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Oncologists making career decisions and practice transitions often do not have the information they need to be make the best choices. That's the premise of Strategies for Career Success, a new series to begin in the next issue of the Journal of Oncology Practice.
The series will provide practical information and advice that will help both Fellows in training and practicing oncologists looking for a new position to make good career choices and be effective in their new practice.
In selecting a practice, “making sure the fit is right is critical,” says JOP Editorial Board member Dean Gesme, MD, who first proposed the idea for the series. Gesme is past chair of ASCO's Clinical Practice Committee, and managing partner of Iowa Cancer Care in Cedar Rapids, Iowa. “In interviewing candidates just out of fellowship, many of us have had the experience that they are very green—they often don't even know the questions to ask that are germane to coming into a practice,” Gesme says.
He hopes the new series will provide the basics that oncologists need to make productive career choices. “Quite a few Fellows find a job, work for a year or two, find out it was a bad match, and then go through the same thing [again]. Usually they're not any better trained the second time around,” he explains. “By providing the basics of what they should be looking for, [we can help them avoid] a lot of mistakes.”
The candidates' lack of knowledge about practice and about how to make sound career decisions can have an adverse effect on the practice that is recruiting, as well, says Gesme. “Oncologists can spend a lot of time and effort recruiting someone and then find out after they join that their values and the kind of practice they're looking for are not consonant with the practice. An incredible amount of time, money, and effort is put forth that has been a waste,” he says.
A 2005 survey conducted by the American Medical Group Association (Alexandria, Virginia) and Cejka Search (St. Louis, Missouri), a national physician recruiting organization, confirms that physician turnover is a concern to medical groups. Noting that a physician shortage is looming, the survey found that more groups are tracking turnover and working on ways to retain physicians: 58% of the groups that responded stated that they have retention initiatives in place, compared with 48% in the 2004 survey.
The new Strategies for Career Success series is designed to help oncologists find the right position from the start. Although physician groups are working on retaining physicians they hire, a mismatch at the beginning can spell problems. “Physicians are most vulnerable to turnover in the early years of practice,” says Kathy Murray, senior search consultant for Cejka Search. “Cultural fit is a dominant theme that emerged in our retention survey.” The survey shows that, among physicians leaving a group, 47% left in the first 3 years, and 60% left in the first 5 years.
Thomas Flynn, MD, the president of a 36-oncologist group in Minneapolis, Minnesota, agrees. “A major factor in deciding on where to practice is the culture of the group,” he says. “Candidates all ask the usual questions about the call schedule, the clinic schedule, and how many patients a day they will be expected to see. That sort of thing is important to know, but then they need to ask questions about what other interests the members of the group have—do they do clinical research, are they involved in community activities and charitable organizations—that sort of thing.”
Strategies for Career Success will fill a need for information that is not provided elsewhere. Although some training programs have periodic workshops or seminars on topics such as contracts and negotiation, there has not been a national resource for career information and guidance geared specifically to oncology practice. “Through this series in the Journal, ASCO can provide such education much more efficiently than individuals could do it on their own,” Gesme says.
Articles in the new series will address how to find and select a practice, as well as basics of practice management information essential for a successful transition. Along with guidance on networking, working with recruiters, interviewing, and evaluating a practice, the articles will offer perspectives from experienced oncologists, recruiters, and oncology practice managers. What do seasoned practitioners know now that they wish they had known then? Flynn, for example, offers this insight from his 25 years in practice: “I wish I had known initially that private practice is every bit as intellectually stimulating and challenging as academic practice. Fellows in training do not have a good picture of private practice.”
The type of career and practice information needed varies greatly from physician to physician. Some Fellows looking for a practice position know a fair amount about the kind of practice they want, but need information on other challenging areas.
US Oncology (Houston, Texas), a network of nearly 1,000 affiliated oncologists, recently commissioned a survey to find out the top concerns of oncologists looking for a new position. Dwight Mussleman, US Oncology's vice president of physician development, notes that the research results confirmed what he has observed in his 14 years of recruiting oncologists.
“The main thing is geographic location,” Musselman says. “After geographic location, the top concerns are quality of life in the community and the quality of the practice, including the practice personality. The last thing is money. If the geography and the practice personalities are the same between two practices being considered, then the primary driver for making a choice is money.”
Priorities vary between men and women, too. The US Oncology survey found that women are much more likely than are men to indicate that quality of life is a primary concern, with 39% of the female respondents ranking it tops, compared to 12% of the men surveyed. “Quality of life was defined as what you can do outside of work,” Musselman explains. “If someone likes a big city and likes to go to opera, is that going to be available? What forms of recreation are nearby? Will their religious preferences be met?”
“The oncology Fellow should do a great deal of work in examining his or her own needs regarding practice issues, compensation, and location,” Cejka's Murray advises. “They should do their homework and ask the tough questions to determine how well a prospective employer's practice policies and culture will fit their own expectations.”
Topics planned for the new series will cover a lot of territory, to match the wide range of information needs and concerns of Fellows and oncologists looking for a new position. For example, Mary Chamberlin, MD, a Fellow at Dartmouth-Hitchcock Medical Center in New Hampshire, is seeking a part-time position that will accommodate her personal and family needs, with two teenagers and a preteen at home. “I'd like to see information about the challenge of finding a part-time faculty position that includes some research time,” she says.
Research is important to Chamberlin, who acknowledges that physician-researchers usually work more than full time. She would like to have more information about part-time career options, including practice sharing and negotiating flexibility into the schedule. She comments, “As our kids get older, our lives simplify, and then we can expand our work and service to a practice or institution.”
Chamberlin also mentions that how to set up a clinical trial and financial management are topics she would like to know more about. “Getting loans in medical school was very easy, but then you are stuck with these big totals of debt. It's overwhelming,” she says. “Through all of our medical training, there is very little about managing finances, managing your debt, looking down the road to see what kind of job you might need. I think a lot of us are clueless.”
These are the kinds of issues the new series will address. Beyond finding a position that is a good match, oncologists need to know basics about practice to make a smooth transition to a new practice and be an effective contributor.
Gesme finds that some Fellows in training—maybe 20%—are very knowledgeable about many aspects of practice. “But most are incredibly naïve. They are accustomed to being in a training environment, and many assume they will stay on as paid university employees,” he says. “Nevertheless, they don't have a clue about what the pay should be, what the hours should be, or what tenure's all about.” He adds that medical training does not give physicians the information or approach they need for career management.
“We want to provide them with tools to help them move forward in their career,” Gesme says. “In training, Fellows are so doggone busy they don't have time to thoughtfully research the issues on their own. And doctors are not patient people. We move fast, making decisions based often on information gathered quickly and on intuition, and then we move on. But entering a practice is very much like a marriage or a long-term business investment. Physicians need to know the rules and know that it's a different paradigm.”
The Journal welcomes ideas for additional topics that will address career and practice information oncologists need. E-mail your ideas and questions togro.ocsa@secnavdareerac.
Send your responses by e-mail togro.ocsa@secnavdareerac