Barriers to pursuing ophthalmology among medical students

Background: Underrepresented in medicine (URM) medical students pursuing ophthalmology are notably scarce. As racial concordance improves health outcomes, understanding perceived barriers is of utmost importance. Limited data exists regarding factors that inform URM medical students’ decisions for declining to pursue ophthalmology. Purpose: To investigate factors associated with students’ motivations and decision-making process with regard to pursuing ophthalmology. Methods: From 2019 to 2022, fourth-year medical students at the University of Michigan who were not pursuing ophthalmology completed a questionnaire assessing intrinsic and extrinsic factors that influence specialty choice. Using Likert scales, students rated the importance of salary, research, and minority climate (1-5; 5 indicating most important), as well as exposure and personal factors (1-4; 4 indicating most important), and reasons for not choosing ophthalmology, such as diversity and outpatient interest (1-3; 1 indicating most deterring factor). These were labeled as career prospects, career exposure, and specialty-specific factors, respectively. Welch’s t test was used to compare responses between URM and non-URM students. Results: Of 683 students who were approached, 200 participated (response rate = 29.3%). Of these, 175 self-identified as non-URM and 25 as URM. Financial compensation was more important for URM students (M = 3.3/5) than non-URM students (M = 3.1/5 [p = 0.03]). Likewise, research opportunities were also less important for URM students (M = 2.3/5) than for non-URM students (M = 2.9/5 [p < 0.01]). URM applicants were less deterred by outpatient aspects of ophthalmology (M = 2.9/3; lower score indicates increased deterrent) than non-URM peers (M = 2.6/3 [p < 0.01]). When it came to selecting ophthalmology, a lack of diversity in the field was a higher deterrent for URM students (M = 2.38/3; lower score indicates increased deterrent) than for non-URM students (M = 2.75/3 [p = 0.02]). Conclusion: Fourth-year URM students consider factors such as the climate for minorities at an institution, lack of diversity in ophthalmology, and financial compensation more strongly than non-URM students when choosing a specialty. The current lack of diversity within ophthalmology may contribute to URM students’ decisions not to apply to ophthalmology. These findings underscore the importance of diversifying the ophthalmic workforce.