Job search strategies and early careers of clinical informatics fellowship alumni (2016-2022)

Abstract

Objective

To report on clinical informatics (CI) fellows’ job search and early careers.

Materials and Methods

In the summer of 2022, we performed a voluntary and anonymous survey of 242 known clinical informatics fellowship alumni from 2016 to 2022. The survey included questions about their initial job search process; first job, salary, and informatics time after training; and early career progression over the first 1-6 years after fellowship.

Results

Nearly half (101, 41.7%) responded to the survey. Median informatics time was 50%; most were compensated similar/better than a purely clinical position. Most reported CI fellowship significantly impacted their career, were satisfied with their first and current job after training, and provided advice for current fellows and CI education leaders. Graduates in 2022 had a median job search of 5 months, beginning 3-15 months before graduation; most had a position created for them. Nearly all graduates from 2016-2021 (61, 93.8%) had at least one change in roles/benefits since finishing training, with a trend for increased informatics time and salary.

Discussion

There was a wide variety of roles, salary, and funding sources for CI positions. This highlights some of the unique challenges CI fellows face and the importance of networking. These results will help CI education leaders, fellows, alumni, and prospective fellowship applicants.

Conclusion

Graduates felt that CI fellowship had a significant impact on their career, were pleased with their first jobs and early career trajectory. Continued follow-up of the experience of new graduates and alumni is needed to assess emerging patterns over time.

Background and significance

It has been nearly a decade since the Accreditation Council for Graduate Medical Education approved the first clinical informatics (CI) fellowships¹ for physicians who have completed a primary residency. Since that time the number of programs has grown from three to nearly 60 with over 80 positions available per year. Though individual programs follow their graduates over time, little is known about the early careers of CI fellowship graduates.

There are limited resources for fellows to use in their job search² and most focus on clinical jobs and are not specific to clinical informatics or other similar disciplines.^3,4 Though informatics job boards exist, most focus on technical, research, or nursing informatics positions.^5–7 The United States Bureau of Labor and Statistics has no job code for physician informaticist,⁸ making it difficult to find data about this specialty. Unlike most clinical fellowships, CI fellows can come from any medical or surgical specialty and thus have a more heterogeneous clinical background.^9,10 In addition, as a relatively new specialty, there is a smaller network of alumni to provide career mentorship. As a result, CI fellows face many challenges when searching for jobs.

A prior survey of one alumni class of informatics fellowship graduates found most stayed at an academic health center, about half stayed at the institution they trained in, and jobs varied from 0-100% informatics time.¹¹ Respondents in that study emphasized the importance of networking, applying early, and negotiating the breakdown of clinical versus informatics time. However, little is known about starting salaries for CI fellowship graduates or their subsequent career progression.

We surveyed all known CI fellows and graduates from 2016 to 2022,¹² identifying demographics and fellowship activities.¹³ Here we report the results of the survey related to the job search process, first jobs, and career changes in the first 1-6 years after CI fellowship.

Materials and methods

During July through September 2022, with Mass General Brigham institutional review board (IRB) exemption, we sent an anonymous, voluntary survey to all clinical informatics fellows and alumni known to the AMIA Clinical Informatics Fellows (ACIF) and Clinical Informatics Program Directors (CIPD) as previously reported.¹³ This study focuses on the subset of respondents who self-identified as having completed CI fellowship during 2016-2022 and the subset of questions regarding their initial job search during CI fellowship, first position after CI fellowship, and current position (for respondents who graduated before 2022).

New graduates (2022 graduates) were asked 27 open-ended questions about their job search timeline, number of applications, job search resources, titles, informatics and clinical time, salary, expected bonuses, funding source(s), startup packages, and other benefits; and 11 multiple choice or multi-select questions. Alumni who graduated 1-6 years before the survey were asked 11 open-ended questions about their first vs current position including changes in salary, title, responsibility, other benefits; and 2 multiple choice questions about their satisfaction and impact of CI fellowship on career trajectory. Two of the authors (EK and JDH) independently coded all free-text responses using inductive content analysis to identify common themes.¹⁴ The two authors then reviewed the code book together to reach consensus.

Categorical results are reported as counts and percentages. Unanswered questions are included as “Did not respond” and rarely as “Other,” where explicitly stated. Multi-select multiple-choice questions summarized each choice as a count and percentage; an unchecked box was considered as negative. Free text responses of percent clinical/informatics time, salary, and bonuses were converted into numerical values, and timing was converted into months before June 2022; the median was used when a numerical range was provided, and all timings were rounded to the nearest whole month. We performed descriptive statistics (counts, percentages, median, IQR). We avoided combining results from multiple questions to maintain anonymity.

