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Simone's OncOpinion: Professional Migrations of Oncologists

Simone, Joseph V. MD

doi: 10.1097/01.COT.0000405402.68507.08
Douglas Blayney, Dean Gesme, Michael Neuss, Joseph Jacobson

Douglas Blayney, Dean Gesme, Michael Neuss, Joseph Jacobson



In a recent column (“Seismic Changes in Medical Practice,” 7/25/11 issue), I described the large professional movement of physicians, including subspecialists; many of these are from ownership of a private practice to employment. This migration has been attributed to poor reimbursement, health care reform, over-regulation of practices, the hassle of bookkeeping and insurance, a desire for more family time, and mental fatigue.

In order to drill down on specific factors faced by oncologists, I checked with four medical oncologists who have made the switch, discussing the reasons, process, and outcomes of their professional moves. I know each of the four personally and have worked with them on projects for ASCO. The interviews were conducted mainly by email.

Dr. Douglas Blayney was in a private medical oncology group with many practice sites in suburban Los Angeles for 17 years before taking the Medical Director position at the University of Michigan Cancer Center. He recently served as president of ASCO and this year moved back to California to a similar position at Stanford.

What are the main reasons that led you to make the change?

DB: Professionally it was time to make a change. I was tired of the commute and the traffic. In the managed care system that developed in Los Angeles, I found myself in more and more uncomfor–table situations regarding treatment decisions. Most importantly, the opportunity at the University of Michigan was a great time to leverage my experience and interests while continuing to practice clinical oncology (which I love); there were more opportunities for formal guidance and mentoring at the U of M. There are great people in both places, whom I enjoyed very much.

I found the thoughts of Peter Drucker, the management theorist useful. He writes about knowledge workers (such as physicians) who max out their skills in their mid-50s and have 20 more years to work. With knowledge workers, as opposed to manual workers who were often worn out by the time they reach their 50s, a second career that combines doing well the job of the first career (which by then comes easily) and acquiring new skills, is very common. I have recommended Drucker's writings to friends and colleagues contemplating a second career.

How did the opportunity arise—i.e., by ad, word of mouth, or recommendation?

DB: I was contacted by a recruiter, who knew of my work within ASCO. I did not look at any other jobs at that time.

How did you finally decide to move, and why that particular job?

DB: It seemed like a good idea at the time. Our children were at points in their education (two in college, one about to start middle school) when family disruption was minimal, and my wife had accomplished all she could in her teaching job.

Was the move a good one professionally and personally?

DB: Yes. We were able to move from California to the Midwest, a region of the country where we had never lived, and from a suburban to a rural environment. We made some great friends, both personal and professional. I was able to obtain training and develop skills by working with a broad range of hospital professionals and easily take courses in the Business School, which would have been much more difficult in my practice setting.

What are the main reasons it has been a good move? Any regrets?

DB: I have learned new skills, made contributions in areas I couldn't have in my previous settings, and looked forward to going to work every day.

Do you think there are such opportunities out there for oncologists who might like to consider such a move?

DB: Yes. I get calls or inquiries about twice per month. Peter Drucker, when he writes about knowledge workers and second careers, cautions that one needs to acquire the skills for the second career during the first. He uses the example of becoming a professional musician or chef as a career switch—the skills for the new career should be gradually acquired during the first career, or otherwise the second career will be a disaster.

Dr. Dean Gesme was in private oncology practice for 24 years in Cedar Rapids, Iowa, before moving to a US Oncology practice in Minnesota.

What are the main reasons that led you to make the change?

DG: I was becoming complacent and bored, I needed a new challenge, as affirmed by my wife who encouraged my wanderlust. My kids were grown and gone, and our grandkids (and kids) were in Minneapolis and San Diego, making these the destinations of choice for myself and my wife.

I was involved in several start-up oncology businesses (patient education website, oncology business news, patient financial assistance, cancer rehab), and I wanted a part-time clinical position that would allow for these ventures (two went bust in the capital market meltdown, but others are doing well).

Another reason for change was that I needed a better airport as I was flying a lot as a consultant, investor in new businesses, volunteer, and visiting grandkids. Cedar Rapids had few direct connections, while Minneapolis allowed national and international connections to most desired destinations.

How did the opportunity arise — ad, word of mouth, or recommendation?

DG: I made the opportunity. The practice I joined was not recruiting, but they were open to my part-time employment as I had helped them when they first came together and joined US Oncology. I also knew several doctors from the University of Minnesota, where I had been before practice in Iowa. I had looked at [academic] Clinical Director positions on the West Coast and at the University of Michigan. I had accepted at Michigan but they pulled the rug out after the fact on my clinical appointment and, on the advice of a mentor (dean of a med school who always called it straight) and my wife, I waved goodbye to academia and contacted Doug Blayney, who applied after me and hopefully used some of my disappointments in shaping his position at UM.

Has this been a good move? Any regrets?

DG: No real regrets. Although academia was a very tempting alternative, there may have been too many restrictions and expectations for my satisfaction. The move has been great for me from the standpoint of refreshing my clinical skills and bringing me into areas of oncology that I hadn't thought possible in Cedar Rapids—e.g., multidisciplinary team building for premier head and neck and esophageal cancer programs. I also continue to pursue new business ventures in oncology and enjoy working with the young people in those businesses and with teaching medical residents.

Do you think there are such opportunities out there for oncologists who might like to consider such a move?

