applying for fellowships in vitreoretinal surgery and cornea/external disease (Figure 2). In contrast, the subspecialty areas of glau-coma, neuro-ophthalmology, pediatrics, and oculoplas-tics have seen an overall decrease in applicant numbers during the past ten years. A workforce planning strategy to meet the future eye care needs not only requires knowledge of the overall supply and demand of ophthalmology services, but also an understanding of the factors that influence ophthal-mologists-in-training to pursue various career pathways. A recent study identified factors influencing graduating ophthalmology residents to enter subspecialty training or a career in comprehensive ophthalmology [1]. Previ-ous studies in the fields of internal medicine [2], pediat-rics [3-5], dermatology [6,7], general surgery [8,9], geriatric psychiatry [10], radiation oncology [11], and emergency medicine [12] have evaluated factors influ-encing career decisions. The purpose of the present study is to elucidate factors affecting graduating oph-Factors Affecting the Decision to Pursue Vitreoretinal Fellowship Training Payman Haft, MD 1 , Steven J. Gedde, MD 1* , Donald L. Budenz, MD, MPH 1 , Joyce C. Schiffman, MS 1 , Yunhee Lee, MD, MPH 1 1 Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL * Corresponding Author & e-mail: sgedde@med.miami.edu Abstract To identify factors influencing graduating ophthalmology residents to pursue vitreoretinal fellowship training. An anonymous survey was sent to each graduating ophthalmology resident in the United States in February 2003. Demographic data and information relating to residency training, career goals, and factors influencing career choices were col-lected from the surveys. Surveys were completed by 222 (50.8%) residents, including 135 (60.8%) who were pursuing fellowships. Among residents applying for subspecialty training, 48 (35.6%) selected vitreoretinal fellowships and 87 (64.4%) chose other subspe-cialties. Residents selecting vitreoretinal fellowships were more likely to be male (=0.035), have more uveitis faculty (=0.006), perform more retina/vitreous procedures (=0.025), publish a paper (=0.003), participate in basic science research (=0.044), and have elective time (=0.012) during residency compared with residents seeking fellowships in other subspecial-ties. Additionally, residents entering vitreoretinal fellowships made the decision to pursue fellowship training earlier (<0.001) and were more likely to intend to practice in a university setting (=0.011). Challenging diagnostic problems (<0.001), peer interactions (=0.015), working with new technology (<0.001), earning potential (=0.012), prestige (=0.020), interest in an academic career (=0.001), and research experience (=0.001) were rated as more important, and working hours was rated as less important by residents seeking vitreoretinal fellowships than those choosing other subspecialty fellowships. A variety of factors are involved in the decision to pursue fellowship training. There are differences in how these factors are weighed among residents seeking vitreoretinal fellowships and other subspecialties. Accepted for publication October 2, 2007 Revision received October 8, 2007 2008; 1:11-19 Available on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the prod-ucts or technologies cited herein. Â 2008