Retention of fellows to the faculty at a research-intensive academic medical center: a mixed-methods study

As clinical practice provides >50% of medical schools' revenue, research-intensive medical schools often seek to retain fellows with clinical-care interests. Fellows' considerations when deciding whether to stay at research-intensive institutions where they trained remain understudied. We sought to identify experiential factors associated with faculty-position offers and decisions of fellows in training.

We conducted a mixed-methods study using a survey and semi-structured interview. We invited 471 fellows training in all clinical departments at our institution to complete an anonymous survey between April and June 2021 to examine their level of agreement (strongly disagree [1] to strongly agree [7]) with positive training and mentoring experiences and their academic-medicine career goals in association with being offered a position and, if offered, accepting or declining. After survey completion, we invited fellows for interviews about their decision-making to seek, accept, or decline post-fellowship faculty-positions as well as what our institution could do to encourage fellows to accept offered positions.

We analyzed survey data from 168 (35.7%) fellows. Of 48 fellows who were offered faculty positions, 21 accepted and 27 declined; 56 fellows were not offered a position and 64 were too early in training to have received an offer. Fellows who were offered/accepted positions reported higher mean (SD) agreement with positive training (5.9 [1.2]; p < 0.02) and mentoring (6.1 [1.0]; p < 0.001) experiences and having academic-medicine career goals (5.8 [0.8]; p < 0.001) than fellows in other faculty-offer groups. In interviews, 24 fellows reported career goals and institutional resources as influencing decisions. Fellows described institutional opportunities for intervention, especially enhanced communication about institutional priorities and potential positions.

Clear communication with clinical fellows about their academic-medicine career goals and fellowship-training and mentoring experiences can inform decision-making about faculty offers and better equip institutional leaders to retain fellows who align with institutional needs.