A Career in Medical Oncology
Daily Life As an Australian Medical Oncologist
Diana Adams, BSc(Hons), BMBCh(Oxon), MRCP, AMEC, FRACP and Gavin Marx, BSc(Med), MBBS(Hons), FRACP
Training in Rural and Remote Areas
The top end
MOGA Members Dr Narayan Karanth and Dr Michail Charadikis were interviewed in the February 2013 edition of the RACP News about their experiences as a supervisor and trainee in the Northern Territory.
Click here to read the interview.
Senior Clinician's Perspective
Name: Professor Bogda Koczwara
Career Stage: Professor of Medical Oncology at Flinders University, Adelaide, and Head of the Department of Medical Oncology at the Flinders Centre for Innovation in Cancer at Flinders Medical Centre. She is also President of the Clinical Oncological Society of Australia.
I became interested in oncology almost by accident. I was working at Flinders Medical Centre as a basic trainee in internal medicine and was asked to do a rotation in oncology to replace another doctor. I liked oncology because I could do much more for patients than I had expected and the experience got me thinking about what makes a fulfilling and meaningful life. My patients were facing that question and I also re-examined my own values. I left my rotation not just skilled but enriched. At that time, Flinders didn’t have an accredited training position in oncology so I did a year of haematology and then three years advanced training at Roswell Park Cancer Institute, in Buffalo, New York. Roswell Park is one of the oldest designated cancer centres in the world. It was amazing to be able to learn the hands-on craft and to see the history around me.
I have always loved Flinders Medical Centre. It is progressive and open-minded. When I came back to Australia from the United States in 1997, I knew I wanted to work at Flinders. It didn’t have a department of medical oncology, so I had to develop one myself. At first, I had a part-time job, which grew into full-time. We recruited more oncologists and developed a clinical trials unit. I am proud of how far we’ve come. It’s been a team effort. The hospital has gone from not even having a department of medical oncology to just having opened Flinders Centre for Innovation in Cancer. We have a busy trainee program, which attracts good-quality trainees. We’re doing a lot of new things in cancer but most importantly we provide a comprehensive cancer service. Creating and growing the department has been a meaningful and exciting part of my career.
I am also proud of my work to establish the Australia and Asia Pacific Clinical Oncology Research Development Workshop (ACORD). The idea for ACORD came after I attended a course for junior researchers in cancer in Colorado, US, in 1998. Cancer visionary Dr Daniel Von Hoff developed the annual course, which continues to this day. It’s where junior cancer researchers work day and night to develop good research ideas. It’s exhausting and inspiring. I came back from that course and felt we needed to have that in Australia. With the help of many people around Australia and the world, I convened the first workshop in 2004. It runs every two years, with participants from all over Australia, New Zealand and Asia. It is inspiring when you see a trainee from Australia sitting next to a doctor from Bangladesh who explains the cancer challenges in their country.
My current main area of interest is survivorship. We are victims of our own success in oncology. More people are surviving cancer, and want to stay cancer-free and live a healthy life. As oncologists, we need to deal with the long-term effects of cancer treatment in survivors — such as heart disease, osteoporosis and premature menopause — and that really stretches our boundaries. I’m hoping we can start to collaborate more on survivorship research around Australia. We will host the first survivorship conference in Australia in February 2013.
Survivorship issues reflect the evolution of oncology. In the 22 years since I graduated from medical school, I have seen an evolution in cancer care — in science, practice and patient outcomes. If this can happen in my career, imagine what will happen 20 years down the track.
I’ve been lucky to find many mentors from many walks of life. Dr Trevor Malden, an oncologist at Flinders, has been a great mentor and friend. He has this wonderful balance of being meticulous and careful and being really connected with patients. The CEO of Cancer Council Australia, Professor Ian Olver, has also been a great support and guide, and was an enormous support in establishing ACORD.
Oncology is an exciting area, because you can really make difference. That difference is based on science, but also on the art of human connection. I take my work personally. I can feel physically ill when I worry about a patient with a suspected recurrence. I need to manage the number of patients I have so that I can maintain personal contact without being overburdened.
One of the hidden gifts of oncology is that you learn about the fragility of life. Oncologists learn to value their life because they know that life can change in an instant. Every success is a miracle. Every sunrise and sunset is a joy. Every joke that a patient cracks with you is a source of celebration. You learn how to face some of the demons of life — death and dying and saying goodbye. You learn that saying goodbye matters. These are important life skills that oncologists are forced to acquire as part of their job. Oncology is not for everybody, but if you can deal with those issues, it enriches both your personal and professional life.
Interview by Marge Overs - reprinted from the Medical Journal of Australia, 5 Nov 2012, Vol 197, No 9
Name: Dr Patricia Bastick
Career stage: Advanced trainee
Medical Specialty: Medical Oncology
What training program are you currently in?
I am completing my final year of Medical Oncology training.
What attracted you to this training program?
I decided on physician training partly through exclusion, but also I found the specialties within physician training interesting. Early on in basic physician training, I thought I would do respiratory medicine. I had not had any exposure to Oncology, and was actually quite afraid of my lack of knowledge in the area! I finally decided in my first year as a medical registrar to request an Oncology term, mainly to allay my fears. Little did I know that I would find it so interesting, and be so inspired by the Oncologists I worked with. I have come to realize during my training that the consultants you work with can have an enormous influence over your ultimate career path, and the Oncologists at St George Hospital amazed me with their enthusiasm and desire to teach. I discovered a specialty that is not only extremely intellectually stimulating, but very rewarding personally and very flexible due to the large outpatient clinic base. My training program allowed me to take 6 months of maternity leave, and return to work 2 days a week based in the clinics. There was not an issue of continuity as I was not involved in inpatient care.
What are some of the things that you did to help you decide and plan your career to get into this training program?
Once I decided that I was interested in Medical Oncology, I approached the consultants at my hospital to seek some advice. I could not believe how excited they seemed to be that I wanted to do their specialty! At that time, Medical Oncology trainee jobs were often empty and I was lucky enough to be offered a position at 4 different hospitals once I completed my exams. It is now becoming more and more popular, and there is now some competition for training jobs, although far less than Cardiology or Gastro.
What advice do you have for students interested in your training program?
Before you decide on a specialty, try to do a rotation in that specialty, at least once, if not twice, during your basic physician training. Try to get involved in all aspects of the job. If your role does not involve outpatient clinics, ask your consultants if you can help out in clinics or at least sit in on clinics. Inpatient Medical Oncology deals only with the sickest patients or those transitioning to palliative care. You will get a very skewed view on Oncology if you do not have exposure to the outpatients, and may decide that is not for you without even experiencing what 90% of the job is about!.
What do you do outside of medicine to relax?
I have a 12 month old son that keeps me very busy and reminds me every day that there is far more to life than work! *Profile and Image courtesy of www.mymedicalcareer.com.au
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