Oncology Fellow Advisor - Fall 2009 - Vol. 1 No. 3

ONCOLOGYFellow

Vol. 1, Issue 3

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

Fellowship Training

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ACADEMIA

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

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DAY IN THE LIFE

In our first installment, we highlight hematologist and oncologist Marc Stewart, MD.

Mentor Memos

Survey Says

Physician Finance

Medical Oncologist Jobs in Demand

PRIVATE PRACTICE

Succeed in private practice and navigate the path to partner.

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lthough much of the US economy has been hit heavily by the current recession, the demand for medical oncologists has been largely unaffected. Even as the economy as a whole continues to shed hundreds of thousands of jobs each month, experts say that with the most cautious estimates, current hematology and oncology fellows can expect to transition into a job market that will demand their skill set more than ever.

“If you look at the supply of oncologists versus the demand for oncologists’ services, there will be a shortage of about 4,000 oncologists by 2020,”

said Michael Kosty, MD, medical director of Scripps Green Cancer Center in La Jolla, CA, and a member of the American Society of Clinical Oncology’s (ASCO) Workforce Advisory Group. “Even under the most optimistic scenarios of increasing training program size by 50%, or lengthening the careers [of current oncologists], you still end up with a substantial deficit of oncologists.”

In 2007, ASCO published a comprehensive report on the medical oncology workforce1; in it, the society reported that the job market for current fellows is strong. According to a 2005 survey see Job Market, page 4

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or fellows attempting to bolster their CVs with published manuscripts, creating a concise and wellwritten paper is merely the first step.

“It’s very naïve to think that fellows can just write anything and it’s going to get published,” said Edward Chu, MD, professor of medicine and pharmacology and deputy director of clinical research at the Yale Cancer Center in New Haven, CT. “There’s an art and science to writing, and in many ways, writing is like doing basic,

clinical, or translational research—it is almost a separate field unto itself.”

For a fellow with the goal of getting manuscripts published, mentorship is absolutely essential.

“The fellows themselves can’t do it, bottom line,” said Dr. Chu. “It is critically important that they work with a senior mentor.”

One key factor is the mentorship infrastructure of a given fellowship program—whether, and how much, see Get Published, page 6

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Oncology Fellow Advisor • Vol. 1, Issue 3

Succeed in Private Practice and Become a Partner

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or every 5 fellows who graduate from oncology proresult. Ms. Bowers believes that in this environment, you grams in the United States, at least 3 will begin their can’t plan and think you’ll be facing certain problems in career in private practice.1 That means in addition to using the next 3 to 5 years.

“Battling with insurers is a time-consuming and frusthe clinical medicine they learned throughout their traintrating process for any private practice, but groups of ing, they’ll also need to quickly learn a new set of skills— all sizes can effectively negotiate with payers,” said navigating the business challenges of private practice Ms. Bowers. and becoming a partner.

The key is to have information systems that accurately “Physician groups want to do clinic medicine; they really capture patient data, which allows physicians to effectivedon’t want to do business,” said Mary Lou Bowers, MBA, ly argue their points and payers to accurately understand president and CEO of The Pritchard Group, an oncology their costs. “Most practices don’t believe they are big practice advisory group. “Unfortunately, they’ve got to enough to negotiate, but if do both.” you’re practicing good medSeasoned private practice icine and you’re willing to be oncologists agree. “One of Navigating the path to a successful private systematic in collecting data the big problems for physipractice career and attaining a partnership and recording outcomes, cians in the current healthstake begins well before the first referral you can negotiate with any care finance environment is walks through the door. The path to partnerpayer,” said Ms. Bowers. “All that it’s really easy to be ship should be clearly laid out before any job payers are happy to trade taken advantage of. To offer is accepted. money for data.” somehow believe that phyManaging a practice sicians should just do their comes in addition to seejob and take care of patients ing an average of 70 to 100 and ignore everything else patients a week, so a clinic is a fatal mistake,” said left unchecked can become Tom Sneed, MD, the pracoverwhelming. “The most tice president of Arkansas common complaints from Oncology Associates in Little physicians of all stripes is Rock, AR. “Frankly, we’re not that they work too hard, very good at business, and have to deal with the busiwhile it is most annoying, it ness and insurance compais absolutely essential.” nies, have to deal with employees, have to deal with an The biggest challenge in managing a practice is keepincreasing patient load, and that they have no time for ing up with the rate of change. Payers—both private themselves or their family,” said Dr. Sneed. “You have to insurance companies and public entities like Medicare— be able to step back and say, ‘OK, I’m going to do things constantly change their coverage for treatments. “Every a little differently because this is not the life I want.’ ” couple of years, they change all the rules,” said Dr. Sneed.

