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Vol. 2, Issue 4

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

Fellowship Training

A DAY IN THE LIFE

We highlight the work of medical director and clinical researcher Sandra Swain, MD.

2 5

CAREER PATHS

Community oncologists play vital 7 role in cancer research trials.

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Mentor Memos

Survey Says

Physician Finance

Fellows Benefit as Locum Tenens

FELLOWSHIP TRAINING

Experts discuss the importance of achieving work–life balance.

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fter Sairah Ahmed, MD, completed her 4-year internal medicine residency and a 3-year fellowship in hematology-oncology, she decided to take a year off before embarking on another fellowship. But she wanted to earn money to support her further training, and she also wanted to see a bit of the country. “The locum [tenens] came in as a way to fund all of it,” she said. A locum tenens physician is one who temporarily substitutes for another physician. Working as a locum tenens physician can be an attractive option for those fresh out of fellowship, who

may have been training in the same geographic location for the past 7 years. “Locum tenens is a good way to find out what patients are like in different parts of the country, whether that’s see Locum Tenens, page 4

Ace Interview and Land Job

s a rule, oncologists in the United States train during fellowship at academic institutions; however, the majority (57%) will ultimately work in private practice. And of these private practice oncologists, most of them (46%) will work in groups with other physicians, mainly in singlespecialty practices alongside other oncologists.1 Although this training model works well for developing physicians’ clinical knowledge, it does not prepare them for the economic reality of cancer care in the community. Presidents of community practices say that associ-

ates emerging from fellowship often have unrealistic expectations, and it is often reflected in the interview process. “Many candidates have expectations that are frankly unrealistic. They expect to work very little, get paid a lot, and not have to worry about participating in the administration of the practice or teaching of the staff,” said Roger M. Lyons, MD, a hematologist who is director of the Myelodysplasia Center of Excellence, in San Antonio. For example, according to the Survey of Clinical Oncology Fellows see Ace Interview, page 6

MENTOR MEMOS

A Day in the Life of Sandra Swain, MD

Oncology Fellow Advisor • Vol. 2, Issue 4

or Medical direct cher Clinical resear

d ASCO’s boar Member of or s of direct

ncology Fellow Advisor presents our Day in the Life disease in which we series. In each segment, we interview a prominent could make more thought leader about how he or she got into the field of progress than the oncology and his or her typical workday. other earlier-stage diseases, which In this issue, we interview Sandra Swain, MD, medweren’t as aggresical director of the Washington Cancer Institute, in sive,” she said. “I Washington, DC. We are honored to include such a promireally felt that it nent clinical researcher in this series. was important to Earlier this year, Sandra Swain, MD, wrote and pubbe doing research lished a paper that in some ways defines her career. The (Left to right): Sandra Swain, MD, in that area.” study was a drug trial of patients diagnosed with early attending, and fellow Since then, Dr. breast cancer, an area in which Dr. Swain is recognized Janice Walshe, MD, at the National Swain has designed as an international authority. More tellingly, the study— College of Ireland in Dublin. and implemented which included more than 5,000 patients from 185 medimore than 20 clinical centers—is the culmination of 14 years of work.1 cal trials and is currently the principal investigator of 3 “Clinical research is very hard and takes a strong comPhase III adjuvant breast cancer trials through the NCImitment,” she says. “Fourteen years working on a clinical funded National Surgical Adjuvant Breast and Bowel trial is a long time without results and a publication. So it’s Project (NSABP). She also has published more than 180 a long-term process; it’s not overnight.” articles in leading medical and cancer research journals. Dr. Swain currently sits on the board of directors of As the director of the cancer institute at the Washington the American Society of Clinical Oncology (ASCO). Hospital Center, much of her time is now devoted to However, when she first began planning her career, administrative tasks; however, she still maintains a robust she actually felt that becoming a full-fledged physician research program and makes time to see patients 1 day might have been beyond her. per week. “I grew up in an age when “I’ve never wanted to be there weren’t that many women primarily in private practice, in medicine and it wasn’t that “I think it’s very important for that’s not my goal. For me, common for women to have the people doing research, especially I’m very passionate about cliniprofessional careers that they cal research,” she said. “[But] have now,” she said. With her if they’re doing clinical research, I think it’s very important for interest in anatomy and physito be seeing patients. You need to people doing research, espeology, Dr. Swain had planned be seeing patients to understand cially if they’re doing clinical to become a physical therapist, research, to be seeing patients. but the guidance of an advisor what the issues and questions are.” You need to be seeing patients helped her realize that she had —Sandra Swain, MD to understand what the issues the capability to go farther in and questions are,” she added. medicine. As a teacher, Dr. Swain has During her fellowship at the received awards for mentoring from both the NCI and the National Cancer Institute (NCI), Dr. Swain carved out the National Institutes of Health. Her most important advice research niche for which she’s now internationally recogfor fellows choosing a mentor: “Make sure that the mennized—inflammatory breast cancer. The disease accounts tor has enough time to spend with them and actually sit for less than 5% of all breast cancers diagnosed in the down with them and come up with a plan.” United States; however, survival rates for those with this The plan should involve both short- and long-term highly aggressive type are far below those of more comgoals, she says. Short-term goals should involve joining mon breast cancer types. Phase II, investigator-initiated trials at a fellow’s home “In those years, we were doing clinical trials on very institution, or other research projects that will allow a felselected rare diseases,” Dr. Swain says of her time at NCI. low to get published fairly quickly and establish research A mentor was researching locally advanced breast cancers credentials. and Dr. Swain became “very interested in working on a Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

