Hematology/Oncology Fellows' Future Plans and Job Expectations: Findings from the 2019 Hematology/Oncology Fellows Survey

Introduction/Background

The American Society of Hematology and researchers at the Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington University are conducting a 3-year study of the hematology workforce to understand training, mentorship, and job market factors that influence the supply of hematology services in the U.S. The 2019 Hematology/Oncology Fellows Survey is one of a series of annual surveys of hematology/oncology fellows, focused specifically on second year fellows. Its goals include 1) examining how training and mentorship experiences during fellowship contribute to changes in fellows' career goals and 2) understanding their perceptions of job prospects in their chosen field (hematology, oncology, or both).

Methods

We collected the 2019 Hematology/Oncology Fellows Survey data via Qualtrics, an online survey platform. The survey included questions about fellows' training and mentorship experiences, career goals, and perceptions. This analysis uses data from the following questions:

-At this point in your training, which of the following best describes your intended focus post fellowship? (malignant and/or benign hematology only, oncology only, both or undecided)

-Given your current career plans, how confident are you that you will be able to find a position that offers what you are seeking in terms of (1) clinical focus, (2) research opportunities, (3) grant funding, (4) work-life balance, (5) income, (6) prestige, and (7) intellectual stimulation? (very confident, somewhat confident, not confident, not applicable)

We used Fisher's exact tests to compare responses to each question about future position expectations by intended focus post fellowship (hematology only vs. oncology only vs. both/undecided) in Stata 15 (p<0.05=statistically significant difference).

Results

Among second year fellows invited to complete the survey, 204 (27.8%) had complete data to be included in the analysis: 71 (34.8%) with intended hematology-only focus, 64 (31.4%) oncology-only, and 69 (33.8%) both/undecided.

We found statistically significant differences between future position expectations across focus areas in 3 domains: research opportunities (p<0.01), grant funding (p<0.01) and income (p<0.01). Fellows with a hematology-only focus were most likely to report being "very confident" they would find a position meeting their expectations for both research opportunities (21.1% vs. 17.2% for oncology-only and 11.6% for both/undecided) and grant funding (8.5% vs. 6.3% for oncology-only and 4.4% for both/undecided), while fellows with a both/undecided focus were most likely to report that these considerations did not apply (34.8% and 50.0% respectively). Fellows in the both/undecided category were most likely to say they were "very confident" they would find a position meeting their income expectations (30.4% vs. 14.1% hematology only and 9.4% oncology only). Fellows with a hematology-only focus were most likely to say they were "not confident" they would find positions meeting their income expectations (23.9%), followed by oncology only (18.8%) vs. only 5.8% both/undecided.

Differences in work-life balance expectations (p=0.07) and prestige (p=0.08) also approached statistical significance. For both metrics, fellows with a both/undecided focus were most likely to report being "very confident" they would find positions with their desired work-life balance (24.6% vs. 8.5% hematology only and 9.4% oncology only) and prestige (18.8% vs. 11.3% hematology only and 9.4% oncology only). We found no statistically significant differences between fellows' expectations of finding their desired clinical focus (p=0.30) or intellectual stimulation (p=0.49) across focus areas.

Conclusions

Findings suggest that roughly ⅓ of hematology/oncology fellows plan to focus on each of 3 career paths: hematology only, oncology only, and both. Statistical analyses suggest stark differences between fellows' priorities and expectations of their future positions across focus areas, likely reflecting differences between more specialized academic positions (which offer greater research opportunities and expectations but possibly lower income) and less specialized, often private practice positions that offer greater income security and work-life balance.