Bristol Myers Squibb (BMS) and the BMS Foundation are committing $100 million to support the Diversity in Clinical Trials Career Development Program (DCTCDP). A partnership with National Medical Fellowships (NMF), the program seeks to advance clinical trial diversity and improve access to quality health care in underserved patient populations in the United States while developing a more diverse medical workforce, including oncologists and oncologic investigators.

"This partnership with the BMS Foundation taps into 2 different things. There is the Pipeline Program, which is providing exposure to underrepresented minority medical students. That’s largely modeled after the Primary Care Leadership Program, but this will have a focus on pathways in clinical research specifically,” said Joy L. Jones, PhD, director of scholarships and programs for NMF. The 75-year-old organization is the only national group in the United States dedicated solely to providing scholarships to students in groups underrepresented in health care. “It’s the scholarship program, the Career Development Program, that takes us into an area where we’re providing support to practicing physicians. Outside of their residency, most of the support that we provide is for students in training. This expands the range of underrepresented minority health professionals that we are supporting.”

DCTCDP plans to train and develop 250 racially and ethnically diverse clinical investigators who have a demonstrated commitment to increasing diversity in clinical trials. Another 250 medical students from underrepresented minority groups will be introduced to clinical research career pathways. The program will assist investigators in building capacity and establish-ing new clinical trial sites in communities with diverse and heavily burdened patient populations. 

Robert Winn, MD, director of the Massey Cancer Center at Virginia Commonwealth University in Richmond, will oversee the DCTCDP. Winn, 1 of only 2 Black directors of a National Cancer Institute–designated cancer center, said this initiative grew in part out of racial issues highlighted by the Black Lives Matter movement, but added that diversity among providers just makes good sense.“There’s the low-hanging fruit that we know from the literature. Folks who actually have people who look like them, sound like them, come from the same backgrounds—patients tend to feel that they’re getting better care,” he said. “But I actually take a different tack. I think that diversity in health care matters just like it does in businesses. Most businesses, most top-notch businesses, recognize that by having diverse groups at the table, bringing knowledge and bringing nuance to the table, strengthens the group.”

Moreover, it is well established that people of different races and ethnicities have unique biomarkers. For instance, African American women present with breast cancer earlier in life and with greater incidence before they are age 50 years, develop histologically more aggressive tumors that are at a more advanced stage at presentation, and have a poorer disease-free and overall survival than their White counterparts.

 However, one reason investigators did not recognize that the presence of the 

 gene was associated with increased risk for breast cancer among Black women is that these women, and Black patients in general, are often not included in clinical trials. Findings from the FDA on racial and ethnic participation show that approximately 80% of trial participants are White. Black Americans represent 13% of the US population but only 7% of participants in clinical trials.

If medicine is serious about eliminating racial disparities, Winn said, improving diversity in clinical trial participants is crucial. Not only will that improve medical knowledge, but participants in clinical trials will also receive more attentive coverage and have better outcomes.

However, many Black patients are often distrustful of the medical establishment, particularly older people with direct experience of being denied care because of race. That skepticism is prevalent across the culture.

“There’s a new generation of misinformation and disinformation that has the potential of increasingly doing us harm. And I think that on the social net-works, there’s a fair amount of misinformation and disinformation that is actually dissuading people from even doing the things that might actually be practical just to save their lives,” Winn said. “This may seem like ancient history, but early in [the pandemic], last February, March, April, we had people talking about, ‘Black folks can’t get COVID-19.’ ”

