A Study of Prospective Ophthalmology Residents’ Career Perceptions

Conclusions

This study provides evidence that residency candidate career perceptions differ from those of practicing ophthalmologists. Our results suggest that prospective ophthalmologists are of the opinion that once into their medical practice; they would have opportunities to spend more time in a continuous medical relationship with their patients. Similarly, they foresaw their careers being diverse in terms of work tasks. Sharing their expertise among fellow physicians were particular ambitions held by candidates. Although job pressure was not considered excessive, they did feel that they’d encounter considerable job responsibility associated with vision care, although in a less secure environment.

The increasing numbers of women medical graduates will likely mean additional women residency applicants, thus altering the role of women in the medical field. Ophthalmology careers may be of interest because of a perceived lifestyle, career and family balance.

Although ophthalmology has historically tended to produce greater private practice opportunities1, the changing medical profession workforce (i.e., increased gender and ethnic diversity; older resident age; increased expectations for career satisfaction; as well as changing child-rearing roles for either parent) may contribute to increased interests in academic medicine or other medical practice options.

Another career factor of increased interest is the application of information and diagnostic technologies. Computer technology and mechanical devices were found to be more an interest to residency candidates than those in practice, perhaps explained by the fact that younger generations are more informed about technology.

Surprisingly, prospective female residents revealed the most interest in computer technology applications perhaps due to its time-saving efficiencies. This has additional implications for evidence-based practice and telemedicine. Patients who are better informed will use information access via the Internet and physician e-mail than ever before.5 In this way, computer based resources will benefit resident training and professional practice.

The influence of candidate family and personal values were found to be more highly rated than those in practice. Women residents appear to be concerned about balancing family and career issues for career satisfaction. Women physicians are found to have 20% fewer work hours than males.5 This may be an important consideration in resident recruitment and curriculum that allow for a balanced career-family lifestyle.

We recommend that resident faculty include career factors related to graduate medical education general competencies (e.g., Patient Care; Communications and Interpersonal Skills; Professionalism; etc.) during the recruitment interview process. Such recommendations may be of special concern to residency programs affiliated with academic health centers where shorter patient hospital stays and a lesser emphasis on teaching in out-patient clinics place added burdens on faculty to teach important career factors.10 Residency programs need to consider the critical factors that determine career satisfaction when recruiting prospective colleagues. In addition, core curriculum designs should incorporate practice management objectives related to Career and Financial Issues in clinical practice. The perceptions of Personal-Family Issues are important for both recruitment and instruction of residents as well as medical students. Career planning during medical school and residency training should be offered so that career, personal and financial issues are effectively explored. In this way, important core competencies for interpersonal communications, professionalism and medical practice are considered particular strengths associated with women candidates.

Therefore, guiding the process of career expectations assists medical students and residents towards effective career decision-making. A changing patient population by ethnicity and age demographics coupled with greater competition in the ambulatory care setting will further influence decisions for practice options. Creating experiences that include private practice role modeling may likewise create a more realistic perception of ophthalmology practice. Moreover, assessing career critical factors may fortify resident general competencies in such domains as interpersonal and communications skills; professionalism; and systems-based practice. Therefore, resident career critical factors may enhance their career satisfaction and longevity as future ophthalmologists to meet the vision care needs of a changing and diverse patient population.

Acknowledgements

Dr. Tom Prager (UT Houston) provided statistical and graphical support.


References

  1. Pankratz MJ, Helveston EM. Ophthalmology: The resident’s perspective. Arch Ophthalmol 1992 110:37-43.
  2. Kay LE, D’Amico F. Factors influencing satisfaction for family practice residency faculty. Fam Med 1999 31 (6): 409-14.
  3. Weaver SP, Mills TL, Passmore C. Job satisfaction of family practice residents. Fam Med 2001 33 (9): 678-82
  4. Debas H. Surgery: A noble profession in a changing world. Ann Surg 2002 236 (3) 263-9.
  5. Gabram SG, Hoenig J, Schroedeer JW Jr., Mansour A, Gamelli R. What are the primary concerns of recently graduated surgeons and how do they differ from those of the residency training years? Arch Surg 2001 136 (10): 1109-14.
  6. Brian RS. Women in medicine. Amer Fam Physician 2001 64 (1):174-7.
  7. Bergus GR, Randall CS, Winniford MD, Mueller CW, Johnson SR. Job satisfaction and workplace characteristics of primary and specialty care physicians at a bimodal medical school. Acad Med 2001 76 (11): 1148-52.
  8. Mayer, KL, Perez RV, Hung SH. Factors affecting choice of surgical residency training programs; J of Surg Res 2001 98: 71-75
  9. Xu G, Rattner SL, Veloski J, Hojat M, Fields SK, Barzansky B. (1995) A national study of the factors influencing men and women physician’s choices of primary care specialties. J Acad Med 1995 70 (5): 398-404.
  10. Commonwealth Fund Report. Training tomorrow’s doctors: The medical education mission of academic health centers. A Report of the Commonwealth Fund, New York; 2002.

