Challenges facing early career academic cardiologists

Workforce Characteristics of Early Career Neonatologists and Comparison of Practice Sites

OBJECTIVE

 Transitioning into the early career physician workforce is a uniquely challenging period in a neonatologist's career. There are limited educational opportunities in fellowship regarding career progression, practice models, and benefits. Understanding these factors are key when searching for employment. This study evaluates the early career neonatologist (ECN) workforce and employment characteristics to improve identification of professional needs.

STUDY DESIGN

 An anonymous 59-question cross-sectional survey was distributed in July 2020 to members of the American Academy of Pediatrics Section on Neonatal Perinatal Medicine Trainees and Early Career Neonatologists (TECaN). The survey instrument was designed using SurveyMonkey and assessed search methods for identifying employers, employment contract details, and professional duties. Questions addressed clinical service time, level of acuity, protected research time, financial compensation, benefits, job search methods, and promotion requirements. Comparisons were drawn between respondents exclusively working in a university-based setting and respondents employed in nonuniversity locations. Responses were collected using SurveyMonkey and then extracted to a Microsoft Excel Workbook for analysis. Statistical analysis was performed using SAS version 9.4.

RESULTS

 Of 1,302 eligible members, 348 people responded (26.7%). Forty-six percent of respondents worked in a university setting and 54% worked in a nonuniversity setting. Using employment site as a discriminator, significant differences were noted in scheduling models. University-located respondents were more likely to work 2-week block schedules, fewer weekend/weeknight call, less clinical weeks per year, and more research/administrative weeks per year. Between university and nonuniversity located positions, benefits were largely comparable, while factors perceived as influential toward promotion varied depending on practice site.

CONCLUSION

 This study provides ECNs with a contemporary workforce description vital to graduating TECaN seeking employment or renegotiating professional obligations. While benefits were largely similar based on practice site, promotion factors and scheduling models may vary depending on location.

KEY POINTS

· Data specific to informing employment decisions for graduating Trainees and Early Career Neonatologists are limited.. · This study provides benchmarks for evaluating employment opportunities presented to early career neonatologists.. · Practice site can influence promotion factors..

Issues Most Pressing to Early-Career Interventional Radiologists: Results of a Descriptive Survey

PURPOSE

To determine demographics, practice patterns, needs from Society of Interventional Radiology (SIR), and preferences of interventional radiologists (IRs) early in their careers.

METHODS

A 28-question descriptive survey was used to identify demographic and practice composition, practice issues, and needs of early career IRs. The survey was distributed to SIR members in the United States (US) (n = 859) within the first 8 years of practice, with 213 respondents (25%).

RESULTS

Respondents were primarily male (n = 181, 87%), less than 40 years old (n = 156, 73%), in practice for 6 years or less (n = 167, 79%), and satisfied with IR as a career (n = 183, 92.4%). The majority were in academic practice (n = 89, 43.2%) or large private practice group (n = 67, 32.5%). Most respondents read diagnostic imaging daily or weekly (n = 130, 61%). The majority of respondents perform complex procedures regularly including transarterial tumor therapy, percutaneous tumor ablation, peripheral arterial interventions, and biliary interventions monthly. Many respondents (n = 49, 23%) have changed jobs at least once citing career advancement, practice issues/disagreements, or compensation as reason. Most respondents would serve as mentors (n = 170, 80%) for trainees and were satisfied with their career mentorship (n = 166, 78%). Respondents felt that mentorship, identification of barriers facing early career IRs, and networking should be the most important functions of the Early Career Section (ECS)of the SIR.

CONCLUSION

As nearly all survey respondents indicated that early career IRs have different needs and priorities than established physicians, they felt that mentorship, identification of barriers facing early career IRs, and networking should be the most important functions of the ECS. Additionally, this same group of IRs report low comfort with the business side of medicine and may benefit from directed content provided by the SIR ECS.

Physician Wellness in Academic Cardiovascular Medicine: A Scientific Statement From the American Heart Association

Academic medicine as a practice model provides unique benefits to society. Clinical care remains an important part of the academic mission; however, equally important are the educational and research missions. More specifically, the sustainability of health care in the United States relies on an educated and expertly trained physician workforce directly provided by academic medicine models. Similarly, the research charge to deliver innovation and discovery to improve health care and to cure disease is key to academic missions. Therefore, to support and promote the growth and sustainability of academic medicine, attracting and engaging top talent from fellows in training and early career faculty is of vital importance. However, as the health care needs of the nation have risen, clinicians have experienced unprecedented demand, and individual wellness and burnout have been examined more closely. Here, we provide a close look at the unique drivers of burnout in academic cardiovascular medicine and propose system-level and personal interventions to support individual wellness in this model.

