Navigating From Fellowship to Early Career in a Middle-Income Country: How To Manage Life-Work Balance

Navigating From Fellowship to Early Career in a Middle-Income Country: How To Manage Life-Work Balance

Guest Commentary

Aug 24, 2021

Dr. Camila Braganca Xavier headshotBy Camila Bragança Xavier, MD

I clearly remember that one of the first thoughts I had when starting my fifth—and last—year of medical oncology fellow training was, "Navigating from trainee to early career couldn't be so difficult, right?" But even being a straightforward person, as I consider myself, equalization becomes increasingly complex when you add variables in your balance. 

In Brazil, some high-profile hospitals, like the one where I'm enrolled in fellowship, have different regimens for attendings. In a nutshell, if you just finished your fellowship, you will start the attending career by joining a senior medical oncologist's team. On the other hand, moving to other health care centers can provide you the opportunity to have patients under your direct care. Both regimens have pros and cons. Counting on the support of senior medical oncologists certainly will help you achieve your long-term career goals, but flying with your own wings can carry you far as well. 

Another particularity in our country is that pursuing an advanced fellowship abroad is highly recommended for becoming a senior medical oncologist. So, another question is whether to apply—immediately after finishing the fellowship or after one period of attending? Not to mention the necessity of finding sponsorship; as our currency is too undervalued compared to high-income countries, financial aid is also relevant.

Whichever pathway you choose, it is clear that you've put so much effort into coming this far, but it is not time to settle in yet. Maintaining your career improvement rhythm is essential. And if that's not challenging enough, add getting married, raising kids, and aiding your family within your workload. Still, you can't overlook the people who are your most significant treasures, and who will support you through the highs and lows.

To help achieve life-work balance for myself, I decided to open my mind and connect with people I admire, both in oncology and in the world beyond. Here I list some steps I followed to encourage myself as I made decisions during my early-career transition.

Seek support in your own institution.

Even if you plan to explore another job, research, or advanced training opportunity, your fellowship program director and preceptors are the people who know you and your work best. During your training years, they had the chance to get a comprehensive view of your strengths and weaknesses. Don't hesitate to share your plans with them, as they can help you find opportunities or recommend your work to others.

Connect with young mentors.

Mentoring opportunities in oncology are known to be vital. Thus, you should use this occasion for much more than conducting research and publishing papers in your areas of interest. Finding a young mentor means you can learn from someone who had to choose a career pathway not so long ago and possibly faced many of the insecurities that you are facing now. The scenario then was probably not much different from the current one in terms of medium- and long-term career opportunities, salaries, and work hours. Furthermore, if you both are open to building a bridge, you will find more than a counselor; you may also have the opportunity to work with a person you trust in the near future. 

Connect with team managers.

Connecting with people responsible for employee selection aids you in understanding what professional features they are looking for and how the selection process occurs in companies and institutions. It doesn't mean that you ought to change your authentic self to fit in, but recognizing what employers value in a candidate makes you feel more comfortable exhibiting your most valuable characteristics. Being ready for the selection process can be tricky. Participating in mock interview rounds with people from another environment can provide you valuable feedback on being clear about your objectives. If you plan to join a team, don't hesitate to be transparent about your medium- and long-term plans with them.

Discuss job possibilities with your co-fellows.

Although the medical oncology field can be very competitive, working with people you trust and mutually encourage is fundamental. Co-fellows usually come from the same background and passed through the same experiences during training. Ordinarily, their technical abilities are very similar to yours—so when it's time to search for a job, one way to distinguish the right opportunities for you is through remarkable personal skills. Seeing an opportunity that doesn't fit your profile but would be a good option for your colleague and the other way round can be an engaging exchange.

Discuss career pathways with your family.

Some things in life occur regardless of our plans, and you can call it destiny or whatever you want. For the factors that are under your control, you must discuss them with the relatives who are on this journey with you. Decisions about having kids, moving to a new town—or a new country—and salary affect every family member. Each household composition performs in a balance, and there is no one-size-fits-all solution in this field. When you put yourself in your beloved ones' shoes, you will notice that it is reassuring to feel like part of the plan.

Enjoy social media but avoid the myth of perfection.

One of the most enjoyable daily practices I have in oncology is checking my Twitter account. When I started using Twitter, my initial idea was to reach people worldwide and access medical education content like breaking news in oncology and conference abstracts. As a plot twist, what drives me the most now is to engage with inspiring accounts that share the accomplishments of women, immigrants, and underrepresented populations in medical oncology. The more underrated you are, I genuinely believe that your achievements can be said out loud to inspire others. Since nothing has only one good side, you must be aware of the perfection myth in social media. Not everything that is said to be easy really is, so don't compare your achievements to what you see—you are doing just great in the circumstances that you are in. 

Last but not least, you must know yourself and act accordingly. If you place your patients and the people you love and respect first, you will always be going in the right direction. Career planning is essential, but the world keeps moving, and new opportunities happen all the time. In the meantime, do your best and enjoy life!

Dr. Bragança Xavier is a medical oncology fellow at Hospital Sírio-Libanês of São Paulo, Brazil. She currently contributes to the ASCO Question Writing Group and is a 2021-2022 member of the ASCO Trainee and Early Career Advisory Group. Follow her on Twitter @CamilaBragancaX. Disclosure.

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