The perspectives of Maternal-Fetal Medicine first-year fellows and fellowship program directors on fellowship start date.

INTRODUCTION: There is increasing support for an August 1 start date for Maternal-Fetal Medicine (MFM) fellowship training programs, but there are concerns of unintended consequences related to the change. METHODS: Two anonymous cross-sectional surveys were administered in-person and electronically to first-year MFM fellows (October 25-27, 2024) and program directors (PDs) (January 29 to February 12, 2025). Fellows provided demographic information about themselves and their programs, their actual and ideal start dates, and whether they encountered financial or non-financial challenges or health insurance coverage gaps. Fellows who considered their ideal start date to be in the month of July were compared to those who chose a date in the months of August or later. PDs were asked about their program's current and ideal start dates and to rate the importance of various factors in deciding their start date. Both cohorts were asked how important they thought a program's start date was in influencing an applicant's rank list and how important it was for all programs to have the same start date. Descriptive statistics using chi-square tests were performed with a significance level of p < 0.05. RESULTS: There were 112 (77.8%) of 144 first-year fellows and 95 (88.8%) of 107 PDs who completed surveys. Start dates varied with 52.7% of fellows responding that they started on August 1. A total of 81 (72.3%) fellows moved to a new city or state, 54 (69.2%) reported health insurance coverage gaps, and 70 (65.4%) reported some financial impact during their transition. Still, most fellows (90.6%, 96/106) considered a start date other than July 1 ideal, with 74.6% of respondents choosing August 1 as their ideal date. For PDs, potential financial challenges and health insurance gaps for the fellow were the most important factors in determining their program's start date. When asked what they considered the ideal start date, 35.8% of PDs still chose July 1. Several PDs cited institutional constraints, disruptions to research coursework, and concern for work visa holders as important considerations for their chosen start date. CONCLUSION: The majority opinion of surveyed first-year MFM fellows supports delaying the fellowship start date, but there are important unintended consequences that must be addressed.