The Stressful State of Pediatric Hematology Oncology Fellow Job Search Process
Authors: Moerdler Scott , Kesselheim Jennifer C. 
Published: November 2021

Abstract
Introduction: The workforce of Pediatric Hematology Oncology (PHO) has been evolving over the last decade. Recently, fellowship application volume has declined, with almost half of the programs at least partly unfilled during the previous MATCH. A perceived paucity of PHO jobs for graduating fellows may exacerbate this declining interest in the field. By surveying fellows, fellowship program directors, and PHO division chiefs, this study aims to investigate PHO fellows' preparation for, and experience with, the search for an initial faculty position.
Methods: After pilot testing with faculty and fellows, all PHO division chiefs and program directors from 115 programs (N=222) were invited to complete the survey and to disseminate the instrument to their fellows. The survey included questions on demographics, job search preparation, job search experiences including barriers and helpful tools, and consequences for well-being such as stress and anxiety.
Results: Some programs chose not to participate, evidenced by representation from 35 states, and many states with multiple fellowship programs only had one response from program leadership. A total of 166 individuals responded to all questions, representing approximately 24% response rate. Of the participants 83 were fellows and 83 were program leaders including fellowship program directors and division chiefs. Nearly 82% (n=136/166) of all respondents believe that PHO fellows are struggling to find a job that aligns with their goals.
Program leaders identified common barriers influencing fellows' job search including geographic constraints (N=60/83, 73%) followed by only a few jobs available (N=51/83, 61%), clinical focus constraints (N=43/83, 52%), and few positions being posted (N=41/83, 49%). Fellows who have started the job search process commonly reported geographic constraints as a barrier (N=26/46, 57%), followed by partner employment opportunities (N=17/46, 37%), and their own clinical interests (N=15, 33%). Of 42 open-ended responses written by fellows, almost half (N=18/42, 43%) cited limited number of jobs available, and 21% (N=9/42) cited difficulties related to job postings.
Almost half of fellows (47%, n=37/79) reported a lack of formal education on the job search process, as opposed to less than 10% of leadership (n=8/83) who agreed. When offered, education most commonly involved strategies for CV building (37%, n=31/83) and less frequently focused on the rest of the job process including negotiation, job talking, interviewing, and writing cover letters.
Nearly all (N=79/83, 95%) of program leaders believe that fellows are somewhat/extremely stressed about the job search process. 75% (n=59/79) of fellows self-reported feeling somewhat/extremely stressed due to the job search process. Nearly 20% (n=15/79) of fellows self-reported severe anxiety over the job search process, and another 25% (n=21/79) reported moderate anxiety.
Conclusions: This study highlights numerous shortcomings in the job search process among PHO fellows. A majority perceive difficulty securing a job which aligns with one's goals. While geography was the most cited barrier, finding a position with the optimal clinical focus was also problematic, a finding especially worrisome given the increasing popularity of additional 4 th year fellowship training in PHO. Other commonly recognized challenges surround the number of positions available as well as how those positions are publicized. Importantly, the job search may negatively impact wellness. Fellows' reports of stress and anxiety surrounding the job search, also acknowledged by program leaders should prompt change.
Next steps include follow up studies including qualitative interviews to better understand the fellows' experiences, development of educational programs to prepare fellows for the job search process, enhanced career counseling, as well as improved support programs focused on the relevant stressors. Educational interventions to help prepare CVs, cover letters, and practice interviewing or negotiation may be able to help alleviate some of the stress fellows experience while undergoing the job search process. These data represent a need to further understand the PHO workforce to determine why fellows and leadership sense difficulty in securing a position that aligns with one's goals, as well as whether these perceptions represent the realities of the current workforce.

Disclosures
No relevant conflicts of interest to declare.