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The purpose of this study was to identify differences in ophthalmology resident …

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- A Study of Prospective Ophthalmology Residents’ Career Perceptions

The aim of this study was to determine the differences in career critical factors between residency candidates and practicing ophthalmologists. This was conducted to consider the possibility that each group might hold differing perspectives about what is important for career satisfaction. We provide a discussion of the study results related to career issues, personal and family issues, financial issues, as well as gender issues.

Career Issues - career issues offered the most interesting results for career perspectives by both groups (e.g., residency candidates and practicing ophthalmologists). Work-related expectations offered no statistical difference between groups with respect to income level, work schedule, amount of autonomy, amount of family/leisure time, innovation required, intellectual approaches to problem-solving and seeing the end results of their work. This consistent viewpoint may be attributable to candidate investigation and inquiry from varied professional information sources (e.g., career analysis, recruitment literature). On the other hand, there are apparent career perceptions differences in the two groups.

Residency candidates reported significantly different response levels to career issues than physicians in practice. Candidates expected less time to be spent in direct patient care along with less continuity of care for the same patient on a regular basis than found by practicing physicians. Academic health centers tend to have fellowship sub-specialists, which practice primarily within their specialty. This may lead candidates to feel that ophthalmology is a sharply defined specialty compared to those in comprehensive ophthalmology practice. Teaching facilities, on the other hand, tend to be large practices affiliated with hospitals. Within these hospitals, other physicians may be more accessible leading the applicants to believe that they will encounter more manual and mechanical activities. This most likely reflects the fact that medical students are often expected to perform their own diagnostic testing whereas practicing ophthalmologists may have technologists perform some of these activities while they interpret the test findings.

The resident candidates anticipate that interaction with other physicians will be a common feature, once in medical practice. Perceptions for higher status with other medical specialties were overstated when compared to practicing ophthalmologists. In contrast, it is interesting to mention that they underestimated the amount of career pressure when compared to practicing ophthalmologists.

Residency candidates tend to hold a more idealistic perception of their career expectations than found among practicing physicians. Equally important, they indicated that they will be able to witness the end result of their work along with a regularity of their work schedule. Residency candidates anticipated greater utilization of manual and mechanical devices as well as computer technology in their eventual medical practice. This latter point, although not surprising given the expanded use of technologies in medical education training, is of particular note because computer-based diagnosis and treatment technologies will continue to be standard practice, especially for the ophthalmology profession. Furthermore, advances in science and technology will continue to affect surgical practices.5 Molecular biology, nanotechnology for less invasive surgical procedures, and advanced imaging methods will impact subspecialty care. Telemedicine will likewise find greater applications for diagnostic and referral information. In addition, other smart technologies such as medical training simulators will reinforce procedure skills that allow for self-directed performance in surgical applications.

As expected, residency candidates underestimate the amount of pressure (e.g., administrative and surgical demands for time) in the field of ophthalmology given the limited professional responsibilities of those in practice. Ophthalmologists are faced with these patient care pressures on a routine basis and we expect would be more likely to rate pressure higher than would residency candidates. Likewise, it is not surprising that candidates would overestimate the status of their chosen specialty. Therefore, one may assume that candidates bereft of professional experiences lack a valid framework upon which to determine many of the specific career expectations.

Personal-Family Issues - Residency candidates and practicing physicians share similar perceptions regarding personal and family issues. This could be because certain personality types align with certain occupational fields, including ophthalmology. Both residency candidates and practicing physicians indicated that their medical discipline offers autonomy, opportunity for innovation, as well as time for family and leisure activities. They prefer a balance between theoretical and specific problem solving approaches. Candidates anticipate that their careers will afford more diversity than was reported among practicing physicians. This may be attributable to the fact that many residency training facilities are within academic health centers and tertiary healthcare institutions with large referral bases along with greater numbers of unusual and complicated patient cases. As discussed in the section on career issues, these training centers often include more sub-specialists that provide medical students a broader clinical experience than in the typical private practice setting. Therefore, as with career issues, experiences could skew the candidates’ frame of reference for the practice of ophthalmology.