Results

We sent the survey to 242 CI alumni and received 101 responses (41.7% response rate). All 101 respondents consented to participate. Sixty-five respondents graduated from 2016-2021 and 36 graduated in 2022.

The job search process and outcomes for 2022 graduates

Table 1 shows responses from 2022 graduates about their job search process. These new graduates utilized a median of 2 different resources (IQR 1-4) for their job search, and thought the 2 most important resources were informatics/clinical networks built during CI fellowship and their medical specialty’s job boards. Most positions (77.8% of responses to this question) were created or customized for the graduate personally (note, 50% did not respond to this question).

Table 1.

Responses from 2022 graduates about their job search process.

Category	Choices	N (%)
Resources used to look for a position? (choose all that apply)
	Informatics network from CI fellowship	24 (66.7)
	Other CI fellows	15 (41.7)
	Clinical network from CI fellowship	15 (41.7)
	Job board other than AMIA	12 (33.3)
	Clinical network from before CI fellowship	11 (30.6)
	AMIA Clinical Informatics Fellows (ACIF) network	8 (22.2)
	Other	7 (19.4)
	AMIA job board	3 (8.3)
	Social network	2 (5.6)
Most important resource used to look for a position? (choose 1)
	Informatics network from CI fellowship	15 (41.7)
	Clinical network from CI fellowship	6 (16.7)
	Job board other than AMIA	5 (13.9)
	Did not respond	4 (11.1)
	Clinical network from before CI fellowship	2 (5.6)
	Other	2 (5.6)
	AMIA Clinical Informatics Fellows (ACIF) network	1 (2.8)
	Peers	1 (2.8)
Was the accepted position posted/existing, or was a position created for you?
	Created for the graduate	14 (38.9)
	Posted or existing	4 (11.1)
	Did not respond	18 (50.0)
Total		36 (100.0)

Figure 1 shows a timeline of the job search process for 31 graduates in 2022, who started applying for positions 3-15 months before July 2022 (median 8 months, IQR 6-9.5). The job search lasted a median of 5 months (IQR 4-7.5) with graduates finalizing their positions at a median of 2 months before July (IQR 0.5-4). They applied to a median of 6 positions (IQR 3-10) in a median of 2 different job sectors (IQR 1-3) (Figure 2).

Figure 1.

Timeline 2022 graduates’ job search of 2022 graduates (each row represents one graduate; the x-axis shows time in number of months from graduation).

Figure 2.

Number of applications in total and in different job sectors by 2022 graduates.

As shown in Table 2, 20 graduates (55.5%) reported an informatics title (eg, CMIO, Deputy Chief Health Informatics Officer, Director of Clinical Informatics), while 15 (41.7%) reported a clinical or academic title (eg, Assistant Professor). Twenty-four (66.7%) stayed in the same geographic region and 18 (50.0%) in the same institution as their clinical informatics fellowship. Most graduates were very satisfied with their first position after fellowship; financially compensated similarly or better than a purely clinical position in their medical specialty; and felt that they could not have obtained their position without having done a CI fellowship. Graduates received funding from a median of 1 source (IQR 1-2) with most receiving at least some funding from their clinical department.

Table 2.

Responses from 2022 graduates about their first position after training.

Category	Choices	N (%)
Title(s)
	Attending or Assistant Professor or similar	15 (41.7)
	CMIO or similar	3 (8.3)
	Director of Informatics or similar	12 (33.3)
	Other informaticist	5 (13.9)
	Did not respond	1 (2.8)
Job in the same geographic region as clinical informatics fellowship
	No	11 (30.6)
	Yes	24 (66.7)
	Did not respond	1 (2.8)
Job in the same hospital system as clinical informatics fellowship
	No	17 (47.2)
	Yes	18 (50.0)
	Did not respond	1 (2.8)
Job in the same geographic region as a previous time in your life
	No	16 (44.4)
	Yes	19 (52.8)
	Did not respond	1 (2.8)
Job region
	Did not respond	1 (2.8)
	East Coast	13 (36.1)
	Midwest	4 (11.1)
	Remote	1 (2.8)
	South	7 (19.4)
	West Coast	10 (27.8)
Satisfaction with the position accepted
	Very satisfied	19 (52.8)
	Satisfied	13 (36.1)
	Unsatisfied	2 (5.6)
	Very unsatisfied	1 (2.8)
	Did not respond	1 (2.8)
Compensation compared to your clinical specialty
	More compensation	9 (25.0)
	Similar compensation	16 (44.4)
	Less compensation	6 (16.7)
	Same compensation (purely clinical position)	1 (2.8)
	Did not respond	4 (11.1)
Sources of funding for the accepted position (select all that apply)
	Clinical department	24 (66.7)
	Hospital, university, operations, information systems, etc	11 (30.6)
	Informatics	7 (19.4)
	Research or grant	5 (13.9)
	Industry	2 (5.6)
Number of different funding sources
	1	18 (50.0)
	2	12 (33.3)
	3	1 (2.8)
	4	1 (2.8)
	Did not respond	4 (11.1)
Do you think you could have gotten this job without a clinical informatics fellowship?
	No	29 (80.6)
	Yes	6 (16.7)
	Did not respond	1 (2.8)
Total		36 (100.0)