“That’s been the most difficult thing to deal with in the Ms. Bowers said that one antidote is physician extendlast few years. You have to figure out how to respond to ers—nurse practitioners and physician assistants—who that so that basically your business, your practice, your can help alleviate the dual pressures of decreased reimlivelihood, won’t get taken to the cleaners by insurance bursement and the shortage of practicing oncologists. companies or the government.”

The pressure to work hard is often especially strong for Developing long-term strategies can be difficult, as a a new associate in a practice. “The most difficult thing for a new attending physician is that you have to be willing to always say yes but also somehow preserve some Table. Tips To Succeed in Private modicum of time for yourself and your family to have a Practice and Become a Partner real life,” said Dr. Sneed.

• Be able, available, and affable Navigating the path to a successful private practice • Use NPs and PAs to alleviate reimbursement and career and attaining a partnership stake begins well staffing pressures before the first referral walks through the door (Table).

• Negotiate with payers by using information sysThe path to partnership should be clearly laid out before tems that accurately collect patient data and any job offer is accepted. record outcomes “The most important thing is that you’re given the NP, nurse practitioner; PA, physician assistant ground rules going in,” said Dr. Sneed. “If the practice

CAREER PATHS

Vol. 1, Issue 3 • Oncology Fellow Advisor

that you’re going to work for is not willing to discuss what you have to do to be successful, before you even get there, you’re going to the wrong place.”

Equally important for fellows is to know beforehand whether their personal and career goals mesh with those of their prospective partners. “It’s not enough to see if clinically you could work with them and they’ll give you the kind of call and hours you want and the pay is OK,” said Ms. Bowers. “You really have to dig in and find out what their goals are, are they looking to get rich, are they looking to take care of patients, do they feel connected to the community, and how does this group fit with what I want?”

In private practice, success is built through relationships with other physicians in the community. The best approach may be an oft-quoted adage among private practice physicians based on the “Three A’s”: be able, available, and affable.

“If somebody calls you and asks if you can help with something, the answer is yes. The answer is not, ‘Gee, I’m really busy today,’ ” said Dr. Sneed. “You also have to be friendly and you have to treat people with respect and communicate with them.”

“The most difficult thing for a new attending physician is that you have to be willing to always say yes but also somehow preserve some modicum of time for yourself and your family to have a real life.”

—Tom Sneed, MD

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

Aside from taking care of patients and developing good relationships with referring physicians in the community, associates can step up in many other ways. For example, the rules on using IV immunoglobulin or epidermal growth factor receptor inhibitor therapy change constantly; staying on top of these changes and reporting them to relevant partners or practice committees is one way to contribute. Another is to get involved in community relations, like taking part in fundraisers such as the Komen Foundation’s “Race for the Cure.”

If these bases are covered, any managing partner will likely be glad to promote an associate to partner.

“If you’re able, available, and affable, and you’ve built a series of relationships with other community physicians, your partners are going to be delighted to have you in their group,” said Dr. Sneed.

Reference 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%20Research/ Oncology%20Workforce%20Report%20FINAL.pdf.

Accessed August 11, 2009.

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.

October 2009

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Job Market

Oncology Fellow Advisor • Vol. 1, Issue 3

underserved areas essentially can tailor a practice environment to fit their needs.

