BACKGROUND: Recently the American Board of Pediatrics has undertaken an effort to examine the components and structure of pediatric fellowship training. To provide the current status of training programs and the perspectives of those in positions of leadership regarding fellowship training, a study of all fellowship program directors in the United States was undertaken. METHODS: We conducted a mail survey of all 719 pediatric fellowship program directors in the United States. RESULTS: The response rate was 82.2%. Fellowship directors were almost evenly divided regarding whether they believe that there is a need to change the expected amount of clinical training time in their own subspecialty, with 51% stating the amount was appropriate and 48% believing it should be increased. Fewer than half (42%) of program directors believe that the amount of scholarly training time should be the same for all fellows in their subspecialty regardless of career path (ie, primarily clinical versus primarily research). The majority (58%) stated that regardless of career path, the required training for all fellows in their own subspecialty should remain 3 years. Only one-third of program directors strongly believed that quality improvement activities were an important component of fellowship training. CONCLUSIONS: Variation exists among fellowship program directors in their perceptions of the goals and structure of fellowship training. Determining the best way to both account for and recognize the specific nuances of each subspecialty, while maintaining a common set of standards for the profession, will be an important and ongoing effort into the future.