Delaying the Pediatric Fellowship Start Date to Improve Trainee Well-Being.

From the Harbor-UCLA Medical Center and Los Angeles BioMedical Research G raduating pediatric residents in the US are under contract until June 30 and may be assigned patient care duties up until then. However, those entering fellowship are usually expected to begin their training on July 1. In addition, many are required to attend orientation before June 30 or must relocate to another city. These factors can cause considerable distress for trainees. To minimize their effect, categorical program directors (PDs) have used diverse methods with varying success. In November 2013, the Council of Pediatric Subspecialties (CoPS) convened an Action Team to examine the current start date for fellowships and to make recommendations on how the transition could be improved. The group included individuals representing PD and fellowship PD (FPD) organizations from multiple specialties as well as Designated Institutional Officials. Although the objective was to establish a single delayed start date for all fellowships, it became evident that this would remain a future goal. Consequently, representatives from pediatrics thought that the opinions of pediatric residents and FPDs about this issue were needed. Through the Association of Pediatric Program Directors (APPD), categorical PDs had expressed their desire for a start date of July 7 or later. In collaboration with APPD, a survey of graduating pediatric residents entering fellowship was conducted in June 2014. The survey was sent to categorical PDs who forwarded it to their trainees. There were 439 respondents with an estimated response rate of 30%. Sixty-nine percent of residents indicated that they were moving to a new city for their fellowship, 59% doing so with other family members. Almost all (95%) were required to attend orientation, and nearly 40% indicated that this was to be held before June 30. When asked about the impact of a delay in the fellowship start date on income for 1, 2, or 4 weeks, 92%, 73%, and 41%, respectively, of residents thought that this was acceptable. Respondents