Most 2022 graduates stayed in a teaching hospital/clinic (67.0%); 9.5% went to each of the following: non-teaching hospital/clinic, government healthcare facility or organization (eg, VHA, NIH, NCI), or industry/startup; and 4.5% went to other job sectors.

First jobs after CI fellowship

Ninety-five graduates (94.1%) provided at least partial information about their salary and percent informatics time. Figure 3 shows graduates’ first job after training, with a median percent informatics time of 50% (IQR 20%-70%) and median salary of about $240k (IQR $200k-$278k).

Figure 3.

Percent informatics time and salary of 2016-2022 graduates’ first job after training.

Though many graduates’ funding were directly associated with their percent clinical time, there were also graduates providing clinical care who received 0% funding support from clinical activities. Likewise, some fellows received 100% of their funding from clinical sources but had a wide range of percent clinical time (Figure 4). The most common were 50% clinical funding with 50% clinical time (5, 13.9%), 0% clinical funding with 0% clinical time (4, 11.1%), and 100% clinical funding with 80% clinical time (4, 11.1%). Median percent clinical time was 50.0% (IQR 27.5%-77.5%).

Figure 4.

Scatter plot of percent of time funded by clinical activities vs percent of clinical time.

Figure 5 shows first job satisfaction among 2022 CI fellowship graduates stratified by the level of compensation compared to a purely clinical position.

Figure 5.

Bar plots of 2022 graduates’ satisfaction with their first position after fellowship, stratified by compensation relative to a purely clinical role in their respective medical specialties.

Responses from 2022 graduates indicate startup packages included anywhere from $6k-$50k for the first year, with some receiving some specified amount of ongoing supplemental compensation and others left open-ended. Other benefits included computer supply budget, further education budget, home office budget, “loan forgiveness,” parking, personal clinical and/or administrative assistant, private office, relocation budget, remote options (fully or partially remote, or even out of state options), research assistant, signing bonus, and transportation subsidy.

Career progression in the first 1-6 years after CI fellowship

Table 3 shows survey responses from 2016 to 2021 graduates (N = 65) including satisfaction with current position as well as job changes since fellowship graduation. Nearly all (61, 93.8%) experienced at least one change (percent clinical or informatics time, responsibility, title, organization, or other benefits) in the 1-6 years since finishing training. Fifty-two (80.0%) were satisfied or very satisfied with their current position. A minority of graduates changed their position and/or institution between their first job and the time of this survey. Reasons for change included more or less clinical, informatics, moonlighting, or industry work; income; more impact; or personal reasons including for their partner or family. Changes in other benefits since their first position after graduation included benefits through a consulting company, leadership training, less clinical time, more administrative support, more flexibility, more informatics time and/or responsibility, more paid time off, more remote options, more team resources, more travel, parking, private office, and profit-sharing.

Table 3.

Responses from 2016 to 2021 graduates.

