Distribution of Research and Clinical Productivity among US Ophthalmologists, 2021 to 2023: A Cross-Sectional Analysis.

PURPOSE: To quantify the association between research output and Medicare-weighted clinical volume among ophthalmologists and to examine variation by gender, career stage, and institution.

DESIGN

Cross-sectional study linking PubMed publications (January 1, 2021-December 31, 2023) to the National Plan and Provider Enumeration System and Medicare Part B claims data.

SUBJECTS: US ophthalmologists with at least one PubMed-indexed publication during 2021 to 2023 (N = 2914). For location-based analyses, 2684 after excluding 230 lacking geographic data.

METHODS

Calculated a publication score using fractionally weighted authorship credits with multipliers based on journal impact factor and estimated Medicare-weighted clinical volume as annualized work relative value units (RVUs) from Medicare claims (scaled from 5% sample). Defined a composite productivity metric as publication score × RVU. Conducted descriptive analyses, Spearman correlation between publication score and RVUs, and comparisons by gender and years in practice.

MAIN OUTCOME MEASURES: Our primary outcomes included publication score, annualized work RVUs, and composite publication score × RVU.

RESULTS

Among 2684 ophthalmologists (1764 men [65.7%], 920 women [34.3%]; median years in practice, 19), median publication score was 0.41 (interquartile range, 0.04-2.19). and median RVUs were 2792 (interquartile range, 982-6246). Publication score and RVUs were weakly inversely correlated (Spearman r = -0.13; 95% confidence interval [CI], -0.16 to - 0.10). Women and men had similar publication scores (median, 0.52 vs. 0.36; difference, 0.16; 95% CI, -0.02‑0.32) but women performed fewer RVUs (median, 1833 vs. 3750; difference, -1917; 95% CI, -2112 to -1722). The composite score × RVU peaked at 21 to 30 years in practice (median, 1436) and was highest in Maryland (median, 6111). Five flagship eye centers accounted for 24% of national publication credit and 34% of combined productivity.

CONCLUSIONS

Among publishing ophthalmologists, research output showed only a small trade-off with clinical workload. Women published at rates comparable to men despite lower Medicare volumes, and peak combined productivity occurred mid-career. Operationally, these data support piloting protected research time and equitable workload targets without materially reducing clinical throughput, while using regional partnerships to diffuse research opportunities.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.