Racial Barriers, Family Income, Debt at Graduation Keep Many from Pursuing Career in Ophthalmology

Glenn Yiu, MD, PhD
Credit: UC San Diego

Data from a study of more than 1000 medical students expressing interest in pursuing a career in ophthalmology is shedding new light on what may be hindering the growth of the specialty.

Results of the study, which examined the demographic and financial characteristics of these students, found medical students who were female or non-Hispanic Black were less likely to pursue a career in ophthalmology than their male or non-Hispanic White counterparts, with further analysis providing evidence of income-based disparities as well.¹

“Gender, racial and socioeconomic disparities among students interested in ophthalmology begin during medical school, highlighting the need to address barriers,” wrote investigators.¹

Across healthcare, the ongoing clinician shortage has placed an undue strain on providers and healthcare systems as a whole. In ophthalmology, a recent study provided insight into just how dire this situation could become if left unaddressed. In the study, which used data from the Department of Health and Human Services, Health Resources and Services Administration website, results indicated that, from 2020-2035, the total number of ophthalmologists was projected to decrease by 2650 full-time equivalent (FTE) ophthalmologists, which represents a 12% decline. During this same period, total demand was projected to increase by 24%,—representing a supply and demand mismatch of 30% workforce inadequacy.²

In the current study, a team from the University of California Davis Medical Center led by Christine Xu, MD, along with colleagues from, the current study was launched with the intent of exploring how sex, race, and financial characteristics of students might differ among those who intend to pursue a career in ophthalmology at matriculation versus graduation. With this in mind, investigators designed their study as an analysis of data from medical students who completed the Association of American Medical Colleges (AAMC) Matriculating Student Questionnaire (MSQ) from 2013-2021 as well as those who completed the AAMC Graduation Survey (GS) from 2017-2022.¹

From the AAMC MSQ and GS, investigators obtained response data from 134,723 matriculating students and 98,628 graduating students. Of these cohorts, 1096 expressed an initial interest in ophthalmology at matriculation and 357 (32.6%) intended to practice the specialty at graduation. Initial analysis of AAMC MSQ data suggested women were less likely to be interested in ophthalmology than men (odds ratio [OR], 0.71; P < .001), with further analysis demonstrating Asian students had greater odds (OR, 1.95; P < .001) and Black students had reduced odds (OR, 0.76; P =.008) compared to non-Hispanic White students. Investigators also pointed out having parental income greater than $220,000, as compared to $75,000 or less, was associated with increased odds (OR, 1.5; P <.001).¹

Results pointed to similar trends when assessing factors associated with an interest in pursuing a career in ophthalmology at graduation. Specifically, women still had reduced off of pursuing a career in the specialty compared to men (OR, 0.67; P < .001) and, compared to White students, Asians had greater odds (OR, 1.61; P < .001) and Blacks had reduced odds (OR, 0.72; P=.005). Investigators noted having premedical education debt (OR, 0.6; P < .001), having noneducational debt (OR, 0.6; P < .001), and having medical education debt (OR, 0.6; P < .001) were also associated with reduced odds of pursuing a career in ophthalmology.¹

“Our findings suggest future efforts in recruitment should be targeted at premedical and medical students, and potentially addressing financial barriers given the high cost of applying to ophthalmology,” investigators added.¹

References:

1. Xu C, Copparam S, Herrera M, Hou M, Yiu G. Demographic and Financial Characteristics of Medical Students Interested in Ophthalmology Before and After Medical School in the United States. Presented at the 2023 American Academy of Ophthalmology Annual Meeting; November 3, 2023; California, San Francisco.
2. Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology Workforce Projections in the United States, 2020 to 2035 [published online ahead of print, 2023 Sep 20]. Ophthalmology. 2023;S0161-6420(23)00677-2. doi:10.1016/j.ophtha.2023.09.018