Vince Cataldo, MD, finished his fellowship last year at continued from page 1 The University of Texas M.D. Anderson Cancer Center in Houston, with the goal of moving back home to Baton Rouge, LA, and dividing his time between private practice of graduating fellows included in the report, 88% of those and an academic environment that would allow him to who started their job search had accepted a position by teach and eventually write research the end of their fellowship trainprotocols. ing; two-thirds of these fellows had One oncology fellow said he Dr. Cataldo approached only 2 their choice of 2 or more offers. At receives more than 100 e-mails potential employers: the Baton the time, 69% of fellows who had Rouge-based Hematology/Oncolreceived a job offer also reported from recruiters each week. ogy Clinic and the Louisiana State receiving one or more sign-on benUniversity (LSU) Health Sciences efits, including moving expenses Center in New Orleans. He negotiated separate contracts (52%), cash incentives (24%), practice support (14%), or with each practice and now spends 70% of his time seeloan assistance (5%). ing patients in private practice and 30% of his time in Although overall demand for oncologists is extremely academic practice at LSU. high, it is not necessarily equally high in all parts of the “The fact is that you can be very creative in developing country. “The important question is: ‘Is that demand uniwhat you want and I think I’ve created the best of both formly equal across the country?’ And I think the answer worlds,” said Dr. Cataldo. He noted that at LSU, every is no,” Dr. Kosty said. “One of the messages for people oncologist on the service also praccurrently in their training or finishtices at a community clinic, partly ing their training in the near future because the academic infrastrucis that absolutely there will be positure is still being rebuilt following tions for them doing what they’re Hurricane Katrina. But Louisiana is trained to do; however, there may not unique in allowing young oncolnot be positions in the precise geoogists the opportunity to design graphic area that they would want their own practice lifestyle. to practice in.”

“Academic centers are so underThis point is critical because the served right now as far as those 2005 survey of fellowship graduwho are willing to bring academics ates found that more than 3 in 5 back to the bedside and teach the trainees, that I’m hear(62%) ranked geographic location as extremely imporing from people all across the nation who are now doing tant in their post-training career plans, whereas only 1 in exactly what I’m doing,” said Dr. Cataldo.

5 ranked salary or pay as extremely important (Table).

For the most part, fellows with a good track record and ASCO’s Workforce Advisory Group plans to study the a clear vision of the kind of medicine they want to practice geographic variation in demand for medical oncolocan set the terms of their practice environment. gists, but until the formal study is conducted, anecdotal “[Fellows] need to be very straightforward when they evidence suggests that fellows who wish to work in make that initial call and say this is what I’m looking for and then you let your credentials speak for you,” Table. Factors Affecting Oncology Fellows’ 1 Dr. Cataldo said. “You will not get everything, but Post-Training Practice Plans you have to be very stern because you bring a lot to Deciding Factors in Practice Plans “Extremely Important” the table in a field that is underserved right now.”

Although the job market is strong for oncoloProviding direct patient care 63% gists, the specifics of job offers have changed Geographic location 62% as a result of financial pressures facing oncology Network of high-quality peers 60% practices. These pressures are not due to the Balancing work and professional life 60% overall US economy but instead are the result of Spousal/partner employment opportunities 50% decreased reimbursements.

Dr. Cataldo, for example, wanted a relatively Salary/pay 20% quick, 1-year path to partnership at his private Adapted from Forecasting the Supply of and Demand for Oncologists: A Report to the American Society of Clinical Oncology (ASCO) from the AAMC practice, but in order to receive a partnership Center for Workforce Studies. http://www.asco.org/ASCO/Downloads/ stake, he is required to prove, over the course of a Cancer%20Research/Oncology%20Workforce%20Report%20FINAL.pdf. year, that he brings more money into the practice Accessed August 11, 2009. than he receives in compensation.

CAREER PATHS

Vol. 1, Issue 3 • Oncology Fellow Advisor

Part 2 of a 2-part series

Academic Oncology: Strategies for a Successful Career

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or fellows interested in a career in oncology research and education, academic opportunities abound. In order to have a successful career, however, there are a few important factors to keep in mind.

“The main [thing] to watch is your clinical load,” said Sunita Nasta, MD, assistant professor of medicine in the Division of Hematology-Oncology at the University of Pennsylvania, in Philadelphia. “If you build your clinic too fast, the workload that you have will prevent you from being productive academically.”

The second consideration fellows must assess is the academic rank they will be appointed. Some institutions require that all entering faculty begin as a clinical instructor; others may place newcomers as assistant professors.

“The academic rank they are offering is really important in terms of your academic clock and how much protected time you are going to have early in your career to establish yourself,” said Dr. Nasta.

