Gender gap and declining surgical activity among new graduates: cataract surgery in Ontario

To investigate the proportion of ophthalmologists performing cataract surgery; the volume performed; and the influence of career stage, sex, and trends over time.

Population-based study of cataract surgical practice patterns among all ophthalmologists in Ontario, Canada, from April 1999 to March 2013.

All active ophthalmologists in Ontario, Canada, providing government health care for the provincial population of approximately 13 million.

The IntelliHealth database operated by the Ministry of Health and Long Term Care, which has excellent accuracy for procedure performance, was used to obtain anonymized physician services.

The percentage of ophthalmologists performing cataract surgery decreased (68% to 64%), but the yearly mean number of cataract surgeries performed per person increased 1.5 times (307.7 to 470.2). The percentage of early-career ophthalmologists performing cataract surgery declined from 85% to 62%, and this was accompanied by a decline in the median number of cases performed per early-career surgeon (from 243.0 to 169.5). This decline in surgical activity among new graduates was accompanied by growth in the percentage of high-volume and late-career surgeons. In each of the years studied, males performed more surgeries per person than their female counterparts, and this gap grew from 1.4 times to 1.7 times more cataract surgery from 2000 to 2013.

Early-career ophthalmologists are becoming less active with cataract surgery, which may be explained by the increasing surgical activity among late-career and high-volume ophthalmologists. A large sex and volume gap exists among cataract surgeons, which continues to increase.