Everybody is aware that career choices in oncology abound these days. But when you ask fellows what job they are interested in once they complete their fellowship, many just don't know-even in their third year.
Everybody is aware that career choices in oncology abound these days. But when you ask fellows what job they are interested in once they complete their fellowship, many just don’t know—even in their third year. This isn’t surprising, because we’re so busy with patient care and learning more about oncology and hematology that little time is left to contemplate our careers after fellowship. Instead, our time is spent adapting to our new fellowship training programs in our first year and then consolidating our knowledge in our second year. Then before we know it, it is time to apply for a job. Although we have waited for this opportunity for many years, now that it’s arrived most of us feel ill-equipped to make a decision. For this reason, organizing an oncology/hematology fellows’ career day is very important.
A fellows’ career day is best held in an informal setting— and ideally with the involvement of a few local hospitals’ fellowship programs. You should invite a diverse group of fellows so as to ensure that everyone is exposed to a number of career choices. In my opinion, the career day is best held between September and December, as the first-year fellows have by then adapted to their respective programs, secondyear fellows have not started looking for a job, and third-year fellows are gearing up to sign their employment contracts. There are a few key elements that should be covered in the career day, which I will discuss here.
Clearly, career options will be the primary theme of your career-day program. Almost all careers in oncology can be categorized into 3 areas: academic practice, communitybased practice, and practice in industry or government. According to FREIDA Online, almost as many oncology fellows go into academia as community practice.1 So, it is important that both fields be equally represented. While the goal of academic practice is patient care, research, and teaching, community oncology is more focused on patient care. Most fellows already know about academic-based practice because most fellowship programs are based in academic institutions (of course), but it is still useful to get a faculty member’s perspective on the pros and cons of academia. Also, for the appropriate audience, discussing career choices in basic lab research will be helpful. On the whole, however, most fellows are less familiar with community oncology practice. It will be very helpful to have an open conversation among practitioners from these 2 disciplines to discuss the various aspects of these career tracks.
Whereas the majority of fellows go into either community or academic practice, careers in industry or pharmaceuticals are less common. And to be frank, oncology fellows rarely go into the pharmaceutical industry or the FDA; however, given the current scenario of a rapidly growing drug armamentarium, this is becoming a more attractive option. Having people from industry interact with the fellows will open your eyes to career options beyond the traditional choices.
Physician Recruitment Process
It’s not enough to merely learn about the nitty-gritty details of various career options; it is also important that fellows learn the basics of launching a career search. It is helpful to discuss the appropriate time to start a job search, resources to use during your search, tips on writing your CV, the qualities or accomplishments that each career choice requires, how to prepare for the interview day, and what questions to ask during the interview.
Physician recruitment agencies are a great resource, so try to have at least 1 such representative at your career day. As you’re undoubtedly aware, most fellows receive job offers from the time they start their fellowships. But it is important to match your needs with the appropriate job description. The physician recruitment agencies can get basic information from you, determine what you’re looking for, and match it to the appropriate jobs. There’s no sense in going through hundreds of job advertisements when you have a certain job description in mind. If you have visa restrictions, for example, it is no use seeking a job at an employer that does not sponsor your particular visa.
Contract negotiation is an important aspect of starting a job, yet no fellow is ever trained in it. Although most fellows hire a lawyer, that won’t help them learn about the various contract terms. Ultimately, it is you who will be up all night taking extra calls, even when you were told in the contract that calls would be “equitable.” (Yes, I learned that equitable doesn’t mean “equal”!) Also, many lawyers are not that familiar with contract negotiation in the health care fields, so you should retain a lawyer experienced in these matters who can highlight the important points in the contract.
With nearly half of all fellows being international medical graduates, it goes without saying that visa concerns should not be ignored.1 With particular job restrictions and J-1 waiver/H1-B visa processing methods in the United States, most fellows are in the dark about how to go about finding the right job with their particular visa. A great addition to your career day, if it can be arranged, would be an immigration expert and/or lawyer or an agency that deals with visa applicants. Because this might be relatively useless for fellows who are not in the United States on a visa, it might be a good idea to present this information at the conclusion of the career day or at an after-hours meeting for interested people only.
Fellowship is all about learning and expanding your knowledge, but the ultimate test of your efforts will be the medical examining boards. Given that preparation for these boards and finding a job go hand in hand, it will be a good idea to teach attendees the best methods of preparation for their boards. Also appreciated will be advice on how to obtain state licensures and CME requirements.
Role of New Physicians
Life after fellowship is another important area to cover at your career day. This is most important for third-year fellows, because once you sign on the dotted line of your contract you’ll be on your way to your new career. It will be crucial for you to learn how to contribute profitably to your practice, how to make contacts, how to approach difficult cases, and whom to ask for help.
Oncology is a difficult field emotionally; most of us already have experienced this downside of our field. And it doesn’t make it easier when you become an attending physician to learn that you are the person who is solely responsible for making potentially life-altering decisions for your patients. For example, maybe you chose a particular chemotherapy regimen that your patient did not tolerate well, and she ended up having an adverse event or even dying. How do you deal with this situation? Or when do you decide you’ve tried enough and it’s time to let your patient go? As a new attending physician, how will you continue to maintain your inner peace and empathy? This would be a great philosophical discussion to have at the career day.
Its drawbacks aside, oncology is an exciting field to be in. Most fellows (>99%) will be employed at the end of their training program.1 And with the anticipated shortage of 3800 oncologists by 2020, the demand far exceeds the supply.2 A fellows’ career day is an ideal opportunity for you to learn and explore your career possibilities. Its goal is to ensure that each fellow gets something out of it. By the end of the day, the first-year fellows should know their career options and best resources for boards preparation, the second-years should know how to embark on the process of job hunting, and the third-years should learn about contract negotiation and how to prepare for their roles as new independent physicians. With a bit of planning, your fellows’ career day will be a great learning experience for all attendees.
1. American Medical Association. FREIDA Online. http://www.amaassn. org/ama/pub/education-careers/graduate-medical-education/ freida-online.page. Accessed February 2, 2012.
2. Hortobagyi GN. A shortage of oncologists? The American Society of Clinical Oncology workforce study [published online ahead of print March 14, 2007]. J Clin Oncol. 2007;25(12):1468- 1469. doi:10.1200/JCO.2007.10.9397.