Motivations and Experiences of Physicians Who Pursued Hemostasis and Thrombosis Fellowship - a Survey Study

Background: There is a shortage of experts in the field of hemostasis and thrombosis (H&T) in the United States (US), which may lead to gap in clinic care if left unaddressed. Hematology-oncology fellows tend to get limited exposure to H&T during their structured fellowship. As a result, some programs offer an extra year of advanced H&T training to further develop Hematology acumen. However, there is limited knowledge regarding the impact of this advanced fellowship. This study aimed to assess the demographics, motivations and experience of physicians who pursued an additional year of advanced training (fellowship) in H&T.

Methods: This was a questionnaire-based study, surveying physicians who completed MD, DO, MBBS, or equivalent clinical training, and started H&T fellowship in a program in the US between 2010-2023. Anonymous surveys were created using RedCap. Survey link was distributed via email to program directors seeking distribution to current and previous H&T fellows around US, emails to past recipients of NHF and HTRS clinical fellowship awards and social media (X and HTRS weekly emails). Survey was composed of 27 questions regarding demographics, characteristics of H&T fellowship pursued, and their overall experience. Descriptive analyses were used for demographics. Due to the Likert-like nature of the survey questions and the non-normal distribution of the data, Wilcoxon rank sum tests were used to make comparisons between respondents’ comfort level with managing specific H&T-related disorders, before and after their fellowship retrospectively.

Results: Out of the 33 respondents, 27 respondents completed the questionnaire. Out of the 27 respondents, 2 respondents declined providing demographic information. Majority of participants were females (63%) with age ranging from 31 to 40 years old. Most of the participants were White (n=13/25, 52%), non-Hispanic (n=22/25, 88%). Majority of participants (81.5%) completed hematology oncology fellowship prior to pursuing H&T fellowship. Seventy percent were enrolled in pediatric H&T fellowship, 22% were enrolled in adult H&T fellowship, and 8% were in combined fellowship. Most respondents reported that the primary motivation for pursuing H&T fellowship was a desire to gain additional knowledge of hemophilia and other bleeding disorders. Gaining experience in thrombosis and research were ranked as the second and third motivating reasons to pursue an additional year of training, respectively. Significant increase in comfort level was reported in the following domains post training: hemophilia diagnosis and counselling, hemophilia management, management of acute severe bleeds, management of hemophilia with inhibitors, surgical planning, gene therapy discussions, interpretation of coagulation assays, management of heavy menstrual bleeding, inherited thrombophilia management, ECMO and anticoagulation, venous thrombosis management, and management of arterial stroke (all domains had P<0.001). Eighty one percent of respondent would recommend H&T fellowship to interested peers. Sixty two percent (17/27) of respondents were hired as an assistant professor after fellowship. Seventy eight percent of respondents were hired in an academic institution after H&T fellowship, 11% were hired in private practice or industry, 11% of respondents did not specify. Out of the 8 participants who were promoted during study period, 75% (n=6) were promoted within 6 years of completion of fellowship. Majority of participants reported publishing a median of 2 peer reviewed manuscript as a result of research or collaborations during H&T fellowship (ranging 0-6 articles per participant).

Conclusion: Although limited by small numbers and recall bias, our study shows overall increased comfort in diagnosis and management of bleeding and clotting disorders after H&T fellowship. Desire to gain additional knowledge of bleeding disorders, including hemophilia, was the primary motivation for pursuing H&T fellowship in this study. Majority of the participants were hired at an academic institution after the fellowship, most participants had one or more peer-reviewed publication due to research or collaboration during H&T fellowship. The results of this study highlight the importance of advanced training in the H&T field. It will also serve as a reference for future trainees who are considering a career in H&T.