Determinants of hematology-oncology trainees' postfellowship career pathways with a focus on nonmalignant hematology

Abstract

Nonmalignant hematologic conditions are extremely prevalent and contribute significantly to the global burden of disease. The US health care system may soon face a shortage of specialists in nonmalignant hematology. We sought to identify factors that lead hematology-oncology fellows to pursue (or not to pursue) careers in nonmalignant hematology. Cross-sectional, web-based survey distributed to 149 graduates of a hematology-oncology fellowship program at a large academic medical center between 1998 and 2016. Eighty-six out of 149 graduates responded (57.7%); most (59 [68.6%]) practice at an academic medical center. Respondents spend a mean of 61% of their time in clinical practice, 23.7% conducting research, 5.2% in education, and 5.2% in administration. Those in clinical practice spend a mean of 52.1% of their time in solid tumor oncology, 37.5% in hematologic malignancies, and 10% in nonmalignant hematology; only 1 spent >50% of time practicing nonmalignant hematology. Factors most significantly affecting choice of patient population included clinical experience during fellowship and intellectual stimulation of the patient population/disease type. Factors that could have most significantly influenced a decision to spend more time in nonmalignant hematology included increased exposure/access to role models and mentors and opportunities for better career growth/advancement. Fellowship graduates spend >50% of their time in clinical practice, but almost none spend a significant amount of time practicing nonmalignant hematology. Given the growing number of patients with nonmalignant hematologic conditions and a possible future provider shortage, medical trainees should be encouraged to pursue careers in nonmalignant hematology.

Associations between hematology/oncology fellows’ training and mentorship experiences and hematology-only career plans

“…A single-institution survey found that hematology/oncology fellows' clinical experiences during fellowship, perceptions of the intellectual stimulation of their chosen field, and having a supportive mentor have a "significant" influence on the types of patients and conditions they treat after fellowship (hematology, oncology, or both). 9 These findings are consistent with other studies that have identified mentorship and networking as critical components to career development within academic medicine. 12 Other studies have highlighted the importance of preclinical education, clinical exposure during medical school and residency, and lifestyle factors in positively and sometimes negatively motivating trainees' decisions to pursue subspecialty training at all, as well as their specialty choices.…”

“…Our findings showing a strong statistical association between hematology mentorship experiences and fellows' plans to enter hematology-only careers align with other studies that have found that mentorship is 1 of the most important factors in fellows' specialty choices. 9,14 The strong association of research mentorship with hematology/ oncology fellows' interest in pursuing hematology-only careers may be related to the prominence of academic medicine careers in hematology. 10,24 Results of a small survey of hematology/oncology fellows trained at the National Cancer Institute-designated cancer centers demonstrated the strong emphasis on academic careers among hematology/oncology fellows, of whom 49% of those surveyed indicated that an academic career was "very important" or "extremely important."…”

“…7 Despite these indicators that hematology/ oncology fellowships are attractive to trainees in general, that nearly all future hematologists train in combined fellowship programs has caused concern in the hematology community that hematology/ oncology fellows do not receive adequate preparation and exposure to hematology patients to motivate them to choose careers in hematology. 8,9 Further, some observers have suggested that declines in National Institutes of Health funding for new investigators may discourage aspiring physician-scientists from pursuing careers in fields such as hematology that place a strong emphasis on academic practice and research grant funding. 10 These concerns about whether fellows will pursue hematology are particularly acute given perceptions that the specialty is likely to lose many practicing hematologists to retirement, whereas the demand for hematology services continues to increase.…”

Development of a virtual benign hematology consultation service: results of a pilot project involving 5 medical centers

“…There is a need for physicians with adequate training, experience, interest, and expertise in assessing and treating patients with these disorders. [1][2][3] Some hematologic issues are complex and require in-person histories and examinations, whereas others can be handled with advice electronically after a thorough chart review. 4 To improve the quality of the care provided to these patients, a virtual benign hematology consultative service was created.…”

Under-representation of classical hematology training on hematology-oncology fellowship program websites in the United States

“…Mentorship has been demonstrated to be a critical factor associated with fellows’ plans to enter careers in classical hematology. 2 , 14 Showcasing the breadth of available mentorship signals commitment to classical hematology training and may attract applicants with diverse interests within classical hematology disciplines. Furthermore, listing additional faculty from classical hematology background in leadership may be especially important for programs with PDs whose academic interests lie exclusively in malignant hematology and/or solid tumor oncology (>80% of PDs).…”