Should You Pursue a Surgical Oncology Fellowship?

Christopher Brian Allard, MD

You probably shouldn’t pursue a surgical oncology fellowship. You have spent a grueling half-decade of residency acquiring and honing the physical and mental skills necessary for surgical competence. After a lifetime of education, you will finally be deemed a “real” surgeon, on par with your mentors. You now have the opportunity to make a good income and start paying down your debt. Isn’t it time to get on with your life?

You probably shouldn’t even consider a surgical oncology fellowship. Think how far you’ve already come. Remember how you used to doubt yourself and wonder if you had what it takes? Remember struggling through basic subcuticular stitches—hand shaking and brow sweating? Remember saying “yes” but thinking “no” when the attending physician asked if you understood the surgical anatomy? Remember how everything on the laparoscopic monitor looked like nondescript fat? All that has finally changed! Seize the moment—put your hard-earned skills to practice. You’re a “cutter” now, and you always will be.

Many surgical oncology fellowships include a research year. Do you really want to lay down the scalpel and pick up the books for a whole year? And why oncology, of all disciplines? You are already capable of performing multiple oncologic surgeries, which are a component of many non—fellowship- trained surgeons’ armamentariums. If a patient presents with an overly complex malignancy, you can always refer the patient to a subspecialist. Those cases tend to be exhausting anyway.

Then again, maybe you like the idea of being that subspecialist to whom complex patients are referred. Perhaps you find challenging cases to be the most intellectually stimulating. You have spent years developing procedural memory for routine cases, yet you relish the opportunity to exercise your intellect by solving unanticipated problems. You enjoy thinking on your feet (literally) and inventing approaches to novel challenges as they arise.

Maybe you see value in spending time in a center of excellence and observing similarities and differences with your own training institution. You might consider it an honor to be trained by some of the most esteemed surgeons in your field. As a future surgical oncologist, you hope to broaden your scope of knowledge by working closely with leaders from complementary disciplines, including radiation and medical oncology. You know that new experiences in a novel setting are inherently rewarding and any additional skills acquired will be icing on the cake.

These are the rewards I’m seeking as I enter the second year of my urologic oncology fellowship. During my research year, I learned more than I ever thought I’d know about biostatistics and research methodology—knowledge that will provide a solid foundation for future research endeavors. I have contributed to oncologic literature, and I’m optimistic these contributions will have a meaningful impact on patients. I feel better equipped to interpret and apply the oncologic literature to my own patients. Most importantly, I have formed relationships with inspirational clinicians and researchers with whom I hope to collaborate throughout a productive career.

Additional voluntary training is a major commitment with a significant opportunity cost. I wondered if my contemporaries had similar reasons for pursuing fellowship training.

“My decision to pursue additional training in surgical oncology was multi-factorial. I had a strong interest in oncology throughout residency and felt that additional training would afford me the opportunity to enhance and expand my technical skills while concurrently expanding my knowledge base to better understand disease processes— with the end goal of providing top quality care to my patients...” said Jasmir Nayak, MD, a urologic oncology fellow at University of Washington.

“A surgical oncology fellowship was an opportunity for me to not only continue developing skills in complex oncologic operations, but also to learn the comprehensive multidisciplinary approach to cancer care," said Alan Thong, MD, urologic oncology fellow at Memorial Sloan Kettering Cancer Center.

Although every physician’s reasons for pursuing a surgical oncology fellowship are unique, we clearly share similar values. So, if you don’t want to maximize your training such that you can confidently approach the most complex of cancer patients— in the clinic and in the operating room—then you probably shouldn’t consider a surgical oncology fellowship. But if you do share these values, then maybe you should!