DG: I see many oncologists who know how short life can be but also seem frozen into styles of life and habits of practice that prevent them from dreaming of how things might be different or better! Our comfort zone after years of training and high achievement seems to be very narrow—little imagination takes place as we confine ourselves to what others define as successful lifestyles.

Almost every oncologist has far more options than they have ever considered. Who else can make as much money, enjoy cutting-edge science, participate in major ways in our patient's lives, and make their own lifestyle than can an oncologist? It is not restricted opportunity but rather restricted comfort zones that make or break our opportunities, in my opinion.

Dr. Michael Neuss was in a private practice in Cincinnati for 25 years until a very recent move to Vanderbilt.

What are the main reasons that led you to make the change?

MN: The pull was the opportunity to see life from the other side and be on the cutting-edge as we move into an era of personalized, genetics-based treatments and set up multidisciplinary care with new payment and quality metrics models and the opportunity to try life in a new city. The push was the [progressively] increasing emphasis on the finances of private practice.

How did the opportunity arise—ad, word of mouth, recommendation?

MN: I was recommended by a colleague.

Did you look at other jobs at that time?

MN: Yes, three others — one hospital-based non-academic, and two other academic jobs that were/are very similar to this one.

How did you finally decide to move, and why that particular job?

MN: You are the Sicilian, but they made me an offer I couldn't refuse, with a very reasonable reporting structure, great support, and clear goals that should be doable. A key factor was that my wife, Gwyneth, said it would be fun, and that she was willing to give up one of the best jobs of her career as a school nurse for special needs children, to support the adventure.

Was the move a good one professionally and personally (so far)?

MN: Professionally, it's very difficult to leave longstanding patients who have given their trust at one of the worst moments in their lives. It feels like I'm abandoning them, and for a variety of reasons, I did make a clean break and that makes it worse.

However, there are patients here too, and there is some relief to go “off service.” Personally, the kids are grown, the dog was dead, and the disruption, while very real, is also very exciting and fun. So personally, great so far. And professionally, I'm working on it.

What are the main reasons it has been a good or a bad move? Any regrets

(so far)?

MN: The best part, which is more important than I realized it would be, is the opportunity to be around young people. The opportunity to be challenged clinically or otherwise by really smart and enthusiastic people is phenomenally satisfying. The fun of being unsettled and in a new environment is generally great.

Do you think there are such opportunities out there for oncologists who might like to consider such a move?

MN: There seem to be, but it's hard to be concrete. I hear stories, but not details.

Dr. Joseph Jacobson was in a hospital-owned community practice in Peabody, Massachusetts for 14 years, seven years in full-time oncology practice, and seven years in part-time practice plus medical administration. He accepted a position at the Dana-Farber Cancer Institute earlier this year.

How long were you in your prior practice, and where was it located?

JJ: I was never in private practice but in a hospital-owned community practice full-time for seven years, and then part-time for another seven. The practice is located in Peabody, Massachusetts.

What are the main reasons that led you to make the change?

JJ: I was mostly employed as a Chair of Medicine (80%) for the last seven years and was beginning to drift away from oncology. My practice for the last two years had been limited to the inpatient setting. The opportunity that I was given allowed me to return to focus full-time in cancer and for the first time in my career, to be paid to work on quality improvement.

How did the opportunity arise—ad, word of mouth, recommendation?

JJ: I was recruited. It was unsolicited. I wasn't looking or even thinking of moving.

Did you look at other jobs at that time?

JJ: No.

How did you finally decide to move, and why that particular job?

JJ: The opportunity to play a major role in helping shape the care at DFCI was compelling.

Was the move a good one professionally and personally?

JJ: SFSG (so far so good).

What are the main reasons it has been a good or a bad move? Any regrets (so far)?

JJ: I have moved into an intellectually stimulating environment full of challenges and unknowns—a huge gift at this juncture in my career.

Do you think there are such opportunities out there for oncologists who might like to consider such a move?

JJ: I suspect that more and more oncologists will become employed, and that there will be leadership opportunities of various types that will become available.

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Change is Risky, But…

So there you have four different stories of senior medical oncologists taking a chance at doing something more exciting and stimulating.

Change is risky, they tell us, but it also can rejuvenate one's career, open new doors, teach one a lot, and challenge one's capacities for change and adaptation that brings out the best in us.

Are these changes a unique sign of the times? No, many physicians have always changed their professional duties in mid-career, sometimes for advancement, but just as often for the reasons given above—boredom (first on my personal list), unhappiness with medical trends, and fear of losing skills because one works daily among those with the same ideas. Others have made more dramatic changes in careers, becoming poets, writers, politicians, or businessmen and women in industry.

When my daughter told me she wanted to go to medical school, I was thrilled, not because I wanted to brag about my daughter the doctor (which I do anyway), but because of the broad array of professional opportunities the profession and its spinoffs offer. For a female physician 25 years ago, this was an especially important consideration, and the relative financial security the profession offers makes such career changes more possible.

We physicians are blessed with multiple opportunities. But, as Doug Blayney said about the advice of Peter Drucker, one must prepare for the potential change years ahead by using some skills one has acquired (Consulting? Take serious cooking lessons?).

I needn't remind you that life is short and that we go around only once. If you look at opportunities when they come along but decide against a move, that is also a good thing because it may reinforce your satisfaction with your current role.

But if an exciting chance comes along at the right time…take it!

© 2011 Lippincott Williams & Wilkins, Inc.
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