A Survey-Based Analysis of Factors Influencing Interest in Hematology-Oncology in Internal Medicine Residents: A Pilot Study at an Academic Center

Introduction:

The demand for hematologist-oncologists has significantly increased in recent years. However, this growing need has not been matched by a proportional rise in fellowship applicants. This study aims to identify the factors influencing internal medicine (IM) residents' decisions to pursue careers in hematology-oncology (heme-onc). Additionally, we seek to gather residents' insights on potential interventions to boost interest in the field.

Methods:

A survey was designed through Google Forms. Demographic information including gender, postgraduate year (PGY) level, and medical credentials (US MD, DO, or international medical graduate) was collected. Data about prior clinical experience in heme-onc was also obtained. Participants were then asked if they were interested in pursuing a career in heme-onc after residency. All respondents identified up to 3 factors that contributed to shaping their decision from a list of options which explored factors in physician-patient interaction, training, and specialty. For participants who expressed interest in heme-onc, we explored how early in their education they became interested. For participants not wanting to pursue heme-onc, we investigated if they had ever been interested and subsequently changed their mind. All respondents were asked to report the most challenging subject matter in heme-onc (solid tumor, malignant hematology, or benign hematology). All participants were given the option to answer an open-ended question regarding what may have enhanced their interest in heme-onc. Surveys were distributed to categorical IM residents through email and social media (WhatsApp). Responses were collected anonymously over a period of 2 weeks.

Results:

The survey achieved a 63.93% response rate (N = 39). We used descriptive analysis and Chi-square test for analyzing our results. The participants of the survey were representative of the survey population in terms of gender (females, p = 0.447), medical credentials (p = 0.72), and PGY level (p = 0.43).

About 23% of respondents expressed interest in pursuing heme-onc. Due to a smaller sample size, we descriptively characterized factors shaping interest in heme-onc. The most common factors motivating the decision to pursue heme-onc were desire to care for patients at their most vulnerable (33.3%), finding meaning in end-of-life conversations, fascination with therapeutic options and evolving treatments (22.2% each), exposure to electives or rotations (17.8%), and mentorship (8.9%). Conversely, the major deterrents were difficulty dealing with death or end-of-life conversations (27.1%), compassion fatigue towards distressing symptoms (25.4%), difficulty breaking bad news (16.9%), lack of opportunities to do procedures and electives or rotations (11.9% each). Among the six respondents who reconsidered pursuing heme-onc, the most common discouraging factors were lack of electives or rotations, lack of procedural opportunities, difficulty finding research experiences, compassion fatigue, and difficulty with end-of-life conversations (33.3% each); less common factors were perceived job market, lack of mentorship, work-life balance concerns, and difficulty keeping up-to-date with evolving treatments (16.7% each).

Having no exposure to heme-onc appeared to be a significant factor in dissuading residents from pursuing a career in the field (p = 0.04). There was no statistically significant association between the perception of the most challenging subspecialty in heme-onc and interest in pursuing a career in the field (p = 0.18). 60% of the residents responding to the open-ended question reported that more exposure could have enhanced their interest.

Conclusions:

Physician-patient interaction factors were responsible for initial lack of interest in heme-onc. However, participants who subsequently lost their interest attributed it to lack of clinical and research opportunities. Inculcating skills in residents for meaningful engagement in end-of-life discussions and coping with death will enhance building physician-patient relationships. Designing an educational curriculum with more core rotations in heme-onc can foster a budding interest. These initiatives hold the potential to inspire residents to pursue a career in heme-onc and address the physician shortage. Large-scale studies based on our pilot study should be pursued to guide these interventions.