MENTOR MEMOS

Vol. 2, Issue 4 • Oncology Fellow Advisor

Expectations between the mentor and the fellow should be made clear up front, she emphasized, with the goal of being first author on research the fellow has done. “You need to make sure that as a fellow, you will get the publication and the credit for the work that you do,” she said. One way to ensure this is to write a review, which also strengthens a whole constellation of research and writing skills. Over the longer term, fellows should focus on getting involved in major clinical trials or other national-scale projects by connecting with key opinion leaders in their chosen area of focus. A great way to do this, Dr. Swain said, is to make a point of joining professional organizations and attending national meetings, like ASCO. Fellows benefit by networking with mature investigators who can guide them as fellows and junior faculty. The society benefits, Dr. Swain said, by getting fresh ideas from younger members with a better grasp of technology and social networking. Dr. Swain added that the annual Methods in Clinical Cancer Research workshop in Vail, Colorado is perhaps the best way for young academics to get ahead. “It’s very competitive for them now, but it’s an outstanding learning experience,” she said. Accepted clinical fellows and junior faculty essentially bring a research project idea and write a protocol over the 1-week conference. In competitive fields like breast cancer research, fellows can establish themselves through their passion, Dr. Swain said. “What it takes is passion and commitment. There is always room for people who have these qualities,” she said. “It doesn’t matter that there are vast people in your area of interest; there are many more questions to ask and progress to be made,” she said. However, even in fields like breast cancer where physicians can specialize in specific disease types or on highly specialized preclinical research topics, ultimately one of the most rewarding aspects of oncology is the holistic nature of cancer care, Dr. Swain added. “One of the reasons that oncology is so great is that we take care of the whole person,” she said. “We’re not just doing a specific procedure, because the disease affects the whole body and mind. So that’s a very positive thing— you really have to have compassion for the patient and be thinking all the time as [to] how it affects the person as a whole.” If you would like to nominate someone to be interviewed for our “Day in the Life” series, please send an e-mail to oncologyfellowadvisor@mcmahonmed.com.

Reference 1. Swain SM, Jeong JH, Geyer CE, et al. Longer therapy, iatrogenic amenorrhea, and survival in early breast cancer. N Engl J Med. 2010;362(22):2053-2065.

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 Copyright © 2011

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oncologyfellowadvisor@mcmahonmed.com with your name, institution, e-mail address, and mailing address. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

FELLOWSHIP TRAINING

Oncology Fellow Advisor • Vol. 2, Issue 4

Locum Tenens continued from page 1

practicing rural medicine or in a larger health system,” said Ramea Bowles, manager of operations, CompHealth, with headquarters in Salt Lake City. At first, Dr. Ahmed wasn’t entirely sure about working as a locum tenens physician. “It didn’t seem like something people in my field do very often, at least not early in their careers,” she said. But a few of the physicians she worked with during her fellowship ignited her enthusiasm. “[My colleague] loved the time she did locums, which she did for about half a year and traveled for the other half,” Dr. Ahmed said. “And it gave her a nice nest egg to start her fellowship with.” Physicians use locum tenens for several reasons. It can be a way to try out an environment without making a full commitment. “Statistics have shown that 48% of recent residents and fellowship physicians leave their very first contract within 1 year, and by the third year, 2 out of 3 physicians will not continue in their contract,” Ms. Bowles said. “A lot leave because it’s just not what they signed up for.” Other physicians use locum tenens while waiting to start a new contract. “They don’t want to just sit there for 3 months while their privileging goes through at a hospital or while they wait for licensing in a new state, so they use locum tenens assignments to offset their income [losses] and travel,” Ms. Bowles said (Table 1). Many physicians choose locum tenens as their main practice option. “After finishing medical school, internships, residency, and fellowships, many physicians find they really don’t enjoy the administrative aspect and office politics that go with joining a practice,” Ms. Bowles said. “The ideal locums candidate is someone who goes in, practices medicine for the community, and completes their assigned time. They’re mainly focusing on seeing patients and practicing medicine—and for oncology, they’re really treating cancer.”

