Finding Time: A Day in the Life of an Academic Oncologist

We all have to balance competing demands on our time. But as an academic oncologist, I have to keep a foot in 2 worlds, research and clinical, while still keeping my balance.

Working as a medical oncologist in an academic setting challenges doctors to have a foot in 2 worlds: the first world revolves around scientific advancement, and the second around patient care. Each realm has inherent opportunities, rewards, and difficulties that we encounter every day. In this brief snapshot of my experiences, I will try to describe a day that illustrates the balance between these worlds, which is essential to achieve a balanced career in academic oncology.

Of course, each academic medical center has its own culture, demands, and spectrum of job types. Some academic physicians have a much more lab-based research practice; others focus on a strictly clinical research practice. My description reflects my own experiences in what might be a typical workday for a clinical trial researcher in gastrointestinal oncology.

Each week, I spend 2 days with an entirely clinical schedule. On these days, I see patients in the clinic and administer chemotherapy. I also have at least 1 day each week for entirely academic work. On this academic day, I dedicate my time to research protocols; student, resident, and fellow mentorship; and administrative duties. On other days, I have a mixed schedule with both clinical and research responsibilities. In this article, I will describe a typical Tuesday, which is the best example of a mixed clinical and academic day on my schedule.

Tuesday 7—8 a.m.

Multidisciplinary colon conference

Our GI oncology group works closely with a variety of other disciplines, and we are lucky to have collaborators in surgery, radiation oncology, gastroenterology, and radiology who share a common vision for patient care and research. We meet weekly to review challenging cases at a colorectal surgical conference. Since this conference is run by our surgical colleagues, we have an early start (but coffee is readily available)! The surgeons review new patient consults and challenging cases. Representatives from each of the participating disciplines have an opportunity to weigh in with their expertise and feedback. This conference is not only a place to collect fascinating cases, it is also a chance to learn the styles and personalities of the other physicians from other departments. Outside of this in-person conference, I may only interact with them over the phone. During conference, we also discuss open research trials, update the group on how shared patients are doing, or vet ideas about possible proposals for new research studies. Getting a “buy-in” for study participation from the providers who have the first contact with patients (in GI, that is usually the gastroenterologists and surgeons) will lead to more fruitful studies and faster subject accrual.

8 am—1 p.m.

Hepatobiliary-pancreas clinic/conference

After meeting with the colorectal surgeons, we share clinic space and time with our hepatobiliary surgical colleagues. Like the colorectal conference, this multidisciplinary clinic provides us with an opportunity to see patients as close to the time of diagnosis as possible. In this half-day clinic, we see up to 7 patients. Pancreaticobiliary malignancies often need neoadjuvant/adjuvant therapy, which requires delicate timing and effective collaboration between medical oncologists, radiation oncologists, and surgeons. This collaboration is both clinically and academically rewarding. Patients like to be able to have a “one-stop shop” to see multiple health care providers, and the close collaboration across specialties maximizes our patients’ potential for the best clinical outcome. In addition to the clinical benefits, this multispecialty coordination allows for direct research collaboration among 3 different sets of research disciplines, since each subspecialty has its own multi-institution research group. We are an Eastern Cooperative Oncology Group (ECOG), Radiation Therapy Oncology Group (RTOG), and American College of Surgeons Oncology Group (ACOSOG) site. Furthermore, having other clinical and research experts from other departments working closely together and reviewing common literature helps keep all of us at the top of our games. At the conclusion of clinic, the most complicated cases are often also reviewed with our colleagues from radiology and pathology, which allows them to offer their insights as well.

1—2 p.m.

GI Research Group meeting

In this meeting, the GI oncologists gather with the research program manager, our mid-level providers, and clinical research assistants to review the status of our study patients for the last week. We review all open study protocols in our disease group. In a systematic way, we also discuss the status of each patient in terms of duration of treatment, toxicity, response to treatment, and survival. Protocol deviations and serious adverse events are reviewed for attribution, and we brainstorm ways to avoid future problems. We review the progress of proposed future studies and evaluate where they are in the regulatory process and how we can speed these ideas through the necessary regulatory bodies. At this meeting, the 4 GI oncologists bring up clinical trial ideas, and we review one another’s proposals, protocols, and grants and provide constructive feedback.

2 p.m.—? (end of the workday)

Administrative time

After a busy first part of the day working with my partners and seeing patients, it is nice to have some time to catch up on clinical administrative work: dictating notes, following up on the results of lab work, scans, and biopsies, and making phone calls to patients. All of these tasks are vital for good patient care. It really takes a dedicated block of time to stay on top of clinical information, and, ideally, some time with the all-too-rare space of peace and quiet. Sometimes it feels as though there is no way to ever be caught up with the administrative work, but it is really essential to make a regular effort to stay on top of clinical documentation. I’m very thankful that I work with very good nurses and administrative assistants, who help to keep me organized and also do as much of the administrative work as possible. But as the doctor, there are some things that I have to do myself.

If I have patients in the hospital, I check in on them during my inpatient time. I’ll also coordinate with the inpatient team to see if guidance is needed.

For my research work, I use some of my administrative time, in addition to my dedicated research hours scattered throughout the week, to review protocols, make study-related conference calls, and meet with study monitors and basic science collaborators. It is especially challenging to find time when more than 2 busy schedules can coordinate, but it is imperative that an academic investigator have regular meetings with mentors and collaborators to keep research heading in the right direction. This is true for both clinical or basic science research. My colleagues who perform basic science research use their administrative time to meet with students and techs in their lab, ensure that their experiments are progressing to the next step, and troubleshoot ahead of time.

Heading home

My workday really ends whenever the rest of those tasks in my administrative time are done. Before I head home, I stop by my department mailbox to see if there are any journals I can pick up and read at home. It is vitally important for any research or clinical physician to make time every day, whether at work or at home, to try to stay current with the literature. I must confess that I have not been able to carve out that reading time at work, so I do my reading after I put my little guy to sleep.

That’s a pretty full day.