In terms of protected time, academic offerings can vary widely. More generous packages may guarantee protected time and a very light clinical burden for the first several years, whereas others may require that junior faculty earn their protected time through research grants.1 Tenure or nontenure track also can affect a start-up package. In some cases, tenure-track positions may mean more protected time or financial support to get a research project off the ground.2 “With tenure track, there is more of a commitment by the institution to your career,” said Karin Hahn, MD,

“I had never seen that before this year, so I think that extra protection [for the practice] was put in place in part because of where the economy was at the time that I negotiated,” Dr. Cataldo said.

Fellows currently searching for positions also say they expect lower starting salaries in the current economy.

“Compensation has been affected very much by the economy,” said Aref Agheli, MD, a fellow at Brookdale University Hospital in New York, NY. “Probably the number of jobs has not decreased, but … I hear all the time that the pay has gone down significantly, that it’s not economical anymore.”

But Dr. Agheli said the number of positions available—

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. “But it also comes with an expectation that there is some kind of time by which you are going to make it or not make it. You’re ‘on the clock.’ ” Importantly, the meaning of tenure has shifted dramatically over the last 2 decades, with some prominent academic medical institutions no longer even offering tenure.

“Tenure nowadays doesn’t mean what it meant 20 years ago, where it meant you were really protected, you were in for life. It’s not that way anymore,” said Dr. Hahn.

Once the oncology fellow has accepted a faculty position, there are a few final steps on the path to promotion.

One of the first is finding a mentor to guide a junior faculty member through the nuances of his or her particular institution. “Fellows need to closely evaluate who they are going to work with and look at mentors who can further their career,” said Dr. Nasta.

Junior faculty also should meet with the office that specifically oversees promotion at their institution, usually human resources or the office of faculty or academic affairs. These meetings can provide junior faculty with information on their specific institution’s expectations well before promotion is considered.

Finally, junior faculty need to set specific times, perhaps the end of their first and third years, to evaluate their position and think about what is and is not “working” and whether any problems can be fixed. “If things can’t be fixed by the end of year 3, then you need to think long and hard about whether you should stay where you are,” said Dr. Hahn.

References 1. Melnick A. Transitioning from fellowship to a physician-scientist career track. Hematology Am Soc Hematol Educ Program.

2008:16-22.

2. Todd RF, Gitlin SD, Burns LJ. Subspecialty training in hematology and oncology, 2003: results of a survey of training program directors conducted by the American Society of Hematology. Blood. 2004;103(12):4383-4388.

he receives more than 100 e-mails from recruiters each week—has put him at ease about finding an ideal position in the current economy.

“It’s my feeling, and also the feelings of my peers, that basically everybody gets what they want,” he said. “In other words, ‘you name it, you got it.’ ”

Reference 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 August 11, 2009.

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MENTOR MEMOS

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Oncology Fellow Advisor • Vol. 1, Issue 3

A more experienced faculty member is likely to be less concerned with authorship and will also have more experience and credibility in the field. The potential continued from page 1 downside of working with a senior faculty member is that he or she may have less time to spend working a program encourages the kind of interaction between with a fellow. faculty and fellows that fosters collaboration. But felRegardless of whether a junior or senior faculty lows should not rely on a program to simply hand them member is chosen, the authorship question should be a mentor that will result in authorship on a publication. addressed right from the start.

