From the moment I started my third year of medical school I knew I wanted to stay in academic medicine. It was a calling of sorts, shaped by the incredible teachers I had during the first 2 years at the University of Rochester School of Medicine, all of whom seemed to have boundless energy for teaching and, at least to me, the seamless organizational skills to balance their teaching and their other professional activities—whether they were in clinical or laboratory medicine. I just knew I wanted to be like them.
Since then my career has taken me to many places: New Haven, New York City, Providence, and Boston. In each, I’ve taken positions that have helped me become a better academic clinician—challenging me to take on more responsibilities yet allowing me to stay involved in clinical practice and in medical education. However, there is nothing “seamless” about the balance between teacher and clinician. Indeed, if anything, it’s becoming harder. So, as I again transition from the Massachusetts General Hospital Cancer Center to the Lifespan Cancer Institute (effective September 1), I thought I’d share my own thoughts on academic medicine and “survival”:
Do what you love. It occurs to me that throughout my career, the passions I have in academia have become more diffuse, rather than more focused. I thought I would stay in early drug development in gynecologic cancers, but I’ve found similar passions in the advocacy for sexual health after cancer and, more recently, the utilization of social media in oncology. If I had listened to my early advisors, I would have never walked through these doors, and personally, that would have robbed me of the very things that make academic oncology rewarding. It’s taught me it’s important to follow your interests, though they may diverge.
Embrace your limitations. There was a time that I wanted to be the person in novel therapeutics, at whatever institution I was at. I now realize that this would have been a mistake. Not only would it have robbed me of opportunities to collaborate both within and outside of medical oncology, but as I said above, it would have limited my opportunities to discover other fields, which ended up being passions. It also means realizing that I cannot be all things to my own patients. Hence, I cannot do primary care for my oncology patients, nor can I be an oncologist for my sexual health patients. The same thing goes for good palliative care—I believe I can initiate these discussions and guide them, but have found strength in collaboration, thanks to a really great palliative care team at the MGH.
We are more than RVUs. Relative Value Units (RVUs) entered my consciousness early on, as a new faculty member at Memorial Sloan Kettering Cancer Center. I remember Paul Sabbatini, a good friend and early mentor, pulling me aside, teaching me how clinical volume translates in to RVUs, and how that goes in to the calculation of salary. Back then (am I dating myself?!), however, institutions also valued the contributions we made to our field, measured in papers and presentations, among other things. As I have progressed in my career, I have since witnessed the RVU system become a more prominent and important measure of physician work. Yet, while it tries to take into account all that goes in to the evaluation and treatment of our patients, it does not take into account the “other things” we do in academia. There is no contribution to RVU calculation based on teaching, research, or publishing, and there is no factoring promotion within our institutions. As a result, I have seen institutions beyond the ones I have worked in (and loved) scale back academic support for its faculty, and I have seen many colleagues opt to leave academia for other opportunities, whether it be in private practice, industry, or governmental posts. As I move to an even more administrative position at the Lifespan Cancer Institute, I hope to instill in my faculty the academic value they bring to our group, and to tell them that they (we) are all more than RVUs.
It’s all about patients, and progress. After all of the papers, presentations, and struggles we might face professionally, we all must remember why we became doctors and clinicians: to improve the lives of others; to care for the sick; and to help pave the way for a healthier future for all. These are tenets we can all strive for, whether we are lab-based, academic, or community oncologists. However, for those of us who have opted for academic careers, our patients should guide our own aspirations. Even as clinical expectations may be lowered to accommodate more administrative duties, everything we do should be to improve patient care. For me, it means I must try to be a good mentor (for new clinical faculty and for those trying to launch their own academic careers), collaborate with hospital and cancer institute leadership effectively, and advocate for patients, including both those who have let me in to their lives and for patients in general, whether they be located nationally or internationally.
I am sure we all have our own lessons and thoughts on what it is to be an academic oncologist. These are just some of my own musings. But to me, they will help in this new transition, as I look back fondly on my time at the Massachusetts General Hospital Cancer Center and, at the same time, excitedly step towards my new role at the Lifespan Cancer Institute.
Edward Kavalerchik, MD
Sep, 02 2017 4:01 PM
Dear Dr. Dizon,
I enjoyed your article and appreciate the spirit it conveys. I can relate to the mentors you described who had somewhat outdated notions of what is required to sustain academic oncology or medicine career in the current day and age. You correctly pointed out that being motivated by patients while pursuing ones personal academic interests is a key component for a successful career. One has to be flexible and open to the opportunities and new choices that are, unspoken here, have funding that allows one to stay in academia despite not becoming "the" expert in a narrow field we imagined or were advised to be.
Your discussion of the RVUs points to the crux of the problem hindering inspired academic career for junior faculty - clinical income from RVUs become the primary or sole source of income for academic junior faculty in the era of reduced federal, state, and institutional funding. Overcoming this challenge will be key to long-term survival of academic oncology and the patient-centered academic career development.
Don S. Dizon, MD, FACP, FASCO
Sep, 03 2017 11:18 AM
Thank you for your comments, Edward. Much appreciated! It's nice to know my sentiments strike a chord with others,for sure. I too believe that leaders and administrators across academic oncology need to re-think value- not only of the treatments we use, but the definition of value we serve as academicians. This is so important for the future of our field- we (all) need to feel we bring more to the table than what we generate in RVUs.