Navigating Your First Years as an Early-Career Oncologist

Jul 20, 2020

By Sumanta K. Pal, MD

It is June 30. Maybe you are wrapping up a rotation on the bone marrow transplant service, or possibly medical oncology clinics, or perhaps finishing up a light research or elective block as you round out your hematology/oncology fellowship. You are eager and excited to jump into your brand-new faculty position on July 1. You've earned it. You've worked hard through high school, college, medical school, residency, and fellowship to get to this point. It’s your first—and possibly your last—job as a full-fledged, practicing physician! 
I remember that point in my life vividly. The year was 2009 and I was fortunate enough to transition from my fellowship at City of Hope into a faculty position. I’ll walk you through my thought process in selecting this faculty position, and some of the first moves I made once I had settled in. 
My research experience during fellowship was varied. I had mentors from multiple fields. Joanne Mortimer, MD, guided me in the field of breast cancer during my time at City of Hope. I had a passion for work in the area of HER2-directed therapies, having spent time in the lab of Dennis J. Slamon, MD, PhD, at UCLA during residency and medical school. Within the Slamon laboratory, I worked under the direction of Mark D. Pegram, MD, now on the faculty at Stanford. But at City of Hope, I was also deeply entrenched in kidney cancer research thanks to my chair at the time, Robert A. Figlin, MD. 
In looking for my first job, I had interviewed for positions far and wide. I had considered a position at the University of Miami focused on breast cancer, an offer at the Fred Hutchinson Cancer Center on sarcoma, and an offer at City of Hope on genitourinary cancer. I decided on the latter option for a number of reasons. 
First and foremost was family, and I will never regret prioritizing them. I grew up in Southern California, and I'm incredibly fortunate to have my parents, my sister, and my in-laws all within a 10-mile radius. I can't tell you what a strong impact family has on my day-to-day quality of life. There's nothing like having a rough day at the clinic and then coming back and sharing a meal at a table full of folks who love you. As you move beyond your years in training, don’t underestimate the benefit of having a close family support network around you. 

Choosing a Position: Academic Considerations

The second part of my decision was predicated on two academic factors. I looked across the various areas of research I had dabbled in—kidney cancer, breast cancer and even some work with heme malignancies—and saw myself making the most progress in kidney cancer research. I was starting to develop some translational studies in kidney cancer as a fellow, and even beginning to draft some investigator-initiated trials. 
Another major component of my decision was “academic momentum.” I saw immense value in the premise of continuing my career journey at the same institution. Some perceive downsides to this; there's always the risk of being considered a "super fellow," a junior faculty member who is scutted out by colleagues and stuck with the least interesting opportunities. There is no doubt some truth to this, and it does take some time for senior faculty members to embrace the transition you are making, but this can be overcome quite quickly. The benefits here far outweigh the risks. As you transition from fellowship into a job at the same institution, you have the perks of knowing the ins-and-outs of the way clinical trials are budgeted and run, the way that studies are pushed through the Institutional Review Board, the way tissue is processed and collected for translational studies, and multiple other nuances that will give you a leg up. The other obvious advantage, of course, is that you can build continuity with projects that you have developed as a fellow and can carry these on through your junior faculty years. There are big expectations when you take on your first junior faculty position—your chair has granted you protected time and expects to see multiple publications out of it. Having projects already in progress from fellowship offers a huge boost. 

Finding Success in the First Years

So far I’ve walked you through my considerations in picking that first job. What tips do I have once you’ve chosen a position and begin to navigate through those first several years out of fellowship? 
Set a goal. My first rule is to develop a very simple and straightforward 10-year plan. My goal when I joined the faculty at City of Hope was to build a widely respected and recognized program in renal cell carcinoma and genitourinary malignancies. It is a vague, somewhat lofty ambition, but having this as the guiding principle for every one of my subsequent moves was critical. 
Prioritize patient care. Developing a well-known program rests first on delivering world-class care. Therefore, my first objective was to spend lots of time with my patients, learn from them, and offer the level of care that I would expect for my loved ones. In those first several years, and still to some extent today, I have a sense of urgency around every consult or new patient that I see. If a colleague extends a hand and needs assistance in caring for a complicated case of kidney cancer, I am happy to drop everything and attend to the patient. A patient-centric philosophy is key to any successful program—a robust research portfolio alone is simply not enough. I see many junior faculty members trying to lobby for less and less time in the clinics. In my mind, that is a mistake for all but the clinician-scientists who are running labs. If you wish to pursue a career as a clinical trialist, seeing many patients within your specialty and rapidly gathering experience is essential. 
Cultivate relationships within your institution. For my second objective, I spent a great deal of time developing projects with a diverse array of colleagues. I had taken a similar stance during fellowship. I arranged at least a dozen sit-downs with laboratory scientists, bioinformaticians, epidemiologists, and other folks with whom I envisioned potential collaborations. I launched into pilot projects with many of these individuals, taking on a breadth of commitments that is only possible with the free time you will have during your early years on faculty. Although many of these collaborations were flops, a handful were simply golden—in fact, these are collaborations that I still maintain today. 
Look outside of your institution for support. I had mentioned that my mentor Dr. Figlin, a world-renowned kidney cancer expert, had inspired me to pursue a career in genitourinary cancers during my fellowship at City of Hope. Ironically, he left the institution shortly after I joined the faculty. He immediately became my first external mentor, followed by multiple others over the years. Toni K. Choueiri, MD, who runs the kidney cancer program at the Dana-Farber Cancer Institute, was one of the leaders in the field I met right out of the gate. Dr. Choueiri still to this day remains on speed-dial for virtually every career decision I make—whether I need advice on how to apply for promotions, which trial to open at my institution, or what to have for lunch, he is always there for me. I would also advise junior faculty to immerse themselves in the cooperative groups. Whether it is ECOG-ACRIN, Alliance, NRG, or SWOG (my personal favorite), these groups house the most brilliant minds in their respective disciplines within oncology. In the SWOG Genitourinary Cancers group, I have been blessed to work hand in hand with Nicholas J. Vogelzang, MD, FACP, FASCO, of Comprehensive Cancer Centers of Nevada, and Primo Nery “Lucky” Lara Jr., MD, of UC Davis. As with Dr. Choueiri, they are on my short list of individuals to call for critical career choices. 
Although I could continue to list dozens of different tips to guide you through your junior faculty years, I will leave you with just one more. Read, write, and repeat. These are the sage words of my chair, Ravi Salgia, MD, PhD, which he repeats at virtually every meeting that I have with him. And you know what? He is absolutely right. You must continue to invest yourself in understanding the translational science that underlies your field through reading, and you must continue to write up the data that you are obtaining in the clinics in real time. Set arbitrary goals for yourself in this regard. I track my progress on MEDLINE on a daily basis. It is often like watching a snail run a marathon, but I do set a multiyear goal for the number of papers I hope to write. It’s a number that is quite outlandish, but working towards this number keeps me focused on developing highly productive collaborations. 
With the sea of meetings, conferences, and journals out there, it is easy to lose sight of the fact that we are here first for patients, and second to produce meaningful research that will benefit patients. Keep these simple tenets in mind and I can almost guarantee you that you will encounter success in your academic career!
Dr. Pal is a professor in the Department of Medical Oncology & Experimental Therapeutics at City of Hope Comprehensive Cancer Center. He serves as the SWOG Renal Cell Carcinoma Translational Medicine chair and is an associate editor for Cancer.Net, ASCO’s patient information website. Follow him on Twitter @montypal.
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