Starting a Research Career in Cardiology: Advice for Fellows in Training and Early-Career Cardiologists

Launching an academic career in cardiology can be challenging. Mentorship has long been considered a core component in the academic career advancement of trainees across different disciplines and career stages, including cardiovascular disease. But simply having a mentor may not be sufficient to embark on a successful academic journey in cardiology. In this paper, we share advice on starting a research career in cardiology from both the mentee and mentor viewpoints. These perspectives reflect academic career guidance models developed at the Johns Hopkins Center for Mobile Technologies to Achieve Equity in Cardiovascular Health, which is funded by an American Heart Association Strategic Focused Network grant, to emphasize training. Core principles include encouraging mentees to develop a unique professional identity cultivated by a diverse, collaborative, and effective mentorship and sponsorship team.

Why clinical training in China should improve: a cross-sectional study of MD graduates

BACKGROUND

China is experiencing major medical education reforms that include establishing national training standards, standards for health professionals, and advanced health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) with PhD programs to improve academic research and clinical training. However, the academic degree-centred system has led to a preoccupation with research rather than clinical training. Unfortunately, there is a shortage of quality information regarding the clinical training of MD graduates from Chinese medical schools. To fill this gap, this general investigation aims to provide the perspective of recent MD graduates in China for the different subspecialties of clinical training as experienced in different contexts.

METHODS

There were 432 MD graduates who participated in an online survey regarding their clinical training. Information collected included overall satisfaction, educational supervision, supervised learning events, curriculum coverage, local teaching, teamwork, educational governance, workload, supportiveness of the environment, feedback, clinical experience, patient safety, handovers, and reporting systems.

RESULTS

Only 37.4% reported satisfaction with the overall clinical training quality; 54.6% rated the informal and bedside quality as "good"; 64.4% reported they knew who provided clinical supervision; but only 35.5% rated the quality of clinical supervision as high; 51.8% reported that they judged senior physicians as "not competent"; 41.9% agreed that the staff treated each other respectfully; 97.4% admitted that they worked beyond the mandatory hours and claimed they were regularly short of sleep; 84.2% raised concerns about patient safety; 45.3% reported that they received regular informal feedback; 48.1% believed that their concerns about education and training would be addressed.

CONCLUSIONS

This study suggests that the quality of clinical training for MD graduates should be improved. While the overall satisfaction with the teaching quality was acceptable, the quality of many clinical training aspects scored poorly. A major problem seems an undue focus on research in MD/PhD training at the cost of the quality of clinical training, due to career perspectives that undervalue clinical competence. The findings of this study should benefit from a deeper investigation to understand the causes and possible remediation. Suggestions include defining subspecialties and training lengths; monitoring, evaluation, and integration SST with MD degree; providing funds or rewards for academic and clinical training; establishing supervising teams to guide clinical training; and establishing physician scientist task force to help overcome challenges.

Landscape of Mentorship and its Effects on Success in Cardiology

•

Mentees are more satisfied with their mentorship experience when they have had more than 3 mentors or a mentor from outside of their practice/institution.

•

Satisfaction with the mentoring relationship is significantly associated with perceived satisfaction in achieving professional goals.

•

Sex and race/ethnicity concordance in mentoring relationships is associated with positive outcomes.

•

Characteristics that mentees desire in a mentor tend to change with time/career stage.

The effects of mentorship on measurable outcomes of success and the aspects of mentorship that are most valuable in promoting the careers of cardiologists are unclear. To address this, we conducted a large-scale survey of cardiologists in a real-world setting. We identified factors that enhance the mentorship experience, and found that mentee needs change with career stage. Importantly, satisfaction with the mentoring relationship is significantly associated with perceived satisfaction in achieving professional goals. Furthermore, we found that gender and race concordance in mentoring relationships is an important variable with the potential to increase diversity in the field of cardiology.

