Hierarchical themes identified in fellows’ interviews as having an impact on guiding individual career decisions
| Theme . | Interpretation . | Quotes . |
|---|---|---|
| Mentorship | Mentorship is the single most important factor guiding fellows’ career decisions | • On the single most important factor in choosing a career: “I would definitely say mentors.” |
| • “Mentors play a huge role because you want to be like them. The cases you see, the change of life, and stuff like that.” | ||
| • “When it comes down to choosing specifically between heme and onc, I think a lot of it comes down to the availability of the mentorship … that’s essentially what makes anybody go into anything.” | ||
| Serendipity | Many mentorship opportunities and career-defining factors occur serendipitously | • “It was serendipitous that I got a good job in a lab that studies cancer right after college at the NIH.” |
| • “The fact that I found someone here who had an interest in [my particular field of] research was completely happenstance.” | ||
| • “I went to a lot of different clinics and I felt like [1 attending] really taught me. He really offered to mentor me and give me good research projects … It was random from me picking attendings to go to their clinics.” | ||
| Clinical exposure and teaching | The distribution of clinical exposure to inpatient and outpatient hematology and oncology may impact fellows’ interests | • “We don’t start thinking about hematology until our second year. By second year, you already have your preferences so you are primarily exposed just to oncology and you don’t have hematology exposure. By the time you are doing hematology you have already picked stuff and you are already thinking about your project… You kind of decide on oncology early on and you don’t really think about hematology and then you get burned out during 6 months [of continuous hematology] and you just really don’t want to do that.” |
| • “So much more time in terms of [fellowship] training months is dedicated toward medical oncology. If you really want someone to go into heme, then [the way our fellowship program is structured] is not really a great way to personalize your fellowship.” | ||
| • From a fellow going into oncology: “I did a fair amount of inpatient hematology. My outpatient experience was more in medical oncology. I think that’s also what made a difference. Inpatient, you see more of the sick patients, and you get caught up with their day-to-day issues … whereas outpatient you really get to focus more on the disease, the onc part of things.” | ||
| Intellectual interest | Regardless of career plans, fellows view hematology as an intellectually interesting and complex field | • “I actually think hematologists are considered to be much smarter than medical oncologists in general.” |
| • “I think the [hematology] patients are much more complex, more acute … With the benign [hematology] I just think it’s a mystery, it’s cool.” | ||
| • “I think [in] hematology you need to be smarter” [than in oncology]. | ||
| • “This is going to sound weird, but I really liked hematology more … [even though] realistically thinking, for the rest of your life, the field is just not for me.” | ||
| Lifestyle factors | Fellows view hematologists as having a worse work-life balance than solid tumor oncologists | • “I think in hematology, the work-life balance is just more towards work because of the acuity of the patients … You see the acute leukemics that come in in the middle of the night, whereas, in oncology, I feel like there’s a better work-life balance.” |
| • “I think being forced to go into the hospital on call for every single acute leukemic whether they were stable or not absolutely discouraged me from going into heme.” | ||
| • “All hematology attendings, they are definitely burned out … They are working from 7:00 AM until really, really late … If you are starting a family and having a kid, it is really hard to imagine that you are going to be able to do that. I think it’s better in oncology.” | ||
| Financial factors | Fellows view hematology as having lower earning and funding potential than solid tumor oncology | • “Benign heme is kind of the one that takes a lot of time and isn’t that well reimbursed.” |
| • “My impression is that hematologists … tend to be less well-funded than oncology departments … They don’t have as many people, they don’t have as much stuff, they don’t have as much support.” |
| Theme . | Interpretation . | Quotes . |
|---|---|---|
| Mentorship | Mentorship is the single most important factor guiding fellows’ career decisions | • On the single most important factor in choosing a career: “I would definitely say mentors.” |
| • “Mentors play a huge role because you want to be like them. The cases you see, the change of life, and stuff like that.” | ||
| • “When it comes down to choosing specifically between heme and onc, I think a lot of it comes down to the availability of the mentorship … that’s essentially what makes anybody go into anything.” | ||
| Serendipity | Many mentorship opportunities and career-defining factors occur serendipitously | • “It was serendipitous that I got a good job in a lab that studies cancer right after college at the NIH.” |
| • “The fact that I found someone here who had an interest in [my particular field of] research was completely happenstance.” | ||
| • “I went to a lot of different clinics and I felt like [1 attending] really taught me. He really offered to mentor me and give me good research projects … It was random from me picking attendings to go to their clinics.” | ||
| Clinical exposure and teaching | The distribution of clinical exposure to inpatient and outpatient hematology and oncology may impact fellows’ interests | • “We don’t start thinking about hematology until our second year. By second year, you already have your preferences so you are primarily exposed just to oncology and you don’t have hematology exposure. By the time you are doing hematology you have already picked stuff and you are already thinking about your project… You kind of decide on oncology early on and you don’t really think about hematology and then you get burned out during 6 months [of continuous hematology] and you just really don’t want to do that.” |
| • “So much more time in terms of [fellowship] training months is dedicated toward medical oncology. If you really want someone to go into heme, then [the way our fellowship program is structured] is not really a great way to personalize your fellowship.” | ||
| • From a fellow going into oncology: “I did a fair amount of inpatient hematology. My outpatient experience was more in medical oncology. I think that’s also what made a difference. Inpatient, you see more of the sick patients, and you get caught up with their day-to-day issues … whereas outpatient you really get to focus more on the disease, the onc part of things.” | ||
| Intellectual interest | Regardless of career plans, fellows view hematology as an intellectually interesting and complex field | • “I actually think hematologists are considered to be much smarter than medical oncologists in general.” |
| • “I think the [hematology] patients are much more complex, more acute … With the benign [hematology] I just think it’s a mystery, it’s cool.” | ||
| • “I think [in] hematology you need to be smarter” [than in oncology]. | ||
| • “This is going to sound weird, but I really liked hematology more … [even though] realistically thinking, for the rest of your life, the field is just not for me.” | ||
| Lifestyle factors | Fellows view hematologists as having a worse work-life balance than solid tumor oncologists | • “I think in hematology, the work-life balance is just more towards work because of the acuity of the patients … You see the acute leukemics that come in in the middle of the night, whereas, in oncology, I feel like there’s a better work-life balance.” |
| • “I think being forced to go into the hospital on call for every single acute leukemic whether they were stable or not absolutely discouraged me from going into heme.” | ||
| • “All hematology attendings, they are definitely burned out … They are working from 7:00 AM until really, really late … If you are starting a family and having a kid, it is really hard to imagine that you are going to be able to do that. I think it’s better in oncology.” | ||
| Financial factors | Fellows view hematology as having lower earning and funding potential than solid tumor oncology | • “Benign heme is kind of the one that takes a lot of time and isn’t that well reimbursed.” |
| • “My impression is that hematologists … tend to be less well-funded than oncology departments … They don’t have as many people, they don’t have as much stuff, they don’t have as much support.” |
Six overarching themes were identified: mentorship, serendipity, clinical exposure and teaching, intellectual interest, lifestyle factors, and financial factors. Representative quotes are shown for each theme.
heme, hematology; lab, laboratory; NIH, National Institutes of Health; onc, oncology.