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Joe’s Career Blog
Career development observations and advice for medical professionals from Dr. Joseph V. Simone.
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.

 

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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:

 

Travel           

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.


Tuesday, July 29, 2014

How do we know that one cancer center is “better” than any other? If we had a cancer diagnosis, should an institution’s ranking in U.S. News & World Report be our standard? U.S. News has virtually taken over the evaluation of cancer programs and centers, as well as universities and hospitals. The ranking is highly publicized and institutions publicize their own ranks, if at a high level. In my opinion, though, such rankings depend too much on the opinion of deans and other academic types, most of whom have no first-hand knowledge of what makes a cancer center good or bad today (i.e., not 10 years ago), or they focus only on scientific eminence, personal relationships, or a long-standing reputation.

 

The result is basically the same old lineup, with small changes back and forth each year. There are centers that are ranked near the top that would never be there if they were they evaluated by a seasoned, knowledgeable group of cancer center leaders. And there are centers that are lower in the ranking that I would gladly choose if I or a loved one got cancer.

 

But the most important failing of such competitive lists is the fact that the evaluations do not measure the quality, efficiency, and value of cancer care, which the public (and most doctors) care about far more than academic reputation. The public and the medical community are often impressed and deceived by terms such as “NCI-designated” or “comprehensive,” which have nothing to do with the quality and efficiency of the care of cancer patients.

 

So what should be done? I believe the cancer center community should take control of the conversation on this issue. The cancer center community should take on the task of developing a realistic, broad-based set of standards for measuring cancer center performance in patient care, efficiency of care, clinical outcomes, and the relative cost of care. This is not an easy task, but it is a critical factor in understanding how good a cancer center is in practice, not in theory.

 

The cancer research of NCI-designated cancer centers (currently 60 that do research and also care for cancer patients) is evaluated by the NCI after they have passed the test of being included in that elite group. The NCI funds such centers to assure a strong research infrastructure that includes an assessment of the cancer research effort of an institution based on stringent guidelines and a peer review process. The NCI reviews each center every five years to ensure the consistency of research excellence. It also grades centers on how well they bring research findings to their cancer patients in the clinic.

 

So one may take the success of an institution’s NCI review process, which regularly grades each center’s research program, as ample evidence of the high quality of research. As good as it is, however, this process does not measure the quality, efficiency, and value of cancer care.

 

Complex and Difficult for Several Reasons

Measuring the quality of cancer care is complex and difficult for several reasons. Patients with the same diagnosis vary a great deal. Cancers have many subtypes, and the physical and psychological constitution of patients also varies. Even the culture that the patient lives in can determine how soon he or she seeks medical help, a critical factor in outcome, and patients’ socioeconomic group may have a major impact on the outcome of treatment.

 

Also, doctors vary in skills and knowledge, and in the face of evidence of better therapy, some are slow to change to the better therapy and continue therapy they have given for a long time and are thus comfortable with. There are many other confounding factors that must be accounted for, but that is a bit less of a problem today as medical information is increasingly digitized and thus more accessible and manageable.

 

AACI?

The Association of American Cancer Institutes, with member from many cancer centers would be a good candidate for leading such a project. It has access to all the cancer centers and their expertise and they are a well-established organization in the cancer community.

 

Experts would develop the model and measures with complete transparency of how measures were chosen and applied. Public information can be gathered independent of any one organization -- e.g., the number of cancer research grants, Cancer Center Support Grant scores, Joint Commission ratings, and hospital evaluations by independent entities. Some measures would need to be developed – for example, clinical outcomes, quality measures, patient satisfaction measured in such a way as to get better data (not Press-Ganey which I believe is flawed because every single hospital I have visited over decades claims a 90+% approval rating). Instead of a ranking of 1, 2, 3, I would have three or four categories like “outstanding,” “excellent,” “very good, and “needs improvement.” Ultimately, the group that collects and analyzes the measures could offer a service to guide a low scoring center to improvement.

 

The data and results from such an effort would belong to the participating cancer centers. Each cancer center would receive a report of how well it performed compared with the other (anonymous) centers.

 

There would certainly be some cost involved, but volunteers could do a lot of the initial spadework -- e.g., health services research faculty. Done right, this could be a source of revenue to help cover the costs of the program. For example, a cancer center that wished to be evaluated would pay a fee to cover the cost of site visits, data collection, etc.

 

The program, run by representatives of cancer centers and other experts, would eventually end up being the arbiter of what a program of excellent cancer care, research, and training should look like. Also, some community hospital systems may wish to be evaluated; they could have their own category (no lab research), and pay for the process.