Table 1. Compensation Rates for Locum Tenens Medical Oncologists Forms of Compensation

Rates

Salary (according to 2 locum tenens agencies)

Sample rate a: $1,475-$1,650 per day Sample rate b: $1,450-$2,500 per day

Travel and housing

Practice pays; rate varies by location

Malpractice insurance

Rate varies depending on location, number of patient visits, and other responsibilities like call coverage

Medical liability insurance

Locum tenens agency pays; rate varies

Adapted from reference 1. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

Practices use locum tenens physicians for a number of reasons. The most obvious is to fill a temporary vacancy during a staff member’s vacation or leave of absence. They also may use a locum tenens physician to maintain the practice while they search for the ideal candidate for a permanent position.1 “There is a lot of stress on the physicians who are already there, taking extra call and extra patients,” Ms. Bowles said. “So, many practices will bring in a locum tenens until they are able to find the right candidate. This allows them to maintain a continuity of care and make sure the patients are taken care of long-term.” Sometimes practices will hire a locum tenens physician because of an influx of patients that strains the practice, but does not quite justify hiring a full-time oncologist.1 A part-time locum tenens physician helps them build their patient base until a full-time oncologist is needed. “We have doctors who work a week on, a week off, because it suits their lifestyle and works well for the practice, which is able to build and see more patients,” Ms. Bowles said. “The practice can build its volume gradually, which helps with physician satisfaction and retention.” With such variety in client needs, locum tenens assignments can range from a week to several months.1 Working as a locum tenens physician, of course, requires a certain degree of flexibility to adjust and adapt to new and different environments. Dr. Ahmed was well versed in electronic medical records and electronic order sets, but before her first locum tenens assignment, she had not written a paper note since she was in medical school. “A lot of the private practice groups still use paper charts, so that’s an adjustment,” she said, noting that although she felt secure about taking care of patients, she was a little worried about writing paper orders. “But I found it really wasn’t that hard.” A more challenging aspect is variation in approaches to patient care. “Anytime you walk into someone else’s practice, you are picking up how they take care of patients, which may not be the way you’re used to taking care of patients,” Dr. Ahmed said. “That [adaptation] can sometimes be difficult to do.” With the aging physician population and projected oncologist shortage,2 Ms. Bowles anticipates the demand for oncology locum tenens will grow. “A lot of aging physicians don’t want to take call every weekend or put in a lot of overtime,” she said. “Also, many newer doctors are not willing to work the long hours the older generation did. But at this point, there is no cure for cancer and there will be more cancer patients who need to be seen and treated.”

References 1. Gesme DH, Towle EL, Wiseman M. Use of locum tenens physicians in oncology practice. J Oncol Pract. 2010;6(3):161-163. 2. Erikson C, Salsberg E, Forte G, et al. Future supply and demand for oncologists. J Oncol Pract. 2007;3(2):79-86.

