Achieving Career Success in Academic Oncology

What to know when deciding on a career in academia

Applying for an academic job

The field of oncology has undergone a significant transformation in the last few years. In this era of individualized medicine, we are learning new ways to tailor treatment based on the molecular pathways of the tumor. There has never been a more exciting time to be in the field of oncology, especially in academic oncology. In addition to the ability to develop a disease-focused clinical career, an academic oncologist can build a research, educational, or administrative career (as, for example, a cancer center medical director or a department section chief). Academic oncologists have a critical role as opinion leaders and shape the future of cancer care by research and training future oncologists, residents, and medical students.If you are planning to pursue an academic career, make sure you have a mentor who can guide you through the application, interview, and selection processes. Generally speaking, there are usually many academic oncology practices in universities and cancer centers that actively search for young talent to build their department or join their established staff. A fellow should start looking for an academic job opportunity before the end of the second year of fellowship or during the early part of third year. A good place to start is with advertisements in major oncology journals or postings at national meetings such as the American Society of Clinical Oncology or the American Society of Hematology Symposium.

The job interview process

Tenure versus non-tenure tracks

Preparing an adequate curriculum vitae (CV) is probably the most important step in the job application process. The CV should include the following information in a clear and organized manner: contact information, academic background and training history, research experience, grants and publications, awards, and voluntary work experience. Emphasizing teaching or mentoring experience and research skills (while avoiding falsifying information) will make a candidate more desirable for an academic job. A candidate should also identify mentors who know him or her well, and who are willing to write letters of recommendation or serve as references if needed.Institutions that have great interest in a candidate will send an invitation for a job interview. This is an opportunity for the candidate to make a lasting impression and also take a closer look at the work environment. To prepare for the interview, the candidate should inquire about interviewees—including other cancer specialists such as radiation oncologists and surgical oncologists—and their clinical interests. This information can be used to emphasize potential areas of collaboration in the future. In general, the candidate is expected to give a presentation related to his or her work and research interest. It’s vital to tailor the depth of the presentation based on the audience’s clinical interest and background. For example, if your audience is predominantly clinicians, try to focus on the translational or clinical aspects of your research as opposed to basic science. The interview is also an opportunity to highlight individual strengths such as involvement with investigator-initiated clinical trials and prior publication.It is important to understand the different aspects of a tenure vs non-tenure academic oncology track, including the academic ranks and specific requirements for each. A proper understanding of the responsibilities associated with a specific academic position, as well as the culture and expectations of the cancer center and department, is crucial for the candidate’s success in that environment.

Usually, a candidate who has recently completed fellowship is accepted as an assistant professor or, in some cases, as a tutor or clinical instructor. In general, the candidate is offered a position in either tenure track or non-tenure track. In the past, tenure track meant guaranteed, permanent job appointment and benefits. The definition, however, varies from one institution to another. It is very important to find out if you are interviewing for a position in the tenure or non-tenure track and what the specific requirements are for each track. The type of appointment and the requirements needed to achieve tenure status should be made clear in the offer letter.

Types of academic appointments

A key factor to advancing the academic ladder is identifying a mentor who shares common clinical and research interests. On average, an assistant professor is usually eligible to be promoted to an associate professor rank after 5 to 7 years. Each institution will have its own criteria for promotion, and new faculty should familiarize themselves with them. The promotion process involves a thorough review of performance in various aspects of the particular track you are in. It is important to maintain a high level of academic, research, and clinical productivity.In general, there are 3 types of academic appointments in oncology: clinical track, scientist track, and clinician scientist track.

Clinical track: Academic oncologists in a clinical track spend most of their working hours (up to 90%) in direct patient care—related activities. This can involve an assigned number of outpatient clinics per week (sometimes up to 4 days of clinic), along with hospital setting or inpatient coverage. The remainder of the time is dedicated to teaching and some research. Since this is a primarily patient care–focused track, the research expectation is limited. However, the faculty member is strongly encouraged to enroll patients in clinical trials and participate in national cooperative oncology group– or industry-sponsored studies. A clinician track oncologist is rarely expected to write an investigator-initiated trial due to their limited time.

Scientist track: In this track, the emphasis is primarily on research (bench or translational). These oncologists can have up to 90% protected time for research, with less emphasis on patient care and teaching responsibilities. In general, academic oncologists in this setting are guaranteed lab space and initial funding to buy supplies and cover other overhead costs for the first 1 to 2 years. In addition, other ancillary services (eg, animal facilities and tissue banking) and access to other collaborative facilities (eg, clinical trial research units and statisticians) is provided. Academic oncologists are expected to eventually bring extramural support for research and mentor fellows with research interest. The patient care responsibility is usually minimal, consisting of 1 or 2 half-day clinics per week.

Keys to Success in Academic Oncology

• Thoroughly understand the expectations and goals of your track.
• Identify a mentor who is familiar with your career goals and who is willing to help you.
• Focus is essential for academic success; concentrate on your strengths and focus on your goals.
• Always try to be a good team player and treat others with respect.
• Take care of your patients, yourself, your family.
• Remember to keep a positive outlook and have fun!

Financial compensation in academia

Clinician scientist track: Clinician scientists are usually translational investigators. They are the bridge between clinicians and basic scientists or oncologist in the scientist track. Clinician scientists are expected to write investigator-initiated trials and be principal investigator for national cooperative oncology group or industry-sponsored trials. Clinician scientists are also expected to acquire financial support through clinical trials or extramural funding. Usually, clinician scientists are in the clinic 2 or 3 days per week, with the rest of their time dedicated to research and clinical trial activities.The financial compensation for an academic oncologist is significantly less than for an oncologist in a private practice. The starting salary for an academic oncologist is $160,000 to $200,000, compared with $175,000 to $300,000 for an oncologist in private practice. However, the financial risk in academia is less since academic oncologists work within the structure of university hospitals where the costs and profits are spread over multiple departments. Academic oncologists can choose to supplement their salary through research grants or by giving lectures at pharmaceutical-sponsored conferences.

Academic oncologists are not isolated from real-world medicalfinancial concerns; they will need to learn about the “ins and outs” of medical billing including, for example, assigning the correct Current Procedural Terminology code for Medicare patients. Familiarity with reimbursement measures such as Relative Value Units (RVUs) is essential since they are also used as a productivity indicator (ie, many practices set RVU goals based on the number of years in practice and assigned academic track).

All in all, finding your niche in academia and tailoring your career to suit your personal strengths and interests is instrumental. As Confucius said, “If you enjoy what you do, you will never work another day in your life.”

Mohammed Almubarak, MD, is assistant professor of medicine in the hematology/oncology section of Mary Babb Randolph Cancer Center in Morgantown, West Virginia.Jame Abraham, MD, FACP, is Bonnie Wells Wilson Distinguished Professor and Eminent Scholar; co-leader of the Breast Cancer Program; chief of the hematology/oncology section; and medical director of the Mary Babb Randolph Cancer Center at West Virginia University in Morgantown.