Ophthalmologists Are Among the Happiest in Medicine. Why Are so Few Students Choosing the Field?

Practicing ophthalmology has always been my passion. I am probably the anomaly, but I never truly considered another specialty. Luckily, my instincts were correct and if I had a chance to do it again, ophthalmology would still be my field of choice.





And while my colleagues may not have chosen ophthalmology as early as I did, the vast majority emphatically state that if they were to repeat the process, they would absolutely select ophthalmology again. A myriad of physician surveys over the years have also demonstrated that ophthalmologists as a group are among the happiest professionally. Meanwhile, the majority of our colleagues in other medical specialties lament their choice of specialty or even their selection of medicine completely.

Based on my own experience and the positive response from others, I found a recent survey in Ophthalmology, published by the American Academy of Ophthalmology, surprising and disturbing. Researchers presented the results of a questionnaire designed to determine the perception of medical students at Johns Hopkins University of a potential career in ophthalmology. Accentuated in their report is the finding that the top three reasons for not choosing ophthalmology as a career path are insufficient interest, limited exposure, as well as the perception the field is too specialized.

In the concluding paragraph, the authors state, “This study from our institution suggests that earlier and increased exposure to ophthalmology for URM and non-URM medical students could be an effective strategy to boost interest.”

While the data provided is from a single institution, my own informal survey of medical students over the past two decades offers very similar results. Here is what they have shared:

First of all, during the basic science years of medical school, there is a disproportionate number of academic hours taught by PhDs as opposed to MDs. The PhDs always emphasize their own personal areas of interest and tend to push their students to consider summer research and clinical exposure to areas they feel are more intellectually stimulating. The depth and breadth of exposure of these PhD medical school teachers to the field of ophthalmology is negligible, bordering on zero. While they themselves learned the basic science of the eye and the visual pathways, they have no experience with clinical ophthalmology.

Second, lectures devoted to eyes and the visual pathways are extremely limited, and, worse yet, almost exclusively focused on hard core basic science. While mentoring one recent student from a prestigious Ivy League medical school, I saw the extent of the curriculum that covered ophthalmology. This school in particular had very few basic science lectures on the topic. All of these lectures were taught by neuroscience PhDs or research neurologists with the exception of one single lecture by one, practicing ophthalmologist. The lectures given to the students were boring, esoteric, and certainly did not motivate the student body to take the initiative to gain more exposure to the field. When I read over the lecture notes, I could see why the field was not enticing.

Third, when students enter their fourth year of medical school, they are instructed to select electives to help make a decision about their specialty, round out their medical school experience and enhance their chances for matching.

Students, who are considering ophthalmology as a possible medical career, find that obtaining a fourth-year clinical elective in ophthalmology is far more difficult to acquire compared to other specialties. For example, if a medical student desires to schedule an elective in emergency medicine, the number of slots in many geographic areas is 10X the number of slots for ophthalmology.

Additionally, with the exception of my own immediate family member medical students, the students with whom I conferred, have never observed a live eye surgical procedure, let alone watched a video in the classroom. While I love the clinical interaction with my patients in the office, the surgical interventions and seeing the positive outcomes are still exciting to me, even after 30 years in practice.

I fervently believe if medical students had basic science lectures given by clinical ophthalmologists, instead of PhDs or physicians from other fields, and if they had the opportunity to watch videos of the cutting-edge procedures we perform, their interest in ophthalmology would be piqued. The availability of additional elective slots for fourth year students would also allow for more intense exposure to this highly desirable but seemingly underrated field of study.

We, as ophthalmologists, should assume a prominent role in teaching the next generation of physicians instead of relegating this task to the non-ophthalmologist lecturers across the country.

Who better to expose the next generation of physicians than those who happily experience it on a daily basis?

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