Clinicians Report Unmet Needs Regarding Training Fellows for Community-Based Careers


Clinicians say that there are substantial unmet needs in terms of deliberately training hematology/oncology fellows for community-based careers.

Substantial unmet needs are present in the training of hematology and oncology fellows for community-based careers in terms of providing community-based longitudinal clinical experiences and curricula discussing aspects of health care delivery, according to findings from a national survey of clinicians in community or academic-community hybrid settings in the United States.

Survey results which were published in JCO Oncology Practice, showed that 41.6% (binomial 95% CI, 32.8%-50.7%) of oncologists and hematologists (n = 125) from 25 states reported receiving training in a community-based setting. Physicians noted that valuable experiences during training could have included rotations in community settings (47%), direct mentorship from community-based physicians (40%), and longitudinal clinic in a community setting (36%). However, most respondents (64.8%) reported they were very satisfied during training for current professional responsibilities and almost all (98%) were satisfied with their training during fellowship. It was more likely that respondents who were in practice for less than 10 years received training specific to a community-based career (RR, 2.13; 95% CI, 1.18-3.86).

Oncologists and hematologists also listed medical operations and administration (63%), health policy (35%), and quality improvement (27%) as curricula of interest during training.

“Trends noted in surveys conducted by various national organizations indicate that 38%-56% of trainees enter nonacademic clinical settings after fellowship training. In our survey, respondents indicated factors related to geography, work-life balance, patient care–focused careers, and compensation to be key factors in their decision to pursue careers in community-based and academic-hybrid settings,” study authors wrote.

The cross-sectional online survey was conducted from March 2022 to February 2023 and featured 14 multiple choice questions across 3 main domains. The domains encompassed current practice setting and satisfaction, opportunities for community-based training during fellowship, and further clinical or didactic experiences that were desired during fellowship to better prepare respondents for community-based careers.

In addition to demographic questions that included sex, years in clinical practice, and location of fellowship training, practicing hematologists and oncologists were asked 2 open-ended questions. “What would better equip a hematologist/oncologist in training to work effectively in your current clinical practice setting?” the first question asked. The second question asked, “what comments or suggestions do you have regarding a professional development pathway for hematology/oncology trainees with a planned focus in community-based hematology/oncology?”

When compiling responses from the open-ended questions, investigators captured themes regarding optimizing clinical training during fellowship for community-based careers showing that respondents thought that mentoring with community providers, exposure to various cases, and health policy/diversity and inclusion/community outreach among others would be helpful. Clinicians also cited finances/billing, patient advocacy, provider wellness/work life balance, health care delivery, clinical research in the community setting, and supportive oncology and community training as important areas of nonclinical training during fellowship for community-based careers. Finally, respondents cited barriers to specific training in the hematology/oncology fellowship for those perusing community-based carriers such as stigma and an imbalance in training.

Varying views were also reported in terms of a need for a community-focused fellowship track with 1 clinician responding it would be a good idea, however the view that academic positions are more prestigious than community ones may lead to bias against fellows looking to pursue a community practice role. Another respondent noted that patient care professional development is almost the same for community and academic oncologists.

Most clinicians surveyed were male (63.2%), White (57.6%), and were certified in both oncology and hematology (64%). Clinicians were in practice for more than 20 years (35.2%), 10 to 20 years (32.8%), or had graduated in the past 5 years (16%). Respondents were based in academically affiliated community centers (32.8%), community practices that are part of large cancer networks but do not have a formal academic affiliation (26.4%), and academic centers (14%). When clinicians were asked why they chose a community-based setting, work-life balance (59%), the desire to have a primarily clinically focused career (47%), financial compensation (39.2%), and previous experiences with mentors in community-based careers (20%) were reasons cited. Further, 92% of clinicians said that they were satisfied with their career choice.

“Our findings provide a foundation on which to prospectively design clinical experiences and targeted curricula in a goal- concordant manner for hematology/oncology fellows who plan to pursue careers in community-based settings,” study authors wrote in conclusion.


Agrawal S, Patell R, Dodge LE, et al. Defining the educational needs for a community-based hematology/oncology career: a national needs assessment. JCO Oncol Pract. Published online February 8, 2024. doi:10.1200/OP.23.00698

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