The Highly Structured Physician Scientist Training Program (PSTP) for Medical Students at the University of Pittsburgh

The University of Pittsburgh School of Medicine Physician Scientist Training Program (PSTP) is a 5-year medical student training program designed to prepare the next generation of MD-only physician-scientists engaging in preclinical research. This article provides an overview of the program, including the novel longitudinal structure and competency goals, which facilitate success and persistence in a laboratory-based physician-scientist career. The authors present data on 81 medical students accepted to the program from academic year 2007-2008 through 2018-2019. Extrinsic outcomes, such as publications, grant funding, and residency matching, indicate that PSTP trainees have actively generated research deliverables. A majority of eligible PSTP trainees have earned Howard Hughes Medical Institute Medical Research Fellow funding. PSTP students have produced a mean of 1.6 first-authored publications (median, 1.0) and a mean of 5.1 total publications (median, 4.0) while in medical school and have authored 0.9 publications per year as residents/fellows, excluding internship. Nearly 60% of PSTP students (26/46) have matched to top-10 National Institutes of Health-funded residency programs in their specialty (based on Blue Ridge Institute rankings). PSTP alumni are twice as likely as their classmates to match into research-heavy departments and to publish first-authored papers. Results of a 2018 program evaluation survey indicate that intrinsic outcomes, such as confidence in research skills, significantly correlate with extrinsic outcomes. The program continues to evolve to maximize both scientific agency and career navigation skills in participants. This medical student PSTP model has potential to expand the pool of physician-scientist researchers in preclinical research beyond the capacity of dedicated MD-PhD and postgraduate training programs.

Inclusion in the Pulmonary, Critical Care, and Sleep Medicine Physician-Scientist Workforce. Building with Intention

Physician-scientists comprise an exceedingly small fraction of the physician workforce. As the fields of pulmonary, critical care, and sleep medicine continue to invest in the development of the physician-scientist workforce, recruitment and retention strategies need to consider the temporal trend in the decline in numbers of trainees pursuing basic research, the challenges of trainees from underrepresented groups in medicine, and opportunities for career and scientific advancement of women physician-scientists. In this perspective article, we examine the headwinds in the training and education of physician-scientists and highlight potential solutions to reverse these trends.

Assigning mentors for new HSC faculty hires: A preliminary policy evaluation

Effective practices for selecting mentors for new faculty at academic health centers (AHC) are currently unknown. The University of New Mexico's School of Medicine assigns a mentor to all new faculty at the time of hire. The effectiveness of this policy measure has not been previously evaluated. The research question was to determine the proportion of new faculty mentees who meet with their assigned mentors before their mandatory orientation held within their first year of hire. At the orientation, faculty are surveyed about their response to the institutional policy of assigning mentors upon their hire. The proportion of new faculty mentees who met their assigned mentors prior to the orientation event constituted the primary study outcome. Of the 289 new faculty surveyed, 79.9% met their assigned mentors prior to the orientation - most meetings were weekly (48.8%) or monthly (27.9%). Among those who had not yet met their mentors, 65% planned to meet them within the month of the survey. 5.5% of all faculty reported a change of mentor from their initial assignment and 2.8% stated that they needed a different mentor. Physicians were less likely to meet with their assigned mentors than non-physician faculty (p=0.02). The preliminary policy evaluation demonstrates that most new faculty either meet or plan to meet their assigned mentors. Most participants stated that they did not need to be assigned a different mentor. Assigning mentors for new faculty hires may be considered a best practice at an AHC.

Show Me the Money: Successfully Obtaining Grant Funding in Medical Education

Obtaining grant funding is a fundamental component to achieving a successful research career. A successful grant application needs to meet specific mechanistic expectations of reviewers and funders. This paper provides an overview of the importance of grant funding within medical education, followed by a stepwise discussion of strategies for creating a successful grant application for medical education-based proposals. The last section includes a list of available medical education research grants.

Factors influencing career progress for early stage clinician-scientists in emerging Asian academic medical centres: a qualitative study in Singapore

OBJECTIVES

To explore the factors that influence career progress for early stage clinician-scientists and to identify ways to mitigate these factors in the context of emerging Asian academic medical centres (AMCs).

DESIGN

Qualitative interviews and thematic data analysis based on grounded theory.

SETTING AND PARTICIPANTS

Five focus group interviews comprising 29 early career clinician-scientists who have received their first national-level career development award in Singapore.

