Gender Differences in Case Volume Among Ophthalmology Residents

• Authors: Dan Gong, Columbia University; Bryan J. Winn, Columbia University; Casey J. Beal, University of Florida; Preston H. Blomquist, University of Texas Southwestern Medical Center; Royce W. Chen, Columbia University; Susan M. Culican, Washington University; Lora R. Dagi Glass, Columbia University; Gary F. Domeracki, Temple University; Jeffrey M. Goshe, Cleveland Clinic; Jeremy Jones, Emory University; Albert S. Khouri, Rutgers New Jersey Medical School; Gary L. Legault, Brooke Army Medical Center; Timothy J. Martin, Wake Forest University; Kelly T. Mitchell, Texas Tech University; Aymen Naseri, University of California San Francisco; Thomas A. Oetting, University of Iowa; Joshua H. Olson, University of Minnesota; Jeff H. Pettey, University of Utah; Maria A. Reinoso, Louisiana State University; Andrew L. Reynolds, University of Buffalo; R. Michael Siatkowski, University of Oklahoma; Jeffrey R. SooHoo, University of Colorado; Grace Sun, Weill Cornell Medicine; Misha F. Syed, University of Texas Medical Branch; Jeremiah P. Tao, University of California Irvine; Parisa Taravati, University of Washington; Darrell WuDunn, Indiana University; Lama A. Al-Aswad, New York University
• Journal Title: JAMA Ophthalmology
• Volume: Volume 137, Number 9
• Publisher: American Medical Association | 2019-09-01, Pages 1015-1020
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1001/jamaophthalmol.2019.2427
• Subjects: Health Sciences, Opthamology; Physics, Optics; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Ophthalmology

Abstract

Importance Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. Objective To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. Design, Setting, Participants This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. Main Outcomes and Measures Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. Results Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, −15.0 [95% CI, −22.2 to −7.8]; P < .001); men performed a mean (SD) of 509.4 (208.6) total procedures and women performed a mean (SD) of 451.3 (158.8) (mean difference, −58.1 [95% CI, −80.2 to −36.0]; P < .001). Eighty-five of 815 male residents (10.4%) and 71 of 456 female residents (15.6%) took parental leave. Male residents who took paternity leave performed a mean of 27.5 (95% CI, 13.3 to 41.6; P < .001) more cataract operations compared with men who did not take leave, but female residents who took maternity leave performed similar numbers of operations as women who did not take leave (mean difference, −2.0 [95% CI, −18.0 to 14.0]; P = .81). From 2005 to 2017, each additional year was associated with a 5.5 (95% CI, 4.4 to 6.7; P < .001) increase in cataract volume and 24.4 (95% CI, 20.9 to 27.8; P < .001) increase in total procedural volume. This increase was not different between genders for cataract procedure volume (β = −1.6 [95% CI, −3.7 to 0.4]; P = .11) but was different for total procedural volume such that the increase in total procedural volume over time for men was greater than that for women (β = −8.0 [95% CI, −14.0 to −2.1]; P = .008). Conclusions and Relevance Female residents performed 7.8 to 22.2 fewer cataract operations and 36.0 to 80.2 fewer total procedures compared with their male counterparts from 2005 to 2017, a finding that warrants further exploration to ensure that residents have equivalent surgical training experiences during residency regardless of gender. However, this study included a limited number of programs (24 of 119 [20.2%]). Future research including all ophthalmology residency programs may minimize the selection bias issues present in this study.