The Profession
Factors that Determine Academic Versus Private Practice Career Interest in Radiation Oncology Residents in the United States: Results of a Nationwide Survey

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Purpose

To determine what factors US radiation oncology residents consider when choosing academic or nonacademic careers.

Methods and Materials

A 20-question online survey was developed and sent to all US radiation oncology residents to assess factors that influence their career interest. Residents were asked to rate their interest in academics (A) versus private practice (PP) on a 0 (strong interest in A) to 100 (strong interest in PP) scale. Responses were classified as A (0-30), undecided (40-60), and PP (70-100). Residents were also asked to rank 10 factors that most strongly influenced their career interest.

Results

Three hundred thirty-one responses were collected, of which 264 were complete and form the basis for this analysis. Factors that correlated with interest in A included having a PhD (P=.018), postgraduate year level (P=.0006), research elective time (P=.0003), obtaining grant funding during residency (P=.012), and number of publications before residency (P=.0001), but not number of abstracts accepted in the past year (P=.65) or publications during residency (P=.67). The 3 most influential factors for residents interested in A were: (1) baseline interest before residency; (2) academic role models; and (3) research opportunities during residency. The 3 most influential factors for residents interested in PP were: (1) baseline interest before residency; (2) academic role models; and (3) academic pressure and obligations.

Conclusions

Interest in A correlated with postgraduate year level, degree, and research time during residency. Publications before but not during residency correlated with academic interest, and baseline interest was the most influential factor. These data can be used by residency program directors to better understand what influences residents' career interest.

Introduction

Radiation oncology has become an increasingly competitive field for medical school graduates in the United States. Annual data from the 2011 National Residency Matching Program indicate that of 163 US seniors who applied to radiation oncology as their only choice of residency, 23 (14%) were not able to match, a rate that is exceeded only by dermatology, orthopedic surgery, plastic surgery, and general surgery (1). As programs continue to be faced with the ever-increasing quality of applicants, many evaluate candidates on the basis of their academic potential as evidenced by research publications, presentations at scientific meetings, and grant funding, factors that are assumed to play an important role in determining the applicant's career path. Programs typically include several months of research elective time to support and encourage academic interest, and overall, radiation oncology residents have been successful in publishing first author publications (2). In fact, resident research productivity has been shown to correlate with elective time allowed during residency (3), suggesting that elective time is an effective way to encourage academic-bound trainees. However, a resident's decision to pursue an academic versus private practice career path is multifactorial, affected by factors both intrinsic and extrinsic to the residency training experience (4).

A study by Wilson et al in 2005 surveyed graduating senior residents of the 2004 graduating class to determine what factors influenced the particular career path they had chosen immediately upon graduation (5). The results suggested that academic pursuits during residency played an important role in choosing an academic career. Nevertheless, several issues remain unclear: (1) Among these residents, what is their degree of academic interest upon entering residency? (2) How does an interest in academic medicine change over time during residency? and (3) What types of academic activities during residency most correlate with academic interest? The answers to these questions could be important for training programs to better recognize trainees with a genuine academic career interest and how to foster and develop that interest during residency.

The purpose of this study was to determine the factors that influence academic versus nonacademic career interest in all radiation oncology residents in the United States.

Section snippets

Methods and Materials

Under institutional review board approval, a 20-question online survey was devised and delivered using commercial software (Qualtrics, Provo, UT). Because no comprehensive mailing list of current radiation oncology residents is maintained, the survey link was sent to the residency program directors and program coordinators at all listed US residency training programs in the online directory of the American Medical Association website (6). Directors and coordinators were then asked to forward

Respondent characteristics

Currently, there are 87 Accreditation Council for Graduate Medical Education (ACGME)-accredited radiation oncology programs with active residents, and residents from 64 programs (74%) responded to this survey. Three hundred thirty-one residents and graduates responded, of whom 259 are current residents at the time of completing the survey. Of the 681 radiation oncology residents currently in postgraduate year (PGY) 2 through 5, the estimated response rate among residents was 38%. In total, 264

Discussion

The decision to enter a career in academia depends on many factors and has been studied previously. A review of the literature by Borges et al (4) highlighted the importance of: (1) individual values; (2) financial considerations (salary and school debt); (3) gender; (4) role models; (5) and research activities. Given the high level of competition now for radiation oncology residency, the common perception is that programs strongly prefer applicants who want to pursue academics and have a track

Acknowledgments

We thank Jessica Kirwan for editing this manuscript and Christopher Morris for providing statistical support for this study.

References (16)

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Conflicts of interest: none.

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