Graham T. Watson, MD, is a medical oncologist and hematologist at Virginia Oncology Associates (VOA), a large medical oncology group with 40 physicians and 11 locations across Virginia. He has held this position since August 2017, after completing his fellowship at Vanderbilt University Medical Center. An ASCO member since 2014, Dr. Watson previously served on the Trainee Council.

How did you initially choose your current career path? Were there any unexpected detours along the way?

GW: I always saw myself ending up in academics, probably as a clinician-educator as opposed to a physician-scientist. I enjoy teaching and it was hard for me to let go of the idea of leading rounds like all of the attendings I looked up to as a trainee. I don’t think you get a lot of exposure to private practice during medical training. Many of us spend the entirety of our training in large academic institutions.

That said, I was always curious about community oncology, and so when it came time for job interviews, I scheduled interviews in both academics and community practice. When it came time to decide, I think I realized that my number one passion was taking care of patients. If seeing patients is what you truly enjoy, a lot of things about community practice make sense.

Describe your typical workday.

GW: My day usually starts with a tumor board from 7 to 8 AM. I head to clinic to prepare for the day and answer emails before my first patient arrives at 9 AM. My last patient appointment is at 3 PM, so I’m usually winding down around 4 PM. I try to finish my notes before I leave and I can usually leave by 5 PM. My clinic is very diverse. I see every solid tumor (except gynecologic cancers) as well as benign and malignant hematologic malignancies, so I never know what’s coming in next. Some weeks, I cover our inpatient service, in which case I round from 7 AM to 1 PM and then see clinic patients in the afternoon.

Our practice (like most) is very busy and a 10-hour day can quickly turn into an 11- or 12-hour day. To help relieve the pressure, every physician in our group has one “admin” day per week (mine is Wednesday). This allows me to catch up on notes, read a few journal articles, and make patient phone calls. It also allows me to get a haircut, go to the dentist, or meet the cable guy who could arrive anytime between 8 AM and 5 PM.

If you have to pick one aspect, what part of your job is your favorite? What part is the most challenging or frustrating?

GW: I love going room to room and feeling like I’m helping people. Few jobs exist that offer the opportunity to make a difference in someone else’s experience in a positive way as medicine does. People come to you in need of help and you show them a path forward. If you have an effective treatment to offer, great! But even if there isn’t a good treatment option, being graceful in the way you deliver that news can mean just as much. Being a full-time clinician is amazingly rewarding.

In community oncology, you are often tasked with working in multiple hospital systems, across various medical records with competing consultant groups and other business interests at play. This creates unique challenges that can frustrate the patient and the clinician.

What’s the biggest change you’ve experienced going from fellowship to practice?

GW: There is a level of ownership over your work that just cannot be simulated in fellowship. It’s a different sense of responsibility when no one is checking over your shoulder. This is both exhilarating and terrifying. I find that I learn more quickly, because when I read about a new case I am so focused on learning the data in order to make the right recommendation for the patient, the information seems to stick. When you’re studying for an exam, sitting in lecture, or seeing your attending’s patients, it can be challenging
to truly engage. For me, this also means that I take the losses a little harder. I find it harder emotionally to bounce back from a tough case where the patient is not expected to do well. But when a treatment I recommended is successful, it’s a great feeling (even if it is just IV iron)!

What do you wish you had known before you chose your career path?

GW: As a fellow, it can be very hard to understand exactly what you’re getting into with regard to a job that you’re seeking. Often some of the most important questions you have are the most difficult to get answered. What kind of support staff does the practice have? How far it is between the hospital and the clinic? What’s the patient population? Do we only see insured patients? Is there a good place to get coffee near my office? Do I get my own office? I recommend shadowing for a half-day at a practice that you’re interested in and ask as many questions as you can. Then forget all of those little details and go with your gut.

Why would you recommend this career to someone starting out in oncology?

GW: The learning curve is very steep. As someone just starting out in practice and seeing case after case after case after case (you get the idea), I feel like I am learning so much every day. Certainly, keeping up with the science is a challenge, but with so many resources online at my fingertips, it’s a blast just sitting in my office between patients and researching the next case.

What kind of person thrives in this professional environment?

GW: I think there are two paradigms that are germane here:

Are you more of an introvert or an extrovert? This is most certainly an oversimplification because there are many personality types that can find success in many practice settings, but I do think it is important to ask yourself where you get your energy. In a busy community practice, you spend a lot of your day talking with people—patients, nurses, office staff, consultants, colleagues. If you’re an extrovert who is energized by these interactions, you finish your workday with enough energy to devote to your life away from work. If you are an introvert who gains energy from time alone, you may thrive with more protected time.

Do you like being a jack of all trades/master of none or are your interests more singular and specific? In community oncology, you need to be comfortable seeing a variety of pathologies. If you’re uncomfortable when you’re not the world’s foremost expert, academics may be a better fit for you.

Is there a personal experience that shaped your professional journey and led you to where you are today?

GW: I met Dr. Jim Evans, a medical geneticist at the University of North Carolina, as I was deciding whether to pursue a job in the biotech industry or apply to medical school. He dispelled several myths about the workaholic lifestyle of a modern physician and reminded me how important it is to come to work every day and feel that you’re making a positive impact in the lives of others. You don’t have to become a physician or an oncologist to accomplish this, but medicine was the right path for me. I’ll always be grateful for his insight and mentorship.

Welcome to the first article in a new series about the numerous and varied career paths in oncology. In each issue, a member will discuss their career journey and give an insider’s view of their profession. Email the ASCO Connection to tell us what career paths you’d like to see covered, or to contribute to this series.