Survey Identifies Factors Most Important to Fellows When Selecting a Career Path

Luis Gonzalez, MD

Hematology and oncology fellows weigh several factors when selecting a career path after fellowship, including clinical interest, desired lifestyle, and finances, but little research is currently available to describe which of these factors fellows value the most. To better describe this area, Luis Gonzalez, MD, a hematology/ oncology fellow at Henry Ford Health in Detroit, Michigan, and his coauthors performed a national cross-sectional study examining factors influencing postfellowship career choices.1

"The hematology and oncology fields have experienced exponential growth in recent years, not only in the realm of scientific advances but also in the interests of candidates for fellowship positions,” Gonzalez said in an email to Oncology Fellows. “We aimed to assess the vehicles that motivated fellows to choose a career in hematology and oncology. Knowing this can help programs focus more on their curriculum and base it on what physicians are looking for.”

To conduct their study, Gonzalez and his coauthors distributed an anonymous 25-question survey to hematology/oncology fellowship programs in the US. The survey included items pertaining to fellows’ demographics, educational background, career plans, and factors influencing career choices. Fellows rated each factor as very important, important, neutral, not important, or not important at all. Fellows were also asked to rate their confidence in finding a position that aligned with their career interests using a scale of very confident, somewhat confident, or not confident.

Fifty-six fellows completed the survey; most respondents were men (54%), were aged 30 to 34 years (79%), and had graduated from medical schools located in the US or the Caribbean (68%). Fellows expressed a high likelihood of pursuing hematology/oncology fellowship if they were given the chance to choose again (97%).

Findings from the study presented during the 2024 American Society of Clinical Oncology Annual Meeting showed that clinical interest was most often rated as very important (76.8%) to fellows in choosing their career path. Other factors rated as very important at notable rates included career mentorship (26.8%), lifestyle considerations (23.2%), and research experiences (19.6%; Table).1

Factors Influencing the Career Choice of Fellows1

“Despite thinking one would consider lifestyle, family plans, or salary as the main drivers for choosing a residency or fellowship in [oncologic] medicine, this was not the case,” Gonzalez said. “The first factor of influence was clinical interest, followed by career mentorship during their residency, and then came lifestyle considerations.”

The top factors that fellows indicated were not important at all in terms of their career choice included having a hematologist/oncologist as a family member (78.6%), family expectations (39.3%), and hematologic or oncologic disease in friends or relatives (32.1%). A significant portion of fellows also indicated that family expectations (25%), hematologic or oncologic disease in friends or relatives (25%), and future family plans (10.7%) were not important.

Factors most often rated as neutral to the fellows’ career choice included specialty competitiveness (39.3%), availability of training programs (37.5%), and research experiences (35.7%).

“These results showed the importance of clinical exposure, mentoring, and scientific development in the early stages of training,” Gonzalez noted. Fellowship programs could start fortifying career mentorship programs, providing increased support for those interested in classical hematology, and fostering research experiences during residency training.”

Additional findings from the study showed that 80% of respondents decided on hematology/oncology as a career during residency. Thirty-nine percent hoped to work in an academic/university setting, and 41% planned to stay within a community setting. Working in a suburban area (45%) was preferred compared with an urban area (39%), and only 2% planned to pursue a career in classical hematology. Beyond classical hematology, fellows planned to pursue careers in hematology/oncology (38%), medical oncology (32%), malignant hematology (16%), and benign/classical and malignant hematology (5%) or were undecided (7%).

In terms of their mentor’s influence on their career choice, fellows responded that it was very important (44%), important (25%), neutral (18%), not important (11%), or not important at all (2%). Future salary had an influence on career choice that was very important (9%), important (47%), neutral (25%), not important (14%), or not important at all (5%).

Fellows were very confident that they would find a career after fellowship that provided intellectual stimulation (73.2%), a job in their clinical area of interest (71.4%), and financial gain (48.2%). They were somewhat confident that they would be able to find work-life balance (58.9%), a career where they would be renowned (57.1%), and a career that would provide them with financial gain (48.2%). Fellows responded that they were not confident they would be able to find grant funding (17.9%), work-life balance (16.1%), and a career where they would be renowned (8.9%).

“The biggest limitation [of the study] was the small number of responses compared with the universe of fellows. Even though we received favorable answers from the program coordinators to send the surveys, all the fellows were not enthusiastic about answering them,” Gonzalez concluded. “[In the future], we want to be more specific and explore the factors influencing career choice in hematology alone.”

Reference

Gonzalez Mosquera L, Balanchivadze N, Ali F, Meranda M, Castro OH, Kuriakose P. Factors influencing career choices and post-fellowship perspectives in adult hematology/oncology fellows: a nationwide cross-sectional study. J Clin Oncol. 2024;42(suppl 16):9016. doi:10.1200/JCO.2024.42.16_suppl.9016