Introduction
Towards the end of the three-year training program, pediatric hematology
and oncology (PHO) fellows begin a search for what is often their first
professional job. This process has become increasingly difficult for
fellows as the field has become more saturated and therefore those
pursuing further subspecialization or non-faculty positions such as
hospitalist or instructor have grown in number. Recent workforce
assessments by the American Society of Pediatric Hematology/Oncology
(ASPHO) indicate a clear discrepancy between the growing number of PHO
trainees and and the decreasing percentage of those in faculty positions
immediately after graduation. Simultaneously, the scope of practice for
PHO has expanded to include evolving fields such as cancer genomics,
immunotherapies, and precision medicine. As the field becomes
increasingly niched, it is speculated that graduates are needing to
compromise on certain aspects of their positions, potentially increasing
the risk of burnout and overall job dissatisfaction.
Some have speculated that the competitive nature of PHO positions for
graduating fellows has led to a declining interest in the specialty
itself. Macy et al. examined trends in first year fellows across all
American Board of Pediatrics-certified medical subspecialties from 2001
through 2018 and found that within PHO, the number of fellows had nearly
doubled from 87 to 161, with an average of 4.63 fellows per year.
However, more recently, National Resident Matching ProgramĀ® (NRMPĀ®) data
suggests that despite the overall number of PHO programs remaining
consistent over the past five years (currently 72 accredited programs),
the number of applicants has steadily declined (188 in 2017 to 135 in
2021), and the number of programs that are unfilled each year has
rapidly increased (3 in 2017 to 32 in 2021). To our knowledge, there is
no objective data on what might be contributing to this declining
interest. The adult hematology workforce shares the concern that an
increasing demand for hematologists will soon exceed the supply; focus
group data by Sharma et al. suggests that lower income potential,
research funding, job availability, and job security are concerns that
fellows share in regards to hematology in particular. In this study, our
aim was to explore the current perceptions of the PHO workforce from
both a fellow and faculty perspective, and to investigate the experience
of seeking a post-fellowship position and its impact on fellow stress
and anxiety.