Factors Influencing Pre-residency Commitment to Pediatric Ophthalmology

Purpose: To characterize the timing of pre-residency commitment to pediatric ophthalmology and to examine the factors influencing that decision. Methods: A cross-sectional, anonymous survey was distributed electronically to pediatric ophthalmologists and fellows who committed to the subspecialty prior to residency. The four-item questionnaire assessed timing of commitment, the single most influential factor in subspecialty selection, career plan certainty, and educational debt burden. Associations were evaluated using Pearson's chi-square tests with effect size quantified by Cramér's V. Results: A total of 116 responses were received; 108 (93.1%) were included in the primary analysis. Commitment most commonly occurred during medical school year (MS)3 to MS4 (76, 70.4%), followed by MS1 to MS2 (18, 16.7%) and college or earlier (14, 13.0%). Timing was significantly associated with the most influential factor (chi-square = 32.64, P < .001; Cramér's V = 0.39). Earlier decisions were linked to personal or family experience, whereas later decisions were associated with mentorship, clinical exposure, and alignment with specialty lifestyle. Timing was also associated with career plan certainty (chi-square = 9.67, P = .046). Educational debt burden was not associated with timing (chi-square = 5.50, P = .978), although 71.3% reported debt less than $150,000. Conclusions: Pre-residency commitment to pediatric ophthalmology most often occurs during the clinical years of medical school and reflects stage-specific influences. Earlier decisions are associated with personal exposure, whereas mentorship and structured clinical experiences are linked to later commitment. Expanding early, accessible exposure and mentorship opportunities may represent a strategy to strengthen the future pediatric ophthalmology workforce.