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Which light to follow at the end of the tunnel?
Weighing career options after fellowship can prove difficult.
Soon after the apprehensions, anxiety and sense of achievement settled after joining an oncology fellowship, reality set in. What will I do after I leave this protected comfort zone? Will I pursue a career in academic oncology and research in a comprehensive cancer center and contribute to finding the cure? Or, will I manage a flourishing community oncology practice and live “happily ever after?” I conducted some research on this issue, and although my decision is now made (or so I think), I decided to share my thoughts.
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Academic career
Oncologists are conducting a lot of research and making a lot of advancements in basic science, diagnostics, therapeutics, epidemiology and translational research. To some it is easy to give in to the temptation of participating in the cutting edge work and contributing to the field with one’s own ideas and innovations. And why not, many of us have the aptitude, drive and knowledge to make our mark. However, the results of a survey of 107 oncology fellowship program directors conducted in 2004 showed that only 36% of the graduates opted for a career in academic oncology.
Dedication to research
Deciding to conduct research during fellowship is one thing, but to come up with a feasible and successful plan is something else. The latter is usually possible not just by an interest in research, but a passion for it. Try to gauge your dedication and drive for research early on. Choose a field of interest and spend all available time and resources to grow in that niche. Being a master of all trades of research might be helpful to get a taste of things, but the sooner one tries to become established as an expert in a field, the easier it will be to be recognized and make a mark.
Type of research
A choice between basic science laboratory-based research and translational research with a focus on clinical trials should also be made early. I have previously talked about looking for the right mentor. It is important that a mentor guides a fellow and helps develop ideas and initiative. So developing research plans is necessary — initial mistakes might be made and will be rectified, but at least the foundation of an inquisitive mind will be strong. Just following the mentor’s ideas may help start the academic career, but a certain amount of autonomy is needed to build confidence. Sometimes the choice of research also depends on the type of opportunities available. An institution may not provide resources or infrastructure for the specific work you want to do; it may help to arrange for an off-site research elective to do what you really want.
Mentorship
An influential role model can help shape the path to a successful future. Developing contacts using a mentor’s network can be helpful. Whether it is a poster or an oral presentation at a conference, a review article that your mentor is invited to write, or original research that is published, you should make all effort to gain experience and be noticed. And for all this, an unselfish mentor can be invaluable.
Literary activities
The need to publish cannot be overemphasized in academics. Start with a case report and get into the habit of achieving an annual target of publications. Fellowship is the time to turn to mentors and learn from their skills. Not all of us are good at it, but making improvements and continuing to publish is imperative. Original manuscripts, both clinical and laboratory-based, clinical trial protocols, research funding grants, posters and oral presentations should all be attempted as a fellow. It is easier to ask for help as a fellow rather than start afresh when you are faculty. Oncology probably has the largest number of meetings, conferences and publications. Trying to make a mark requires just a little effort.
Money matters
Research funding and grants are used to gauge the success of an academic physician. An attempt must be made to obtain these during fellowship. There are several resources for fellows such as ASCO, the American Association for Cancer Research, the NIH, the Leukemia Lymphoma Society, etc. Ask your mentor to help initiate the process. This way you get money to do the fun things you want to research. Any institution will try to hire a fellow as faculty when it knows the fellow’s research proposal was funded by peer-reviewed grants.
Another aspect of money that matters is reimbursement, ie, salary. According to the results of a survey published in 2004, the median starting salary for hematology oncology academic jobs was $127,308 vs. $315,969 for oncology-related private practice.
It might have been unfair to end a discussion about academic careers with a talk of lesser salaries, though I hope that is not the only factor in consideration. So some thoughts about private practice in oncology may be appropriate.
Being a good generalist
Being a good clinician is important for every physician. Academic oncologists might be able to say that they follow patients only with certain diagnoses, but a general oncologist does not enjoy that luxury. Skills in treatment of a variety of cancers are essential for any community oncologist. A sound base for this must be laid with good fellowship training. With so many journals to read and research to keep up with, a generalist must have the enthusiasm to remain updated and translate these developments to quality patient care.
Medical vs. hematology oncology
There are indeed several jobs available for medical oncologists, but the choice and flexibility increases with additional training in benign hematology. Group practices feel better when a hired oncologist has benign hematology training, especially for weekend and night coverage issues. All said and done, there is always that right job for every oncology fellow finishing training.
Is research coming back to haunt me?
With changing times, research is creeping into community oncology as well. This stems from the need to conduct large, valid trials to improve upon the existing treatment armamentarium. The advent of community clinical oncology programs and contract research organizations has brought phase-2 and phase-3 clinical trials to the doorstep of subspecialty and multispecialty community oncology groups. Thus, a working knowledge of clinical research would help make a fellow more marketable for better jobs.
To find the right job, the first job after fellowship might be the most daunting task for a lot of us. It might help to start with the distinction between an academic or community oncology-based career choice. The thoughts I have presented are hopefully enough to stir a debate in all our minds and at least some help in choosing the right light at the end of the tunnel.
Sikander Ailawadhi, MD, is a second-year medical oncology fellow at Roswell Park Cancer Institute in Buffalo, N.Y. and is a member of the HemOnc Today Editorial Board.
Dr. Ailawadhi would like to acknowledge his mentor, Dr. Asher Chanan-Khan at Roswell Park Cancer Institute.