RESULTS

Clinical priorities represented an overarching concern with many reporting the difficulty in delineating responsibilities between clinical care and research. Additionally, there was a prevailing perception of the lack of support for research at the institutional level. Participants tended to identify mentors through their own efforts in a relatively haphazard manner, often owing to the dearth of role models and perceived inadequacy of reward systems for mentoring. Support from mentors was thought to be limited in terms of targeted scientific guidance and long-term commitments to the relationship. Most of the participants expressed concerns about how they could secure the next level of funding with diminishing confidence. Notably, the work-life balance was neither conceptualised as a 'barrier' to successful pursuit of research career nor was it translated into the reason for leaving the dual clinical-research career pathway.

CONCLUSIONS

Results revealed specific limitations presented by the research environment in newly emerging Asian AMCs. To retain a vibrant clinician-scientist workforce, additional measures are needed, aiming to improve institutional culture of research, build mentoring networks, adopt effective tools for tracking career progress and provide a clear and viable career progression path for clinician-scientist. Further research might explore the cross-cultural differences in managing work-life balance in academic medicine.

The Uk Academic Foundation Programmes: Are the Objectives Being Met?

Background

Since the Academic Foundation Programme was established in the UK in 2005 a number of trainees have participated in this programme; however, there are few published national data on the experiences of these academic trainees. We aimed to assess the perceived value and challenges of training on the AFP.

Methods

In March 2017, an anonymous electronic questionnaire was distributed to all Academic Foundation Programme trainees in the UK, via their local foundation school administrators.

Results

Fifty-six respondents completed the survey from 9 out of the 15 Academic Units of Application. Of these, 82% were undertaking a research based Academic Foundation Programme; however, 41% reported not having access to any training on research methods and governance. Sixty-six percent reported they were aware of the aims and expected outcomes of the Academic Foundation Programme, but the self-reported achievement of academic compendium outcomes was relatively low. Sixty-three percent rated the quality of their experience on the Academic Foundation Programme as excellent or good and 75% reported that they intended to continue in academia. Most trainees (64%) reported that the completion of a postgraduate qualification as part of their Academic Foundation Programme would improve the programme.

Conclusion

The Academic Foundation Programme plays a valuable role in trainees’ development and preparing them for a career in academia. However, the objectives of the programme are currently not being uniformly achieved. Furthermore, trainees feel there remains room for improvement in the design of the Programme.

Training cardiovascular outcomes researchers: A survey of mentees and mentors to identify critical training gaps and needs

BACKGROUND

Many young investigators are interested in cardiovascular (CV) outcomes research; however, the current training experience of early investigators across the United States is uncertain.

METHODS

From April to November 2014, we surveyed mentees and mentors of early-stage CV outcomes investigators across the United States. We contacted successful grantees of government agencies, members of professional organizations, and trainees in CV outcomes training programs.

RESULTS

A total of 185 (of 662) mentees and 76 (of 541) mentors completed the survey. Mentees were equally split by sex; most had completed training >3 years before completing the survey and were clinicians. Mentors were more likely women, mostly ≥20 years posttraining, and at an associate/full professor rank. Mentors reported devoting more time currently to clinical work than when they were early in their career and mentoring 2-4 people simultaneously. More than 80% of mentees started training to become academicians and completed training with the same goal. More than 70% of mentees desired at least 50% research time in future jobs. More than 80% of mentors believed that future investigators would need more than 50% time dedicated to research. Most mentees (80%) were satisfied with their relationship with their mentor and reported having had opportunities to develop independently. Mentors more frequently than mentees reported that funding cutbacks had negatively affected mentees' ability to succeed (84% vs 58%). Across funding mechanisms, mentees were more optimistic than mentors about securing funding. Both mentees and mentors reported greatest preparedness for job/career satisfaction (79% for both) and publications (84% vs 92%) and least preparedness for future financial stability (48% vs 46%) and work-life balance (47% vs 42%).

CONCLUSIONS

Survey findings may stimulate future discourse and research on how best to attract, train, and retain young investigators in CV outcomes research. Insights may help improve existing training programs and inform the design of new ones.

How well does early-career investigators' cardiovascular outcomes research training align with funded outcomes research?

BACKGROUND

Outcomes research training programs should prepare trainees to successfully compete for research funding. We examined how early-career investigators' prior and desired training aligns with recently funded cardiovascular (CV) outcomes research.