FELLOWSHIP TRAINING

Vol. 2, Issue 4 • Oncology Fellow Advisor

Achieve Work–Life Balance in Oncology Practice

octors who are just entering the field of oncology expect to work—it’s what they spent years of medical school, residency and fellowship preparing themselves for. But the same traits that helped them go the distance in training can hang them up if they fail to achieve a degree of balance in their lives. “As human beings, we have multiple dimensions and all of them need to be attended to,” said Ahnna Lake, MD, a 20-year veteran of physician wellness counseling. “Ignoring one ultimately influences another. ‘Balance’ means making sure that your broader needs get met.” A crucial first step toward achieving work–life balance is recognizing it.1 “I think younger physicians understand what work–life balance is and put it high on their list of priorities,” said Peter S. Moskowitz, MD, life and career coach for physicians and executive director of the Center for Professional and Personal Renewal, in Palo Alto, California. Even with awareness, however, balance may be hard to find during fellowship. “You have little flexibility in controlling how you allocate your time,” Dr. Moskowitz said. When Jeffrey A. Stevens, DO, director of the Family Risk Assessment Program, Pottstown Memorial Regional Cancer Center, in Pennsylvania, joined an oncology practice 6 years ago, he knew how to take care of sick patients. Less clear was how to manage all the details of a practice in 60 hours per week. “There are a lot of things you’re not responsible for when you’re a fellow, and for me it was a little difficult to make the transition,” he said. “I was spending a lot of time in the office trying to get caught up on dictations and labs, and I started to feel burned out.” As a consequence of unrelenting stress, Dr. Stevens’ ability to deal with new challenges began to deteriorate. “When problems come up, you’re less able to focus on and solve them—you’re just sort of angry that you have to deal with it,” he said. “You get less interactive and compassionate with patients, and your attitude toward them changes.” His wife even commented that he no longer seemed to be enjoying his work and was spending free time doing tasks. “She said, ‘this isn’t working for you.’” Dr. Stevens learned how to run his practice more efficiently and was able to rein in the stress that was beginning to cause him harm. But it can be difficult for many physicians to recognize that work–life imbalance is taking a toll; the progression can be insidious. “Over time, sometimes slowly and quietly, it will increase the level of stress a physician deals with every day,” Dr. Moskowitz said. Personal and professional relationships may erode, along with the ability to empathize with patients. “Further down the line, there may be self-medication behavior, physical symptoms, depression, anxiety and disruptive behavior in the workplace,” Dr. Moskowitz said. “Doctors can end up in a pretty bad spot.”

Ideally, physicians should protect each of the 6 domains of balance, according to Dr. Moskowitz (Table 2).

Table 2. Domains of Work–Life Balance Domain

Definition

Physical

Institute and maintain a personal wellness program

Emotional

Have a sense of calmness and resilience

Spiritual

Have a sense of self-awareness and connectedness in the world

Relationships Have the abliity to give and receive; respect your own needs and the needs of others Community

Be part of a group of people who share similar interests and values

Work/career

Make sure that your contributions are recognized by your partners or group

There is irony in the notion that perfect balance is attainable. Part of the equation is being able to let go of perfectionism. “It’s a question of changing the focus from perfection to excellence,” Dr. Lake said. It may be impossible to tend to each domain every day. “The idea is not to go madly rushing from one domain to another, but hopefully one can carve out an allocation of time so that in the course of a week, you spend some time in all domains,” Dr. Moskowitz said. Establishing boundaries and control in the workplace can be particularly tricky for physicians, but it is critical.2 Dr. Lake gave an example of a Wisconsin-based oncologist whose directors wanted him to see only the sickest patients and send the healthier ones to an assistant. “He said no, that for every sick patient he needed to see 2 who were well,” she said. “At some point, you have to put your foot down; otherwise the cost becomes too great.” For Dr. Stevens, part of finding work–life balance meant recognizing that although oncology may be a calling, it’s also just a vocation—one with a quitting time. “You spend a lot of time with patients and feel privileged to be part of their lives,” he said, “but it’s OK to recognize that this is just a job—that once you’ve taken care of the most immediate tasks, the rest can wait until later.” For more information on Dr. Moskowitz’ career and life coaching for physicians, please visit www.cppr.com.

References 1. Strategies for career success: balancing your life at work and home. J Oncol Pract. 2009;5(5):253-255. 2. Berry E. Achieving work–life balance: more than just a juggling act. http://www.ama-assn.org/amednews/2010/01/04/ bisa0104.htm. Accessed November 5, 2010. Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

