oncology fellow advisor - summer 2009 - vol. 1 no. 2

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SUPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

oncologyfellowadvisor.com

ONCOLOGYFellowadvisor

see Career Choice , page 7 �

Many successful physicians point to their mentors as a defining

influence on their professional devel-opment, underscoring the importance of this relationship in a fellow’s train-ing. Studies have demonstrated that mentoring plays a vital role in the development of young physicians. Fellows tend to go into the same field and practice setting as their mentor, and oncologists with mentors tend to be more involved in research and have more successful faculty careers.1-3

Yet the mentorship process is not clearly defined. Fellows have a wide range of highly personal experiences with their mentors.

“Not all fellows understand mentor-ship,” said Fadi Braiteh, MD, a fellow in medical oncology at The University of Texas M.D. Anderson Cancer Center in Houston. “Most of the time trainees are in denial about the importance of finding a mentor, but you realize how crucial it is at the end. And if you

The Fellow’s Guide To Finding a Mentor

see Mentors, page 4 �

For the latest oncology-related news,

please visit

www.oncologyfellowadvisor.com

STRESS BUSTERS

Ways for the oncology fellow to beat stress and avoid burnout. 2

COMMUNITY PRACTICE

Tips on transitioning from fellowship to private practice. 5

ACADEMIA

Part 1 of 2: Experts outline strategies for a successful career in academic oncology. 6

CareerPaths

FellowshipTraining

MentorMemos

Survey Says

Physician Finance






Fellows approaching the end of their train-

ing are faced with one of the most significant choices of their lives. They must decide whether to pursue an academic posi-tion or a community-based career in a private or hospi-tal-based practice.

“It’s a very com-plicated decision, and it’s very dif-ficult. It’s a fork in the road for all of us,” said K.M. Steve Lo, MD, a medi-cal oncologist at Bennett Cancer Center in Stamford, CT. “And it’s a major fork in my life. One of many, but certainly one of the big ones.”

In making this decision, fellows must weigh sev-eral factors that generally fall into

1 of 2 categories: how they spend their

time at work, and per-sonal lifestyle choices like work–life balance,

salary, and the non-clinical respon si-bilities of which-ever practice e n v i r o n m e n t they choose.1

“It’s a cen-tral, major issue and it’s one that

people wrestle with on different levels,” said Andrew Seidman, MD, attending physician at Memorial Sloan-Kettering

Career Crossroads? Choose Wisely

ooo

Vol. 1, Issue 2

http://www.oncologyfellowadvisor.com/index.asp?show=subs

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2 FELLOWSHIP TRAINING Oncology Fellow Advisor • Vol. 1, Issue 2

Burnout is a significant problem that may occur dur-ing oncology fellowship. One recent survey found

that more than two-thirds of fellows reported emotional exhaustion and a diminished sense of empathy.1 Most commonly, oncology fellows reported that they did not have enough time to give patients the emotional atten-tion they felt they needed, highlighting the importance of communication and time-management skills in alle-viating stress and avoiding burnout.1

“I see different levels of stressors, and they kick in at different levels [during fellowship] training,” said Fadi Braiteh, MD, a fellow in medical oncology at The University of Texas M.D. Anderson Cancer Center in Houston.

The first stressor that many fellows face on arriving at their institution involves integrating their education with the care of their patients. Fellows must get up to speed on a large and ever-expanding body of literature and then apply it as best they can in a new environment.

“The learning pace is faster than any of the other medi-cal subspecialties. For a trainee to catch up with all the key papers, with the thinking and decision making, is extremely challenging,” said Dr. Braiteh.

Once fellows settle in, they must learn to cope with the lifelong stresses of the subspecialty: the specific patient population and the multimodal nature of the care they are required to provide.2

“The other stresses are subliminal, like dealing with cancer patients, where you know a certain percentage of cancer patients will be dying,” said Dr. Braiteh. “Because if, in oncology, you think it’s a battle and you are going to win the war against cancer, you are going to burn out. Because we know, most of the time, we cannot do it.”

