The American Society of Clinical Oncology projects significant shortages of practicing oncologists compared with patients with new cancer diagnoses and existing cancer by 2025.
The American Society of Clinical Oncology (ASCO) projects significant shortages of practicing oncologists compared with patients with new cancer diagnoses and existing cancer by 2025.1 For an oncologist entering the workforce, this is valuable news. The job search for physicians in the COVID-19 and post–COVID-19 era will undoubtedly be different from any years before 2020. Nonetheless, fellows in hematology-oncology graduating in this time and recruiting in the next year will still have to go through requisite steps to secure desired jobs and positions. Through my own experiences this past year, I hope to highlight some key elements of the process, including unexpected pitfalls and pleasant surprises.
Growing up, I spent every vacation and many weekends in Maine, and even went to college in Brunswick, Maine. But, I didn’t learn about a nonprofit health care system called Maine Health until the 2019 ASCO Annual Meeting when I was a first-year fellow. Maine Health operates the state’s only academic medical division and is very closely affiliated with Tufts University, my residency alma mater.
I thought this would be a no-brainer in terms of personal and career fi t. I had my first job interview there in January of my second year of fellowship—nearly 18 months before graduation. The interview went well and both parties left feeling that we were close to being on the same page.
Summer came about and I went on my second, seemingly perfunctory, interview and thought that I had a job lined up. Ultimately, the job offered to me by Maine Health turned out not to be the one I thought I’d have. Instead, they had an opening for a community oncology job with academic affiliation in Brunswick.
The role and location of the practice did not match my expectations. It’s difficult to convey in print the disappointment that I felt at that time, knowing that I’d have to embark upon more interviews and that my dream of settling down in Maine as an academic oncologist would not yet come to fruition.
I uploaded my curriculum vitae to online physician job sites and within days I was fielding interview requests from health systems, hospitals, and practices around the country. I learned so much, so quickly about the job market only after opening myself up to various opportunities across the entire country. However, had this all happened later in the job search cycle, it would have been a painful lesson to not invest too heavily into your 1 potential dream job.
As much as I love Maine, I knew I didn’t want to practice only in Brunswick. Location has a significant influence on the type of opportunities available to you and may affect the range of compensation you can expect. For example, New York City, Boston, and San Francisco are known for low physician salaries overall and hematology-oncology is no exception.
However, these cities offer copious opportunities for academic faculty positions because of their tight clustering of medical schools and cancer centers in a small geographical region. Similarly, these are some of the best cities for those considering a pivot to an industry job.
After several years as an academic oncologist, preferably with clinical trial experience, you will likely see high demand for your skill set from pharmaceutical companies, regulatory agencies, and clinical practices. A skill set that includes patient care and research experience allows for a transition to almost any oncology job out there, and major cities allow you to change jobs or industries while staying in the same area.
That said, there are advantages to working outside major population centers as well. There is great demand for well-trained oncologists to practice outside big cities in the United States. One in 6 Americans lives in a rural community and patients there have similar cancer incidence to those in urban centers.2
I realized during my interview process that many communities with lower population density have impressively sophisticated medical communities where I could employ my skills and training. Contrary to most professions out there, physicians, including oncologists, are often financially rewarded for practicing in more remote locations. Many rural or suburban practices off er larger sign-on bonuses, loan repayment, and higher starting salaries than those in urban locations.
Finally, consider the implications of noncompete clauses in offers of employment when choosing where to work and live. In my experience, almost everything in a contract, including a noncompete clause, is negotiable, though sometimes unavoidable. However, if your contract includes a geographical noncompete clause and you work with the biggest player in a more remote community, you may be forced to move if things don’t work out.
Of course, there are benefits and drawbacks to the different types of oncology jobs (TABLE). You’ll have to weigh financial considerations, potential for teaching or research, level of autonomy, influence over health policy, and overall population impact. During training, we have largely been exposed only to academic models of medicine, practiced within the confines of a hospital or health system, which does not encompass the full range of professional opportunities.
Personally, I had eschewed ideas of joining a private practice and only somewhat considered moving to industry. However, during this job search process, I realized that I highly value my autonomy and independence, and typically do my best work when I am my own sole motivator.
I also wanted to maintain a strong presence in clinical trials. I found a compromise by joining a private practice with a strong clinical trials program, recognizing in advance that much of my research time will have to come out of my free time after a potentially busy clinic day.
Some of my co-fellows chose to pursue clinical educator or research physician academic tracks at various academic centers where they will have to climb the ivory tower and navigate health system politics while writing investigator-initiated studies and building their reputations.
Whether you join a practice as a partner track junior physician, join a pharmaceutical company as an associate medical director, or join an academic center as junior faculty, gratification is unlikely to be instant. It will require hard work, consistency, and perseverance. Tian Zhang, MD, an academic genitourinary specialist and clinical trialist at UT Southwestern Medical Center, says, “Delayed gratification is gratification enough.”
In the end, aside from the perks and annoyances of our jobs, we must be content with the work that we do day in and day out. I hope you will explore many opportunities to discover your ideal job, and I hope that you will find fulfill-ment with the job you ultimately choose.