How I Became a Radiation Oncologist and Advocate for Health Equity

Jul 18, 2018

Since 2016, Karen M. Winkfield, MD, PhD, has been an associate professor of radiation oncology at Wake Forest Baptist Comprehensive Cancer Center, where she also serves as associate director of the Comprehensive Cancer Center and director of the Office of Cancer Health Equity. She was previously an assistant professor of radiation oncology at Massachusetts General Hospital. Dr. Winkfield is past chair of the ASCO Health Disparities Committee, chaired ASCO’s Roundtable on Addressing Barriers to Clinical Trial Participation, and participated in the Leadership Development Program.

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

KW: I like to think that my career chose me. Nothing about my career trajectory was “normal.” It wasn’t even clear that I would go to undergraduate school—not because I lacked capacity, but simply because of family dynamics. So my pathway to medicine was full of diversions and pit stops. My undergraduate education started in classical music as a voice major. After 2 years, I elected to withdraw from school to focus on my performance career. Four years later, I made my way back to Binghamton University and completed my undergraduate degree in biochemistry. As a Howard Hughes Undergraduate Fellow in biochemistry, my goal was to become a world-renowned basic scientist. However, since my research was in insect enzymology and I had no context for human disease processes, I pursued a combined MD/PhD to learn about the human condition—not to become a practicing physician. Duke University became my school of choice because of its unique curriculum at the time, which contracted 2 years of didactics into 1 and moved clinical exposures to year 2. This resonated with me, as it was important to focus my dissertation research on an area of clinical medicine that was meaningful. It was an amazing privilege to care for patients and I truly enjoyed my time on my gynecologic oncology rotation. This was my first exposure to clinical oncology and it solidified my desire to pursue a career focused on caring for individuals with cancer.

I can still remember the young lady with metastatic cervical cancer I met on the inpatient gynecologic oncology service who was terrified about her disease and prognosis. I was a second-year medical student; of all of the members of the team, my greatest asset then was time. So, that is what I gave. I sat with her for several hours—just listening. We talked about her fears, her concern for her young children, what her husband would do when she was gone. It didn’t matter that we were not of the same race/ethnicity or that she came from a different country. We were just two women having a poignant and meaningful conversation. She changed my life. That was the only time I received flowers from a patient after they were discharged from the hospital. I like to think that meant I changed her life as well. 

Describe your typical work day.

KW: Due to the nature of my varied roles, I don’t really have a typical work day. I have 2 full days of clinic that combine new patient consultations and follow-up visits with radiation treatment planning, assessment of patients already on treatment, and resident education. The remaining 3 days are spent in my dual role as associate director of the Comprehensive Cancer Center and the director of the Office of Cancer Health Equity. My roles help to address the mission of the cancer center to reduce cancer health disparities. There are currently five full-time employees in my office and we focus on community outreach and engagement, educational programming, and improving access to clinical trials. My day is full of meetings, research, writing, talks, etc. No two days are alike and I love it this way.

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

KW: My passion is to improve cancer health equity. This will always be a part of my personal mission and I am so fortunate that the Wake Forest Baptist Comprehensive Cancer Center has provided a way for me to work within my passion for a living!

What is incredibly challenging and frustrates me deeply are health care inequities. My passion and mission are related to the fact that the United States—a place that claims to be progressive and a world leader—allows people to die because they cannot afford the exorbitant costs associated with care in this country. The costs are multifactorial and the stakeholders are many. But when I am in clinic and have to spend time bickering with insurance carriers about the number of radiation treatments a woman with breast cancer can receive, there is a huge problem.

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

KW: I wish I had known a bit more about population health. I’m essentially learning on the job, as it were, since my doctorate is in basic science. Although I specialize in community engagement, the techniques and metrics associated with population health are new to me. I would be more effective in my work had I learned some of the research strategies associated with social science and population health earlier.

I also stumbled upon radiation oncology as a clinical practice. I was working on a project evaluating the phosphoproteome of breast cell lines following irradiation—it was due to this project that I even learned about radiation oncology as a specialty. That was three years after I began medical school! My hope is that we can begin exposing students to careers in oncology sooner in their medical education.

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

KW: It is an honor and a privilege to care for patients with cancer. The capacity to engage another human being during one of the most vulnerable, scary times in their lives is a unique blessing. I can’t tell you how many times my life is changed based on patient interactions. We are curing cancer, one patient at a time. Yes, there are times where we lose a battle, but the war is being won.

What kind of person thrives in this professional environment?

KW: It depends on which environment you are referring to. In academia, we tend to have very eclectic job descriptions due to the requirements of patient care, research, and training the next generation of oncologists. I like to add the fourth leg to that stool: community outreach and engagement. In my view, every physician should be engaging the community and working to improve population health. So yes, it requires someone who doesn’t mind being pulled in several directions, but a person who also knows how to prioritize. One of my mentors says, “You can do everything you set your mind to, just not at the same time.”

“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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