Impact of Gender and Fellowship Training on Academic Advancement in Ophthalmology

Background: Women have reached near parity within ophthalmology, but significant gender disparities persist at the higher academic ranks. Purpose: To evaluate the impact of gender, residency graduation year, and fellowship training with academic rank in ophthalmology across U.S. academic ophthalmology departments. Methods: Academic ophthalmology residency program websites were reviewed to collect faculty data on gender (as defined by pronoun usage in profiles), year of residency graduation, fellowship training, academic rank, and promotion track (clinical vs. academic). Univariate analysis was performed using one-way ANOVA and Pearson χ2 tests. Multinomial regression with likelihood ratio tests were conducted for multivariate analysis of association of gender, residency graduation year, and fellowship training to academic rank. Results: The profiles of 3,277 faculty members were reviewed; a total of 1,976 (71.3%) faculty in the academic track. Women comprised 38.9% of all faculty (37.1% in clinical track, 40.2% in academic track, and 36.9% without academic rank). There was no difference in gender in promotion track or having fellowship training; however, there were differences of gender representation among subspecialties, particularly in vitreoretinal surgery and pediatrics. Male gender, greater number of years since residency graduation, history of fellowship training (vs. none), and vitreoretinal surgery fellowship were associated with advancement to professor rank (p < 0.001). After adjustment for year of residency graduation and fellowship training, women had significantly lower odds of reaching professor rank than men (OR = 0.665; 95% CI, 0.497-0.889; p = 0.006). Conclusion: Women remain underrepresented in academic ophthalmology at the professor level, even after accounting for years in practice and fellowship training.