Category	Choices	N (%)
Are you satisfied with your current position?
	Very satisfied	25 (38.5)
	Satisfied	27 (41.5)
	Unsatisfied	6 (9.2)
	Very unsatisfied	2 (3.1)
	Did not respond	5 (7.7)
Change in research grants or funding between first and current position?
	No	60 (92.3)
	Yes, more	4 (6.2)
	Yes, less	1 (1.5)
Change in clinical responsibility between first and current position?
	No	61 (93.8)
	Yes, more	4 (6.2)
Change in informatics time and/or responsibility between first and current position?
	No	41 (63.1)
	Yes, more	24 (36.9)
Change in industry work between first and current position?
	No	64 (98.5)
	Yes, less	1 (1.5)
Changed organization between first and current position?
	No	51 (78.5)
	Yes	14 (21.5)
Change in title(s) between first and current position?
	No	46 (70.8)
	Yes	19 (29.2)
Total		65 (100.0)

While 24 (37%) of these graduates reported an increase in percent informatics time and/or responsibilities, Figure 6 demonstrates a median +0% change in informatics time (IQR +0% to +21%) with a wide range (-50% to +95%). Figure 6 also shows the change in salary among previous graduates with a median change of +$15k (IQR $0 to $40k, range −$134k to +$150k). Of note, several graduates who had a decrease in informatics time or decrease in salary commented that they were pleased with these changes in the context of their overall quality of life and work-life balance.

Figure 6.

2016-2021 graduates’ change in percent informatics time and salary between their first and current position (note, first position may be the same as current position for some graduates).

Reflections on the job search and CI fellowship

Most graduates from 2016 to 2022 (N = 77, 76.2%) provided at least 1 free text response about the job search process. Table 4 show themes among the 42 responses about what graduates wished they could have known or done differently during their job search process; 38 responses with advice for current CI fellows; and 47 responses with suggestions for CI fellowship programs, program directors and ACIF to improve the marketability of CI fellowship graduates.

Table 4.

Themes in free text responses from CI graduates.

Question	Themes	Number of responses	N (%)
Wished I knew or did differently		42
	Develop a job search strategy		15 (35.7)
	Network		8 (19.0)
	More industry exposure		8 (19.0)
	Application and interview preparation, and value proposition		7 (16.7)
	Job research and preparation		6 (14.3)
Advice to current CI fellows		38
	Application and interview preparation and value proposition		16 (42.1)
	Have a job search strategy		12 (31.6)
	Negotiation and salary information		12 (31.6)
	Network		9 (23.7)
	Job research and preparation		9 (23.7)
	Career evolution		5 (13.2)
	Industry exposure and training activities		5 (13.2)
Suggestions for CI fellowship programs, directors and ACIF		47
	Advocacy and awareness		28 (59.6)
	Exposure to more diverse activities		26 (55.3)
	Networking		23 (48.9)
	Develop career tracks or competencies		15 (31.9)
	Publish about value of CI fellowship training		13 (27.7)

Overall, nearly all graduates (82, 81.2%) felt that CI fellowship has significantly impacted their career, while 7 (6.9%) did not and 12 (11.9%) did not respond.

Discussion

The early careers of CI fellowship alumni show promising activity. As early as 1-6 years after training, nearly all alumni reported at least one progression in responsibilities or benefits. Over one third of prior graduates from 2016 to 2021 indicated an increase in informatics time/responsibility since their initial job, nearly a third had a change in title, and almost a quarter changed organizations. There was a trend for an increase in percent informatics time and most saw a salary increase. Moreover, some of those who took a pay cut indicated better quality of life.

Importantly, most CI fellowship alumni were satisfied or very satisfied with their first job after training and remain satisfied as their responsibilities, salary, and percent of clinical/informatics time changes during the first 1-6 years after training.

There was a wide range of salary and percent informatics time. Studies on physician compensation and lifetime earnings have shown they can vary by specialty, gender, employment setting, geography, and clinical time and volume. Compared to other medical specialties, CI includes physicians from different specialties and employer types¹³ and therefore has more potential for variation in compensation. Future studies with more data and longer follow-up may be able to test for a correlation between salary and early career trends.

Most graduates thought they were compensated the same or more than if they had a purely clinical position in their respective clinical specialty. Moreover, they were satisfied even if the compensation was less. This is similar to results of a 2021 survey of CMIOs and other CI leaders by WittKieffer presented by Association of Medical Directors of Information Systems (AMDIS).¹⁵ They found about three-quarters of respondents reported making the same or more than their full-time clinical counterparts. That survey found that the lowest quartile of respondents had a base salary of less than $300,000, so it seems reasonable that new fellowship graduates would mostly fall in that category. Of note, recent CI fellowship graduates are very different from the AMDIS survey population, who were mostly not formally trained in CI and had many more years of work experience.

Graduates felt that the CI fellowship significantly impacted their initial job search and their early career trajectory. 2022 graduates applied to a wide number of positions across a handful of job sectors, but most were in academic hospitals/clinics. The earliest that graduates reported finalizing their jobs was 6 months before graduation. This does not account for the variations in hiring timing by specialty, practice setting, and employment setting. Even those fellows who started applying 3-6 months before graduation were able to find jobs. However, the median job search lasted 5 months, which shows the importance of starting early.

