Nov 10, 2020
Merry-Jennifer Markham, MD, FACP, FASCO, is a gynecologic medical oncologist at the University of Florida (UF) and associate director for medical affairs at UF Health Cancer Center; in 2018, she was appointed interim chief of the Division of Hematology and Oncology at UF. Dr. Markham is a member of ASCO’s Core/Symptom/Oral Measures Panel, COVID Impact on Physician Well Being & Practice Health Measures Panel, and Telehealth Disparities Measures Panel; associate editor of the Gynecologic Cancer Advisory Panel; and chair-elect of the Quality Oncology Practice Initiative (QOPI) Steering Group. She serves on the Social Media Working Group and is a consultant editor for social media for the Journal of Clinical Oncology. Follow her on Twitter @DrMarkham.
How did you initially choose your current career path? Were there any unexpected detours along the way?
MJM: My detour happened early in my education. I was in graduate school to earn a master’s degree in psychology, and I had a moment of clarity and realized I was actually meant to become a medical doctor. Later, after shifting gears, I worked for 2 years as a clerk in an oncologist’s office to pay for post-baccalaureate pre-med coursework and the MCAT. Working with patients with cancer, interacting with them in my clerical role in the office, was profound. I knew then that I wanted to be an oncologist. Once I entered medical school, I never wavered from that course.
When I was a new oncology faculty member in July 2008, my sole objective was to take excellent care of my patients with cancer. This remains my goal, but over the years, I’ve intentionally broadened my focus to a desire to make sure that all patients with cancer receive excellent care, not just my own patients. I became involved in quality assessment and improvement work as part of a collaborative research project in my first year as a faculty member, and I discovered that I really enjoyed it.
Over time, I became increasingly involved in projects at my institution that would lead to improved experiences for patients with cancer or more efficient and effective clinical operations. I became involved with ASCO’s QOPI and became the local physician champion for QOPI. Later, I became the chair of our hospital’s cancer committee. Through all of this work, I gained invaluable experience working with and leading teams and collaborating across multiple disciplines. The skills I gained through those experiences helped lead to my appointment as interim chief.
There are those who are long-term planners, and I am definitely not one of them. I never set out to become a division chief. I learned over time, however, that I’m actually pretty good at getting things done, collaborating with and leading diverse teams, and tackling the hurdles of making positive changes in the academic environment. Becoming a chief eventually just made sense in my career trajectory.
Describe your typical workday.
MJM: My typical workday varies depending on the day of the week. One full day of the week, I spend my time seeing patients in my clinic. As much as possible, I avoid scheduling any meetings on my clinic days. My goal in clinic is to be entirely focused on my patients.
On the other four days of the week, I spend a lot of my time in meetings. In between these, I spend my time reviewing manuscripts, mentoring trainees or faculty, collaborating on research projects, signing forms and reviewing patient information for clinical trials, planning efforts for faculty recruitment, and various other administrative tasks. On a daily basis, I spend some time checking my inbox for our electronic medical record so I can share test results with patients or answer calls as needed. When I get spare moments, I read an article (or abstracts of articles), catch up with Twitter, and answer emails.
If you have to pick one aspect, what part of your job as division chief is your favorite? What part is the most challenging or frustrating?
MJM: As division chief, I view my primary task as helping my faculty succeed and enjoy their work. This is my favorite part of the job. When faculty are satisfied in their jobs and happy to be at work, there are so many positive downstream effects, including better patient care, improved teaching and mentoring, and happier trainees.
The most challenging part of my job is managing a resource-limited budget in a financially constrained academic environment. The second most frustrating part of my job is meetings. I really don’t enjoy meetings.
What do you wish you had known before you chose your career path?
MJM: I knew that managing people would be a part of my job as chief, but I didn’t realize the extent to which this would hold true. Having difficult conversations, providing constructive feedback, and coaching someone whose work needs improvement all take practice, and these things were uncomfortable and felt awkward to me in my first few months as chief. Luckily, I participated in a few leadership development programs, including the ASCO Leadership Development Program, and these helped prepare me and gave me resources to refer back to.
Why would you recommend this career to someone starting out in oncology?
MJM: Being a chief is an incredibly rewarding but challenging role. It may be scary for someone starting out in oncology to consider doing, but for the oncologist who has more years of experience, who loves working with and leading teams, and who doesn’t mind administrative work, being a chief is a wonderful opportunity.
What kind of person thrives in this professional environment?
MJM: To thrive as a division chief in academic medicine, a physician must have good people skills, be able to make hard decisions even in the face of disagreement, be a problem solver, and be adaptable and flexible. Being able to at least tolerate meetings is also helpful.
What experiences have shaped your professional journey and led you to where you are today?
MJM: The most powerful experiences that have shaped the way I approach being an oncologist have come from the experiences of my own family members who have been ill and have been treated at my institution.
My father was diagnosed with an acute pulmonary embolism when I was a resident, and his case was a near-miss in the emergency room that day. He was almost discharged without the diagnosis being made. Years later, I sat with my father in several different hospital rooms over several different hospitalizations as his health declined due to worsening dementia and complications from that diagnosis. I sat with him again, first in the intensive care unit and then in the hospice care center, as he lay dying from an acute and devastating stroke. I helped my grandmother, when she was 87, navigate my health care system months after a missed diagnosis of lymphoma, held her hand through chemotherapy and oncology appointments, and watched her stubbornly trudge onward into survivorship, only to die of complications from a hiatal hernia at age 94.
With my father, my grandmother, and with other hospitalizations of people I love, I’ve paid close attention to their experience as patients at my own institution. I’ve noticed how it felt as a family member and caregiver to have to wait on answers, to watch my loved one be NPO for too long, to have less-than-empathetic interactions with hospital staff or trainees or other physicians. I’ve also watched as some physicians and nurses went above and beyond and served as examples of true heroes and angels. I still remember the ICU nurse who comforted me when my father was dying and, later, sent a beautiful and heartfelt sympathy card.
Each of these experiences have taught me so much about the work that we—and I—need to do in order to better care for our patients. This has shaped my approach to oncology care for my patients and guides my daily focus to help make the health care experience better for patients and their caregivers at my institution.