Oncology Fellow Advisor - Summer 2009 - Vol. 1 No. 2

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Vol. 1, Issue 2

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

Fellowship Training

2

COMMUNITY PRACTICE

Tips on transitioning from fellowship to private practice.

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ACADEMIA

Part 1 of 2: Experts outline strategies for a successful career in academic oncology.

Mentor Memos

Survey Says

Physician Finance

Career Crossroads? Choose Wisely

STRESS BUSTERS

Ways for the oncology fellow to beat stress and avoid burnout.

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ellows approaching the end of their training are faced with one of the most significant choices of their lives. They must decide whether to pursue an academic position or a community-based career in a private or hospital-based practice. “It’s a very complicated decision, and it’s very difficult. It’s a fork in the road for all of us,� said K.M. Steve Lo, MD, a medical oncologist at Bennett Cancer Center in Stamford, CT. “And it’s a major fork in my life. One of many, but certainly one of the big ones.�

In making this decision, fellows must weigh several factors that generally fall into 1 of 2 categories: how they spend their time at work, and personal lifestyle choices like work–life balance, salary, and the nonclinical responsibilities of whichever practice environment they choose.1 “It’s a central, major issue and it’s one that people wrestle with on different levels,� said Andrew Seidman, MD, attending physician at Memorial Sloan-Kettering see Career Choice , page 7

The Fellow’s Guide To Finding a Mentor

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For the latest oncology-related news, please visit www.oncologyfellowadvisor.com

any successful physicians point to their mentors as a defining influence on their professional development, underscoring the importance of this relationship in a fellow’s training. Studies have demonstrated that mentoring plays a vital role in the development of young physicians. Fellows tend to go into the same field and practice setting as their mentor, and oncologists with mentors tend to be more involved in research and have more successful faculty careers.1-3

Yet the mentorship process is not clearly defined. Fellows have a wide range of highly personal experiences with their mentors. “Not all fellows understand mentorship,� said Fadi Braiteh, MD, a fellow in medical oncology at The University of Texas M.D. Anderson Cancer Center in Houston. “Most of the time trainees are in denial about the importance of finding a mentor, but you realize how crucial it is at the end. And if you see Mentors, page 4

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Oncology Fellow Advisor • Vol. 1, Issue 2