“A fellow should be proactive in trying to make it clear “Fellows should clarify what their expected role will that they want to have an active role and that they want be and I would advise that, in most circumstances, they as much ownership as they’ll be allowed to take,” said should try to position themselves Scott Gitlin, MD, an associate proto be first author and take on fessor of medicine at the University “If a fellow has an idea for a the primary responsibilities and be of Michigan in Ann Arbor, and directopic for a review or a case reinvolved with the initial writing,” tor of the Hematology/Oncology said Dr. Gitlin. “If it’s going to be Fellowship Program at that instituport, they should be aggressive a lot of work and not much credit tion. “If a fellow has an idea for a about finding a faculty member or a useful experience, they should topic for a review or a case report, to work with on that.” walk away and look for something they should be aggressive about —Scott Gitlin, MD else.” finding a faculty member to work Beyond writing, there are a host with on that.” of other experiences that fellows In terms of publishing, the first can undertake to better prepare themselves to sucthing to look for in a faculty mentor is a track record cessfully publish. If the mentor is a reviewer for a jourof working with fellows who get authorship on pubnal, a fellow can assist with reviewing studies that have lications—a group that is “active, credible, and expebeen submitted to the journal for publication, Dr. Chu rienced,” said Dr. Chu. Another key is that whichever advised. Likewise, if a mentee is attached to a group research group or mentor is chosen, they must be willing working with original data, a fellow should ask to be to give up some level of authorship to the fellow. involved in the data analysis to learn how to interpret The experience level of the mentor can play a role as study results, Dr. Gitlin added. well. “There is always a trade-off [working] with a junior If a fellow knows which career path he or she would faculty member or the senior faculty,” said Dr. Chu. For like to pursue after fellowship, either in an academic or example, a junior faculty member will likely be hungrier a community setting, that can also affect the kinds of for publications to bolster his or her own CV and may manuscripts he or she plans to publish. be more enthusiastic about helping a fellow; conversely, Dr. Gitlin noted that fellows hoping for a career in there can be a conflict of interest if the faculty member academia should be looking toward “new knowledge.” is also trying to get first-person authorship on papers.

If possible, they should bypass opportunities to write reviews and book chapters, which can involve extensive Table. Submission Rates to Major reading of the published literature, and focus on writOncology-Related Journals ing research papers. “I usually advocate that a fellow Journal Published/ should find a research study that is further along and Received (%) closer to being concluded, so that they may be able to Archives of Dermatology 35 get involved with writing the manuscript,” he said.

Often, the exact research area is not as important as Archives of Internal Medicine 10 the impact of the study on a given field or the journal Archives of Neurology 26 in which it is published (Table). “If a fellow really wants Archives of Surgery 54 to have a solid academic career, it will be important to JAMA 8 write something of substance that gets into one of the better-known journals,” said Dr. Chu. Journal of Clinical Oncology 20 And although publishing is not as vital for a comThe Lancet 5 munity-based career, it can be a great help as a fellow The New England Journal of Medicine 8 moves into practice. In this case, fellows should focus Adapted from Forecasting the Supply of and Demand for on a particular disease or topic.

Oncologists: A Report to the American Society of Clinical Oncology “My experience has been that review articles and (ASCO) from the AAMC Center for Workforce Studies. http://www. asco.org/ASCO/Downloads/Cancer%20Research/Oncology%20 book chapters have been very valuable to have, Workforce%20Report%20FINAL.pdf. Accessed August 11, 2009. because it allows the practice that they are joining

MENTOR MEMOS

Vol. 1, Issue 3 • Oncology Fellow Advisor

A Day in the Life of Marc Stewart, MD …

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disease; 90% of them went on to have very productive ncology Fellow Advisor presents our Day in the Life lives,” said Dr. Stewart. series. In each segment, we interview a prominent “At the time I was training, the hope was that these thought leader about how they got into the field of oncolprinciples could be applied to other malignancies, and ogy and their typical work day. they have in part, but not with the success rate that we In this issue, we interview Marc Stewart, MD, professee in testis cancer. Metastatic tumors such as lung cansor of medicine in medical oncology at the University cer and melanoma, kidney cancer and pancreatic cancer of Washington Medical School, member of the Fred are very difficult and the response to treatment is often Hutchinson Cancer Research Center, and medical director disappointing. But at the time, it was very inspiring for me of the Seattle Cancer Care Alliance, in Seattle. Dr. Stewart to see how Dr. Einhorn clearly outlined the methodology serves as a board member of the National Comprehensive to find new treatments, a methCancer Network (NCCN) and as an odology that we continue to use editorial board member of Oncology “I would suggest that a fellow successfully today,” he said.

