Oncology fellows' career plans, expectations, and well-being: Do fellows know what they are getting into?

Purpose To evaluate the career plans, professional expectations, and well-being of oncology fellows compared with actual experiences of practicing oncologists.

Methods US oncology fellows taking the 2013 Medical Oncology In-Training Examination (MedOnc ITE) were invited to participate in an optional postexamination survey. The survey evaluated fellows' career plans and professional expectations and measured burnout, quality of life (QOL), fatigue, and satisfaction with work-life balance (WLB) using standardized instruments. Fellows' professional expectations and well-being were compared with actual experiences of US oncologists assessed simultaneously.

Results Of the 1,637 oncology fellows in the United States, 1,373 (83.9%) took the 2013 MedOnc ITE. Among these, 1,345 (97.9%) completed the postexamination survey. The frequency of burnout among fellows decreased from 3% in year 1 to 7% in year 2 and 1% in year 3 (P <.001). Overall, the rate of burnout among fellows and practicing oncologists was similar (34.1% v7%; P =.86). With respect to other dimensions of well-being, practicing oncologists had lower fatigue (P <.001) and better overall QOL scores (P <.001) than fellows but were less satisfied with WLB (P= .0031) and specialty choice (P <.001). Fellows' expectations regarding future work hours were 5 to 6 hours per week fewer than oncologists' actual reported work hours. Levels of burnout (P =.02) and educational debt (P.≤.004) were inversely associated with ITE scores. Fellows with greater educational debt were more likely to pursue private practice and less likely to plan an academic career.

Conclusion Oncology fellows entering practice trade one set of challenges for another. Unrealized expectations regarding work hours may contribute to future professional dissatisfaction, burnout, and challenges with WLB.