Utkarsh Acharya, DO
So it’s July 1 and you’ve finally arrived in the big leagues as a freshly minted first year hematologyoncology fellow. After having devoted the last decade to countless hours in medical school and internal medicine training, you have arrived on the final path of your ultimate career destination.
With the promotion to the coveted title of “fellow,” this exciting transition comes with the challenges of navigating through the foreign landscape of the vast field that is hematology-oncology. While it is true that some fellows may have the logistical advantage of resuming their fellowship training at their home residency institution, many of the growing pains that accompany the entry to fellowship are ubiquitous.
Almost within 24 hours of receiving this new title, patients (and even colleagues) will cease to acknowledge you as a board-certified/eligible internist. As they read “Hematology-Oncology” on your newly pressed white coat, they will expect you to address management and prognostic expectations at the level of a proficient oncologist.
Learning To Be A Fellow
I recall the excitement and apprehensions that overwhelmed me during my first days as a newly indoctrinated fellow. I have vivid recollections of the constant internal flurry of doubts regarding my ability to grasp my new role and my ability to master the daunting scope of hematologyoncology over the coming years.
Skeptical with concerns about my intellectual reserves and capacity for acquiring new knowledge after 3 arduous years of internal medicine residency, I was naturally distraught over the thought of an impending American Board of Internal Medicine (ABIM) examination, and triaging after-hours oncology pages, imparting prognostic information about life expectancy to highly anxious cancer patients, delineating esoteric side effects of chemotherapeutics I could barely pronounce or barely knew the indication for— oh, and not to mention—learning a whole new specialty. Nevertheless, as the year progressed, the dreaded ABIM boards came and went. Gradually, I was able to maneuver through National Comprehensive Cancer Network (NCCN), chemoregimen.com, and adjuvantonline.com, and I became accustomed to the many common chemotherapeutics we encounter in our daily practice.
Steadily, my apprehensions were allayed and I gradually was able to relay the expected treatment course for my patients and consider contingency treatment plans in anticipation of potential treatment failures for commonly encountered malignancies. I was even able to correctly pronounce many of the numerous tongue-twisting biologics that I used to cringe at the thought of during my early months of fellowship.
I became quite scarce during the many months that I was running the bone marrow transplant (BMT) unit or the inpatient oncology service. Between performing bone marrows, administering intrathecal chemotherapy, transcribing chemotherapy orders, teaching students and residents, and taking care of patients, I could hardly come to grips with where the day went.
Given such a hectic clinical workload, it was difficult to carve out dedicated time to read. Fortunately, reassurance from my senior fellows helped alleviate the guilt, as it is evidently a common theme during your first year. With that stated, it is important to find balance between inundating yourself in your new profession and taking time for yourself and family to enjoy your personal life. With time, I realized that this was the natural course of fellowship during the first year, and that over the coming years, I would have plenty of time to consolidate my knowledge and continually grow as an oncologist as so many have before me.
Your Role As A Consultant
Most new fellows have inevitably interacted with consultants from their prior training/hospitalist experience. Unfortunately for some, they became the poor obedient intern who functioned as a human punching bag as an exasperated fellow went on a tirade over their allegedly requesting a “frivolous” consult.
I recall experiencing the apprehensions and frustrations of serving as a junior fellow for a busy consult service in my early days of fellowship. At times, it was vexing to carry the consult pager with its constant never-ending beeping, as it almost invoked post traumatic stress disorder flashbacks of my time as an overnight house officer not so many years before.
The infrequent but intermittent late afternoon lulls would be equally unnerving as I eagerly awaited the urgent 4:45 PM consult for a thrombocytopenia that the patient had experienced for the past 6 months. Many times, it seemed that I could never be accessible enough to my colleagues no matter how early I reported or how late I left.