Stress Busters for the Oncology Fellow

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may choose to go into academia or community practice, urnout is a significant problem that may occur durand there are stressors unique to each (Table).3 ing oncology fellowship. One recent survey found that more than two-thirds of fellows reported emotional “Toward the last 12 months before graduation, it is exhaustion and a diminished sense of empathy.1 Most career and job placement and as a third-year fellow, I can tell you that it is major,â€? said Dr. Braiteh. commonly, oncology fellows reported that they did not After identifying potential stressors, 2 of the most imporhave enough time to give patients the emotional attention they felt they needed, highlighting the importance tant tools that fellows can develop to cope with stress of communication and timethroughout their fellowship are communication and timemanagement skills in alle“Particular patient stories hit you, management skills, according viating stress and avoiding burnout.1 to Walter F. Baile, MD, profesand you carry them with you. And it sor of medicine and chief of “I see different levels of can contaminate and outweigh your the Psychiatry Section at M.D. stressors, and they kick in personal life and cause damage.â€? Anderson. at different levels [during “One of the very, very fellowship] training,â€? said —Fadi Braiteh, MD important aspects of caring Fadi Braiteh, MD, a fellow for patients and interacting in medical oncology at The with colleagues is having University of Texas M.D. good communication skills,â€? said Dr. Baile. “It’s the volAnderson Cancer Center in Houston. ume of challenging conversations and interactions that The first stressor that many fellows face on arriving at can take their toll during fellowship, when fellows may their institution involves integrating their education with not have the skills or experience to deal with it.â€? the care of their patients. Fellows must get up to speed Importantly, physician communication is a key aspect on a large and ever-expanding body of literature and of patient satisfaction, which in turn affects how oncolothen apply it as best they can in a new environment. gists feel about the care they provide.4 “The gratitude of “The learning pace is faster than any of the other medical subspecialties. For a trainee to catch up with all the our patients is a very important aspect of being satisfied key papers, with the thinking and decision making, is with one’s career,â€? said Dr. Baile. extremely challenging,â€? said Dr. Braiteh. Communication skills, particularly those required for Once fellows settle in, they must learn to cope with the patients who don’t respond to treatment or who should lifelong stresses of the subspecialty: the specific patient be transferred to palliative care, must be learned, emphapopulation and the multimodal nature of the care they are sized Dr. Baile.5 Departmental conferences, mentorship 2 required to provide. from senior faculty, role-playing, and online education are “The other stresses are subliminal, like dealing with cancer patients, where you know a certain percentage of Table. Stressors by Job Type3 cancer patients will be dying,â€? said Dr. Braiteh. “Because if, in oncology, you think it’s a battle and you are going Community Practice Academia to win the war against cancer, you are going to burn out. • Ensuring fellows are • Large number of Because we know, most of the time, we cannot do it.â€? patients to treat competent to diagnose When patients do respond poorly to treatment, the and act in life-threaten• Unpredictable and conemotional stress, particularly for junior fellows, can spill ing situations stantly changing hours over into their personal lives. “Particular patient stories hit • Path to promotion/ • Night/weekend shifts you, and you carry them with you,â€? said Dr. Braiteh. “And tenure may be loosely • Burden of losing a it can contaminate and outweigh your personal life and outlined patient (worsening of cause damage.â€? • May feel less self-worth condition, death) For the first time, fellows also are at the center of a multithan those treating and • Loads of paperwork disciplinary team and are ultimately responsible for the saving patients (insurance filings, balcancer patient. “The medical oncologist plays a central and • Lower pay than private ancing the books) coordinating role and if a colleague is functioning poorly— practice despite similar a surgeon, a radiation oncologist—that comes back to you, knowledge base/training the patient complains to you,â€? said Dr. Braiteh. Adapted from Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping During the third year of fellowship, oncology fellows your career to maximize personal satisfaction in the practice of must navigate the job market and make decisions that oncology. J Clin Oncol. 2006;24(24):4020-4026. will likely affect the rest of their career. For example, they

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FELLOWSHIP TRAINING

Vol. 1, Issue 2 • Oncology Fellow Advisor

all ways in which fellows can learn to improve their communication skills. Fellows also should remember that they still are in a significant learning phase of their careers, despite being responsible for many patients. “Fellows need to recognize that they are learners and are not always going to do things perfectly. Fellows should have a mindset of going ‘beyond blame’ to look at training experiences as training experiences—as opportunities to improve their skills,� said Dr. Baile.

Communication is key. Here are a few ways to improve physician communication skills: • Attend departmental conferences • Attend Grand Round meetings • Engage in online education

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

• Receive mentorship from senior faculty members • Practice role-playing with other fellows A mentor often can help a fellow with many aspects of his or her career. During high-stress cases or situations— or even career burnout—a mentor can provide empathy and support. “It’s hard to find a good mentor, but if you can, it really is a great opportunity when you’re feeling stressed out to have someone who can listen,â€? said Dr. Baile. “Often, they don’t necessarily have to say anything but simply help you think through the situation.â€? Although most oncology fellows experience stress from the demanding responsibilities of their career and personal life, if the feeling is consistently overwhelming, now is the time to recognize and correct the problem. There are many continuing medical education courses designed to help physicians manage the numerous nonclinical demands of medicine. “A lot of people struggle with time management and organization. I think that during fellowship, there is an opportunity to ‌ get help if you’re not good at managing your time and being organized,â€? said Dr. Baile.

References 1. Armstrong JL, Holland J. Survey of medical oncology fellows’ burnout, communication skills, and perceived competencies. J Clin Oncol. 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition). 2004;22(14S):8132. 2. Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol. 1991;9(10):1916-1920. 3. Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026. 4. Dugdale DC. Time and the patient–physician relationship. J Gen Intern Med. 1999;14(Suppl 1):S34–S40. 5. 5. Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005;55(3):164-177.

