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Joe’s Career Blog
Career development observations and advice for medical professionals from Dr. Joseph V. Simone.
Friday, January 9, 2015

As physicians and other health care providers age they often become wiser, but not always. I like to think I am one of those who is self confident enough to take an honest look at my experience objectively as it developed and evolved over the years. Like many colleagues I am often asked for advice by those who are in the medical profession or considering joining it about the current status of their careers and/or what steps one might take to advance a career.


Because I have a consulting business, I receive calls from physicians or nurses asking if they could hire me to consult with them on their careers. My answer always is negative; I do not charge any individual for providing career advice or for putting one in contact with an institution or medical group that might be a better fit for his or her career. Providing this advice is a way of paying back the kindness of the many people who offered free advice to me. I believe that helping others navigate a career in such a complex profession is part and parcel of our professional responsibility.


Most professionals who have been active for many years in the field are asked for career advice. Unfortunately, some of us should not give career advice because we have serious handicaps—for example:

·    People who have been in the same institution for their entire career including residency and fellowship. Their advice may be OK, but their personal experience is very narrow and they may reflexively recommend that the advisee remain in the same institution, which may not be the best fit for the advisee.

·    People who cannot keep a counseling session in confidence. Too often a professor has a session with the advisee and casually drops bits of information in the cafeteria or elsewhere--“Hey, did you know John Smith is looking for a job at the University of Norwich?” This is a breach of trust, unless the advisee gives permission to spread the word, which is unlikely because it may tee off his immediate superior.

·    People who have strong biases in favor of one career direction. A common example: the advisor is an academic and the advisee is talented and it is likely that he/she could make it in academia, so the advisor leans heavily in that direction. But what if the advisee has a family to support and is deep in debt for his/her education? What if the advisee has a handicapped child who needs special schools? The correct approach is to learn as much as possible about his/her needs, family situation and what type of career the advisee prefers before narrowing the choices.


A potential advisor should consider himself or herself as a confidential counselor, like a good lawyer, whose role it is to help the advisee arrive at the best solution for that particular person. The counselor asks questions to understand the advisee’s circumstances, desires, and talents, and to raise red flags that the advisee had not considered. Here is where the advisor draws on a long experience and knowledge of institutions and their leaders. There are institutions that are considered “career killers” due to poor leadership, a lack of resources, rapid turnover of staff, or a lack of any extraordinary medical or nursing programs.


An advisor’s approach is determined in large part by where the advisee is in career development. For example, the advisor may be asked to advise a professor in the later part of his/her career; a mid-career faculty member who believes it is time to advance where she is or move on to another institution; a junior faculty member seeking an opportunity to become more independent in his professional progress; a trainee who needs help learning the basics of assessing and getting a faculty or partnership position--or, lastly, the advisee may still be in college or medical school, a scenario I was asked about recently:


A good friend of mine who lives nearby has a daughter who is in college on track for a bachelor’s degree in nursing. She is bright and has done very well in school, so some of her teachers are urging her to apply for medical school. She doesn’t have enough experience to know what that means and whether that track would be satisfying. Her father asked me if I would meet with her; I agreed, but suggested that we invite my daughter, who is a physician (she is a big shot at the CDC and my buttons are popping!), to join us to balance our viewpoints.


The four of us, she and her father and my daughter and I, sat around a table and started to chat. She told us about her current course in college and wanted some advice on nursing versus medical school. My daughter and I both described our views of the experience of medical school and the training that comes afterward. She asked a number of questions. The next step was to ask her what drew her to nursing and what part of nursing she liked best. At first she said public health was attractive because one can influence the health of a large number of people. My daughter then described what type of work nurses do when recruited to the CDC.


Then we asked what I believe is the most important question--whether her ultimate goal is to work directly with patients or was it something else, such as an administrative role. She said she leaned toward working directly with patients. Then my daughter explained that nursing opportunities include nurse practitioners and physician assistants, some of whom specialize in one aspect of medicine and nursing and advanced training was available in all. The downside of medical school is that she would need to take extra classes to qualify for applying and the number of years required after medical school to then become a specialist in medicine.