To address these disparities, Winn said the DCTCDP will use “multilevel mentorship” to help young physicians develop soft skills that are vital but rarely taught. He added that this is the first program designed to help young investigators develop their knowledge beyond designing and carrying out a trial.“What we are also doing [in] this program, the first ever, is trying to develop a skill set of having those physicians actually also know how to create bridges and networks outside of the university setting and into the community,” he said. “Not only are we developing this cohort—they’re going to be amazing clinical trialists—we also are now arming them with an additional skill set of learning how to network and how to bridge within communities. “If we can have this next generation that is already steeped and trained with not only how to do clinical trials, but how to work with communities, how to engage communities, how to bridge communities, and how to network with communities, we may have much more effective trust within our communities to become involved with these clinical trials. I see that this workforce has the ability to really reduce health disparity.”Applications for the DCTCDP are open until July. Eligible candidates must hold the degree of MD, MD/PhD, DO, or DO/PhD and have an interest in clinical research in hematology and/or oncology, cardiovascular disease, and immunologic disorders. In addition, they will reflect the National Institutes of Health (NIH) definition of early stage investigator and the NIH definition of underrepresented populations in the US Biomedical, Clinical Behavioral, and Social Sciences Research Enterprise or have a demonstrated commitment to increasing diversity in clinical trials. To learn more about eligibility and program details, please email DCTCDPinfo@nmfonline.org.

Richardson LC, Henley SJ, Miller JW, Massetti G, Thomas CC. Patterns and trends in age-specific black-white differences in breast cancer incidence and mortality—United States, 1999-2014. 

. 2016;65(40):1093-1098. doi:10.15585/mmwr.mm6540a1

US Census Bureau quick facts. US Census Bureau. Accessed January 18, 2021. https://www.census.gov/quickfacts/fact/table/US/PST045219

2015-2019 drug trials snapshots summary report. FDA. November 2020. Accessed November 20, 2020. https://www.census.gov/quickfacts/fact/table/US/PST045219

Jacobs EA, Rolle I, Ferrans CE, Whitaker EE, Warnecke RB. Understanding African Americans’ views of the trustworthiness of physicians. 

. 2006;21(6):642-647. doi:10.1111/j.1525-1497.2006.00485.x


Articles

New Program Aims to Improve Diversity Among Investigators, Clinical Trial Participants

“Happy New Year. Just checking in to see everything is OK.”

I received that text from a mentor early this year. We had not interacted for about a month, and I was happy to learn I had not been forgotten.

I had a busy schedule and deadlines, but we set up a Zoom meeting and discussed academia and research. We shared some frustrations with life during corona-virus disease 2019. Before the pandemic, I used to go to my mentor’s office with a cup of coffee and a list of things to discuss. Now we can only meet virtually, but I believe in the value of mentorship and my mentor feels the same. We are getting better with our roles: mentor and protégé.

Mentorship is vital in oncology. Mentors can be sources for advice and guidance. When you match in oncology fellowship, you are assigned a mentor by your fellowship program or a list of interested candidates will be available. Mentors may help in career development, personal matters, research activities, and professional growth. It is important to identify the mentor who best meets your current needs and future goals.

The benefits you will get as a protégé should outweigh what the mentor will get from you. You will need a list of goals to achieve over time and a mentor who will help you fulfill them. The ideal mentor is available when needed and will direct you to the appropriate person when he or she cannot help.

There are many reasons why a specific mentor may not be helpful for a fellow. Not all faculty members are interested in mentorship. Some are better suited for mentoring in a specific disease. A first-year fellow who has not settled on a field of interest may find that a mentor focused on research in a specific disease is not the best choice. Senior mentors may not be available because of commitment to other protégés. An overwhelmed mentor will not accommodate your needs.

The goals of having a mentor are dynamic. In the first year, a fellow will need guidance on how to transition from residency to oncology and how to navigate a new system while maintaining work-life balance. Later in training, fellows will need mentors who help in research activities, career and study planning, job searches, and professional growth. Setting goals and associating each with a potential mentor may be helpful. Some protégé-mentor relationships can be temporary to achieve a specific goal. The number of mentors each fellow may need is different. Many training programs may have a certain structure with various available mentors having different roles. While this structure may be helpful for some fellows, it will not be ideal for all.

Your senior cofellows can be your best mentors. You are dealing with a situation that they just went through, and they will tell you how best to deal with an obstacle or achieve a goal. They can guide you on best options for an available mentor and provide tips on approaching faculty members to seek mentorship.