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 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 Š 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. July 2009

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MENTOR MEMOS

Oncology Fellow Advisor • Vol. 1, Issue 2

Mentors continued from page 1

identify the stress of finding a mentor early, face it, and work it out, it will determine the next part of life.� The first step begins with formal programs. Fellowship institutions often will offer career development workshops, lectures, and meetings to allow fellows to become acquainted with the concept of mentorship. They may even match a fellow with a mentor. The process often is much less formal, however. Fellows will be exposed to many possible mentors throughout their early training, and one key to finding the right teacher may be to seize an opportunity when it arises. “Although there is a formal structure in place, finding [mentors] is informal,� said Alison Conlin, a medical oncologist at Providence Cancer Center in Portland, OR. “I just happened to be in [my mentor’s] clinic, thought he was great, and said ‘I’d love to work with you for the next few years’ and that was it.� Another key is realizing the benefits that particular mentors can provide. “You should never pick one senior mentor,� said Dr. Braiteh. “You need short- and long-term mentors. You need someone who is seasoned, who can see the 30,000-ft. view of things, but you also need to pick up junior mentors, because they were in your shoes just a few years ago and were struggling with the issues you are struggling with.� Finding a good mentor often is more about a good mentor–mentee pairing and should not be focused solely on research interests. The goal of an effective mentorship should be overall academic and personal development. “One of the things fellows don’t often know is that your mentor does not necessarily have to be within your division,� said Sunita Nasta, MD, assistant professor of medicine in the Division of Hematology-Oncology at the University of Pennsylvania in Philadelphia. “You may find someone in another department who can provide guidance and mentorship for you from an academic point of view, and it’s important to make these institutional connections beyond just your small group.� After a connection is made, a mentor can provide substantial guidance. For example, mentors can immediately help fellows gain experience in research by allowing them to write clinical trial protocols and helping them generate, present, and publish data. For oncology fellows interested in bench research careers, the importance of a mentorship cannot be overstated. “If you’re interested in a bench research career, the most important thing is finding a mentor to guide your early career, and that is probably more important than the particular institution that you go to [for fellowship],� said Dr. Nasta.

Mentors also play an invaluable role in patient care, not only in providing guidance for clinical questions and patient management, but also in less tangible areas like communication and stress management. “It’s hard to find a good mentor, but if a fellow can find someone to coach them, to talk with not only about difficult clinical cases, but about difficult communication aspects, [that] is extraordinarily important,� said Walter Baile, MD, professor of medicine and chief of the Psychiatry Section at M.D. Anderson. Perhaps the most significant role a mentor can play is guiding a fellow in selecting a career path. A good mentor not only provides practical information about the nuances of success in academic research, but also actively provides the mentee with opportunities. For example, when Dr. Nasta—who specializes in nonHodgkin’s lymphoma—was looking for an academic appointment, she asked her mentor to speak with prominent lymphoma specialists along the Eastern seaboard to see if there would be openings when she anticipated looking for a job. “Finding the right mentors pays early in job placement— to know about opportunities and to know about people at those opportunities,� said Dr. Braiteh. “Sometimes, one sentence from a person about a chairman of an institution can really change the tone of how you want to approach them.� Although mentors often are best equipped to help fellows who want to remain in academia, they still are capable of providing support to those who wish to go into community practice. Fellows who want to leave academic medicine should not be afraid to ask for their help. “I think it’s hard and I know people who were scared to tell their mentors they had chosen private practice,� said Dr. Conlin. “But I would tell fellows that this is your life, your choice, and your job. You have to do what feels right in your heart and you hope that they support you and want the best for you.� Although Dr. Conlin now has her own thriving community practice far away from her fellowship institution, her mentor is never too far away. “My mentor will be with me my whole life,� she said. “I will always e-mail him with hard cases.�

References 1. McCord JH, McDonald R, Sippel RS, Leverson G, Mahvi DM, Weber SM. Surgical career choices: the vital impact of mentoring. J Surg Res. 2008 Aug 13. [Epub ahead of print]. 2. Riechelmann RP, Townsley CA, Pond GR, Siu LL. The influence of mentorship on research productivity in oncology. Am J Clin Oncol. 2007;30(5):549-555. 3. Gitlin SD, Yuan Z, Little RJ, Todd RF. Factors that influence successful training and faculty career development in hematology/oncology patient-oriented clinical research. J Cancer Educ. 2005;20(2):72-78.