When patients do respond poorly to treatment, the emotional stress, particularly for junior fellows, can spill over into their personal lives. “Particular patient stories hit you, and you carry them with you,” said Dr. Braiteh. “And it can contaminate and outweigh your personal life and cause damage.”

For the first time, fellows also are at the center of a multi-disciplinary team and are ultimately responsible for the cancer patient. “The medical oncologist plays a central and coordinating role and if a colleague is functioning poorly—a surgeon, a radiation oncologist—that comes back to you, the patient complains to you,” said Dr. Braiteh.

During the third year of fellowship, oncology fellows must navigate the job market and make decisions that will likely affect the rest of their career. For example, they

may choose to go into academia or community practice, and there are stressors unique to each (Table).3

“Toward the last 12 months before graduation, it is career and job placement and as a third-year fellow, I can tell you that it is major,” said Dr. Braiteh.

After identifying potential stressors, 2 of the most impor-tant tools that fellows can develop to cope with stress

throughout their fellowship are communication and time-management skills, according to Walter F. Baile, MD, profes-sor of medicine and chief of the Psychiatry Section at M.D. Anderson.

“One of the very, very important aspects of caring for patients and interacting with colleagues is having

good communication skills,” said Dr. Baile. “It’s the vol-ume of challenging conversations and interactions that can take their toll during fellowship, when fellows may not have the skills or experience to deal with it.”

Importantly, physician communication is a key aspect of patient satisfaction, which in turn affects how oncolo-gists feel about the care they provide.4 “The gratitude of our patients is a very important aspect of being satisfied with one’s career,” said Dr. Baile.

Communication skills, particularly those required for patients who don’t respond to treatment or who should be transferred to palliative care, must be learned, empha-sized Dr. Baile.5 Departmental conferences, mentorship from senior faculty, role-playing, and online education are

Stress Busters for the Oncology Fellow

“Particular patient stories hit you,

and you carry them with you. And it

can contaminate and outweigh your

personal life and cause damage.”

—Fadi Braiteh, MD

Table. Stressors by Job Type3

Community Practice Academia

L• arge number of patients to treat

Unpredictable and con-• stantly changing hours

Night/weekend shifts•

Burden of losing a • patient (worsening of condition, death)

Loads of paperwork • (insurance filings, bal-ancing the books)

Ensuring fellows are • competent to diagnose and act in life-threaten-ing situations

Path to promotion/• tenure may be loosely outlined

May feel less self-worth • than those treating and saving patients

Lower pay than private • practice despite similar knowledge base/training

Adapted from Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.


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Vol. 1, Issue 2 • Oncology Fellow Advisor FELLOWSHIP TRAINING 3

Editorial Board

Karin Hahn, MD

Associate Program Director, The University of Texas M.D.

Anderson Hematology/Oncology Fellowship

Chief of Medical Oncology

Assistant Professor

Lyndon B. Johnson General Hospital

Houston, Texas

Jamal Rahaman, MD

Fellowship Director

Division of Gynecologic Oncology

Mount Sinai School of Medicine

New York, New York

Andrew D. Seidman, MD

Attending Physician, Breast Cancer Medicine Service,

Memorial Sloan-Kettering Cancer Center

Professor of Medicine

Weill Cornell Medical College

New York, New York

Marc Stewart, MD

Program Director, Hematology/Oncology Fellowship

University of Washington/Fred Hutchinson Cancer

Research Center

Medical Director, Seattle Cancer Care Alliance

Professor of Medicine, University of Washington

Seattle, Washington

DISCLAIMER—Oncology Fellow Advisor (brought to you by

McMahon Custom Publishing with financial support from Lilly

USA, LLC) is designed to be a summary of information. McMahon

Custom Publishing and Lilly USA, LLC, neither affirm nor deny

the accuracy of the information contained herein. No liability will

be assumed for the use of this educational publication, and the

absence of typographical errors is not guaranteed.