There Is Always An Option For An Outside Mentor

If you cannot find your appropriate mentor in your institution, you can seek an outside mentor. They are available through various interest groups, committees, or professional organizations such as the American Society of Clinical Oncology and the American Society of Hematology. Send an email. Ask for help. Building a professional relationship with an outside mentor may help in filling mentorship gaps in your institution.

Fellowship is busy. Clinical training, studying, and family commitments can be your most compelling priorities. Setting achievable goals that fit your work schedule and match your future mission should be your most important consideration. No other person can know what you are going through better than yourself. Some mentors may not have the same obligations you have, so their expectations may not align with what is possible for you. They will not know unless you speak up.

It is unfortunate that in rare instances you may encounter inappropriate behavior during mentorship. This includes harassment, bullying, discrimination, or research misconduct. It is important to know how to deal with such instances should they occur. Inappropriate behavior should not be accepted just because you are a trainee. Most people will support you and try to help resolve such rare incidents.

Fellowship programs try their best to assist trainees, but smaller fellowship programs may not have the infrastructure and tools to meet all their trainees’ needs. Identifying your goals and understanding what is possible within the fellowship institution is important and can help in mapping your road to success.

Regular meetings with your mentor can help you address problems as they arise. Together, you can discuss challenges and how to deal with them. You can argue, when necessary, and work to reach your goals. Even if you leave your institu-tion, your mentor will always be your colleague, a friend, and a person to provide advice when needed.

Fellowship experience is extremely rewarding for most trainees. Mentorship helps to make this experience better. The oncology community is supportive of trainees, and if you cannot find the right mentor the first time, try again.

Mentors may help in career development, personal matters, research activities, and professional growth.

Getting the Best From Mentorship

As a first-year hematology/oncology fellow, I often find myself involved in difficult conversations with patients and families. During a recent week, I had to discuss metastatic cancer diagnoses in multiple young patients, most notably a 28-year-old woman with a new diagnosis of metastatic breast cancer. I had to be brutally honest with the patient and her family members while she sat in her examination chair in shock.

I tried to address their questions, some of which I did not know the answers to, ranging from the treatment timeline to the possibility of the patient being able to become pregnant. I was extremely impressed with my attending, who is always terrific in these situations.

“I’ve been a medical oncologist for many years,” he told me. “You learn a thing or two over time.”

Other first-year fellows understand how difficult these encounters can be, yet we put in our orders, write up our notes, and move on to the next patient. Friends and colleagues often ask how I manage to maintain my composure after caring for patients with advanced illnesses. I tell them about my own story.

I was abruptly introduced to the field of hematology/oncology while completing my undergraduate studies at New York University in October 2009. My father, Lenny, received a diagnosis of acute myeloid leukemia (AML). His physician referred him to a hematologist who immediately commenced an aggressive course of chemotherapy.

My father was my best friend; life without him was inconceivable. I was on the receiving end of heart-breaking news on multiple occasions. I would wake up every morning while my father was admitted for treatment, hoping he was not sent to the intensive care unit overnight. It was a tremendous burden on me, my mother, and my sister. Meanwhile, I had to try to focus on my education. But how could I study organic chemistry while constantly worrying about my father?

My mother rushed to the hospital every morning to meet the primary care team as they made their rounds. We often felt we were not being given enough updates or explanations, and I was frustrated with the lack of communication. I cannot recall a time when any of the physicians sat down to speak with us. My father was not a complainer and did not want to feel like a burden, which forced my mother to essentially spend every day with him in the hospital until visiting hours ended.

What made this experience more difficult was not understanding the pathophysiology of AML at the time. I did not know what adverse effects to expect with each chemotherapy. I had not started medical school and was not familiar with most medical terminology. The staff would hand us my father’s blood counts every morning, but I could not interpret the results and no one took the time to explain.