 

Potential Problems

There are potential problems, of course:

·    Many in our profession often reject anything new out of hand;

·    Conflicts of interest would need to be assiduously avoided; and

·     Accepting support from commercial entities like pharmaceutical companies risks a loss of credibility by academic and other institutions.

 

Nonetheless, I believe this approach should be considered with oncologists leading the pack to develop a system that can honestly advise patients and referring doctors of the quality of cancer care at a cancer center.


Saturday, July 19, 2014

The degree of success and satisfaction in one’s job is the result of a complex interplay of environment, colleagues, opportunity, institutional culture and one’s work ethic and other personal characteristics. Some people have a super intellect that carries them ahead, while others have a fierce worth ethic and make up for a lesser intellect by very hard work.

 

But there is one factor that is accessible to virtually everyone. Success often depends on recognizing and adapting to the changing dominant cultural and financial features of one’s era. The evolution of academic medicine is a good example of the effect of the shifting economic and professional sands on the structure of an industry.

 

A failure to keep up with changes that affect one’s job is like an ostrich with his head in the sand. The cycle of ups and downs in NIH grant support is never-ending. I am old enough to have been through at least four and maybe five such cycles. The changes are sometimes caused by a lack of political support for academia or a global economic problem like the Great Recession of the past six years. In any case, those that continue to thrive usually recognize the problem and find alternative sources or write many more grants.

 

At the professional level, top-level scientists do not wait for the next new thing to appear in publications. They attend elite symposia where they learn what other good scientists are doing. They accept speaking engagements to academic centers and pump all the scientists for the latest information or equipment. They collaborate with investigators around the world, not just in the U.S., to learn of new, efficient twists in studies.

 

Academic physicians sometimes do the same thing, but, alas, a large number scans the current literature and attends a national professional meeting or two each year. Nothing wrong with that, but by the time they learn of something new, they are already behind. Cooperative groups move very slowly and are seldom making breakthroughs. In other words, one must have colleagues who appear to be doing good work that is a step or two ahead of the game and take advantage of exchanging ideas.

 

The art of staying ahead of the game or at least being in the game is necessary to both job success and satisfaction. One can choose to wait for publications or meetings and be quite happy and successful at one’s everyday work. But long term satisfaction is more likely with the hard work of trying to stay in the game or ahead of it.


Friday, June 13, 2014

We often admire those who have long tenures in jobs. Some continue to do good work and enjoy job satisfaction for 20 or 30 years. These people often have a niche that is valuable to the organization, so they may be content with the same job for an extended period of time.

 

But longevity can be a sign of danger. One may have security, but longevity is not a good measure of success, accomplishment, or happiness.

 

Job satisfaction is never perfect in any job. For some, comfort and predictability rather than professional development are the sources of satisfaction. But for many of us who work in the academic and community medical arena, longevity can be a sign of professional inertia, ego-driven self-satisfaction, or enjoyment of being a big fish in a very small pond, where the competition is weak and the pressure for productivity is low.

 

In some cases, a person may work at a single institution for two or three decades but have a series of varied jobs during that time, each providing new learning experiences and challenges. Often this results in increasing leadership responsibility and professional growth. Others may find a better career path by leaving the home institution for a job that is a step up in another one.

 

So how does one know when it is a good idea to move on? Here are a few signs, but they will be of no use unless one is willing to be honest with oneself; sometimes it is better to have a discussion about it with a trusted senior colleague or friend. Here are some signs that a change should at least be considered:

 

1.   Boredom: This is a no-brainer. If you are bored out of your mind with the job, then looking for another one, whether within your current institution or elsewhere, is a good idea.

2.   A sense that there is no chance for advancement or serious professional development: That may be because there are no openings or one believes that gender or racial bias are part of the problem.

3.   An unhappy or toxic atmosphere in one’s unit: There may be grudges or difficult personnel making work difficult or unpleasant.

4.  The problem may actually be you: One may be trapped in a job that is a bad fit for one’s talents or desires, or the job, in retrospect, was a poor choice. Be careful with this one. Blaming yourself requires courage and truth; a trusted colleague is essential in this circumstance.

 

What if you want to move, but cannot due to family, geographic, or financial reasons? For this situation, a heart to heart with the leader of your group or the department chair is in order. You must ask for help and advice about how to make your situation more satisfactory. But keep in mind that this may require a change in your behavior.

 

I repeat: This process requires courage and facing the truth head on. But that will help you choose the best solution.

About the Author

JOSEPH V. SIMONE, MD
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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