FELLOWSHIP TRAINING

Oncology Fellow Advisor • Vol. 2, Issue 4

Ace Interview continued from page 1

Completing Training in 2005, 60% of fellows rated balancing home and personal life as “extremely important” and 1 in 5 rated salary/pay at the same level.1 Salary, time to partnership, and amount of time on call are all important aspects of any new job in a community practice. However, there is a correct—and an incorrect—way to go about finding out these necessary details. “We expect people to ask about salary and advancement, and possible partnership, but [if those are] the only questions that they have available, then they appear to be just interested in financial remuneration,” said David Gordon, MD, a medical oncologist and hematologist who is the president of Cancer Care Centers of South Texas. Questions like these are fundamental to any job offer. They’re usually best left unasked by an applicant during the initial interview, Dr. Lyons said. “If I’m interested in them and they will fit with our practice, they don’t have to ask me,” he said. “They are going to hear starting salary range, time on call, and time to partnership—what you have to do and how you’re going to get there.” But if applicants ask before a senior partner is ready to have that discussion, it gives the impression that the fellow may not want to “pay their dues to be part of the group,” he said. First-line questions, Dr. Lyons said, should be “Will your group be able to help me build my practice? Are you willing to mentor me? Do you have [physicians] who are willing to teach me how to evaluate difficult patients?” Generally, questions should revolve around contributing to a practice and reflect a fellow’s work ethic, open mind, and willingness to sacrifice for the greater good of the group. “When you join a partnership, it is like a marriage and you have to treat partners much the way you would treat your spouse in terms of changing your schedule to accommodate someone else or changing your call so that someone else can do something they need to do,”

Table 3. Resources on Job interviewing and Career Advice • Interview tips from The New England Journal of Medicine Career Center: http://www.nejmjobs.org/career-resources/physician-interview-skills.aspx • The American Association of Medical Colleges “Careers in Medicine” http://www.aamc.org/students/cim/start.htm • Visit the Office of Professional Development at your home institution Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

said Dr. Gordon. “I think that type of dynamic is less evident in today’s applicants. There is a much greater push for individuality.” This also underscores the key difference between treating patients in fellowship and in private practice— developing a referral base. Unlike the tertiary care centers at which most fellows train, “in private practice, unless you’re taking over from a retiring physician, you have zero patients,” said Dr. Lyons. “I think [associates] often are surprised at the beginning of their practice [because] they have to work to get referrals,” said Dr. Gordon. “This is something that they’ve never had to do before.” In fact, added Dr. Lyons, young associates detract from a practice’s revenue because they increase overhead without generating significant revenue. “Physicians who start in practice are really being supported by their partners. Their salary is paid; overhead is paid; and they are given patients who the other physicians would otherwise see,” he said. Thus, physicians who want to be offered positions in competitive areas should portray themselves as willing to work hard to generate referrals, which means more than just providing top-notch clinical care. During the interview process (Table 3), and before joining a practice, fellows should assess who they will be drawing patients from, he added. “In building a practice, one should also ask about the nature or competition both from physicians outside the practice and from within. The key is the enduring equation of time versus money,” Dr. Gordon said. Older physicians who are cutting back on work or nearing retirement may be more likely to give up some of their patients and income to a junior physician, he said. And although there is a projected shortage of oncologists,1 for those jobs “in desirable locations there is intense competition,” Dr. Gordon said. The key for fellows who want to succeed is understanding how to fit into the group dynamic. “We want people who are bright, who have passion, who want to work hard, and people who are actually team players, who understand that we are all in this together,” said Dr. Lyons.

References 1. 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%20 Research/Oncology%20Workforce%20Report%20FINAL. pdf Accessed November 5, 2010.

Vol. 2, Issue 4 • Oncology Fellow Advisor

CAREER PATHS

Community Investigators: Best of Both Worlds?