Regarding wait times, I am very empathetic to the patients and family members who spend hours in the cancer center each time they visit. I remember waiting for more than an hour each time my father had to visit his hematologist, followed by another wait for chemotherapy. We felt pushed around like cattle. I was sometimes upset with his team of providers for not seeming empathetic—we felt like outsiders who were showing up for numerous appointments without much reasoning. I would sometimes take out my phone and stream big band music from the 1940s as well as modern jazz after my father and I were seated in the infusion suite, because we both enjoyed it. I was amazed by his knowledge of the music from that era. It provided a sense of tranquility.

My father ultimately succumbed to the adverse effects of his treatments. Despite the desperate and tragic circumstances, I grew fascinated with the number of treatments being introduced by the medical community to combat leukemia and other malignancies.

When speaking with patients and their families, I talk to them the way I wanted to be when I was a caregiver. I avoid using advanced medical jargon and instead simplify the diagnosis and treatment regimens. I show patients their CT scans and tell them, “This is your body and your diagnosis. You have every right to look at your scans.”

I write things down for patients when I sense there is something they do not understand, whether it is a medication schedule or the pathophysiology of their illness. When I see a patient who I know has been at least 20 minutes in the examination room, I apologize for the long wait before introducing myself. I also tell the patients and their families that they should never hesitate to contact us, reminding them that it is better to be safe than sorry.

Physicians who spend an extra 1 to 2 minutes making small talk with patients can mean the world to a patient and their caregivers. I recall the office visits with my dad where there was not much of a conversation with his doctor who would often walk in, perform a brief exam, say a few sentences, then walk out. We would have welcomed an occasional comment such as “It seems like a nice day today; do you have anything planned?” or “Are you looking forward to the holidays?” Though it is not mandatory, it helps to strengthen the bond between patients and their doctors.

I find that most patients and family members enjoy encounters with doctors who can make them laugh. Whenever my patient laughs during an encounter, despite the circumstances, I know that the patient feels comfortable with me and has faith in my team. If there is a strong bond between the doctor and patient, the patient is likely to be more adherent to their medications and show up for their scheduled visits. Of course, there are certain situations where it is safest to avoid using your sense of humor—we must use our best judgment and maintain situational awareness.

My experience as one of my father’s caregivers during his battle with AML has allowed me to form strong bonds with many of my patients with solid tumor and hematologic malignancies. Standing in the care-giver’s shoes has given me a unique sense of empathy—more than most physicians, I know what patients and families are going through. Although there are some weeks that are harder than others during my first year of fellowship, I sincerely feel that there is nothing I would rather be doing than practicing medicine.

Although there are some weeks that are harder than others during my first year of fellowship, I sincerely feel that there is nothing I would rather be doing than practicing medicine.

A Caregiver’s Experience Defines a Physician’s Practice

The number of patients with coronavirus disease 2019 (COVID-19) continues to rise, with more than 117 million confirmed cases and 2.6 million deaths worldwide as of March 9, 2021.

 I never thought I would be included in that statistic; despite my abundance of caution, I was infected with COVID-19. Although most patients present with mild symptoms and convalesce at home, a minority of patients, often with significant comorbidities, will be hospitalized and have a higher incidence of critical or fatal disease.

On a Sunday afternoon, I was running my usual 5K to prepare my mind and spirit for the challenges of the week ahead. I noticed I was more tired than usual. Three days later, I was exhausted walking up the stairs. Later that night, I experienced coughing, muscle pain, and extreme fatigue. Suspecting I might have contracted COVID-19, I called my chief fellow, program director, and occupational health to get tested. When the results came back, my greatest fear became real. I had the virus. My main concern was not only my well-being but the safety of my patients and colleagues.

After missing several weeks of work, I was dealing with a mix of guilt, fear, and uncertainty. I realized that if I did not do something proactive to work on my overall health, my anxiety would grow and affect my patient care and my life. I want to share 4 strategies that helped me cope and improve my well-being during that difficult time.

, Jay Shetty recounted how, on his first day of instruction, he noticed a 10-year-old monk teaching a group of younger children how to breathe. Instead of numbers or the alphabet, he said that “breathing is the only one constant through your life. Your friends, family, the country you live in, your health—all that can change. But breathing is always with you. When you are stressed, angry, or anxious, your breathing can change. If you learn to navigate and manage your breathing, you can navigate any situation in life.”

