How I Became an Oncologist, Palliative Medicine Physician, and Director of Quality for Cancer Services

Mar 07, 2019

Cardinale B. Smith, MD, PhD, is an associate professor of medicine and the director of quality for cancer services at Mount Sinai Health System, in the Division of Hematology/Medical Oncology and Brookdale Department of Geriatrics and Palliative Medicine. She is co-chair of the Protocol Review and Monitoring Committee and the Supportive Care Disease Management Team and co-director of diversity recruitment initiatives for the institution’s internal medicine residency program. Dr. Smith is a member of ASCO’s Annual Meeting Scientific Program Committee and Palliative Care in Oncology Committee, and a 2017-2018 participant in the ASCO Leadership Development Program.

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

CS: I originally matched in a radiation oncology residency program. I came to Mount Sinai to do a preliminary medicine year and had a pivotal clinical experience that solidified my interest in becoming an oncologist and palliative medicine physician.

In the first month of my internal medicine internship I was already worried that radiation oncology was not the field I felt happiest in. At that time, I was on an oncology rotation and had a patient with metastatic prostate cancer with severe pain from bone metastases. Daily he would say, “Why are you doing this? I am suffering.” I did not know what to say to ease his pain. We called a palliative care consult to help with his pain, and I was in the room when the team came in. When the patient said to them, “Why are you doing this? I am suffering,” the palliative medicine physician simply said, “Tell me what concerns you the most.” That empathic statement then opened the door to a bigger conversation about his goals of care that ended with being able to align that patient’s treatment with his preferences. In that moment I knew I wanted to have the skillset to not only be an oncologist but a palliative medicine physician as well.

Describe your typical work day.

CS: I wish I had one! I have three main roles:

  • Clinical: I see patients with lung cancer 1 day a week and do 4 weeks of inpatient palliative care consults.
  • Clinical researcher: My research is focused on improving the quality of care for patients with cancer with an emphasis on minority populations.
  • Administrative: As director of quality for our health system, I am involved with leading our quality initiatives for oncology, many of which are focused on supportive care.

My days vary. Often a day involves meetings, mentoring trainees, working on quality initiatives, and writing manuscripts and/or grants.

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

CS: My favorite is mentoring the trainees and developing new quality/research projects. The most challenging is dealing with administrative hurdles to move programs or processes forward.

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

CS: The many opportunities available for someone that is dually trained in oncology and palliative care, and has leadership skills in both areas.

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

CS: It is incredibly rewarding. There are endless opportunities that can be clinical, administrative, research, education, or a combination of these.

What kind of person thrives in this professional environment?

CS: Someone who is adaptable to change and can be flexible.

"How I Became” is a 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 to tell us what career paths you’d like to see covered, or to contribute to this series.

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