Results
We invited program leaders from all 74 PHO fellowship programs, and at
least one representative from 49 programs (66%) responded. A total of
162 completed surveys (79 fellows and 83 faculty) were submitted. Table
1 illustrates the distribution of respondents regarding the U.S. region
of the program, size of the fellowship program, and the respondent’s
role.
The overall perception of fellow stress was endorsed by the vast
majority of respondents, both by faculty and fellows. When asked to rate
fellow stress level, faculty were more likely than fellows to perceive
that fellows are either “extremely stressed” or “stressed” due to
the job search (95% of faculty versus 75% of fellows,P= 0.0003). The struggle to find post-fellowship jobs was
perceived more by fellows than by faculty (72% of faculty versus 87%
of fellows, P= 0.0198). The majority of fellows (89%) reported
feeling anxious thinking about the job search on “several days”,
“more than half the days”, or “nearly everyday”.
Overall, the distribution of desired career types by fellows was similar
at all time points during their training with ‘academic
clinician-educator’ and ‘academic clinician with focus on clinical,
outcomes, or population sciences research’ being the most common.
Expectedly, the number of ‘unsure’ fellows was higher at the beginning
of fellowship compared to later timepoints. When asked about the ideal
position for immediately after fellowship, the number who responded as
planning to pursue further ‘sub-specialty fellowship’ declined from the
beginning of fellowship (21.5%) to the time of survey completion
(12.6%). In contrast, the number of fellows who responded as planning
to pursue a ‘faculty position’ increased from the beginning of
fellowship (58%) to at the time of survey completion (72%).
Fig. 1 illustrates the various reported barriers to the job search, as
recognized by both faculty (n=83) and fellows who had initiated the job
search (n=44). About half of faculty responded that fewer jobs were
available (63%), and fewer positions were being posted (49%). Other
commonly noted barriers to the search included geographic constraints,
clinical focus constraints, partner employment opportunities, practice
format constraints, visa limitations, and family situations. Notably,
income constraint was only noted as a barrier in 6% in faculty, and in
5% of fellows.
By June 2021, 30 out of 44 (68%) graduating fellows who had
participated in the job search had been offered a position. Of those
thirty, 24 (80%) had accepted a position. Most fellows (75%) had
started the job search process during late second year or early in the
third year of fellowship. In the setting of the COVID-19 pandemic, the
majority of fellows (82%) thought that the multitude of consequences of
the pandemic impacted the job search. Fellows noted that COVID-19 had
affected the search in that fewer positions were posted (73%), fewer
jobs were available (71%), they were unable to interview in person
(55%), and and job offers had been changed or rescinded (7%). Among
the 30 who had been offered a position, about half (47%) of fellows
felt that the position was “extremely close” or “very close” to
their ideal job goals, and 44 of 83 (53%) faculty believed that fellows
were having difficulty finding jobs that aligned with their career
goals. Fig, 2 demonstrates that regardless of whether a job had been
offered, stress levels were still quite high among fellow respondents.
There was no significant relationship between stress level and whether a
job had been offered (P= 0.345), the degree to which the job offer
aligned with ideal career goals (P= 1.00), nor whether or not
fellows had a change in career goals (P= 0.112).
Fellows reported online job centers/mailing lists (82%), fellowship
program leadership (80%), word of mouth (75%), and prior connections
to other institutions (48%) as resources used to identify available
positions. However, when asked which resource was most helpful, the
majority responded online job centers/mailing lists (20 of 44, 45%). Of
the 10 respondents who had not utilized ‘word of mouth’, 50% of them
were from smaller fellowship programs with 0 – 6 fellows. Only 6 of the
44 (14%) fellows who had been offered a job felt that their program
leadership was the most helpful resource. Fellows noted that their
clinical mentor (61%), program director (55%), research mentor (52%),
near peers (30%), and division chief (25%) were helpful in their job
pursuits. These mentors were marked as helpful in a variety of ways,
including sharing information about potential jobs (61%), writing
letters of recommendation for a job at another institution (50%),
sharing information about past fellows’ employment and contact (41%),
advocating for a position at the home institution (41%), and advocating
for a position at another institution (39%). In contrast, twelve of the
44 fellows (27%) also reported that they did not receive any assistance
from their home institution.
Several fellowship programs offer educational resources for fellows in
various aspects of career development including CV preparation (40%),
lessons on negotiation (23%), giving job talks (20%), and practice
interviews (17%). Fellows identified CV preparation (22%) and giving
job talks (12%) as the two most helpful resources. Other available
resources included panel discussions with program graduates and
individualized job application advising through program leadership.
Notably, however, almost half of the fellows (48%) reported that there
is no current formal education available at their institution.
All respondents identified a need for more readily available resources
for fellows to help alleviate some of this stress and anxiety. Sample
responses to an open-ended question regarding tools that might be
helpful are shown in Table 2 and 3, by faculty and fellow, respectively.
The distribution of perceived needs, however, differed slightly for
faculty and fellows. The top three responses for both respondent types
were formalized training on career development tools (33% of faculty,
59% of fellows), a centralized, up-to-date job listing (36% of
faculty, 20% of fellows), and an overview of all career types within
PHO (23% of faculty, 18% of fellows). Comments from both respondent
types regarding open positions not being listed online and having to
rely on ‘word of mouth’ were categorized as part of the ‘centralized,
up-to-date job listing’ theme. Specifically, 15 of 79 (19%) of fellows
mentioned the need for guidance on negotiation. Networking needs were
mentioned by 8% of faculty and 11% of fellows. Emphasis on early
mentorship was suggested by 12% of faculty and 11% of fellows. About
7% of faculty also noted ‘increased flexibility and managing
expectations of a first job’, while 14% of fellows commented that
‘increased transparency on the job search process’ would have been
helpful.
Despite the high degree of stress, fellows who had undergone the job
search experienced benefits like networking (32%), learning how to
market oneself (16%), learning about available positions (14%),
clarifying one’s career interests (7%), and mentorship (2%). When
asked about what aspects of the process were most challenging in an
open-ended context, fellows most commonly reported the lack of job
opportunities (57%) and lack of transparency (34%).