Background: The hematology-oncology inpatient service at the University of Louisville underwent a major change in July 2021 from a medical oncology service run by hematology/oncology fellows and attendings to a hospitalist-run service with hematology/oncology fellows and attendings sharing patient care responsibility as a consulting service. We planned this study because, to date, no published work has studied the effect of transitioning from an inpatient to consult service on fellow burnout, education, and training. Methods: A survey was distributed in July 2021, and a follow-up survey was sent in January 2022. The survey had 38 questions regarding the impact of the workload on time for study, research, personal and professional life, which were scored from 1 to 5. Two tail paired t-test was used to compare the difference in means. The survey also contained questions from the Mayo Clinic Resident Well-Being Index (RSWBI). This index has been validated to identify distress among fellows and allows for the comparison of local results with national data from RSWBI. In RSWBI, scores range from 0-7, with 0 being the lowest risk and 7 being the highest risk of burnout. A cut-off of a score ≥ 5 identifies individuals with a high degree of distress, is associated with an increased risk of error, suicidal ideation, and burnout, and has been validated in more than 1700 residents/fellows. Results: We distributed the survey to 2nd and 3rd-year fellows. 5/6 fellows completed the survey. 3 of them were male and 2 females. Change in inpatient service structure did not impact time for study, research, patient encounter, or ability to handle the volume of work. Improvement in adequate time preparing for clinic was statistically significant (P=0.03), and other improvements were also noted in concentration, time for family, and better personal and professional relationships (Table). RSWBI median score before the transition was 3.6, which improved to 2.0 after the transition to consulting service, which was similar to the national average where the median score was 2.0 among 8237 residents/fellows. 2 fellows (40%) were at high risk of distress before the transition. 1 fellow (20%) was at high risk of distress after the transition, which was comparable to the national average where 19.4% resident/fellows scored ≥5. Conclusions: These results show increased levels of distress in fellows that improved to the national average following transition from a primary inpatient medical oncology service to a consult service.

Comparison of means. *p=0.03.