Predictors of Academic Career Trajectory Among Spine Surgical Fellows

Introduction: Producing academic surgeons and future thought leaders remains a mission of many fellowship programs. While spine surgery careers are longitudinally influenced by a multitude of professional and personal factors, early predictors of academic career trajectories may be identifiable at the spine fellow applicant stage. This study aims to determine if spine fellow application factors are predictive of future appointment at academic medical institutions and research impact.

Methods: Spine fellowship applications between 2017-2021 at a single academic institution were reviewed. Metrics including research output, awards, prestige of prior training, extracurriculars, reputation of letter of recommendation (LOR) writer, USMLE scores, and applicant interests were extracted from fellow applications. Primary outcomes included career trajectory (employment status at academic, private, or community setting) and research impact (current H-index). Univariate analysis and logistic and multivariate linear stepwise regressions were utilized to identify predictors of academic career trajectory and research impact.

Results: A total of 310 applications were reviewed. Current employment in an academic medical center (n=80), in comparison to private or community practice (n=230), was associated with greater number of publications, first author publications, basic science publications, spine publications, publications during residency, podium and poster presentations, grants awarded, journal reviewer positions, academic scholarships, highest publication impact factor, H-index at the time of application, average H-index of the LOR writers, residency program ranking, USMLE Step 2 and Step 3 scores, and applicant interest in academic medicine or physician scientist careers (p < 0.05). In logistic regression, number of publications during residency (odds ratio [OR]:1.09, p=0.0116), number of basic science publications (OR:1.24, p=0.0447), and applicant interest in academics (OR:2.25, p=0.0229) were significant predictors of academic careers. In linear regression, number of residency publications (b:0.19, p< 0.001), submitted publications (b:0.29, p=0.001), poster presentations (b:0.15, p< 0.001), H-index at the time of application (b:0.72, p< 0.001), and applicant interest in academic medicine (b:1.09, p=0.0463) or physician scientist careers (b:0.82, p=0.0194) predicted research impact.

Conclusion : Publication during residency, basic science research, and applicant academic interest were uniquely predictive of a spine surgery academic career. Current research impact reflected research metrics including submitted publications, poster presentations, and expressed applicant interest in physician scientist careers.