Career trends after fellowship: the rising tide of private equity and the ebb of academic medicine in fertility care.

Abstract

While the number of fellows graduating Reproductive Endocrinology and Infertility fellowship has remained relatively stable in the last decade, the places and ways in which they can practice have shifted significantly. There has been not only a marked growth in the number of assisted reproductive technology cycles performed annually in the United States in recent years but also an increase in large multisite or "network" group practice models backed by private equity firms changing the professional landscape for those seeking their initial career postfellowship. To analyze the workforce trends among graduates from Reproductive Endocrinology and Infertility fellowship over the last decade. An online cross-sectional analysis of careers among all Reproductive Endocrinology and Infertility fellowship graduates from 2012 to 2022 was performed via internet search. This was followed by an anonymous online survey disbursed to the same group of fellowship graduates to assess demographics, postfellowship career selection and decision-making factors, and current practice setting. Of the 540 Reproductive Endocrinology and Infertility fellowship graduates analyzed, 386 (71.5%) responded to the survey. About two-thirds of surveyed physicians (64%) have remained in the same practice since graduation. Half of respondents are currently in a network-affiliated practice associated with private equity. The most important factors in selecting a postfellowship position were geographic location and practice reputation. Those who started in private practice and changed careers commonly remained in private practice (86%), while those who started in academic practice and changed only remained in an academic medical center 28% of the time. Survey respondents most frequently attributed career changes to feeling the practice was not an overall good fit (54%), needing to relocate (37%), or factors related to partnership (42%) and salary compensation (20%). Only 7% of physicians noted an interest in spending more time on trainee education as a career-changing factor. Over the past decade, the workforce providing Reproductive Endocrinology and Infertility care has been evolving. Fellows are currently placing a high degree of emphasis on geography and reputation for their first job. Many graduates are joining network-affiliated practices associated with private equity, while a high number of physicians are leaving academic practices.