Meditation has been an invaluable tool to achieve mindful breathing for me. But it takes practice. With a fellow’s busy schedule, sitting in silence for 30 minutes or even 5 is difficult if not impossible.

However, after learning all the benefits of meditation, I had to carve out time in my day. How much time could I devote?

Three minutes. Every morning, I park my car outside the hospital and use a meditation app. I close my eyes and focus on my breathing for 3 minutes. It is not much, but the practice has changed my days completely.

I learned from Marc Brackett, PhD, director of the Yale Center for Emotional Intelligence, that emotional literacy can affect overall wellness, with a particularly strong effect on new learning, relationships, decision-making, physical health, and performance. Feelings are meant to be felt. By using his evidence-based RULER skills, you can

Recognize emotions in yourself and others.

The most important question that we often fail to take seriously is, “How are you feeling?” You must be willing to ask yourself that question and listen to the honest answer to achieve emotional intelligence.

Even when we are surrounded by people, we can feel lonely. Different from the isolation that is based on the number of people around you, loneliness is defined as a discrepancy or a gap between the connection you need and the social connection you have.

 There is no doubt that the pandemic has enhanced social isolation and loneliness worldwide.

Nowadays, it is widely understood that one of the most critical factors in preventing and addressing toxic stress is healthy social connection.

 While a traumatic past may increase our fear of bad things happening, we are not defined by our history. It is in our relationships with one another that we can find healing and a better path forward.

 Therefore, an antidote to loneliness is seeing the power of connection and creating a network or a community of people who share your sense of purpose and interests.

A meaningful shared experience like joining online cooking classes, painting, yoga classes, or simply showing up with kindness, gratitude, and compassion for yourself and others can make a huge difference in creating meaningful connections. Sharing my experience might resonate with you, and then we are not lonely anymore. By sharing the same path, we can rescue one another.

Emotional exhaustion, depersonalization, and decreased sense of accomplishment are the 3 components of burnout.

 Exacerbated by COVID-19, the incidence of burnout is as high as 44% among 4424 physicians in a cross-sectional study.

 Higher levels of stress require more effective ways of managing that stress.

Understanding the distinction between the stressors that we cannot control (external) and the stress that we feel in our bodies (internal) was crucial for me to avoid burnout. I learned that emotions are like a tunnel with a beginning, a middle, and an end. We experience burnout and emotional exhaustion when we get stuck in that tunnel.

How do we close the stress cycle? Emily Nagoski, PhD, and Amelia Nagoski, DMA, have written extensively on managing stress and burnout. They have found that physical activity is probably the most efficient way to deal with stress.

Any activity counts: running, dancing, biking, swimming, stretching, yoga. There is increasing evidence highlighting the positive effects of exercise on mental health through different physiological and biochemical mechanisms that we all know.

If you do not believe me, try at least 15 minutes early in the morning of any aerobic or nonaerobic activity you like and see how your day goes. After a difficult day, try running for 30 minutes outside, and your body will let you know that you have completed the stress cycle. Breathe, feel, share, and run is my new mantra.

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Think Like a Monk: Train Your Mind for Peace and Purpose Every Day

Permission to Feel: Unlocking the Power of Emotions to Help Our Kids, Ourselves, and Our Society Thrive

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Together: The Healing Power of Human Connection in a Sometimes Lonely World

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Burnout: The Secret to Unlocking the Stress Cycle

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The COVID-19 pandemic has inspired a new mantra for wellness in the oncology community and beyond.

COVID-19 Inspires a New Mantra for Wellness

YoungNa Lee-Kim, MD, director of the Fellowship Program in Pediatric Hematology-Oncology at Texas Children's Cancer and Hematology Centers, was always interested in medicine, but there was no guarantee she would become a physician. She earned a bachelor of arts in economics and thought about pursuing a graduate degree. Ultimately, the appeal of being a healer was too strong to ignore.

