Hospitals in the United States are anxious to be included in the annual US News and World Report’s list of top hospitals. To make the 2011 to 2012 cut, cancer centers had to treat at least 254 inpatients with high-level expertise in 2007, 2008, and 2009.1 The following are the top 10 cancer centers in US News and World Report, in ascending order of quality: University of Texas MD Anderson Cancer Center, Memorial Sloan-Kettering Cancer Center (MSKCC), Johns Hopkins (JH), Mayo Clinic, Dana Farber Cancer Institute/Brigham & Women’s Cancer Center, University of Washington Cancer Center in Seattle, Massachusetts General Hospital, UCSF Medical Center, Cleveland Clinic, and Ronald Reagan UCLA Medical Center.1

Oncology Fellow Advisor spoke with Daniel Spratt, radiation oncology trainee at Memorial Sloan-Kettering (No. 2 on the list) and Zeshaan Rasheed, MD, PhD, medical oncologist who trained at Johns Hopkins (No. 3 on the list) about the advantages and challenges of their experiences.

MSKCC is a large institution in New York City with several smaller regional centers. JH is in Baltimore, Maryland, and also has some regional centers. Inpatient admissions are 24,346 per year at MSKCC and 2,300 per year at JH.2,3 Average length of stay for patients is 5.9 and 8.9 days,3 respectively. Radiation treatments and implants number 59,223 at MSKCC,2 whereas radiosurgery numbers 230 at JH.3 The total number of employees at MSKCC is 11,474 and 1,000 oncology employees work at JH.2, 3

According to Dr. Spratt, who is currently training at MSKCC, he is “surrounded by excellence, innovation, inspiration, and opportunity, all with the focus of finding a cure for cancer.” MSKCC focuses only on treating cancer, which affects the caliber of physicians, fellows, and residents. The best people from around the world come to train at MSKCC and having top colleagues to work with is a privilege, he noted. “The level of detail is unparalleled,” he added.

“For example, to our radiologists, a vertebral metastasis is not just listed as a bone metastasis, but is described in remarkable detail as to the degree of epidural disease, spinal cord compression, neural foramina involvement, and subtleties that aid in choosing an optimal radiological therapy. The multidisciplinary approach provides collaborative innovative care,” he said.

Dr. Rasheed said that there are 2 main benefits of training at JH. The first is that year 1 is devoted entirely to clinical training and treating patients with a wide variety of malignancies. “The fellows are the primary caretakers of their patients, and the attending physicians oversee the cases. This is unique and doesn’t happen at most other institutions.” The second benefit is that years 2 and 3 are focused on research, with clinical care accounting for about 20% of each week. “JH strives to create physician scientists. Many other training programs outside the top tier have much less focus on research,” he noted.

Both doctors agreed that the major challenge is dealing with patients who often are very sick and helping with their physical, psychological, and at times, even their financial dilemmas. “Often these are patients who have failed routine treatment and are enrolled in a variety of clinical trials of investigational therapies. However, these methods don’t always provide the cure we hoped for. It is challenging to treat people who have failed nearly all options and have nothing else to offer them in hopes of a cure. Fortunately, MSKCC has resources to help patients and families in other ways, as well as to provide physicians a wealth of resources to find solutions for them,” Dr. Spratt said.

For Dr. Rasheed, the challenge of training is the intensity of the first year due to a combination of patients’ needs and how sick they are. “Treating cancer is emotionally exhausting and physically depleting due to the nature of the illness and the long hours we work,” he noted.

To be accepted as a trainee at a top-tier institution, Dr. Spratt said, “You need to demonstrate that you are dedicated to being a future leader in oncology research. This will be looked at in depth by using measures such as your dedication and success in research, and common clinical parameters, such as honor society memberships, grades, and board scores. Most people who become fellows at a top institution already have published research and presented nationally.”

Dr. Rasheed agreed that in addition to the standard requirements of board scores and recommendations, it is key “to make yourself distinct by being involved in lab and clinical research on topics that are at the forefront of medicine—for example, novel therapeutic targets, biomarkers, public health policy, and health disparities.”

Once accepted into a top-tier training program, the trainee should maximize his or her experience by taking advantage of the multitude of resources, including the endless opportunities for collaboration with leaders in the field of oncology, Dr. Spratt advised. “Expand your repertoire. If your main interest has been clinical, then learn about basic science.”

According to Dr. Rasheed, the biggest challenge is getting funding for research. Once training is complete, staying at an academic center involves accepting less money than in private practice. “My advice is to stay focused on your research and be patient. Practicing clinical medicine is gratifying at the end of the day, whereas doing research does not always have immediate payback.”

References

     

  1. U.S. News and World Report. U.S. News Best Hospitals: Cancer. http://health.usnews.com/best-hospitals/rankings/cancer. Accessed October 19, 2011.
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  3. Memorial Sloan-Kettering Cancer Center. 2010 Annual Report. Statistical Profile. http://www.mskcc.org/annualreport/2010/pdfs/MSK_AR2010_stats.pdf. Accessed October 19, 2011.
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  5. Johns Hopkins Medicine. Facts about The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. http://www.hopkinsmedicine.org/kimmel_cancer_center/our_center/facts_figures.html. Accessed October 19, 2011.
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