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Abstract

JR Scott, EdD, MPH and CA Gunderson, MD

Department of Ophthalmology and Visual Sciences;
University of Texas Medical Branch

Abstract: Objectives: The purpose of this study was to identify differences in ophthalmology resident candidates and practicing ophthalmologists’ career perceptions. A secondary aim was to evaluate specific demographic factors (e.g., gender, ethnicity, career interests, etc.) among residency candidates regarding their career perceptions.
Methods: A survey instrument (Critical factors in Career Perceptions) was sent by e-mail to prospective residents (n= 122). Group differences were calculated using a one sample t-test analysis.
Results: Compared to practicing ophthalmologists (n = 56), residency candidates were more likely (p < 0.05) to expect greater professional job satisfaction from a number of career factors (e.g., time with patients, physician teamwork, etc.); family-personal factors (e.g., diversity of job skills, sole professional responsibility, etc.); and financial factors (i.e., income and security) than those in practice. Gender differences between candidates revealed that women were more interested in spending time with patients and in computer technology applications.
Conclusions: These results suggest that medical school and residency program leaders to consider specific factors ophthalmologists encounter in their profession so that residency candidates have a more realistic view of their chosen profession. Several recommendations for resident recruitment and curriculum development are provided.

Key Words: resident career perceptions; ophthalmology career satisfaction; ethics/professionalism

Med Educ Online [serial online] 2003;8:9. Available from http://www.med-ed-online.org

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Personal as well as professional goals, values, and interests are often formulated prior to commencing a professional career. Applicants to residency programs frequently chose their field of specialty based upon rather naive perceptions of that specialty. These initial perceptions may differ from those of physicians practicing within that specialty and may differ by the applicant’s gender. Although their viewpoints are further refined during residency, significant career choices are based on those initial perceptions. In particular, understanding the career perceptions of ophthalmology resident applicants may provide a greater understanding of their unique capabilities and preferences for this medical specialty. In fact, ophthalmology is recognized as a medical specialty for the high degree of patient contact across all age groups; the amount of surgical procedures; and the potential for a favorable life-style.1 Not surprisingly, long-term physician job satisfaction is shown to relate to career turnover2 as well as satisfaction during the residency training experience.3

     The purpose of this study was to more accurately assess and describe the perceptions of ophthalmology residency training candidates towards their chosen profession. By understanding these perceptions, residency programs may be better able to select applicants able to achieve greater career satisfaction.


Methods

An electronic survey was delivered to resident applicants qualified for review to the University of Texas Medical Branch at Galveston (UTMB), Department of Ophthalmology and Visual Sciences, for the entrance year 2003. The survey was based upon a validated and administered survey of Critical Career Factors among practicing ophthalmologists developed by the American Medical Association (AMA). Modifications in the survey were made to measure anticipated perceptions without changing the original survey’s intent. The instrument consisted of twenty items using a Likert-type rating scale on a 10-point continuum (e.g., “1” having lesser value to “10” having greater value) as well as five open-ended questions added to the original instrument. The modified survey was piloted among similar resident respondents for clarity, appropriateness, and comprehension. IRB approval was obtained in accordance with established ethical standards for expedited institutional research. This study was a cross-sectional survey of residency candidates using an e-mailed questionnaire with survey responses stored within the departmental web page.

     The Critical Factors assessed by the survey included:

      Critical Factors were divided into four broad categories: Career-oriented issues; Personal-family issues; Financial issues; and Gender-related issues. Career-oriented issues included time, continuity, expertise, physician interaction, manual/mechanical, pressure, schedule, end results, status, and computer/technology. Personal-family issues consisted of autonomy, routine/diversity, family/leisure, innovation, intellectual, responsibility, and family influence while Financial issues included income and job security.

