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Oncology Careers: Knowing When to Make the Right Move

By Shannon Aymes, MD, MDalert.com contributor.
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Oncology practice involves a multidisciplinary team of specialists that includes medical oncologists, surgical oncologists, radiation oncologists, and psychologists.

Oncology is advancing rapidly, providing the physician the opportunity to form strong relationships with patients and to take on leadership roles.

With performance-based medicine becoming an integral part of medical practice, oncologists are faced with the need to make decisions regarding how to integrate best practices, measures of performance, and clinical performance data into the practice setting of their choice.

Choosing the Right Practice Setting

Figure 1. Keck School of Medicine of the University of Southern California.

 

Academic Hospitals

For someone who has chosen to practice oncology in a major academic setting or teaching hospital, how one spends the day can be quite variable. For example, an oncologist who focuses on research may divide his or her day between caring for patients, conducting research, applying for grants, preparing manuscripts, and attending meetings. An academic oncologist is also involved in mentoring and training and in presenting at conferences and outside institutions. 

Another important role of the academic oncologist is teaching. This may involve the bedside teaching of medical students, residents, and fellows, lecturing, and participating in case discussions. Mentoring medical students or leading electives may require a substantial level of commitment -- but it can be quite fulfilling.

Finally, beyond clinical care, an academic oncologist may travel to participate in expert panels and in community educational programs or board programs.

Factors that may cause a graduate not to choose a career in an academic setting include a high level of educational debt and a potentially smaller income. Studies of career trends among graduate of academic hematology and oncology programs reported that 40% choose a nonacademic career setting.

The surveys also noted that women, those with experience in basic research, and those with other graduate degrees were more likely to report interest in an academic setting. Overall, after adjustments for debt, years in training, age, sex, and published research, having a mentor was associated with interest in an academic career.

Private Practice and Community-Based Hospitals

Community-based and private oncologists typically spend most of the day in an office setting. The office may be in a professional building, adjacent to a hospital, or in a cancer center. The office is where the oncologist sees patients during initial and follow-up visits, and during sick visits for case management. In certain cases, chemotherapy is administered in the office.

Also, new consults and admissions at the hospital typically require daily rounds. An integral portion of the private oncology practice involves the coordination of patient care between social workers, infusion nurses, pharmacists, and dietitians. Offices that participate in research may also have trial coordinators and data managers.

Beyond patient care, a private oncologist may spend a portion of the day meeting with hospital committees, management, reviewing business development and operations and performance improvement, and participating in the activities of regional and national oncology organizations.

Finally, community practice does not isolate an oncologist from teaching opportunities. The private practice oncologist may volunteer to teach office-based practice to trainees from a local educational institution.

Interestingly, in a 2014 survey, 36.8% of the oncology respondents reported an preferences in private practice or nonacademic settings. The 2014 American Society of Clinical Oncology (ASCO) analysis of the location of oncology practices revealed that only 5.5% (600 oncologists and hematologists) were based in rural locations. Rural patients’ lack of access to adequate cancer care results in longer travel times to places where they can receive care.

With private oncologists subjected to increasing regulatory and financial pressures, they are shifting to larger groups, hospital employment, and staff model practices. Likewise, the turnover pace in oncology practices accelerate during the 5 years following fellowship. 

Other Practice Settings

Medical oncologists also have the option to work in settings such as government agencies, the pharmaceutical industry, and free-standing specialty cancer centers.Government settings for oncologists include the FDA, CDC, NCI, and the CA.

Oncologists working as investigators for the NCI may focus on research, development, or other crucial endeavors. Investigators may also focus on specific diseases and even cancer prevention.

The FDA offers fellowship programs to train oncologists in the process of research and regulations. More experienced oncologists at the FDA focus on creating guidelines for the approval of new agents, regulations, and trial design.

The NCI and FDA work closely together to identify new biomarkers for new agents, cancer prevention strategies, and for developing a foundation for cancer bioinformatics.

Of note, governmental employees are restricted regarding the companies in which they may hold stock and are not allowed to consult for industry. Furthermore, governmental salaries are typically less than those of oncologists based in private practice.

Medical oncologists are involved in many aspects of the work of both small biotech firms and large pharmaceutical companies. They play roles in research, commerce, management, and regulatory aspects. 

Free-standing specialty cancer centers employ multiple specialists in a setting that allows them to work simultaneously in patient care and research. Such specialty centers require a central organization to achieve success in cancer care and research.

Academic cancer centers, are typically not-for-profit entities that are not part of a larger organization. This offers many benefits to both oncologists and patients.

In the environment of a cancer center, physicians and researchers can focus their resources solely on cancer, with simplified administration and control of revenue and fundraising. Cancer centers can attract excellent clinicians by having ties to respected medical schools and providing an environment ideal for scientific discovery.

Conversely, there are also for-profit cancer centers; these offer standard chemotherapy and radiation but also unconventional interventions, including acupuncture, yoga, and reiki.

For-profit centers are known to rank high in patient satisfaction. However, concerns have been expressed about the high survival rates of their patients, specifically those with non-small cell lung cancer (NSCLC). Noted reasons for the higher rates of cancer survival include the possibility that the patients accepted generally are younger, and that only selected patients are accepted. For-profit often subsidize the care of charity patients

Finding a Work-Life Balance

When asked about reasons for choosing a particular practice setting, oncology fellows noted that they were influenced by experiences with patients while training, personality, job satisfaction, and the intellectual setting of the intended practice. Perceived independence and job security were associated with a lower interest in academic practice.

Surveys conducted after in-training examinations found that oncology fellows with higher levels of educational debt were more likely to choose private practice. Furthermore, when the fellows were compared with practicing oncologists, the practicing oncologists reported less satisfaction with work-life balance and choice of specialty but a better quality of life and less fatigue. This difference may be related to oncology fellows having inaccurate expectations regarding work hours after graduation.

During training, oncology fellows may develop a mentality of delayed gratification, which can lead to an imbalance between their work life and personal life. Coping with stress, emotional exhaustion, and burnout is associated with work-life imbalance.

Physicians in training sometimes develop a coping skill termed “survival attitude” that causes them to give up self-care, relationships, and spiritual activities, so that they have less opportunity for recovery after stressful days at work.

There are several strategies oncologists can use to improve work-life balance and prevent burnout. First, they can assess their priories and values in regard to their personal and professional lives. Secondly, identifying what makes their job meaningful to them may improve job satisfaction. Finally, oncologists need to balance their personal needs with work, allowing time for hobbies, reflection, sleep, nutrition, and exercise.

The Changing Face of Oncology Practice

Finally, healthcare reform encourages patient involvement in treatment and physician communication regarding the true benefits and costs of treatments. Performance-based care has led to the development of payment reform models that support quality improvement, federal incentives, data registries, and patient-centered medical homes.

The practice of oncology in the United States is currently evolving under the pressures of cost of care and rapid development of new agents. However, one aspect remains constant – medical oncology provides physicians the opportunity for variety, innovation, job satisfaction, and the development of close patient relationships.

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