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CAREER PATHS

Community Practice: Transitioning From Academia

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ity of their physical assessor oncology fellows who enjoy caring for patients, a ment. The advantage of career in private or hospital-based community pracRVUs is that physicians tice offers many advantages compared with an academic can slide their productivity path. Community practice offers the intellectual rewards of up or down depending on treating a broad range of malignant diseases, better pay, their schedules. greater control over work–life balance, and recognition in “When I’m gone and one the community as a subspecialist with unique skills and of my colleagues is seeing contributions.1 a patient for me, then he Once the decision has been made to leave academia or she gets paid for that. and transition to community practice, fellows need to be And the busier you are, the familiar with the different community practice models and more money you make, define their career expectations accordingly. However, felso we have the option of lowship provides little preparation for private practice. ratcheting up and down “Having recently gone through the process, it is pretty depending on our needs,� daunting,� said Alison Conlin, MD, a former fellow at said Robert Raish, MD, a medical oncologist at North Puget Memorial Sloan-Kettering Cancer Center in New York Oncology, LLC, in Mount Vernon, WA. City, who is now a medical oncologist at Providence To find positions, oncologists may use traditional methCancer Center in Portland, OR. “There are definitely ods, such as recruiters or advertisements. Another method some things that we aren’t prepared for and don’t underis to attend career development sessions at the American stand because we spend all of our training time in the Society of Clinical Oncology meetings. world of academia.� Community practices often are unique, however, so One of the most important facets of community practhe best method to find employment is to personally talk tice that fellows should understand is the types of priwith oncologists who have recently gone into community vate-practice opportunities that will be available to them. practice. There are generally 3 types of private practice: the solo “It’s hard for anyone outside a practice; the subspecialty group, community position currently to made up entirely of medical In choosing a community tell you how to do something difoncologists; and the multispeferent than academia,� said Dr. cialty group, in which oncolopractice, the 2 most important Conlin. “In terms of finding this gists practice with physicians issues are anticipated workload kind of job, I had to reach out to from one or more subspecialand time to partnership. former fellows, and once I did find ties, often within an HMO. them, they were helpful in pointFurthermore, each of these ing me in the right direction.� models may be independent, Generally, fellows are offered a position in a community hospital-based, or university-affiliated. These differences practice on a probationary basis. Because new oncologists define the fundamental business model of a practice.1 need time to build their clinic, this typically involves a base An independent oncology practice functions as a selfsalary and in some cases a productivity payment if fellows sufficient business unit in which the partners are responwork particularly hard. sible for managing its revenues and expenses. Private In choosing a community practice, the 2 most important practices based on this model often buy and sell chemoissues are anticipated workload and time to partnership. therapy and may invest in infrastructure such as scanners Fellows should specify their expected ambulatory clinic or office space, all of which function as additional sources hours, hospital rounding responsibilities, and on-call time of revenue above and beyond professional billing fees. Hospital- or university-based practices receive their before joining a practice.2 income from an affiliated institution. The hospital also “What everyone worries about is how much time reduces its overhead by providing practice space and they’re going to be on call, but fellows should worry a additional support, such as billing services. little bit more about what their time is going to be like The fundamental salary difference for academic and during the week,� said Dr. Conlin. If a practice demands community oncologists is that a community oncologist’s more work than expected, weekday responsibilities can pay is generally based on productivity. In many pay schedquickly pour over into the weekend and affect work–life ules, salary is based on relative value units (RVUs), which balance. standardize and measure physicians’ work depending on Similarly, oncology fellows need to be clear about what how much time they spend with a patient or the complexsee Community, page 6

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CAREER PATHS

Oncology Fellow Advisor • Vol. 1, Issue 2

Part 1 of a 2-part series

Academic Oncology: Strategies for a Successful Career

T

he path to a successful academic career is a long road with many discrete steps. With a projected shortage of oncologists, however, well-prepared fellows interested in a career in research and education likely will find academic opportunities after training.1 The first steps to a successful academic career begin in fellowship. Oncology fellows who wish to go into academia need to demonstrate an interest in scholarly activities and develop the skills to carry out research projects. Some of the most common activities include publishing manuscripts in peer-reviewed journals, presenting clinical data at national meetings, sitting on institutional review or research boards, and writing study protocols. For fellows with access to educational programs, a master’s degree in public health or clinical epidemiology is a formal way to both demonstrate an interest in and conduct research. The American Society of Clinical Oncology also offers workshops on clinical trial design and grant writing for oncology fellows at annual meetings.1 Oncology fellows who specialize in a particular research theme, such as a tumor site or a specific type of investigation (eg, Phase I clinical trials) also may gain an advantage as they look for academic jobs after fellowship. Finally, fellows must decide which academic track they wish to pursue; generally, there are 4: physician-scientist, clinician-investigator, clinician-educator, and academic clinician.1 Each of these positions divides its time differently among 3 main job functions—research, seeing patients,

