So...What Now?

So...What Now?

David L. Graham, MD, FASCO

Mar 29, 2012
Fellowship programs can (should) make a part of their training a discussion and explanation of the varying types of practices that a trainee can consider. Although there are more precise subcategories, it basically breaks down into academic vs. non-academic practices. Now I grant that while any practice with a research arm can be called “academic,” I think the distinction I am trying to describe is clear. At some point in fellowship, an oncology trainee makes a choice what type of practice they will transition into. The factors influencing this decision are legion and highly individual.

A time may arrive, however, when an oncologist may decide that they wish to change their career path. Given that most of us have 30+ year careers, that is not an inconceivable thought to have. What are the possibilities to make that change, should one wish to? In other words, “So...what now?"

For oncologists starting in an academic practice, those opportunities are not difficult to find. I refuse to state that they will have to learn to work “harder.” Academic oncologists work very hard and it is unfortunate that fact can be often discounted. They may have to learn to adapt to a position with less resident/student support. On the other hand, an oncologist in their mid-career can potentially find a hospital/clinic department chair position with administrative duties that lessen their clinical responsibilities.

What about an oncologist who determines, mid-career, that they have a desire to move to a more academic track? That is a more difficult proposition. They will be aware of the differences in the practice requirements and rewards (financial and otherwise). Not a large number of non-academic practices have true disease-oriented practices. As a result, even though an oncologist may have a true disease focus, it is difficult to have that focus recognized. Cooperative groups can be very exclusive in the personnel involved in the discussion of developing trials, much less the actual trial development. Authorship on cooperative group trials publications can be difficult to achieve for a multitude of reasons. The consolidation of the cooperative groups is only going to exacerbate that. An oncologist might be extremely knowledgeable in a disease field and, with the experience of their practice, may have a true skill at critical thinking in disease questions. They may have great ideas for protocol questions. As they look for the possibility of academic positions in that disease field, however, they may very well be discounted because they do not have the “check off” criteria of disease-focused publications and awarded grants.

ASCO has made a strong and appropriate commitment to assist young investigators. I am not aware of efforts available to assist those mid-career oncologists who may wish to travel that path. Remember, we are looking at a physician who may still have 15-20 years left in their career. We should not discount their interest and enthusiasm.

So…what now?


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Don S. Dizon, MD, FACP

Apr, 07 2012 1:23 PM

Dear David,
What a great post.
Transitions in medicine can happen anytime, yet, most guidance is only available to those moving from fellow to attending. For those of us no longer young enough to be considered "junior faculty" (which- for those not sure, often arrives when you begin to use the phrase "when I was a fellow...") career direction is often not readily available. In academics, the pathway is promotion, whether that be in the institution where you are currently, or moving up by moving on. For others, it becomes a choice of staying in academics, leaving for industry, moving on to private practice, or doing something altogether different.
I agree that for those looking to return to academic medicine from private "non-academic" practice is difficult. But as institutions and cancer centers look towards the future and an inconsistent (and recently shrinking) federal commitment to medical research, I believe institutions will welcome mid-career clinicians looking for a role as clinical educators or teaching scholars. These positions already exist at some places, but perhaps we need to define a pathway that welcomes mid-career physicians to apply for them.

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