Recent trends in Pediatric Hematology Oncology fellowship match and the workforce impact

In the manuscript authored by Macy et al., global trends of the pediatric subspecialty workforce are described by reporting the numbers of applicants entering fellowship training from 2001 to 2018.¹ They conclude there has been an increase in the number of physicians entering pediatric subspecialty training. We would like to highlight discrepant changes in accrual into Pediatric Hematology Oncology (PHO) fellowship training, compared to other subspecialties (Table 1). Among the larger fellowship programs, Macy et al. reported PHO to have a marked increase in the number of individuals entering fellowship 2008–2018. However, in the recent PHO fellowship matches there has been a significant and consistent decrease in total applicants. The 2021 fellow match resulted in an 8% decrease in applications and left nearly half (44%) of PHO fellowship programs unfilled (Table 2). Across the country, PHO programs have been scrambling to fill these unoccupied positions. More broadly, fellowship program directors and division chiefs are trying to understand the cause of continued decline in PHO training interest and its future impact on our workforce.

Table 1 National Resident Matching Program (NRMP) pediatric subspecialty fellow match results 2018–2021.⁴

Table 2 NRMP Pediatric Hematology/Oncology subspecialty match results, 2008–2021.⁴

From 2008 to 2016, PHO fellowship applications steadily rose from 150 applicants to a peak of 201 applicants in 2016. However, in the past 5 years fellow applications have steadily fallen, with only 133 applications in the 2021 match cycle (Table 2). Interestingly, the number of programs and positions has increased consistently during this time, with 72 PHO fellowship programs (representing 176 positions) participating in the 2021 Match. Other pediatric subspecialty programs did not demonstrate the same decline in fellowship applications (Table 1). Herein we try to offer some reasons that may have contributed to these findings.

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