Career Paths in Medical Oncology

Robert Maki, MD, PhD, Northwell Health Cancer Center Institute, New York, breaks down career path options for fellows in medical oncology at the 2019 Great Debates and Updates in Gastrointestinal Malignancies meeting. 

Maki - Great Debates GI from HMP on Vimeo.

Transcript: 

Dr. Robert Maki:  Hi, I'm Bob Maki. I'm a medical oncologist working on Long Island in New York. I work at the Northwell Health Cancer Institute as well as some time over at Cold Spring Harbor Laboratory.

In one of the sessions, we met with some of the fellows to discuss differences in terms of career paths. Either pursuing a more traditional path in research or a more traditional path in clinical management of patients.

About 45 percent of people who finish their fellowship in medical oncology go into private practice and spend the bulk of their time seeing patients. Whereas about 35 percent of people who finish their fellowship stay in academic practices in some way, shape, or form. Beyond that, there are some people who work, for example, the VA System, or have gone into industry or do other things with their training.

We discussed the pros and cons of both of those contexts for working. And really, the fluidity and the spectrum of opportunities that are available really across that whole range of seeing patients and doing research - both in terms of standard clinical care according to guidelines, clinical research, translational research, as well as basic science research for some people who have, often times, prior training in basic science research where they would like to continue that as a career path.

Even people in the most academic programs, a lot of them will end up in standard clinical therapies for patients, providing a good standard of care. In fact, as you know, only about four percent of adults end up on clinical trials.

So a lot of the things we do, at least in medical oncology, represent administration and follow up of those standards of care. Just how much you can take part in research studies really will vary based on your training and your interest and, to some degree, the opportunities that have presented to you  n your particular program.

There's some programs in hematology oncology that are largely clinical with only, let's say, a few months of research over the three years of the program. Whereas others really try and front load the clinical experience over the first year and then just provide a continuity clinic to allow people to do more research over the last two years of their fellowship.

Some people do stay on and either do other lab research or, as new and burgeoning fields, working in big data, sort of a dry lab approach. Outcomes research is also quite a bit different, but still constitutes research of a different nature. Questions about access to care and the quality of the administration of that care. Especially given the rapidly evolving standards of care as they go along. So there really are a number of paths forward depending on your training.

Some of the key points that came out were to try and find a mentor to help guide you through and help you make those decisions. If you're lucky enough to do some research, then try and find good people to work with.

Just in general, whether you're in clinical practice or in research, you have to play well in the sandbox together. It really is a team sport, and you really do rely on your colleagues a lot. So, treat them well and know the Golden Rule. If you treat your colleagues well, they're going to treat you well. You'll hopefully develop worthwhile relationships over the course of your career.