Copyright © 2009, McMahon Publishing Group, 545 West 45th

Street, New York, NY 10036. Printed in the USA. All rights

reserved, including the right of reproduction, in whole or in part,

in any form.

July 2009

Supported by

all ways in which fellows can learn to improve their com-munication skills. Fellows also should remember that they still are in a significant learning phase of their careers, despite being responsible for many patients.

“Fellows need to recognize that they are learners and are not always going to do things perfectly. Fellows should have a mindset of going ‘beyond blame’ to look at training experiences as training experiences—as opportu-nities to improve their skills,” said Dr. Baile.

Communication is key. Here are a few ways to improve physician communication skills:

Attend departmental conferences•

Attend Grand Round meetings•

Engage in online education•

Receive mentorship from senior faculty members•

Practice role-playing with other fellows•

A mentor often can help a fellow with many aspects of his or her career. During high-stress cases or situations—or even career burnout—a mentor can provide empathy and support.

“It’s hard to find a good mentor, but if you can, it really is a great opportunity when you’re feeling stressed out to have someone who can listen,” said Dr. Baile. “Often, they don’t necessarily have to say anything but simply help you think through the situation.”

Although most oncology fellows experience stress from the demanding responsibilities of their career and personal life, if the feeling is consistently overwhelming, now is the time to recognize and correct the problem. There are many continuing medical education courses designed to help physicians manage the numerous non-clinical demands of medicine.

“A lot of people struggle with time management and organization. I think that during fellowship, there is an opportunity to … get help if you’re not good at managing your time and being organized,” said Dr. Baile.

References1. Armstrong JL, Holland J. Survey of medical oncology fel-

lows’ burnout, communication skills, and perceived com-petencies. J Clin Oncol. 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition). 2004;22(14S):8132.

2. Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncolo-gists. J Clin Oncol. 1991;9(10):1916-1920.

3. Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.

4. Dugdale DC. Time and the patient–physician relationship. J Gen Intern Med. 1999;14(Suppl 1):S34–S40. 5.

5. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005;55(3):164-177.


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4 MENTOR MEMOS Oncology Fellow Advisor • Vol. 1, Issue 2

identify the stress of finding a mentor early, face it, and work it out, it will determine the next part of life.”

The first step begins with formal programs. Fellowship institutions often will offer career development work-shops, lectures, and meetings to allow fellows to become acquainted with the concept of mentorship. They may even match a fellow with a mentor.

The process often is much less formal, however. Fellows will be exposed to many possible mentors throughout their early training, and one key to finding the right teach-er may be to seize an opportunity when it arises.

“Although there is a formal structure in place, find-ing [mentors] is informal,” said Alison Conlin, a medical oncologist at Providence Cancer Center in Portland, OR. “I just happened to be in [my mentor’s] clinic, thought he was great, and said ‘I’d love to work with you for the next few years’ and that was it.”

Another key is realizing the benefits that particular mentors can provide. “You should never pick one senior mentor,” said Dr. Braiteh. “You need short- and long-term mentors. You need someone who is seasoned, who can see the 30,000-ft. view of things, but you also need to pick up junior mentors, because they were in your shoes just a few years ago and were struggling with the issues you are struggling with.”

Finding a good mentor often is more about a good mentor–mentee pairing and should not be focused solely on research interests. The goal of an effective mentorship should be overall academic and personal development.

“One of the things fellows don’t often know is that your mentor does not necessarily have to be within your division,” said Sunita Nasta, MD, assistant professor of medicine in the Division of Hematology-Oncology at the University of Pennsylvania in Philadelphia. “You may find someone in another department who can provide guid-ance and mentorship for you from an academic point of view, and it’s important to make these institutional con-nections beyond just your small group.”

After a connection is made, a mentor can provide sub-stantial guidance. For example, mentors can immediately help fellows gain experience in research by allowing them to write clinical trial protocols and helping them generate, present, and publish data.

For oncology fellows interested in bench research careers, the importance of a mentorship cannot be over-stated. “If you’re interested in a bench research career, the most important thing is finding a mentor to guide your early career, and that is probably more important than the particular institution that you go to [for fellow-ship],” said Dr. Nasta.