“I eventually came back to medicine because I think the interactions that you have with families and with patients—being able to support a patient during what is usually a very hard time in their lives and to be able to help them heal—I think that is a real privilege,” she said.

Today, Lee-Kim is director of the fellowship program in pediatric hematology-oncology at the Texas Children’s Cancer and Hematology Centers and an associate professor of pediatrics at Baylor College of Medicine in Houston. Even that comes as a bit of a surprise; she thought she would become an investigator rather than a clinician and administrator. Pediatric hematology-oncology lends itself to a career in investigation because it is a very research-driven field, she said.

Instead, shortly after completing her own fellowship in pediatric hematology and oncology at Baylor, she became the associate program director in 2008. She’s been program director since 2018.

“Because I was not that far out of fellowship, I thought, ‘Well, I could contribute to this because I was a recent fellow.’ Medical education in and of itself is a very robust and rewarding career track,” she said. “I went on to get my master of education degree and get more involved in medical education. And honestly, that has been one of the best things in my career to be involved in—training fellows and working with fellows, residents, and medical students.”

, Lee-Kim discussed the differences between working with pediatric patients rather than adults, managing money during fellowship, and how the faculty at Texas Children’s strives to show its appreciation for fellows.

: How is a fellowship when training to treat pediatric patients different from a fellowship where you are training to treat adult patients?

: The communication skills that you need in pediatrics may be different from what you need for adult medicine. We actually see patients through age 21, so there’s a little bit of overlap, but when you’re dealing with a younger child, there are different kinds of skills that you need to be able to talk with them and understand what it is that they’re hearing.

Then, of course, the way you interact with parents. They’re making decisions for a different person. As a parent myself, I find that it’s much harder to make decisions for my children than I would for myself. There’s a different level of concern, or guilt, even, that you’re making the wrong decision on behalf of somebody else.

Most of our fellows are already aware of these differences because they’ve already completed a pediatric residency. But I think that the way the training might be different is just a little bit more of a focus on the entire family unit and the social issues that come with that. The other thing, though, is the way people handle death or bad outcomes. It is very hard to see a child not do well or a child who passes, so we do have resources for our fellows. We have debriefings and opportunities for them to share the difficulties in seeing those kinds of situations.

What do you tell your fellows about managing their money?

That has been an area of interest among our fellows, and we have a faculty member who has a personal interest in just financial health and has given our fellows a workshop on this.

At the institutional level, we have workshops for the fellows as well. The trajectory of your income in medicine is pretty atypical compared with other job markets and industries.

To be honest, if you’re going down the route of pediatrics, most of us are not in this for the money to begin with. I don’t think people go into pediatrics because they’re going to strike it rich.

How do you encourage your fellows to take their own health and wellness seriously?

We have dedicated scheduled efforts to do this. And then, as a fellowship director, I also check in on them, especially with the pandemic that has brought its own issues of wellness. We’ve also evolved in this at the start of the pandemic; our wellness issues were very different from what we’re seeing right now.

We have wellness programs offered at the institutional level and at the level of what we call fellows college, which is for all the fellows at our institution. Finally, our fellowship has its own wellness activities, some that are directed by us as faculty and others that are directed by the fellows themselves, and we encourage them, because I think that wellness means different things for different people.

I’m always very cognizant of the impact of the work that fellows do on their wellness and health when we decide on their rotations or their schedules for the year, or even what they do during each rotation. One of the things that I focus on a lot is how this is going to impact them, not only from an educational level, but just from a health and wellness level. Is this too much for 1 person to handle? Is this going to burn them out? These are all things that we as program directors, and as leadership in our section, think about, as we’re creating the program for the fellows.

This year, we decided to implement a Fellows Appreciation Week. All our faculty sign up to do special things for our fellows every day of the week. The sign-up sheet filled up to the point where some faculty felt sad that they didn’t get a chance to sign up to do something.

Every day this week, we’ve had people doing special things for our fellows. The giver gets a lot out of it and, of course, the recipient also feels appreciated. That’s just an example of the sort of activities and culture we have in our training program.

Is there any 1 thing that a fellow must take from a fellowship?

