Choosing Your Path

As you begin to up your oncology fellowship, you may be questioning the right path for your career. Do you travel down a road that leads to an academic field? Does pharmaceutical work speak more to your passion? Or, do you have a desire to work more in the community setting?

Megan M. Dupuis, MD, shares the complex journey she traveled during medical training and how it brought her to the academic setting.

As an academic hematologist/oncologist with a unique path, I am often asked how I ultimately chose my current position at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. For me—as it will be for you—the answer is multifaceted and deeply personal, and was ultimately rooted in what I value most: patient care and education.

To understand how I arrived here, my past training bears mentioning. As an MD/PhD candidate, I had fully intended to study microbiology for my PhD and become a physician-scientist.

Then, in a twist of fate, my intended principal investigator (PI) had to suddenly leave, and I was left adrift. Panic-rotating through a cancer immunology lab at Roswell Park Cancer Institute that I was fortunate to join, I received exceptional training over 4 years, finished my PhD, and made lifelong friends. I also sealed my fate as a future oncologist, since I found both the science and patients deeply interesting. However, during that time, I also discovered that basic research did not “spark joy”—to quote professional organizer and declutter expert Marie Kondo. I found myself feeling depressed, lonely, and truly missing patient interactions.

This left me in a bit of an identity crisis. If I wasn’t going to be a physician-scientist, who was I going to be? For the first time in my life, I had to potentially disappoint others—my MD/PhD program and my PI, especially. Ultimately, I recognized that what did bring me joy was teaching and education. Through my undergraduate years, the first 2 years of medical school, and throughout my PhD program, I worked for Kaplan as an instructor for standardized tests including the MCAT, served as a teaching assistant, and was invited to create curricula for our PhD program. It was in cramped classrooms, hospital workrooms, and clinic spaces that I felt most alive.

Thus, I began to pursue education intentionally both during residency and fellowship. I completed training programs in adult learning theory; created new curricula still in use at my residency and fellowship programs; and served as education chief for 2 years during fellowship. I felt confident that I knew my path: academic medicine with a focus in education.

When I began thinking about applying for positions, my mentor and program director, Nishin Bhadkamkar, MD, of The University of Texas MD Anderson Cancer Center, gave me exceptional advice. “Megan,” he told me, “You need a list of needs and wants. The needs are nonnegotiables, and the wants are bonuses that help to decide between jobs. The needs list should be short, and the wants list should be as long as you please.”

Therefore, here were my needs:

• A job with a focus on patient care;
• A job that allowed dedicated access to learners;

• And a job that was in a warm part of the country.

As I began my third year of fellowship, I wondered whether either an academic or private practice setting could potentially meet my needs and thus applied to both. Like other trainees, I knew what academics involved but wanted to better understand the responsibilities and practice patterns of community oncology, as well.

To my surprise, I discovered that several community-based positions had opportunities for educators, too. For example, some of the private practice physicians I interviewed with had positions within community residencies, ran tumor boards at the local hospital, taught rotating PA and NP students, and worked with national organizations, such as ASCO or ASH. Conversely, I also discovered that just because a role is academic does not mean that it would guarantee contact with learners. If a position had an expectation for heavy clinical work or research, it would not necessarily afford protected time to work with learners, too.

I learned to hold my needs at the forefront of my decision-making, which allowed me to authentically pursue my current position at VUMC. Here, I wear 2 hats: one as a general hematologist and oncologist, the other as the associate program director for the fellowship program.

However, the details are so much more rewarding than that one-liner. I see patients 2 days per week in one of the regional centers in the greater Nashville area; I can care for nearly everyone that comes through the door. Additionally, I serve on the inpatient oncology service 10 weeks per year, allowing me to work with our fantastic medical students and house staff. The diversity of patients in my clinic is both personally satisfying and allows me to better teach and advise trainees. Seeing a range of clinical cases helps me stay up to date with the latest research and developments in oncology, which I can then share with my learners.

Being part of a university system that has a diversity of learners was also a major draw for me. I appreciate the opportunity to work with medical students, residents, fellows, and other healthcare professionals. It provides a rich and stimulating environment where I can learn from my colleagues and my trainees, who expect me to remain current in my knowledge of medicine and oncology.

Additionally, I get to be part of an academic center offering the resources of a larger institution. For oncology alone, this includes access to tumor boards, clinical trials, and disease-specific experts. This also means I can quickly access specialists in other fields, such as endocrinology, rheumatology, and mental health—all of which are critical to the care of patients with cancer.

A significant portion of my time is focused on educational initiatives. In addition to my associate program director duties, I founded a Medical Humanities certificate program and direct the oncology sub-internship for medical students, and also participate in the ASCO Education Scholars Program, which requires monthly meetings and quarterly travel. The activity I have in educational spaces is possible because I have 3 days of protected time each week and a supportive division chair. In academics, so many things can demand your attention; therefore, having true protected time and support from your superiors for your needs is key to job satisfaction.

Academics also intrigued me because of the broad network of support for my career path. I have been blessed with a strong community of mentors and “friendtors” (an excellent portmanteau that is exactly what it sounds like—friends who can mentor you). I still regularly meet with Dr Bhadkamkar, my former program director and mentor, at least once monthly. I also heavily rely on my senior mentor at VUMC, Jill Gilbert, MD, for advice in education, oncology, and life. I have been lucky to collect several friendtors who have written letters of recommendation, made key introductions, and collaborated on projects. It is critical to surround yourself with a like-minded community to support your growth and embrace your purpose, especially if your career path is more unique.

Of course, the decision to pursue academic medicine does come with certain sacrifices. My pay is less than what I would make in a private or community practice—perhaps half as much, based on the salaries I was offered on the interview trail. However, the balance between my work and home life is fantastic. By working in a large system, my individual call time is reduced and the responsibility for patient care is divided over faculty, fellows, nurse practitioners, and physician assistants. This frees 40 weekends per year for me to pursue hobbies, such as ballroom dancing, camping, hiking, and enjoying city life. This balance is important to me; it allows me to be a more fulfilled and effective physician and educator.

It’s important to note that the decision to pursue a career in academic medicine should also not be based solely on the workload, as data show that oncologists in both academic and community practice spend about the same amount of time working each week. According to a survey published in the Journal of Clinical Oncology, oncologists reported working an average 58 hours per week in academic practice vs 62 hours per week in community practice.¹ I believe that the less your work feels like work, the more you are able to authentically dedicate yourself to it without burning out.

Academics can also be clunky. It can be challenging to make changes quickly when you are one voice of many; things are often decided by committee and require layers of approval. Moreover, your individual interests or passions may not be shared at a divisional, departmental, or even institutional level. I would absolutely choose this path again. Each day is different, challenging, and invigorating. My clinical practice allows me to stay up to date with the latest research and developments in oncology, while also providing me with the resources of a larger academic center. Being part of a supportive division and university system has been critical to my success and happiness in my job, and I am grateful for the opportunity to pursue what I love intellectually with support and mentorship.

Megan M. Dupuis, MD, is an assistant professor of medicine in the Division of Hematology Oncology and associate program director of the Hematology and Oncology Fellowship Program at Vanderbilt University Medical Center.

Reference

Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol. 2014;32(7):678-686. doi:10.1200/JCO.2013.51.8480.