Mentors also play an invaluable role in patient care,

not only in providing guidance for clinical questions and

patient management, but also in less tangible areas like

communication and stress management. “It’s hard to

find a good mentor, but if a fellow can find someone to

coach them, to talk with not only about difficult clinical

cases, but about difficult communication aspects, [that]

is extraordinarily important,” said Walter Baile, MD, pro-

fessor of medicine and chief of the Psychiatry Section at

M.D. Anderson.

Perhaps the most significant role a mentor can play is

guiding a fellow in selecting a career path. A good mentor

not only provides practical information about the nuanc-

es of success in academic research, but also actively pro-

vides the mentee with opportunities.

For example, when Dr. Nasta—who specializes in non-

Hodgkin’s lymphoma—was looking for an academic

appointment, she asked her mentor to speak with promi-

nent lymphoma specialists along the Eastern seaboard

to see if there would be openings when she anticipated

looking for a job.

“Finding the right mentors pays early in job placement—

to know about opportunities and to know about people

at those opportunities,” said Dr. Braiteh. “Sometimes, one

sentence from a person about a chairman of an institution

can really change the tone of how you want to approach

them.”

Although mentors often are best equipped to help fel-

lows who want to remain in academia, they still are capa-

ble of providing support to those who wish to go into

community practice. Fellows who want to leave academic

medicine should not be afraid to ask for their help.

“I think it’s hard and I know people who were scared

to tell their mentors they had chosen private practice,”

said Dr. Conlin. “But I would tell fellows that this is your

life, your choice, and your job. You have to do what feels

right in your heart and you hope that they support you

and want the best for you.”

Although Dr. Conlin now has her own thriving com-

munity practice far away from her fellowship institution,

her mentor is never too far away. “My mentor will be

with me my whole life,” she said. “I will always e-mail him

with hard cases.”

References

1. McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical career choices: the vital impact of men-toring. J Surg Res. 2008 Aug 13. [Epub ahead of print].

2. Riechelmann RP, Townsley CA, Pond GR, Siu LL. The influ-ence of mentorship on research productivity in oncology. Am J Clin Oncol. 2007;30(5):549-555.

3. Gitlin SD, Yuan Z, Little RJ, Todd RF. Factors that influence successful training and faculty career development in hema-tology/oncology patient-oriented clinical research. J Cancer Educ. 2005;20(2):72-78.

Mentors

continued from page 1


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Vol. 1, Issue 2 • Oncology Fellow Advisor CAREER PATHS 5

For oncology fellows who enjoy caring for patients, a career in private or hospital-based community prac-

tice offers many advantages compared with an academic path. Community practice offers the intellectual rewards of treating a broad range of malignant diseases, better pay, greater control over work–life balance, and recognition in the community as a subspecialist with unique skills and contributions.1

Once the decision has been made to leave academia and transition to community practice, fellows need to be familiar with the different community practice models and define their career expectations accordingly. However, fel-lowship provides little preparation for private practice.

“Having recently gone through the process, it is pretty daunting,” said Alison Conlin, MD, a former fellow at Memorial Sloan-Kettering Cancer Center in New York City, who is now a medical oncologist at Providence Cancer Center in Portland, OR. “There are definitely some things that we aren’t prepared for and don’t under-stand because we spend all of our training time in the world of academia.”

One of the most important facets of community prac-tice that fellows should understand is the types of pri-vate-practice opportunities that will be available to them. There are generally 3 types of private practice: the solo practice; the subspecialty group, made up entirely of medical oncologists; and the multispe-cialty group, in which oncolo-gists practice with physicians from one or more subspecial-ties, often within an HMO.

Furthermore, each of these models may be independent,

hospital-based, or university-affiliated. These differences define the fundamental business model of a practice.1

An independent oncology practice functions as a self-sufficient business unit in which the partners are respon-sible for managing its revenues and expenses. Private practices based on this model often buy and sell chemo-therapy and may invest in infrastructure such as scanners or office space, all of which function as additional sources of revenue above and beyond professional billing fees.