The discussion lasted over an hour, and neither she nor we arrived at a decision. That was not the purpose of our meeting, which was to provide her with ideas, information, and vignettes from our own careers, and to offer a place to go (us) to discuss any of the issues that may come up in the future She is clear-headed, smart, and realistic without the fanciful pie-in-the-sky ideas that we sometimes hear from people her age.


She left us feeling that she would make her own decision based on what she learns at school and from people like us, and most of all, based on what she believes is likely to make her happy in her career. And that is the way these advisory chats should end.

Tuesday, December 23, 2014

Dear friends and colleagues

I am writing to let you know that I am dying.

I just finished reading Atul Gawande’s book

Being Mortal and realized that I have many of

the symptoms of the patients in his book--therefore, I too must be dying.


I am a little sad about this, but to be honest

I knew this was coming and so was not totally surprised.

I learned when I was quite young that all people die,

though like most adolescents I believed deep down

that it wouldn’t happen until I was 110 or so.

But that attitude gradually died soon after I began

going to funerals.


Funerals were a big deal in the

Italian-American culture in which I grew up.

Our entire family went to the funeral home (no baby-sitters)

and walked up to the open casket to pay our respects.

The female relatives of the deceased all dressed in black

would be sitting in the front row of the visitor seats

mentally recording who showed up and who didn’t.


The women in black resumed weeping when friends visited

the casket and turned to embrace them, now both crying.

The casket was surrounded with a forest of flowers

that gave off a strong sickly sweet scent that often made me feel sick,

so I learned the trick of stealthily leaving the room to get a

few breaths of fresh air in the entrance corridor.


On one occasion of escaping into the corridor I noticed a

small room at the back with the door cracked open.

Being nosey I stuck my head in to find a dozen or more

people (mostly men, none of whom had a formal funereal role)

eating from a large buffet of food, smoking and drinking wine or spirits,

but it was the Italian cannoli that caught my eye when I was invited in.

Food and drink were (and are) common at Italian or Irish wakes.


Wakes were also an important occasion of reconnecting with distant

relatives and friends that we saw rarely. That and the food and drink

lightened the atmosphere, with eventual laughter in the background

recalling shared funny experiences long before. It also got us up to date

about who else had died or moved in the interim. It was a positive

social event at a time when many rarely travelled far and phone usage

was relatively expensive and used infrequently.


My mother would talk at home for days afterward about the news and gossip;

she loved that part of it. It was more effective than Facebook because

one got the information directly from a reliable source with all the gory details,

and everyone hugged and kissed to cement our relationships and love

for one another (my sisters and I aggressively wiped our faces of the juicy kisses from aunts and uncles as soon as possible).


In those days, wakes were held for three days (to some, shorter would

have been a sign of disrespect for the deceased).

That was a significant burden for the decedent’s family because after the wake

they still had to go to the funeral Mass on the fourth or fifth day

and then lead a parade of cars to the cemetery.

My father and I usually managed to avoid the multiple days

and the Mass. Enough is enough.


I don’t know when the tradition of long wakes died out along with

the shift to a closed casket with a photo of the deceased on a table.

Cremation was unheard of in those days due to some quasi-religious

taboos. My mother nearly fainted when my wife and I said we would

be cremated. Of course, when she died we had a traditional wake

for her as she wished.


So that is the story. I hope you don’t mind that I made this announcement

in such an informal way, but times have changed.

And since I have no date certain for my demise, I thought I would

take care of this bit of business while I was still able instead of burdening

my family with trying to contact all my friends and colleagues.

I’ve had a good, productive and overwhelmingly happy life with a loving family.

What more could one ask of life?

Thursday, October 9, 2014

Two years ago I notified five state agencies that I would not renew my medical licenses. I had maintained the five licenses for many years with no reason other than caution; What if I move back to Illinois or California?


