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Original Investigation
July 18, 2019

Gender Differences in Case Volume Among Ophthalmology Residents

Author Affiliations
  • 1Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, New York
  • 2Department of Ophthalmology, University of Florida, Gainesville
  • 3Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
  • 4Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 5Department of Ophthalmology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
  • 6Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
  • 7Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
  • 8Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
  • 9Brooke Army Medical Center, Fort Sam Houston, Texas
  • 10Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  • 11Department of Ophthalmology & Visual Sciences, Texas Tech University Health Sciences Center, Lubbock
  • 12Department of Ophthalmology, University of California, San Francisco
  • 13Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
  • 14Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis
  • 15Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City
  • 16Department of Ophthalmology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans
  • 17Ross Eye Institute, University at Buffalo Jacobs School of Medicine, Buffalo, New York
  • 18Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City
  • 19Department of Ophthalmology, University of Colorado School of Medicine, Aurora
  • 20Department of Ophthalmology, Weill Cornell Medicine, New York, New York
  • 21Ophthalmology and Visual Science, University of Texas Medical Branch, Galveston
  • 22Gavin Herbert Eye Institute, University of California, Irvine
  • 23Department of Ophthalmology, University of Washington, Seattle
  • 24Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis
  • 25Department of Ophthalmology, New York University School of Medicine, NYU Langone Health, New York, New York
JAMA Ophthalmol. 2019;137(9):1015-1020. doi:10.1001/jamaophthalmol.2019.2427
Key Points

Question  Do differences in cataract surgery and total procedural volume exist between US male and female residents during ophthalmology residency training?

Findings  This analysis of the case logs of 1271 ophthalmology residents from 24 US ophthalmology residency programs estimates that 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, and the gap widened during this period for total procedural volume.

Meaning  The current state of surgical training in ophthalmology residency programs deserves further study to ensure that male and female residents have equivalent training experiences.


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.