Community continued from page 5

their patient mix will be like; this is important both intellectually and economically. For fellows with an interest in a specific disease type, this may allow them to ensure that they will have exposure to the types of patients they enjoy treating. From a financial point of view, fellows entering a practice may want to find out which disease types are underserved and they can provide much-needed expertise in those areas. Fellows also should understand the financial details of joining the practice, including the terms for their probationary period, criteria for raises and bonuses, and other opportunities for profit sharing. More importantly, an offer letter should clearly define the time to partnership, generally 1 to 3 years, and if they will be required to buy a percentage of the practice at that time. According to Drs. Conlin and Raish, when visiting a potential practice, the most important thing is to judge

and teaching. For example, a traditional breakdown for a physician-scientist may be 80% time in the laboratory and 20% patient care, whereas an academic clinician may spend 80% to 100% of their time seeing patients, with few administrative or teaching duties. After demonstrating an interest in research and choosing an academic track, a fellow is ready to step into academia and weigh the different options specific institutions have to offer. The No. 1 question fellows must ask a potential employer is how their research and clinical duties will divide. “When it comes time to go out looking for an academic job, particularly as a physician-scientist, fellows need to know how much protected time they are going to have for their research,� said Karin Hahn, MD, 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. This is critical because success in academia is gauged almost entirely on scholarly activity and too much time spent out of the laboratory—covering inpatient service, seeing patients—will detract from producing data.

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%20Research/ Oncology%20Workforce%20Report%20FINAL.pdf. Accessed May 2, 2009.

whether or not the current partners enjoy their work. Two of the best ways to evaluate a practice are speaking with former physicians of the practice and with the current nursing staff. Finally, as fellows negotiate the terms of their first community position, they should remember that they are no longer trainees. “We get used to doing the scut work for people,� said Dr. Conlin. “Fellows need to remember they are valued physicians who should be compensated well and respected for their long training, knowledge, and skill. We forget that once you become an attending, although you’re not entitled to everything, you should be respected and treated equally, even if you don’t have the same experience yet.�

References 1. Shanafelt T, Chung H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026. 2. Todd RF III. A guide to planning careers in hematology and oncology. Hematology Am Soc Hematol Educ Program. 2001:499-506.

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Vol. 1, Issue 2 • Oncology Fellow Advisor

Career Choice continued from page 1

Cancer Center and professor of medicine at Weill Medical College of Cornell University, both in New York City. The main difference between the work environments is that an academic oncologist will have protected research time, and scholarly activities (eg, publication in peerreviewed journals, presentations, and committee memberships) will be the yardstick by which their success is measured. “I really enjoy the time I spend in clinic, but for me, 40 to 50 patients a week is fine,� said Dr. Seidman. “I enjoy having time away from the clinic, developing protocols, writing papers, and giving lectures. For me, it provides a nice balance.� In contrast, the work life of a community-based oncologist is mainly defined by patient care. “Our priority is caring for patients, and if you don’t enjoy that, you’re not going to enjoy private practice,� said Dr. Lo. But these distinctions are starting to become obscured. For example, at Bennett Cancer Center where Dr. Lo practices, there are multiple ongoing clinical trials and more than 10% of patients are enrolled in trials. In terms of research, the primary difference is that academic oncolo-