Residency candidates differed from practicing physicians by underestimating the amount of responsibility expected in medical practice. This lack of experience may shape their perception for the extensive responsibility extant in medical practice. Likewise, their perceptions of personal and family values indicate a more dominant role in their career decision-making. While practicing physicians have already made important and enduring career decision, most residency candidates have yet to initiate these long-term career considerations (e.g., private practice versus academic medicine; geographic location/lifestyle; family/child-rearing; etc.).

Residency candidates further indicated a significant degree of influence among personal and family values on their career decisions. Here again, lack of other life experiences (e.g., competitive healthcare market forces; child-rearing responsibilities; etc.) may contribute to this rather idealistic viewpoint. Many are drawn to the field of ophthalmology because of its perceived controllable lifestyle for personal and family time.5 In fact, surgical residents’ while in training shift their main issues and concerns from those of a personal nature to more financial perspectives.6 Furthermore, female residents show greater concerns than men when accommodating their work-life balance, especially for child-rearing. Child-rearing during the residency years can be demanding, both emotionally and physically.7 On the whole, personal and family influences play significant roles in forming important career decisions.

Interestingly, residency candidates’ Personal-Family Issues were found to be similar to those of practicing ophthalmologists. Both groups consistently viewed autonomy, innovation and intellectual development in much the same manner. Specifically, they expressed considerable motivation for autonomy, innovation or intellectual problem-solving expression in their medical practice. This observation may suggest that both groups realize that they are not independent from healthcare influences and that ophthalmology practice may involve a fair degree of routine, lack true innovation with intellectual development in a non-research environment remaining somewhat limited. Similarly, both groups felt that family and leisure were important for their quality of personal and professional life expectations.

Financial Issues - Among financial issues, only security was indicated as a significant ophthalmology professional attribute. Residency candidates anticipated a significantly lesser amount of certainty in the profession and its related income potential than those in practice. Moreover, both groups agreed that higher income, when compared to other specialties, was not a determining factor in their career expectations. This may be attributable to an awareness of evolving practice management patterns and healthcare financial reforms. Higher income levels than other subspecialties may not materialize given the tumult in healthcare financial reform measures. Limitations in insurance reimbursement and rising malpractice costs in a more competitive healthcare marketplace continue to fuel practicing physician concerns. Applicants have yet to experience these challenges and may overestimate the degree of security that this profession provides. Therefore, residency-training programs ought to consider interventional strategies that improve the work environment for residents that promote career satisfaction.8

Gender-related Issues - When residency candidates were compared by gender, the data reveal that time spent with patients and the applications of computer technology were the only factors where there were statistically significant differences. Female candidates expected to spend greater amounts of time in the patient-physician encounter. They likewise anticipated greater use of computer technologies in their eventual practice as compared to their male counterparts.

The number and proportion of women graduating medical schools in the United States has risen from 5.0% in 1961 to 42.4% in 2000. This has implications for life-style issues in both primary and specialty care specialties.9 Changing enrollments indicate differing values and skills that may affect residency training and the world of practice. Furthermore, women primary care physicians “are more influenced than men by both personal and family values” and “are more often in dual-career families and/or are less motivated by financial aspirations, or are more altruistic” in their career decisions.10 Societal expectations that “women handle the responsibility of child rearing to a greater extent than men” are deeply engrained.6 These dynamic factors may play a significant role in the career decisions by participants in this study.

There were several limitations in the study. Only prospective residency candidates who applied to the department were surveyed through their e-mail addresses. A cover letter indicated that although not anonymous, the survey results and subjects would remain confidential. Only AMA member physicians provided data in the original survey. All data are self-reported by the research subjects. In an attempt to eliminate conflict of interest concerns for prospective residency applicant acceptance, the survey was administered to the qualified applicants after the residency match results were released. This was done so that applicants understood that survey completion had no bearing on their eventual residency program selection. The study was based upon assumptions that career decisions include objective and subjective criteria. In addition, it is assumed that poor career choices yield job dissatisfaction and reduced quality of patient care delivery.

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