Integrating the business of oncology during oncology fellowship: An ASCO State of Cancer Care in America (SOCCA) study of professional preparedness and practice expectations among medical oncology fellow physicians in training between 2013 and 2023.

48 Background: The current healthcare climate calls for a deep understanding among physicians on the business side of medicine. Oncology fellows entering clinical practice face key issues related to the business of cancer care, prompting us to explore the preparation from fellowship training for those financial competencies that factor into day-to-day practice. Methods: All fellows taking the 2023 ASCO Medical Oncology In-Training Exam (ITE) were invited to participate in a post-exam survey which included items on perception of preparedness for future practice and expected practice setting. Respondents answering one or more survey items are included in this analysis. Practice setting expectations were compared to findings from the 2013 post-ITE survey (n=1536). Descriptive statistics and Chi-squared tests comparing responses by fellowship year and exam years are presented. Results: Overall, 2184 (97%) of 2231 fellows taking the 2023 ITE participated in this post-ITE survey study, including 704 in their first, 807 in their second, and 673 in their third year of fellowship. Overall, in areas of communication, most felt adequately prepared by their program: communicating with patients about treatment options (98%), multidisciplinary care coordination (97%), electronic records or other healthcare tech use (95%), staying up to date on changes in oncology (95%), and practicing cultural humility (92%). However, in areas on business of oncology, a greater proportion felt under- or unprepared; specifically, 30% of fellows felt unprepared or unsure about discussing the cost of medical care with patients, 35% on obtaining prior authorization, and 45% on participating in alternative payment models. Compared to 2013, the expected practice setting of the 2023 fellows remained unchanged with subsets anticipating an academic practice (62% in 2023 vs 61% in 2013), non-academic practice (hospital/health system or physician/independently owned; 32% in 2023 vs 34% in 2013), government/regulatory (2%), industry (<1%), or other setting (3%). Conclusions: While nearly all oncology fellows reported high levels of preparedness for certain essential components of patient-centered multidisciplinary practice, over a third felt unprepared or underprepared to navigate domains under the business of oncology. These findings highlight the opportunity to augment oncology fellowship training to include financial competencies of clinical practice and care, which collectively form the foundation of cancer care.