Sometimes the best advice comes from people who have years of experience under their belt. To gather some pearls of wisdom, Oncology Fellow Advisor talked to 2 seasoned oncologists. Cathy Eng, MD, is associate professor and associate director of the Colorectal Center, Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas. Robin Zon, MD, is vice president and partner at Michiana Hematology-Oncology, PC, a practice with 15 oncologists and 6 locations in Indiana.

Although Dr. Eng went straight to MD Anderson after her fellowship 9 years ago, she recommends that fellows explore all opportunities, including private practice, even if they feel set on an academic career. “If they have any hint of interest in private practice or pharma, they should also look at those jobs,” she said. If a fellow ultimately chooses the academic path, he or she should shop around. “You won’t know until you actually go visit,” Dr. Eng said.

During an interview, an employer is sizing up a candidate, but fellows also should be gauging whether an institution is appropriate for them. For example, is a center going to provide adequate clinical and scientific mentorship? Ask the people you are interviewing with whom they have mentored, and ask who transitioned out of the department and why, Dr. Eng noted. Fellows should find out how many days of clinic they will have per week, how many patients they are expected to see, if they are going to be supported by a mid-level provider or nurse practitioner, and what type of cancer the institution treats. All fellows also should get perspective on whether doctors at the academic institution have a well-rounded life and are able to balance a successful academic career. “If it is your second or third interview, you are allowed to ask those questions,” Dr. Eng said.

“To have more than 2 full days of clinic a week can be challenging for an academic career,” Dr. Eng said. Successful academicians need time to work on their research project, educate others, network, and fulfill other institutional commitments. “Do not overcommit early on,” Dr Eng said. She cautioned against being misled by clinic half-days—they might turn out to be almost a full day, depending on the size of the practice.

Private practice is another ballgame, and Dr. Zon said a lot has changed since she completed her fellowship nearly 14 years ago. “When I came out of my fellowship, 90% of the practices were independent and there were very few that were wholly affiliated with hospitals, but the landscape of the community practice has changed,” Dr. Zon said. Nowadays, small, 2- to 3-person practices are rare, and private community practices that have a relationship with a hospital are bountiful. Hospital affiliations provide practices with the purchasing power and business management acumen they need to survive, and before choosing a practice, fellows should be aware of these relationships.1

Young oncologists should ask themselves how much autonomy they want. “If the answer is they want complete autonomy, they are going to have to accept the risk that comes with that decision and consider an independent, stand-alone, private practice group,” Dr. Zon said. “If you don’t want the headaches of running a business, but you are willing to relinquish some authority, then you are probably best served by seeking an employed position affiliated with an institution such as a community hospital.”

Dr. Zon also believes in assessing work–life balance opportunities before an oncologist enters a practice. Does a practice allow physicians to request specific weeks off? “It was important that I have spring breaks off with my girls,” said Dr. Zon, pointing out that this type of benefit should be discussed with the hiring practice before signing a contract.

Whether fellows enter a private or an academic setting, leaving a fellowship and suddenly being in charge can be daunting. Drs. Zon and Eng think that fellows should seek opportunities at the end of their fellowship for more autonomy. Dr. Eng said that as a third-year fellow, she was allowed to complete a half-day of clinic and weekly inpatient rounds as an attending. This gave her confidence in her first year as a faculty member.

Just because doctors are leaving a fellowship, however, doesn’t mean they should stop receiving guidance from mentors.2 “Some people have too much pride to ask, and that is when you are going to run into problems,” Dr. Eng said. Dr. Zon suggested asking a senior partner during an interview if he or she would be willing to provide guidance about specific patients if questions arise. Tumor boards are another way for young oncologists to obtain feedback.

Regardless of which path young doctors choose, they should focus on enjoying their careers. “[Fellows] should not lose sight of the fact that they are treating an individual patient who wants to understand his or her disease. For any oncologist, the best patient is the one who understands why we are making our treatment decisions,” said Dr. Eng.

References

     

  1. Hospital–physician relationships: taking a proactive approach to building mutually successful relationships. JOP. 2008;4(2):72-76.
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  3. Afrin L. What I have learned since fellowship: tips for professional success and happiness. http://www.onclive.com/publications/oncology-fellows/2011/April-2011/What-I-Have-Learned-Since-Fellowship-Tips-for-Professional-Success-and-Happiness. Accessed November 28, 2011.
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