Paper Proposes New Community-Oriented Fellowship Training Model for Hematologists/Oncologists

Daniel A. Roberts, MD

As patients with cancer increasingly receive treatment in community hospitals and clinics and many such centers experience a shortage of oncologists, a group of physicians at Dana-Farber Cancer Institute, Beth Israel Deaconess Medical Center, and Harvard Medical School has proposed the first-ever training blueprint for oncologists planning careers in a community or academic-community setting.

The model, described in a paper published online today by the Journal of Oncology Practice, would provide an alternative to the traditional oncology training paradigm in which a year of clinical training is followed by two years heavily focused on basic or clinical research. The new pathway would instead focus the latter two years of training in areas particularly germane to community cancer care, such as equity in care, patient safety, quality improvement, and health policy, while increasing clinical time in community-based cancer centers.

Like traditional oncology fellowships, the new model would be based at an academic program but would offer a novel framework for training in the community and gaining exposure to areas more relevant to cancer-care delivery. This approach would help meet the needs of a changing cancer care delivery system in the United States, in which large, academic cancer centers are forging networks of smaller, community providers – an arrangement known as the academic-community hybrid (ACH) model.

“Over the last 15 years or more, cancer care has become increasingly complex. At the same time, there has been substantial growth in the delivery of care at regional and community centers, with most patients receiving their care in the community. However, the conventional model for training oncologists – fellowships designed to produce clinician scientists/researchers – has been slow to reflect these changes,” says Dana-Farber’s Daniel Roberts, MD, the first author of the paper. “It’s also important to acknowledge that many fellowship programs already have a great deal of community-facing work and likely have elements of this in place. What we hope to provide with our proposal is a blueprint for all fellowships across the country to prepare interested trainees to practice in a community-based setting."

For young oncologists who hope to work in that environment, and who may be less interested in a research-intensive career, the current system offers few alternatives to the standard fellowship, which emphasizes producing publishable research and acquiring grant funding, Roberts notes. The misalignment between the growth of community cancer care and the structure of most current fellowship programs creates the space, and the need, for the new program, the paper’s authors say.

“The model of doing this integrated work – where you’re in the academic realm but practicing in the community as well – is becoming a very attractive career path for oncologists across the country,” Roberts remarks. He cites the Dana-Farber cancer care network, which consists of six regional campuses linked to the Institute’s main campus in Boston’s Longwood Medical Area, as an example of an ACH model that could support the new pathway.

Under the proposal, trainees would spend more time engaging in areas critical the future of community cancer care delivery, including clinical care and community-based clinical trials, patient safety and quality improvement, business and operations, care equity and community access, health policy and alignment with professional organizations, and medical education. “Research would still be very much part of the program, but research in areas outside the traditional scope of bench science and clinical trial enrollment at the academic hubs,” Roberts says.

The senior author of the paper is Deepa Rangachari, MD, of Beth Israel Deaconess Medical Center. The co-authors are: Jennifer Faig, MD, Jonathan Wischhusen, MD, Sara Giordano, MD, and Christopher Lathan, MD, MS, MPH, of Dana-Farber; Utkarsh Acharya, MD, of Dana-Farber and Brigham and Women’s Hospital; Kelly Bodio-Downey, MD, and Kathleen Leahy, MD, of Lank Cancer Center at Beth Israel Lahey Hospital–Needham; Jason Shpilsky, MD, and David Dougherty, MD, MBA, of Abraham Cancer Center, University of Pennsylvania; and Reed Drews, MD, of Beth Israel Deaconess Medical Center.