Hospital- or university-based practices receive their income from an affiliated institution. The hospital also reduces its overhead by providing practice space and additional support, such as billing services.

The fundamental salary difference for academic and community oncologists is that a community oncologist’s pay is generally based on productivity. In many pay sched-ules, salary is based on relative value units (RVUs), which standardize and measure physicians’ work depending on how much time they spend with a patient or the complex-

ity of their physical assess-ment. The advantage of RVUs is that physicians can slide their productivity up or down depending on their schedules.

“When I’m gone and one of my colleagues is seeing a patient for me, then he or she gets paid for that. And the busier you are, the more money you make, so we have the option of ratcheting up and down depending on our needs,” said Robert Raish, MD, a medical oncologist at North Puget Oncology, LLC, in Mount Vernon, WA.

To find positions, oncologists may use traditional meth-ods, such as recruiters or advertisements. Another method is to attend career development sessions at the American Society of Clinical Oncology meetings.

Community practices often are unique, however, so the best method to find employment is to personally talk with oncologists who have recently gone into community practice.

“It’s hard for anyone outside a community position currently to tell you how to do something dif-ferent than academia,” said Dr. Conlin. “In terms of finding this kind of job, I had to reach out to former fellows, and once I did find them, they were helpful in point-ing me in the right direction.”

Generally, fellows are offered a position in a community practice on a probationary basis. Because new oncologists need time to build their clinic, this typically involves a base salary and in some cases a productivity payment if fellows work particularly hard.

In choosing a community practice, the 2 most important issues are anticipated workload and time to partnership. Fellows should specify their expected ambulatory clinic hours, hospital rounding responsibilities, and on-call time before joining a practice.2

“What everyone worries about is how much time they’re going to be on call, but fellows should worry a little bit more about what their time is going to be like during the week,” said Dr. Conlin. If a practice demands more work than expected, weekday responsibilities can quickly pour over into the weekend and affect work –life balance.

Similarly, oncology fellows need to be clear about what

Community Practice: Transitioning From Academia

see Community, page 6 �

In choosing a community

practice, the 2 most important

issues are anticipated workload

and time to partnership.


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6 CAREER PATHS Oncology Fellow Advisor • Vol. 1, Issue 2

The path to a successful academic career is a long road with many discrete steps. With a projected shortage

of oncologists, however, well-prepared fellows interested in a career in research and education likely will find aca-demic opportunities after training.1

The first steps to a successful academic career begin in fellowship. Oncology fellows who wish to go into academia need to demonstrate an interest in scholarly activities and develop the skills to carry out research projects. Some of the most common activities include publishing manuscripts in peer-reviewed journals, pre-senting clinical data at national meetings, sitting on insti-tutional review or research boards, and writing study protocols.

For fellows with access to educational programs, a mas-ter’s degree in public health or clinical epidemiology is a formal way to both demonstrate an interest in and con-duct research. The American Society of Clinical Oncology also offers workshops on clinical trial design and grant writing for oncology fellows at annual meetings.1

Oncology fellows who specialize in a particular research theme, such as a tumor site or a specific type of investi-gation (eg, Phase I clinical trials) also may gain an advan-tage as they look for academic jobs after fellowship.

Finally, fellows must decide which academic track they wish to pursue; generally, there are 4: physician-scientist, clinician-investigator, clinician-educator, and academic clinician.1

Each of these positions divides its time differently among 3 main job functions—research, seeing patients,

and teaching. For example, a traditional breakdown for a physician-scientist may be 80% time in the laboratory and 20% patient care, whereas an academic clinician may spend 80% to 100% of their time seeing patients, with few administrative or teaching duties.

After demonstrating an interest in research and choos-ing an academic track, a fellow is ready to step into academia and weigh the different options specific institu-tions have to offer.