Fellow Advisor. training in oncology see as Dr. Stewart’s fellowships were many patients as he or she a bit of a trial by fire, but they Like many physicians, Marc Stewart, possibly can.” helped him quickly acclimate to MD, was influenced early on by a famthe reality of patient treatment. ily member. He got his first glimpse at —Marc Stewart, MD “They just said, ‘here’s the clinic, the world of medicine working in the jump in; we have to see all these office of his grandfather, who was a patients by the end of the day.’ ” physician. Later on, exposure to outstanding professors further guided Arguably, this is a very stressful him into the field of oncology. “Where approach, but it has its merits, your interests go sometimes depends Dr. Stewart said. “I would suggest on who inspires you,” he said. “I think that a fellow training in oncology it’s the best teachers who are the see as many patients as he or she most inspiring.” possibly can.”

One of those teachers was Lawrence “Sometimes fellows are a little Einhorn, MD, the renowned oncologist reticent about ‘jumping in’ and at Indiana University who revolutionseeing patients. It’s a little intimiized the curative treatment of testicudating because you’re in an area Left to right: Marc Stewart, MD, with one lar cancer, most notably in the clinical of his mentor’s, Peter Quesenberry, MD, that you don’t know, that you’re use of platinum-based chemotherapy. and Dr. Stewart’s wife and colleague, just learning about. But on the “The strides he’s made, plus the fact Pamela Becker, MD. other hand, you have people there that he’s an excellent teacher, are the who are willing to help guide you things that inspired me in oncology,” said Dr. Stewart. and teach you.” A strong fellowship should also be roundHe conceded that his experience as a student of Dr. ed out by proper reading, he added.

Einhorn, watching large tumors virtually melt away with Dr. Stewart attended medical school at Indiana chemotherapy, may have skewed somewhat his early University in Bloomington, and completed medicine and perception of the field of oncology and the curative powfellowship training in oncology at Indiana University. He ers of chemotherapy. “Dr. Einhorn saw many, many young did a second fellowship in hematology at the University men referred for testis cancer. This treatment helped to of Virginia in Charlottesville. cure these persons who otherwise would have died of the see Day in the Life, page 8

to market them as an expert in a given area,” said Dr. Gitlin. Having a credible expertise area provides an introduction to other local physicians and paves the way for referrals.

Fellows should be clear, both Drs. Gitlin and Chu warned, that publishing can be a time-consuming and arduous process. “It requires focus, commitment and, at the end of the day, it just requires hard work,” said Dr. Chu. Even that may not be enough. “Ultimately, you

can have all of those elements and still not be successful, and the reason is because you don’t have a good mentor that really fosters that focus.”

But down the road, potential colleagues and partners will recognize this sacrifice. “A lot of people can work in the laboratory or participate in clinical research,” said Dr. Gitlin “But getting to that finished point, where it’s actually packaged to communicate to the world, is a huge step.”

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MENTOR MEMOS

Oncology Fellow Advisor • Vol. 1, Issue 3

Day in the Life the administrative aspects of my job, then it’s usually a series of meetings and conference calls.” He generally continued from page 7 works a 5- to 6-day workweek, with some weekend work when he’s on service.

At the Seattle Cancer Care Alliance, Dr. Stewart’s pracIn addition to fulfilling his responsibilities as medical tice is quite diverse; it is essential that his knowledge run director, Dr. Stewart is a board member of the NCCN, deep and in many directions. “I practice general oncology, a group of 20 academic centers working together to hematology, and stem cell transplantation,” he said. “I work create guidelines for cancer care. intermittently in all of those areas. As “We’re always trying to look at medical director, it’s important for “I practice general oncology, what are the best practices in me to understand how oncology is hematology, and stem cell oncology, from the kinds of drugs practiced in all of those areas.” transplantation. … As medical you give to the way you are orgaDr. Stewart stays on top of director, it’s important for me nized to deliver care,” he said. oncologic trends in these areas by to understand how oncology is The NCCN is also increasingly attending oncology conferences and focusing on the fellowship aspect grand rounds. In addition, although practiced in all of those areas.” of their organization. “We tailor his grandfathered status does not —Marc Stewart, MD some of our annual meetings to be require this of him, he is currently directed toward fellows training in enrolled in board recertification. oncology and hematology.”

His days start early and run fairly long. “About 75% When Dr. Stewart is not working, he enjoys photograof my days start at 7 AM and end at 6 PM or 7 PM,” Dr. phy, reading—mostly history—and spending time with Stewart said. The content of his workday varies. “If I’m his wife and 6 children. on service, it’s almost all clinical. But if I’m dealing with

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