If you ask any certifying body, they’ll give you a 50-page document of what fellows need to know at the end. I think you what you need to take out of a fellowship is, obviously, you need to be able to recognize the disease. You need to know how to do basic management of that disease, and when to ask for help.

We have so many advances in medicine and that makes our patient population much more complex. But then because things are so complex, you also need to know when you’re beyond the scope of your expertise and you need to know when to reach out and ask for help.

All the other things—whether it’s academics, academic medicine, or if you’re going into a leadership role in clinical care or research—look for opportunities to do things that you may not have considered before, but you may not know that you love it. If an opportunity arises for you to teach, or for you to be involved in a collaborative research project, until you’ve tried it, you don’t know whether you love it or not.

Be open-minded. Figure out what it is that you love, and maybe figure out the things that you don’t like as much. But keep an open mind because you don’t know where your career is going to evolve.

YoungNa Lee-Kim, MD, shares advice on how to advance as an oncology fellow.

To Advance as a Fellow, Be Open to the Unexpected

"Find mommy a good job," we were told. We both came to hematology/oncology fellowship as mothers of small children and, more unusually, worked as primary care physicians before that. The significant progress of women in medicine and the changing culture of medical training have enabled nontraditional applicants like us to gain entry into competitive subspecialty positions in areas such as hematology/oncology. The boys’ club of medicine is becoming extinct as talented women gain leadership positions in institutional medicine. Academic medicine is unquestionably more welcoming of mothers as trainees and faculty than was the case a generation ago.

However, maternal discrimination in the medical field requires continued attention. Physicians who prioritize balancing their family’s well-being with professional advancement risk being dismissed as unserious.

 The structure and culture of medical training presume, at most, limited family responsibilities, as trainees are expected to work extended and unpredictable hours and complete research on nights and weekends. Gap years, slowdowns, or time off track may be interpreted as a lack of commitment to the field. Residencies are structured such that a single resident’s maternity leave disrupts the whole program. Pay discrepancies, gender-related job expectations, and unrealistic expectations during pregnancy and post partum remain the norm.

Medical training spans more than a decade, usually through the prime of women’s reproductive years. Although men in medical training also face difficult decisions about balancing family life with career, a gender differential remains. Biological concerns about fertility and the physical toll of pregnancy, birth, and lactation fall primarily on women. Culturally, men are more likely to rely on a partner to be a young child’s primary caregiver; men are more likely to have a “doctor’s wife” who has or assumes a more flexible career.

 Of course, having children is common for men and women alike and usually joyous. Being a doctor mom is normal and being or becoming a parent during training should be feasible, despite the challenges it presents for finances, long hours, childcare requirements, and geographic mobility.

Options for timing childbearing with career advancement include the following:

Taking a gap year during medical school. Time off risks long-term career derailment, but this option benefits family life and one’s focus during training. It is, however, logistically difficult and expensive, and difficult to repeat with subsequent children. Furthermore, one then has a toddler during residency.

Having children during training. This is common but arduous. Maternity leave is usually no more than 6 weeks and must be paid back, complicating placement (and paternity “leave” is generally 48 hours). Given the call structure, colleagues are forced to shoulder the extra burden of one’s absence, which can engender hostility and lead to guilt and distress.

Having children while in a junior faculty position. Faculty are on a clock, biologically and professionally. The risks of infertility increase with age and opportunities for midcareer advancement can be capricious, meaning new mothers may be passed over unfairly.

We can speak to these challenges personally. Dr Kline had her first child during residency, sometimes working more than 100 hours a week while pregnant and pumping breast milk in call rooms while charting. Her second child was born during her years as a primary care physician with a relatively predictable office schedule.

With her daughters, Dr Baum utilized a modified gap year strategy; her older child is a “chief-year baby.” Chief year is a very popular time to have children, though it presents challenges such as a short maternity leave. Her second was born at the end of a palliative care fellowship, prompting off-cycle payback of her leave. Supportive spouses and full-time childcare have helped them to complete hematology/oncology fellowship with young children.