METHODS

We (1) reviewed literature to identify 13 core competency areas in CV outcomes research; (2) surveyed early-career investigators to understand their prior and desired training in each competency area; (3) examined recently funded grants commonly pursued by early-career outcomes researchers to ascertain available funding in competency areas; and (4) analyzed alignment between investigator training and funded research in each competency area. We evaluated 185 survey responses from early-career investigators (response rate 28%) and 521 funded grants from 2010 to 2014.

RESULTS

Respondents' prior training aligned with funded grants in the areas of clinical epidemiology, observational research, randomized controlled trials, and implementation/dissemination research. Funding in community-engaged research and health informatics was more common than prior training in these areas. Respondents' prior training in biostatistics and systematic review was more common than funded grants focusing on these specific areas. Respondents' desired training aligned similarly with funded grants, with some exceptions; for example, desired training in health economics/cost-effectiveness research was more common than funded grants in these areas. Restricting to CV grants (n=132) and National Heart, Lung, and Blood Institute-funded grants (n=170) produced similar results.

CONCLUSIONS

Identifying mismatch between funded grants in outcomes research and early-career investigators' prior/desired training may help efforts to harmonize investigator interests, training, and funding. Our findings suggest a need for further consideration of how to best prepare early-career investigators for funding success.

Status of Early-Career Academic Cardiology: A Global Perspective

Early-career academic cardiologists, who many believe are an important component of the future of cardiovascular care, face myriad challenges. The Early Career Section Academic Working Group of the American College of Cardiology, with senior leadership support, assessed the progress of this cohort from 2013 to 2016 with a global perspective. Data consisted of accessing National Heart, Lung, and Blood Institute public information, data from the American Heart Association and international organizations, and a membership-wide survey. Although the National Heart, Lung, and Blood Institute increased funding of career development grants, only a small number of early-career American College of Cardiology members have benefited as funding of the entire cohort has decreased. Personal motivation, institutional support, and collaborators continued to be positive influential factors. Surprisingly, mentoring ceased to correlate positively with obtaining external grants. The totality of findings suggests that the status of early-career academic cardiologists remains challenging; therefore, the authors recommend a set of attainable solutions.

Barriers to and Facilitators of a Career as a Physician-Scientist Among Rheumatologists in the US

OBJECTIVE

To determine perceived barriers to and facilitators of a career in rheumatology research, examine factors leading rheumatologists to leave an academic research career, and solicit ways to best support young physician-scientists.

METHODS

A web-based survey was conducted among the domestic American College of Rheumatology (ACR) membership from January through March 2014. Inclusion criteria were ACR membership and an available e-mail address. Non-rheumatologists were excluded. The survey assessed demographics, research participation, barriers to and facilitators of a career in research, reasons for leaving a research career (when applicable), and ways in which the ACR could support junior investigators. Content analysis was used to extract relevant themes.

RESULTS

Among 5,448 domestic ACR members, 502 responses were obtained (9.2% response rate). After exclusions (38 incomplete, 2 duplicates, 32 non-rheumatologists), 430 responses were analyzed. Participants included fellows, young investigators, established investigators, mentors, clinicians, and those who previously pursued a research career but have chosen a different career path. Funding and mentoring were the most highly ranked barriers and facilitators. Protection from clinical and administrative duties, institutional support, and personal characteristics such as resilience and persistence were also ranked highly. The most commonly cited reasons for leaving an academic research career were difficulty obtaining funding and lack of department or division support.

CONCLUSION

This is the first study to examine barriers to and facilitators of a career in rheumatology research from the perspectives of diverse groups of rheumatologists. Knowledge of such barriers and facilitators may assist in designing interventions to support investigators during vulnerable points in their career development.

National Institutes of Health Career Development Awards for Cardiovascular Physician-Scientists: Recent Trends and Strategies for Success

Nurturing the development of cardiovascular physician-scientist investigators is critical for sustained progress in cardiovascular science and improving human health. The transition from an inexperienced trainee to an independent physician-scientist is a multifaceted process requiring a sustained commitment from the trainee, mentors, and institution. A cornerstone of this training process is a career development (K) award from the National Institutes of Health (NIH). These awards generally require 75% of the awardee's professional effort devoted to research aims and diverse career development activities carried out in a mentored environment over a 5-year period. We report on recent success rates for obtaining NIH K awards, provide strategies for preparing a successful application and navigating the early career period for aspiring cardiovascular investigators, and offer cardiovascular division leadership perspectives regarding K awards in the current era. Our objective is to offer practical advice that will equip trainees considering an investigator path for success.