The No. 1 question fellows must ask a potential employer is how their research and clinical duties will divide. “When it comes time to go out looking for an academic job, particularly as a physician-scientist, fellows need to know how much protected time they are going to have for their research,” said Karin Hahn, MD, assistant professor of medicine in the departments of Breast Medical Oncology and Epidemiology and associate program director of the Hematology/Oncology Fellowship at the University of Texas M.D. Anderson Cancer Center in Houston.

This is critical because success in academia is gauged almost entirely on scholarly activity and too much time spent out of the laboratory—covering inpatient service, seeing patients—will detract from producing data.

References1. Forecasting the supply of and demand for oncologists: a

report to the American Society of Clinical Oncology (ASCO) from the AAMC Center for Workforce Studies. http://www.asco.org/ASCO/Downloads/Cancer%20Research/Oncology%20Workforce%20Report%20FINAL.pdf. Accessed May 2, 2009.

Part 1 of a 2-part series

Academic Oncology: Strategies for a Successful Career

their patient mix will be like; this is important both intel-lectually and economically. For fellows with an interest in a specific disease type, this may allow them to ensure that they will have exposure to the types of patients they enjoy treating. From a financial point of view, fellows entering a practice may want to find out which disease types are underserved and they can provide much-needed expertise in those areas.

Fellows also should understand the financial details of joining the practice, including the terms for their proba-tionary period, criteria for raises and bonuses, and other opportunities for profit sharing. More importantly, an offer letter should clearly define the time to partnership, gener-ally 1 to 3 years, and if they will be required to buy a per-centage of the practice at that time.

According to Drs. Conlin and Raish, when visiting a potential practice, the most important thing is to judge

whether or not the current partners enjoy their work. Two of the best ways to evaluate a practice are speaking with former physicians of the practice and with the current nursing staff.

Finally, as fellows negotiate the terms of their first community position, they should remember that they are no longer trainees. “We get used to doing the scut work for people,” said Dr. Conlin. “Fellows need to remember they are valued physicians who should be compensated well and respected for their long training, knowledge, and skill. We forget that once you become an attending, although you’re not entitled to everything, you should be respected and treated equally, even if you don’t have the same experience yet.”

References1. Shanafelt T, Chung H, Lyckholm LJ. Shaping your career to

maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.

2. Todd RF III. A guide to planning careers in hematology and oncology. Hematology Am Soc Hematol Educ Program. 2001:499-506.

Community



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Vol. 1, Issue 2 • Oncology Fellow Advisor CAREER PATHS 7

gists tend to develop trial protocols, whereas community-based oncologists tend to implement them.

The other clinical distinction is that academic oncologists frequently specialize in a

single disease type, whereas com-munity oncologists often manage many different disease types.2

“In most academic centers, clini-cians focus on one disease type,

while community oncologists tend to be jacks of all trades, instead of just a master

of one,” said Dr. Seidman. “Some of them are a master of many, but they do have the chal-

lenge of trying to stay up to date with many different disease types.”

Factors outside of patient care and research, such as work–life balance, salary, and other responsibilities also play a significant role in the career decision (Table).

For example, Dr. Lo made a dra-matic change in his career path based on these factors. Having received all of his training at Harvard

University and its affiliated medical centers, Dr. Lo was awarded a prestigious physician-scientist grant from the National Institutes of Health. Married with a newborn, Dr. Lo found himself working 80 hours per week in the lab, seeing patients, and moonlighting in a local intensive care unit one night per week to help make ends meet.

“I realized pretty soon, by the time we were married for a couple of years, that if I continued working long hours

Cancer Center and professor of medicine at Weill Medical College of Cornell University, both in New York City.

The main difference between the work environments is that an aca-demic oncologist will have protect-ed research time, and scholarly activities (eg, publication in peer-reviewed journals, presentations, and committee memberships) will be the yardstick by which their suc-cess is measured.

“I really enjoy the time I spend in clinic, but for me, 40 to 50 patients a week is fine,” said Dr. Seidman. “I enjoy having time away from the clinic, developing protocols, writing papers, and giv-ing lectures. For me, it provides a nice balance.”