As they say, there is no good time to have children. However, the degree of adversity physician-mothers often experience is mostly unnecessary. Many of the challenges facing mothers in medicine reflect ingrained societal and medical cultural norms and apply to professional women more broadly. Research demonstrates that women are promoted based on accomplishments, whereas men are rewarded for potential.

 This inequality is exacerbated by delays incurred by women while having and raising children. New research in labor economics shows that “childbirth penalties” account for around two-thirds of the earnings gap for mothers in their mid-tolate 30s relative to women without children. Furthermore, the presence of female leadership does not mitigate this gap.

Conversely, when men become fathers, they are rewarded financially and perceived as mature and responsible.

 In medicine, male physicians receive more professional respect: They are promoted earlier, hold more leadership positions, and are called Doctor more often.

Colleagues and supervisors more readily perceive men as competent and self confident, rewarding them with respect and positions of influence.

Men often receive authorship credit for their research efforts earlier in their training, and are informally credited for their contributions to collaborative work.

 Men are steered into more prestigious and lucrative specialties, within which male subspecialists make significantly more money.

Finally, the ongoing negative impact of sexual harassment, bullying, and intimidation in medicine is alarming; nearly half of medical trainees report experiencing harassment.

 In a recent study at a large US academic medical center, most female faculty reported gender-based harassment within the past year; more than 80% reported harassment from fellow staff members and more than 60% reported harassment from patients. Experience of gender-based harassment was associated with worse mental health and lower job satisfaction.

Our predecessors faced overt discrimination in medical school admissions, the Match, and hiring decisions, as well as hazing and a lack of role models. We benefit from the visibility of women as senior faculty, physician-scientists, and leaders and from the mentorship of men and women alike. Years of legal and institutional changes have made great strides in promoting gender equity, and persistent attention to these issues promotes continued improvement. Continuing to address institutional, cultural, and interpersonal factors that support women in academic medicine will create space for diverse female oncologists whose experiences will enrich their research, teaching, and clinical care. The ongoing shift to value and accommodate diversity can lead to an oncology workforce that better understands and responds to patients’ needs.

We believe that hematology/oncology is an excellent career for physician-mothers. Recognizing and accommodating talented female physicians in their early careers can help prevent the female “brain drain” out of academia and the invisibility of mid-career women faculty, thus fostering the significant long-term contribution of these skilled physicians.

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Hematology/oncology programs can make it easier and more rewarding for would-be mothers to participate in fellowship.

Normalizing Motherhood in Medicine

The coronavirus disease 2019 (COVID-19) pandemic has forever changed our world. We must remember the heavy societal burden this virus has wrought, including lives lost, the significant and debilitating late effects for survivors, and the mental health crisis for survivors, caregivers, and the general population. What are the lasting effects of more than 12 months of isolation, economic downturn, family separation, and, in some cases, forced family quarantine? The world is paying attention and these areas are all topics of intense, ongoing investigation as we grapple with the collective human toll of this unprecedented event in our lifetimes.

As an oncologist, I compare this great effort to rapidly understand the viral epidemiology, prevention, treatment, health disparities, and late effects of infection with the field of cancer discovery. As hematologists-oncologists, our field has always been defined by discovery. We have witnessed huge advances in drug discovery and applied these to cancer treatment.

However, these milestones have taken decades to achieve, and governmental financial investment in the National Institutes of Health/National Cancer Institute can be sidelined depending on presidential or congressional budget priorities. Although COVID-19 discovery and translation have occurred at an incredibly rapid pace, this cancer care provider wonders whether we can take the lessons learned from the pandemic and apply them to our world. What are the lessons that we can glean from this experience? Although much has been written about the new paradigm for rapid drug discovery and translation into tangible clinical use, I want to focus on the other significant lessons that we should take from the pandemic experience.

The coronavirus disease 2019 pandemic has forever changed our world. We must remember the heavy societal burden this virus has wrought, including lives lost, the significant and debilitating late effects for survivors, and the mental health crisis for survivors, caregivers, and the general population. 