Rescuing the physician-scientist workforce: the time for action is now

The 2014 NIH Physician-Scientist Workforce (PSW) Working Group report identified distressing trends among the small proportion of physicians who consider research to be their primary occupation. If unchecked, these trends will lead to a steep decline in the size of the workforce. They include high rates of attrition among young investigators, failure to maintain a robust and diverse pipeline, and a marked increase in the average age of physician-scientists, as older investigators have chosen to continue working and too few younger investigators have entered the workforce to replace them when they eventually retire. While the policy debates continue, here we propose four actions that can be implemented now. These include applying lessons from the MD-PhD training experience to postgraduate training, shortening the time to independence by at least 5 years, achieving greater diversity and numbers in training programs, and establishing Physician-Scientist Career Development offices at medical centers and universities. Rather than waiting for the federal government to solve our problems, we urge the academic community to address these goals by partnering with the NIH and national clinical specialty and medical organizations.

An International Survey on Taking Up a Career in Cardiovascular Research: Opportunities and Biases toward Would-Be Physician-Scientists

BACKGROUND

Cardiovascular research is the main shaper of clinical evidence underpinning decision making, with its cyclic progression of junior researchers to mature faculty members. Despite efforts at improving cardiovascular research training, several unmet needs persist. We aimed to appraise current perceptions on cardiovascular research training with an international survey.

METHODS AND RESULTS

We administered a 20-closed-question survey to mentors and mentees belonging to different international institutions. A total of 247 (12%) surveys were available (out of 2,000 invitations). Overall, mentees and mentors were reasonably satisfied with the educational and research resources. Significant differences were found analyzing results according to gender, geographic area, training and full-time researcher status. Specifically, women proved significantly less satisfied than men, disclosed access to fewer resources and less support from mentors (all P<0.05). People working in institutions not located in North America or Northern/Central Europe were significantly less satisfied and disclosed much less support (both P<0.05). Those in training reported limited opportunities for collaboration (P = 0.009), and non-full-time researchers disclosed more limited access to tutors and formal grant writing training (both P<0.05).

CONCLUSIONS

Several potential biases appear to be present in the way training in cardiovascular research is provided worldwide, including one against women. If confirmed, these data require proactive measures to decrease discriminations and improve the cardiovascular research training quality.

The Choice Between an Academic Versus Private Practice Career in Cardiology: A Fellow's Perspective

This study is written in editorial style from the perspective of a fellow-in-training. The editorial profiles specific principles to assist other fellows as they deliberate on the choice between an academic versus private practice career in cardiovascular medicine. Among the key principles are: outlining the general differences between academic and nonacademic careers, identifying the areas of overlap and change, understanding the heterogeneity within academia, and choosing the opportunities that invest in your success. Emphasis is also placed on outlining ways in which one can advance their competitive frontier in cardiology. In conclusion, this editorial emphasizes guiding principles to help fellows-in-training as they search for a career in cardiovascular medicine that fosters growth and empowers them to achieve their professional goals.

Current and future status of adult congenital training in North America

Adult congenital heart disease (ACHD) presents a unique and growing patient population, but there are no data to suggest there are sufficient training programs available to train specialists to meet the needs of this population. The objective of this national survey was to determine the current status of ACHD fellowship curricula and training. An online questionnaire was provided to adult and pediatric cardiology fellowship programs to determine program demographics, status, duration, faculty teaching responsibilities, volume or patient exposure, and institutional obstacles. Of the 225 programs surveyed, 81 responded (36%). Nearly all were university affiliated (93%) with <1/3 (29%) reporting an ACHD fellowship program. Most offered either a 1- (42%) or a 2-year (47%) fellowship. ACHD fellowship funding was provided by hospital budget (68%). Half reported an increase in applicants to their fellowship. Applicants were more likely to have had previous training in adult cardiovascular medicine (56%). Respondents ranked "Volume of Outpatients/Year" and "Lack of Institutional Support" as the most important aspect of an ACHD program to applicants and greatest obstacle to ACHD training, respectively. After training, ACHD fellows obtained adult cardiology/ACHD positions (47%) and were within an academic center (88%). In conclusion, the results demonstrate a deficiency in the number of currently available ACHD fellowship programs. Measures should be taken to strengthen and standardize ACHD training to meet the increasing workforce requirements of this population.