gists tend to develop trial protocols, whereas communitybased oncologists tend to implement them. The other clinical distinction is that academic oncologists frequently specialize in a single disease type, whereas community oncologists often manage many different disease types.2 “In most academic centers, clinicians focus on one disease type, while community oncologists tend to be jacks of all trades, instead of just a master of one,� said Dr. Seidman. “Some of them are a master of many, but they do have the challenge of trying to stay up to date with many different disease types.� Factors outside of patient care and research, such as work–life balance, salary, and other responsibilities also play a significant role in the career decision (Table). For example, Dr. Lo made a dramatic change in his career path based on these factors. Having received all of his training at Harvard University and its affiliated medical centers, Dr. Lo was awarded a prestigious physician-scientist grant from the National Institutes of Health. Married with a newborn, Dr. Lo found himself working 80 hours per week in the lab, seeing patients, and moonlighting in a local intensive care unit one night per week to help make ends meet. “I realized pretty soon, by the time we were married for a couple of years, that if I continued working long hours see Career Choice, page 8

Table. Community Practice Versus Academia1 Community Practice

Academia

Patient Care Almost all of your time is spent caring for patients

Time spent caring for patients can vary from none to some

Schedule Hectic schedule, often working nights and weekends

Schedule can be dictated by oncologist—picking classes, when patients are seen—but travel required

Clinical focus Work on malignant/nonmalignant hematology and oncology

Work on a variety of malignant hematology and oncology, with a subfocus

Pay Usually higher pay than other oncology disciplines, but based on efficiency (number of patients seen)

Pay is salaried, with some incentive to see patients occasionally

Reputation Local community recognizes you as a specialist/lifesaver

Regional accolades as medical educator, world/national recognition for outstanding work/findings

Adapted from Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your career to maximize personal satisfaction in the practice of oncology. J Clin Oncol. 2006;24(24):4020-4026.

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Oncology Fellow Advisor • Vol. 1, Issue 2

Career Choice work functions that differentiate the 2 career tracks. Academic oncologists must travel for lectures or consulting projects, whereas community-based oncologists must learn the aspects of managing a business or negotiating and doing competitive research, I would not have stayed contracts with a hospital. These functions tend not to be married,� said Dr. Lo. “So I said, ‘let’s look at my options.’ the focus of most oncologists’ practice. It was about refocusing on my family.� “Travel can get old pretty quickly, Generally, both community and in that it can take time and energy academic oncologists must “launch� A survey of fellows completing from other pursuits like family and their careers, either through buildtraining found that 88% had leisure,� said Dr. Seidman. ing a base of patients or starting accepted jobs by the end of Similarly, many community oncolresearch projects—work hours are their fellowship, and two-thirds ogists find the business side of their comparable in both environments. had a choice of 2 or more offers. practice to be arduous. “The busi“That’s where I think there is a ness is certainly the most complilack of difference. I think they both cated part,� said Dr. Lo. work incredibly hard; they just Ultimately, whichever path fellows choose, they are spend their time doing different things,� said Dr. Seidman. likely to find positions that meet their needs. A 2005 “To estimate the hours worked in a week, there’s probsurvey of fellows completing training found that 88% had ably very little difference.� accepted jobs by the end of their fellowship, and twoIn terms of pay, academic oncologists often have lower thirds had a choice of 2 or more offers.3 base salaries than community oncologists. Another clear 1 distinction is how each doctor is paid. References Academic oncologists are paid a base salary, and 1. Shanafelt T, Chung H, White H, Lyckholm LJ. Shaping your although some institutions may offer bonuses for an career to maximize personal satisfaction in the practice of increased patient load, an academic oncologist’s base saloncology. J Clin Oncol. 2006;24(24):4020-4026. ary makes up the majority of his or her pay. 2. Todd RF. A guide to planning careers in hematology and In contrast, community oncologists’ salaries are tied to oncology. Hematology Am Soc Hematol Educ Program. productivity, usually through a formula based on relative 2001:499-506. value units. As a result, they may adjust their workload to 3. Forecasting the supply of and demand for oncologists: a meet financial and lifestyle expectations. report to the American Society of Clinical Oncology (ASCO) “My partners and I try to balance these things, in that we from the AAMC Center for Workforce Studies. http:// obviously want to have a comfortable income, but also balwww.asco.org/ASCO/Downloads/Cancer%20Research/ ance the work to have a decent family life,� said Dr. Lo. Oncology%20Workforce%20Report%20FINAL.pdf. Accessed May 3, 2009. Finally, there are obligations outside of the primary continued from page 7

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