I casually mentioned this to a friend who said he could never give up his license, even though he, like me, had retired from medical practice well over a decade ago.


It was as if he would consider himself a lesser person if he no longer had a license, and not having a license would mean that he would have a lower stature in his profession and, perhaps in society.


This got me thinking. Am I less a doctor or a person if I no longer have a medical license?


At my peak I thought I was one of the best pediatric oncologists in the world, but I never gave a thought to my license except to pay the annual fee(s).


So why did I decide to drop it? Here is how my rationale developed chronologically with the most important first:


First, in any profession if one doesn’t practice regularly, the skills honed daily gradually begin to dull and the residents and fellows know more about the current lineup of antibiotics than you do and the nurses start reminding you of important steps in caring for patients. The risk of providing inferior care grows. I did not want myself to be able to return to practice after such a long hiatus.


Second, I am retired with a pension and enjoy part-time work as a writer and consultant. These activities are satisfying and far less demanding than a return to practice. Some doctors retire without preparing for some activity to keep them engaged.


Third, sustaining a medical license has become more and more complex and demanding. Continuing Medical Education credits are required and, depending on the state, involves more and more work. Some CMEs are not about patient care; one I was required to take was a tutorial on sexual harassment. And I am unaware of any study that demonstrated a strong relationship between CME credits and the quality of an individual physician’s medical care. In any case, the hassle of maintaining licenses at this time of my career became the last straw.


I don’t feel that my ego was injured in this process: I still can legally put an MD after my name, I saved some money, and I have enjoyed the increased flexibility in retirement.

Wednesday, September 24, 2014

This is a common reaction at social gatherings

when people learn that I am a pediatric oncologist.


I didn’t ask them if they could "do that”

and wonder why they are prompted to say it.


Then they try to make me some kind of hero

for “doing that,” which I certainly am not.


I’ve tried to avoid these exchanges by just saying I am retired,

but most press on trying to fit this stranger in a pigeon hole:

is he important or not, worthwhile knowing or not?


I try to explain that it is simply the profession

that I have chosen and never regretted.


In fact caring for children with cancer and

trying to develop better therapy has

given me more joy and satisfaction than I deserve.


Even when the cancer wins and we grieve with the family,

I feel privileged to have been a small part of that family

doing whatever little I can to console them.


If there are heroes in these stories, it is the children and their

parents who work hard to maintain a “normal” environment in

the face of constant worry and stress, and unpleasant treatments

and side effects. Some families disintegrate under this stress, others

grow even stronger.




I would very much like to hear from you readers of any similar experiences

you may have had -- comment here, or email OT@LWWNY.com

Tuesday, September 16, 2014

Many readers of OT travel a great deal and many are in their senior years as oncologists and academics. This poem arose on a plane and reflects the poignancy of our jobs and lives as we get older:



The plane has halved the continent at last

Although discomfort from takeoff to now

Still pesters my back and legs.


I read and write, do crosswords for a while

But the tedium grinds away my will

I stare at flight screens but

The painfully slow pace is depressing.


I must take the long flight because of work

But even that “must” has begun to erode

And I don’t need to work for subsistence,

But I see engagement with

The world narrowing in my 70s.


Which is compounded by drifting apart from colleagues 

As we retire, become infirm, and skip professional meetings,

And the authors of published articles and names of seminar

Speakers are no longer familiar.


The youngsters are doing what we all did

Slowly taking the reins and leading the pack

And my domestic routine with Pat becomes my Eden.


So I suffer traveling to exercise my intellect and to feed

My curiosity about what is new and exciting. But this

Damned flight never seems to end.

About the Author

JOSEPH V. SIMONE, MD, has had leadership roles at, among other institutions and organizations, St. Jude Children’s Research Hospital, Huntsman Cancer Institute, Memorial Sloan-Kettering Cancer Center, the University of Florida Shands Cancer Center, the National Comprehensive Cancer Network, and the National Cancer Policy Board.

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