Finding the Inspiration to Make a Global Impact in a World of RVUs

Finding the Inspiration to Make a Global Impact in a World of RVUs

Don S. Dizon, MD, FACP, FASCO

Jan 28, 2020

Originally published in "Discussions with Don S. Dizon" on The Oncologist.

By Julie R. Gralow, MD, FASCO, and Don S. Dizon, MD, FACP, FASCO

One of the things that gives me great pleasure professionally is the ability to travel. I have been so fortunate to have had opportunities to speak and teach nationally and internationally, to see places I probably would not have otherwise had the chance to see, and to meet colleagues from all over the world. Truth be told, it was one of the reasons I went into academic oncology and is a major reason I have stayed; it remains an important part of what I do.

My interests in education and global oncology have also allowed me to connect with great people. One of them is Dr. Julie Gralow, the Jill Bennett Professor of Breast Medical Oncology and Professor of Global Health at the University of Washington School of Medicine. She is a fierce advocate for global oncology and an international expert in breast cancer. She is also an executive officer with SWOG National Clinical Trials Network and serves on SWOG’s Latin America Clinical Trials Initiative. In 2018, ASCO honored her with its Humanitarian Award, which recognized her work as the personification of ASCO's mission and values in the U.S. and abroad.

We often speak of key opinion leaders in our field, and she is definitely one of them. I had long admired her work, but years back, I never had the courage to introduce myself—she intimidated me. It was not until I joined Twitter that I was able to make her virtual acquaintance. In fact, she was one of the first people I followed, and soon after, we were exchanging tweets as part of social media conversations involving the breast cancer community (shout out to #bcsm) and during the tweetstorms that accompanied ASCO Annual Meetings. I finally got a chance to get to know her personally through my work at SWOG, after I was asked to head Digital Engagement, and our social media conversations made a face-to-face introduction incredibly easy—as if we had been friends for a long, long time. Yet, even with my promotion to professor, I still marvel over her remarkable achievements.

I asked Dr. Gralow to share some thoughts about how she was able (and continues) to do all that she has done. She explained:

I would not be where I am without the support of some terrific mentors and colleagues along the way, as well as a great team of clinical, admin, and research support staff, and a supportive spouse. Sometimes opportunities were offered to me, and sometimes I created them—but not being afraid to push a little beyond my comfort zone, and not always following the easiest path, has proven to be incredibly personally rewarding. I always try to make sure to have my long-term, ‘big picture’ goals in sight, along with shorter-term milestones that can be celebrated along the way. When I run or climb a mountain, I like setting a challenging and exciting goal, but I can get freaked out by looking too far ahead. While the finish line or mountain top is the ultimate achievement, my immediate focus is on making it to the next water stop or rest break—the smaller milestones almost always seem achievable even when you’re exhausted. I am also a strong believer in teamwork and collaboration. A favorite proverb of mine is, ‘If you want to go fast, go alone; if you want to go far, go together.’

I loved that; especially since we share the whole concept of collaboration and share in SWOG’s vision of team science. It’s tempting to ascribe her success to an early established vision, and I could definitely imagine Dr. Gralow as a high school student, seeing this path very clearly delineated. It was certainly far from the truth for me. Although I knew I wanted to be in academic oncology, my path has followed opportunities, accepting the very many detours that ultimately got me to where I am. Instead of assuming how Dr. Gralow got there, I decided to ask her to describe that journey. She said:

I had an interest in medicine from an early age. At age 6, I wanted to be a doctor, teacher, or a princess. I was pre-med in high school and college. I was extremely fortunate to get a job as a research technician as an undergrad in an oncology laboratory, making hybridomas that created antibodies that actually treated a few patients with lymphoma. That experience led me to pursue a career in oncology. I did not think about specializing in breast cancer until partway through my fellowship, when I picked a lab project related to breast cancer and decided to focus on women patients and breast cancer in my clinic. I particularly bonded with the young patients with breast cancer I was seeing, who were asking for help in recovery from treatment and getting on with their lives.

Still, one of her most remarkable achievements has to be the work she has embarked on globally. For those of us who are interested in global health, it stands as a bar to reach for and I often enjoy the chance to talk to her about what she’s seen and done. I decided to ask her about that—specifically, what could be considered a common theme across all of her experiences with the worldwide cancer community:

No matter where you live, we all want the same basic things for ourselves and our families—food, shelter, education, and health. We are much more similar than we are different. It’s ironic that those of us who have the most are frequently the least satisfied, the least happy, and sometimes the least willing to share.

“My WE CAN project (Women’s Empowerment Cancer Advocacy Network) has allowed me to connect with patients with breast and cervical cancer across the globe. Hearing the stories of these women, understanding their obstacles, and seeing their strength is very inspiring. I’ve seen the power in connecting patient advocates, policy makers, and health care providers who are all working towards a common goal—improving the lives of patients with cancer.”  

Finally, I asked her to give some advice to the coming generations of oncologists who might be interested in taking up a similar cause. None of us are immune to the current environment, with its emphasis on RVUs and where financial toxicity is a real phenomenon. Faced with such pressure, I feel it is important to show it is possible to make a global difference. The question remains, “How?” Dr. Gralow answered:

Prioritize, pursue your passions, and keep the big picture in sight. Many changes in medical practice have resulted in higher clinical workloads, more time spent in documentation, and less time spent with actual patients. Try suggesting pilots of creative ways to improve patient care, support, and workflow. An idea for a possible solution will be better received by leadership than just pointing out the problems. Find others with similar interests and create a network for regular interactions and support. 

“Identify mentors who will help advise and find opportunities for you, and who will support you when you propose something that might be a bit unconventional. Don’t be afraid to reach out to people you see who have succeeded in a path or field that you are interested in who aren’t at your institution—ask if you can schedule a short phone call for career advice, or if you can meet for a quick coffee at an annual meeting. You’ll likely get a positive reply.”

Suffice to say, I consider Dr. Gralow more than a colleague and friend; she has become a mentor to me, helping me forge connections in the global cancer community even now. While I consider this one of many great fortunes professionally, it is remarkable to think she once intimidated me… my bad! 


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