In contrast, the work life of a community-based oncolo-gist is mainly defined by patient care. “Our priority is caring for patients, and if you don’t enjoy that, you’re not going to enjoy private practice,” said Dr. Lo.

But these distinctions are starting to become obscured. For example, at Bennett Cancer Center where Dr. Lo practices, there are multiple ongoing clinical trials and more than 10% of patients are enrolled in trials. In terms of research, the primary difference is that academic oncolo-

Career Choice


see Career Choice, page 8 �

Table. Community Practice Versus Academia1

Community Practice Academia

Patient CareAlmost all of your time is spent caring for patients Time spent caring for patients can vary from none to some

ScheduleHectic schedule, often working nights and weekends Schedule can be dictated by oncologist—picking classes, when

patients are seen—but travel required

Clinical focusWork on malignant/nonmalignant hematology and oncology Work on a variety of malignant hematology and oncology, with a

subfocus

PayUsually higher pay than other oncology disciplines, but based on efficiency (number of patients seen)

Pay is salaried, with some incentive to see patients occasionally

ReputationLocal community recognizes you as a specialist/lifesaver Regional accolades as medical educator, world/national recogni-

tion for outstanding work/findings

Adapted from Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.


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Oncology Fellow Advisor is a resource for the

next generation

of oncology

practitioners.

8 CAREER PATHS Oncology Fellow Advisor • Vol. 1, Issue 2

and doing competitive research, I would not have stayed married,” said Dr. Lo. “So I said, ‘let’s look at my options.’ It was about refocusing on my family.”

Generally, both community and academic oncologists must “launch” their careers, either through build-ing a base of patients or starting research projects—work hours are comparable in both environments.

“That’s where I think there is a lack of difference. I think they both work incredibly hard; they just spend their time doing different things,” said Dr. Seidman. “To estimate the hours worked in a week, there’s prob-ably very little difference.”

In terms of pay, academic oncologists often have lower base salaries than community oncologists. Another clear distinction is how each doctor is paid.1

Academic oncologists are paid a base salary, and although some institutions may offer bonuses for an increased patient load, an academic oncologist’s base sal-ary makes up the majority of his or her pay.

In contrast, community oncologists’ salaries are tied to productivity, usually through a formula based on relative value units. As a result, they may adjust their workload to meet financial and lifestyle expectations.

“My partners and I try to balance these things, in that we obviously want to have a comfortable income, but also bal-ance the work to have a decent family life,” said Dr. Lo.

Finally, there are obligations outside of the primary

work functions that differentiate the 2 career tracks. Academic oncologists must travel for lectures or consult-ing projects, whereas community-based oncologists must learn the aspects of managing a business or negotiating contracts with a hospital. These functions tend not to be the focus of most oncologists’ practice.

“Travel can get old pretty quickly, in that it can take time and energy from other pursuits like family and leisure,” said Dr. Seidman.

Similarly, many community oncol-ogists find the business side of their practice to be arduous. “The busi-ness is certainly the most compli-cated part,” said Dr. Lo.

Ultimately, whichever path fellows choose, they are likely to find positions that meet their needs. A 2005 survey of fellows completing training found that 88% had accepted jobs by the end of their fellowship, and two-thirds had a choice of 2 or more offers.3

References1. Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your

career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.

2. Todd RF. A guide to planning careers in hematology and oncology. Hematology Am Soc Hematol Educ Program. 2001:499-506.

3. Forecasting the supply of and demand for oncologists: a report to the American Society of Clinical Oncology (ASCO) from the AAMC Center for Workforce Studies. http://www.asco.org/ASCO/Downloads/Cancer%20Research/Oncology%20Workforce%20Report%20FINAL.pdf. Accessed May 3, 2009.

Career Choice


A survey of fellows completing

training found that 88% had

accepted jobs by the end of

their fellowship, and two-thirds

had a choice of 2 or more offers.


oncology fellow advisor - summer 2009 - vol. 1 no. 2

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