There is great diversity in CI roles and responsibilities¹⁶ and a lack of data on the careers of CI fellowship alumni. The job search process and negotiations are more challenging for clinical informaticians than for other clinicians due to the prevalence of multiple titles and funding sources, even for first positions. While there have been attempts to characterize CI “phenotypes,”¹⁷ the lack of standardization makes it challenging to look for CI opportunities on existing clinical or informatics job boards. Unsurprisingly, most 2022 graduates had a position created or modified for them personally. It is therefore not surprising that networking was deemed most important for the job search, including both informatics and clinical relationships developed during CI fellowship. Though there was some correlation between clinical time and clinical funding, there were graduates with >50% clinical time had funding from non-clinical sources and graduates with <50% clinical time had 100% clinical funding. This demonstrates the variety of ways CI jobs can be structured.

The Association of American Medical Colleges (AAMC) reported in 2021 that 47.0% of active physicians practiced in the same state as their graduate medical education.¹⁸ This was similar to our findings of 2022 CI graduates' first job after training: 50.0% were in the same hospital system as CI fellowship, 66.7% were in the same geographic region as CI fellowship, and 52.8% were in the same geographic region as a previous time in their life. This further supports the importance of networking during fellowship. There is no way to distinguish between fellows who deliberately sought fellowship in an area in which they were planning or hoping to stay, from fellows who enjoyed their fellowship and through organic networking ended up staying after training. Fellows’ family and friends likely also contribute. It can be more challenging to network outside of your region, which likely contributed to the small numbers who left.

Many alumni advised current CI fellows to prepare themselves with negotiation techniques and salary information. However, there is a lack of information for CI fellowship graduates and a wide range in clinical specialty average salaries. We hope that results of this and our planned future surveys will help CI fellows. Alumni wanted CI fellowship leaders to continue advocacy and awareness for CI; expose fellows to more diverse activities; and help fellows have more networking opportunities (reference our manuscript 1). These remain high priorities for AMIA’s ACIF, CIPD, and Physicians in AMIA Working Groups, and alumni, and current CI fellows are encouraged to join these efforts.

Limitations

Our survey results are limited by our methodology, specifically our decision to make all survey questions optional in an effort to increase response rate. This makes multi-select questions particularly difficult to interpret as a null response could represent not encountering any of the options or choice to decline the question. Likewise, for questions with a low response rate, it is difficult to tell if the answers are representative of the larger group. For example, 50% of 2022 graduates did not answer whether a position was created or modified for them. This low response rate may be due to difficulty interpreting the question, complexities of the job they accepted (eg, multiple components some of which may or may not have existed previously), or survey fatigue. Regardless, it means anywhere from 39% to 89% of graduates may have had a position created/modified for them.

The results on salary and percent informatics time changes may be underestimated given that many survey respondents have only been in practice for 1-2 years. There may also be differences in how respondents interpreted salary (eg, base salary with or without bonuses or moonlighting), which could contribute to the wide range in salary reported.

Conclusion

This study confirms findings from the prior CI fellows job survey¹¹ around institutional and geographic trends as well as funding percentages. In addition, our study adds data on salary and career trajectory over time. There was a wide variety of roles, salaries, and funding sources for CI positions, highlighting some of the unique challenges facing CI fellows. CI fellowship graduates were nearly all satisfied with their initial jobs and early career advancement, and reported CI training significantly impacted their careers. There were wide ranges of salaries and dedicated time for informatics activities. Recommendations for fellows seeking their first job include networking, having a job search strategy, preparing for applications and interviews, defining the value proposition of hiring a physician informaticist, and negotiating on the amount of funded CI time. These results will help CI education leaders, fellows, alumni, and prospective fellowship applicants. While it is encouraging that some graduates are already seeing increases in informatics responsibility and funding, it will be important to continue to track these figures over time. We intend to continue to survey new graduates annually and alumni periodically, and as we have more data it will be interesting to compare results by subgroup and to try to look at trends over time.

Author contributions

All of the authors have had substantial contributions to the conceptionalization, investigation, methodology, interpretation of results, and writing revision/editing. All authors have given final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EK performed data curation and use of software. EK and JH performed formal analysis, validation, visualization, and writing original draft.

Funding

None declared.

Conflicts of interest

None declared.

Data availability

To preserve respondents’ privacy, these data are only available to the study authors.