Research Letter 

July 29, 2024

Midcareer Satisfaction and Likelihood of Leaving Current Position of Former Career Development Awardees

Reshma Jagsi, Kent A. Griffith, Kelly C. Paradis, et al

JAMA. 2024;332(8):666-667. doi:10.1001/jama.2024.12262

The National Institutes of Health K-award program invests in the career development of promising early-career faculty. Because retaining diverse faculty is necessary to achieve the mission of improving health, we assessed career satisfaction, discrepancies between ideal and expected careers, and likelihood of leaving current positions among former K awardees overall and by gender, race, and ethnicity.

Methods

A questionnaire was developed and administered by mail and online between August 2021 and August 2022 to individuals who first received K08 or K23 awards between 2006 and 2009.¹ Outcomes measures included the Career Satisfaction Scale² (5 items, measured on a 5-point Likert scale from strongly disagree [1] to strongly agree [5], with higher scores representing greater satisfaction), discrepancy between ideal and actual expected career path (Effort Discrepancy Scale³: 3 items, measured on a 5-point Likert scale from strongly disagree [1] to strongly agree [5], with higher scores representing more discrepancy), and the likelihood of leaving current position within 2 years (1 item, ranging from very likely to very unlikely) (eAppendix in Supplement 1). Results were analyzed by gender (self-identified as “man” vs “woman”) and race and ethnicity (self-identified using categories listed in the eAppendix in Supplement 1 and then grouped by investigators as Asian, underrepresented race and ethnicity in medicine [URM], or White). Comparisons were made using the χ² test for categorical data and the F test from a general linear model for the continuous scaled data.

Data were analyzed with SAS version 9.4; P < .05 (2-sided) was the threshold for significance. The University of Michigan institutional review board approved this study and waived documentation of informed consent because the research involved no procedures for which written consent is normally required outside the research context.

Results

Of 1430 individuals surveyed, 926 responded (65%). Overall, 841 respondents (91%: 89.3% of men [426 of 477], 92.2% of women [392 of 425], 92.0% of Asian respondents [172 of 187], 88.0% of URM respondents [66 of 75], and 90.8% of White respondents [580 of 639]) reported remaining in academic positions; and 64 (7.0%), having left academics.

Overall, mean score on the Career Satisfaction Scale was 4.17 (95% CI, 4.12-4.22), and on the Effort Discrepancy Scale, 2.07 (95% CI, 2.00-2.15); 17.4% (95% CI, 15.0%-20.0%) reported being very likely or likely to leave their current position within 2 years. No statistically significant gender differences were observed in satisfaction, effort discrepancy, or likelihood of leaving (Table).

URM respondents reported lower satisfaction compared with White respondents (mean, 4.02 [95% CI, 3.83-4.21] vs 4.20 [95% CI, 4.15-4.26]; P = .04), and Asian respondents reported higher effort discrepancy (mean, 2.21 [95% CI, 2.03-2.38] vs 2.00 [95% CI, 1.91-2.09]; P = .03) (Table). Likelihood of leaving varied significantly by race and ethnicity, with 21.9% (95% CI, 15.6%-29.9%) of Asian respondents and 22.7% (95% CI, 13.3%-35.9%) of URM respondents indicating being likely or very likely to leave their current positions within 2 years compared with 15.0% (95% CI, 12.0%-18.7%; P = .03) of White respondents.

Discussion

In this survey of medical faculty with early-career research funding, most respondents remained in academic medicine, but many indicated likelihood of leaving their current positions, particularly among URM and Asian subgroups. Career satisfaction was high and discrepancies between ideal and actual expected career low, with no differences by gender and small differences by race and ethnicity.

Dissatisfaction and attrition are serious concerns in academic medicine.⁴ The higher dissatisfaction of URM faculty and discrepancy between ideal and actual careers of Asian faculty are consistent with data showing diminished representation of these groups in the most influential positions in academic medicine.⁵

Study limitations include the possibility of selection bias and insufficient numbers to assess interactions between race and gender. Differences between groups may not be meaningful even when P < .05, especially in the context of multiple comparisons. The discrepancy measure may understate differences in experiences of minoritized identity groups if the vision of an ideal career is bounded by a limited awareness of opportunities or self-belief. Intention to leave may reflect pursuit of better opportunities elsewhere and does not necessarily indicate departure from academia.

Given the unique potential of these faculty, the findings may motivate interventions to improve mentorship⁶ and the work environment¹ to ensure that clinician-researchers thrive.