sicians,” says Lori Minasian, MD, chief of the Community or many years, cancer research in the United States Oncology and Prevention Trials Research Group at the was the exclusive province of large academic centers. National Cancer Institute, Bethesda, Maryland, which Now, community oncologists who want to participate oversees NCI-sponsored trials in the community. “Most in research trials have several opportunities. Experts of the care that oncology patients get today has been describe research in the community as difficult but the direct result of trials that the cooperative groups rewarding. have run.” Even as late as the mid-1970s, cancer research was limitThese advances also have led to far more complicated ed to approximately 15 cancer centers around the country.1 cancer research. However, in 1975 a sea change began with the forma“The trials are now far tion of the first communitymore sophisticated, so at based clinical research conthe end of the trial we not sortium in Michigan. Three Lori Minasian, MD, only know if regimen A may years later, the Cooperative believes that the next have been better than regiGroup Outreach Program research frontier for men B, but [also whether] (CGOP) was created, allowthere are particular molecing community hospitals community oncologists ular correlates that would to actively participate in will be validation explain why one group cancer treatment trials. In studies of molecular did better than another 1982, the National Cancer or particular genetic polyInstitute (NCI) established markers and assays. morphisms might explain the Community Clinical why one group of patients Oncology Program (CCOP) had more side effects than research network, linking another,” said James Wade community and academic III, MD, a medical oncologist investigators and providand founder of Cancer Care ing access and funding for Specialists of Central Illinois NCI trials to community and the principal investigaresearch programs.1 tor of the NCI-sponsored Now, about 3 decades Central Illinois CCOP. later, community oncoloThis often means tissue procurement and blood samgists who want to participate in NCI trials have 3 differpling, the use of more complex assays, and measurement ent avenues, depending on their research capacity. This of quality-of-life outcomes, he said. year in the CCOP alone, which represents the highest “It’s very exciting, but it makes the work clearly harder,” level of participation by a community medical institution, Dr. Wade added. there were 3,375 participating physicians working on For fellows moving into practice, both Drs. Wade and more than 300 active treatment trials and more than 70 Minasian emphasize finding a practice that participates in active prevention and control trials.2 research trials. Furthermore, community physicians also may join “Joining a practice that does research tells the young industry-sponsored clinical trials or for-profit networks physician that he is joining a group that has a higher quallike ACORN Research, which provide trial sponsors with ity level,” Dr. Wade said. By not participating in clinical access to research sites.3,4 trials, “very quickly you realize that you have lost track In short, community oncologists currently play a vital and that within 2 to 3 years, you are out of date.” role in the cancer research enterprise, having contributed Dr. Minasian added that rural practices affiliated with significantly to large and important cancer prevention NCI-sponsored community research programs also tend trials in the United States. Community physicians are to recruit higher-quality physicians, meaning that fellows attributed with putting large numbers of patients in the who join these practices are likely to be surrounded by big, multispecialty trials sponsored by the NCI’s Clinical more motivated colleagues. In these areas, physicians Trials Cooperative Group.1 with clinical trial experience also may become regional “The bulk of the treatment regimens that we know to be experts who serve both patients and other physicians as standard of care came out of trials that the cooperative a valuable “second opinion” in the community.5 groups did, and in many cases, more than one-third of the [patient] accrual overall came from community physee Community Investigator, page 8 Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

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Community Investigator continued from page 7

However, research in the community is difficult. If enrolling patients in trials is more demanding, then actively contributing to studies is downright hard, experts say. “There is an opportunity for young physicians in the community to write and guide studies, but I must say that it is an awful lot of work,” said Dr. Wade. “Especially now, when reimbursement is getting tighter and tighter and the pressure to generate revenue is getting more and more, the time for a community oncologist to actually generate a novel study is incredibly small,” said Dr. Minasian. In fact, research draws time from seeing patients, and studies have demonstrated that reimbursement for NCI-sponsored cooperative trials does not cover the per-patient cost of conducting these trials.5,6 However, community physicians do have opportunities to influence study design by sitting on committees within the research cooperatives or by developing a long-standing history of high patient enrollment. Both are ways to influence study design and get coveted authorship on published papers. Moreover, research participation is the way to make a difference in the lives of patients and the future of the profession, Dr. Wade said. “It’s harder, it’s uncompensated, it’s more time out of your day, but if you want to be a part of making things better, that’s how you do it,” he said. Dr. Minasian believes that the next research frontier for community oncologists will be confirming new molecular markers and assays that show subsets of patients who Oncology Fellow Advisor ® is brought to you as a professional courtesy by Lilly USA, LLC, and McMahon Publishing.

either are at higher risk for disease or will respond better to treatment. “If the practice of oncology is going to be changed significantly as a consequence of this new biology, we need to do a lot of clinical validation of these markers and assays. There is a huge amount of potential in the community to participate in some of these validation studies,” she said. “The other thing I would say specifically to the fellows,” she added, “is that research is not easy, but it can be very gratifying. If private practice is really where you want to go, consider a private practice that participates in research because we need young community investigators for the future.”

References 1. Jean-Pierre P, et al. Community-based clinical oncology research trials for cancer-related fatigue. J Support Oncol. 2006;4(10):511-516. 2. About the Community Clinical Oncology Program. http://prevention.cancer.gov/programs-resources/programs/ccop/about/history. Accessed November 4, 2010. 3. Baer A, et al. Basic steps to building a research program. J Oncol Pract. 2010;6(1):45-47. 4. ACORN Network. http://www.acornresearch.net. Accessed November 4, 2010. 5. Cohen GI. Clinical research by community oncologists. CA Cancer J Clin. 2003;53(2):73. 6. Emanuel EJ, et al. The costs of conducting clinical research. J Clin Oncol. 2003;21(22):4145-4150. MG68965