Always remember why you are a doctor

I was recently asked to speak at hematology-oncology Grand Rounds at Rhode Island Hospital. Instead of my usual topics on gynecologic cancers or sexual health, my colleague, MaryAnn Fenton, had asked me to speak to them about promotion in academics. I was both touched and taken aback that I was now in a position to give that kind of advice. Somehow, when I look in the mirror, I still see myself as fresh out of training (although its been almost a decade since I finished fellowship).

I thought about what I could say and what I have learned. This is what I came up with:

Do what you love. There are many career paths to choose from in oncology. Some of us are motivated by the study of pathways and pathogenesis—the identification of molecular targets and drug discovery. Others are drawn to a certain group of cancer survivors and find a niche in the treatment of organ-specific malignancies. Yet others love the field in general and find their passion in general oncology. These paths do not exist independent of one another, but are interconnected spheres, and all are important and valid careers. We cannot all be drug discoverers and we cannot all be limited in our scope of practice. We benefit from those who provide care in each of these spheres, and in the end, it is the joining of these circles that will move oncology forward in the spirit of translational medicine.
When you start, you should be hungry. As one starts as an attending (whether it be in private practice or academic oncology), you should be hungry. As opportunities arise, take them—whether it be an invitation to write a new protocol or paper, sit on a hospital committee, or squeeze in a last-minute new patient. Every opportunity presents a chance to learn and to grow, and to increase your visibility. It may not be entirely obvious in the present, but the rewards of taking advantage of opportunities will be felt far out into the future. One of my mentors once told me the art of academic medicine is the ability to say “no.” I find it more true now than when I was younger—time is precious and at the end of the day, there is usually more work than there is the time to do it. But, as you are starting out, “no” is not something to be said quickly.
Find good mentors. I was fortunate to have trained at Memorial Sloan-Kettering, and I benefitted from the tutelage of wonderful mentors, like David Spriggs, Richard Barakat, and Nancy Kemeny. When I left MSKCC for Women & Infants Hospital, I took them with me. Mentors are critical to help you develop, particularly as you define your own expertise. For those of us who choose a career in academics, meet with your mentors about the pathways to promotion early on. For me, I found it helpful to know what benchmarks would be used to define my success—when I started at Brown, it was quite specific recommendations from my chair, Don Coustan: “success” at the level of assistant professor would include publication of three first author papers a year, opening two clinical trials, and one national presentation. It was really an important piece of advice for me to make sense of academic goals.
Volunteer to serve in national organizations. Part of what defines success in academia (and on a personal level for me as well) is involvement in national organizations. There are many to choose from, with ASCO being one of the most important for those of us in oncology. Learn about how to get involved on committees (for ASCO, be cognizant of when the solicitation for volunteers happens). Be aware that involvement can come in circuitous ways. For one of the groups I am now involved with, the National Consortium of Breast Centers, I had originally responded to a call for abstracts. This lead to a poster presentation and a discussion with the incoming President of the group, Dr. Jay Parikh, at the national meeting. Two years later I was asked to serve as chair of the poster committee, and following that, was elected President of the group. My involvement in the NCBC has lead to many other opportunities, including increased visibility at ASCO, with whom the NCBC co-sponsors the Breast Cancer Symposium.
Remember why you are a doctor. No matter what you do and what opportunities arise, always remember why you are a doctor, and especially, why you chose oncology. We are here to care for patients, address illness, and (especially in oncology), provide relief. Treat your patients with compassion and never condescend. As your practice becomes busy, avoid the rush in and out of patient rooms and learn to ignore the cacophony of voices telling you “you’re running late.”When I am running late in clinic, the first words out of my mouth to a patient waiting for me are not an explanation of why I am late, but rather an expression of attention—that when the exam room door closes, “I am here for you now, and only for you.” That patient may take 5 or 30 minutes, but at the end of the day, I want to know I did right by her.
Maintain balance. As important as it is to strive to be a focused clinician, dedicated researcher, and/or clinical expert, your happiness and life outside of oncology is more important. In a quote from a 2009 New York Times article entitled “Taking Time for the Self on the Path to Becoming a Doctor” by Pauline Chen, an internist at UC San Francisco, Neda Ratanawongsa, put it best:”…doctors will have a greater capacity to know their patients as a person if they know themselves… (this) requires a sense of balance and an understanding of why they chose to become a doctor. It comes down to their capacity to be an empathic, caring and compassionate provider, and it comes not from their medical knowledge, but from their soul. This is something we should never sacrifice, even temporarily.”