     An initial e-mail survey was sent April 2002 with a second e-mail submission to non-responders by June 2002. Responses by the residency candidates (n= 42) were then compared to the responses of practicing ophthalmologists (n = 56) who completed the original instrument administered by the AMA. Regrettably, no other data was available regarding AMA practicing physician scores (e.g., demographics; practice patterns; etc.). A one-sample t-test was used to compare means for critical factor scores between the two groups (e.g., candidates and practicing physicians). A two-sample t-test was used to measure gender differences on each critical factor among residency candidates. Means and Standard Deviations were calculated using Excel with data analyzed from the resident applicants at the 0.05 level (< p). A Bonferonni Adjusted Probability was used to determine the critical value of the t-test.


Results

One hundred and twenty-two qualified applications were received for the entering class of 2003. Electronic responses to the survey were received by 40 applicants with two returned by the postal system for a total of 42 (34.4 %). There were 18 (43 %) female and 24 (57%) male participants with a mean age of 27.54 years. Figure 1 illustrates the reported ethnic background of the respondents.

Resident candidates (n= 42) revealed career interests among several categories. Nearly one third (35.7 %) sought careers in academic medicine while most (55 %) held private practice interests with the remaining (7 %) expressing research career interests. There were 2.3% who were undecided in their career interests.

Perceptions in the following critical factors were found to be significant (p < 0.05) by a one-sample t-test: Patient Interaction Time, Continuity, Routine/Diversity, Expertise, Physician Interaction, Manual/Mechanical Activities, Pressure, Responsibility, Security, Status, Computer/Technology, and Family Influence (See Table 1).

Career Issues represented the most striking difference between ophthalmology resident applicants and practicing ophthalmologists among career perception categories. In particular, most resident candidates perceived that they would spend lesser amounts of time with their patients on a less regular (mean = 7.97), continuous, basis. They likewise perceived a lower level of expertise (mean = 7.10) in a teamwork setting with other physicians (mean = 6.39). Moreover, they rated a career in ophthalmology as having greater status (mean = 7.87) than other subspecialties. Yet, they underestimated the pressures of dealing with crises and patient decisions (mean = 3.52). Finally, among Career Issues, they perceived that significant amounts of their time would be spent performing highly skilled manual/mechanical activities along with computer technology applications (mean = 7.95).

Residency candidates perceived several Personal-Family Issues as being significant. They expected greater diversity in job skills (mean = 6.97), lesser degrees of sole responsibility in their profession (mean = 8.44), and greater family influences on career decisions than that of practicing physicians (mean = 7.39).

Only one Financial Issue was found to be significant for residency candidates. Although reported on a reversed scale (e.g., Likert-scale rating where greater security was rated a “1” as demonstrated by the significantly lower mean value of 3.14) they expected greater levels of professional security (mean = 3.15), although lower income expectations than experienced by practicing physicians (mean = 6.29).

Critical Factors were then analyzed concerning different career perceptions based upon applicant gender (See Table 2). Female residency candidates indicated two factors that were significantly different from their male counterparts: time spent directly caring for patients (p = 0.054) and using computer-related technology (p = 0.001).

Qualitative findings from open-ended survey questions were provided by most (n = 38) of the respondents. Their classifications are described in the Discussion section.

Two open-ended questions provide added insight into individual residency candidate career perceptions. In particular, they were asked to describe the most and least appealing aspects of their chosen profession. Several themes emerged. These were classified from the candidate’s perspective, or viewpoint. The most cited comments were categorized into themes. The predominant theme regarding the question on the ‘most appealing’ nature of the ophthalmology profession was revealed by six subjects who indicated the professions’ “highly specialized medical and surgical” career attribute. Other appealing career aspects were expressed by two subjects who reported the specialties’ “specific expertise, clinical and technical skills, and continuity of patient care”. The ‘least appealing aspects’ of the profession were revealed by three subjects regarding “insurance and medical care cost reimbursement” concerns. Other ‘least appealing’ aspects were cited by two subjects who cited concerns for “procedural/legal risk” and competition from optometrists. Thus, many of the concerns and comments expressed by the candidates are supported by these research results for aspects of the ophthalmology profession (e.g., financial, legal, and competition).


Discussion

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