Finding Your Second Career: Stories From Oncologists

Kate M. O'Rourke

Disclosures

December 05, 2018

If you've thought about decreasing your patient load or transitioning away from patient care entirely, you're not alone: An increasing number of academic and community oncologists are making the leap to second careers in different industries.[1] Recently, Medscape reached out to several oncologists who have made this leap. Read on for their advice and their stories.

Jacqueline Huntly, MD, MPH, president and founder of Athasmed, LLC, is a career and leadership development coach who works with physicians. She envisions four main categories of opportunity for oncologists who want to transition away from academic or community oncology: the pharmaceutical industry, hospital administration, healthcare technology, and the health insurance industry. She said the role of physician advisor is also a growing field. "Among other responsibilities, physician advisors engage in second-level medical necessity reviews and compliance issues; claim denial management; and assist in length-of-stay management questions," said Huntly. "They can be a bridge between the administration and the physician staff, speaking both languages. They may also be involved with issues related to Medicare and other regulators."

Physicians are so used to seeing patients, they think it's all they can do.

Practice management consultancy is another growing area. "I worked with one oncologist who had been a medical director and run a practice, and was interested in leveraging her workplace flow and practice efficiency skills along with her hard-earned knowledge related to coding, utilization review, etc.," said Huntly. "[Practice management consultants] can help other physicians develop algorithms and processes to help manage practice flow. That is often a big issue in any practice."

Huntly advises oncologists thinking about changing jobs to gain a clear picture of their financial picture, why they want to leave, what they are looking for on the larger scale, and their strengths and skills. She urges physicians who feel on the edge of burnout to make choices early, before they progress to more advanced stages of burnout.

"Often physicians know their clinical skills but they haven't assessed what their other skills are—administrative, communication, etc. Physicians are so used to seeing patients, they think it's all they can do," said Huntly. "They should think beyond that and how else they can have an impact in the healthcare field. They should realize that there are a lot of opportunities out there for them, and also consider taking advantage of coaches or mentors to help them make that transition."

Early-Phase Drug Development

Kimberly Blackwell, MD, a leading breast cancer expert who spent decades at Duke University Medical Center, joined Lilly as vice president of early-phase development and immuno-oncology in March 2018. Blackwell knew she wanted to leave academics for pharma but was undecided about whether it should be for a large pharmaceutical company or a small life science opportunity.

"We are at a point in cancer drug development [where] many people are recognizing that we have to do things differently in order to accelerate improvements," said Blackwell. "I decided that I might be able to influence and have a larger impact by looking at drug development from a larger scope and scale, and I saw an opportunity at Lilly. All of the stars aligned."

She knows she made the right move. "It's like I am playing in the Super Bowl . I have a vision of where I think the ball needs to go, and I have lots of resources to get the ball down the field," said Blackwell. In academia, she said, researchers often have vision but do not have the resources to get the vision materialized.

I took a long, hard look at what gets me up in the morning.

Blackwell was drawn to the fact that Lilly had new leadership, including Levi Garraway, MD, PhD, senior vice president of global development and medical affairs, who made the leap to pharma after a distinguished career at Dana-Farber Cancer Institute. "I saw a unique opportunity to be more nimble and speedy in getting the drugs down the football field, with some very creative thinking, science, diagnostics, and enrichment strategies," said Blackwell. She said she loved the quality and quantity of the science that she sees every day, but the icing on the cake is that it is science with a therapeutic intent.

"As someone who has been in academics, you think the science is top-notch where you live, and it is; but the science here is equal, and it has a focus that I love as a drug developer, which is [that] the science informs how you develop the medicine, which then influences how you are going to help patients from the science. That connection is really the sweet spot for many of us who have done clinical trials for a long time," said Blackwell. "We have seen the benefits of the science getting to the clinic, and now we want to get the science to the clinic even faster."

Blackwell says she spends one workday a week traveling and still attends all of the "fun meetings" that she did when she was an academic oncologist. One of her tasks at Lilly is to improve academic partnerships. "We have been in that world, and we know what works and what doesn't work," said Blackwell. "We are thinking very creatively about how to have a very transparent interface with our academic collaborators and what will best serve both parties, both the academic researchers and Lilly researchers."

When asked whether she had any advice for oncologists thinking of transitioning, Blackwell said they should ask themselves what excites and inspires them. "I took a long, hard look at what gets me up in the morning, and what I found was that I loved taking care of patients. That [provided] immediate gratification. Every day of my career as an academic clinician, I could drive home at night and say that I have helped someone today. The other thing that gets me up in the morning is delivering new treatments to patients facing cancer who don't have many options," said Blackwell. "If drug development and influencing how we get new drugs to patients who need them gets you up in the morning, then a career in pharma should be a strong consideration."

Late-Phase Drug Development

Maura Dickler, MD, spent 23 years at Memorial Sloan Kettering Cancer Center in New York City before making her move to Lilly in March 2018. She serves as vice president of late-phase development in oncology and loves it.

"I was pondering what direction I wanted my career to take over the next 10 to 15 years of working life," said Dickler. "Did I want to take on a new challenge within academia or did I want to try something entirely new? I had to do some soul-searching at the time."

I had to push myself out of my comfort zone to make a big move.

Dickler says she encourages fellows to consider many different opportunities when they look for their first job after fellowship, and she did the same. "I considered different academic opportunities, but at the end of the day, I realized that everything I wanted in academia was at Memorial. I also decided that it was a good time to explore opportunities outside of academia," she said. Pharma was high on her list, because she was already very passionate about drug development through her work with clinical trials.

When Dickler was preparing her MONARCH-1 presentation on Lilly's abemaciclib for the annual ASCO meeting in 2016, she worked closely with colleagues at the company. "I could see how passionate and dedicated they were to moving the field forward, and how they worked together so well as a team. That increased my interest in pharma in a much more serious way," said Dickler. "I could see how the pharmaceutical industry played a critical role in the successful evaluation of novel agents."

At Lilly, Dickler works with teams of people who are assigned to a molecule, drug, or other asset. "I work across agents to help design clinical trials and develop a strategy for how and where a drug might fit best in the changing landscape of oncology," she said. Blackwell is involved in phase 1/2 trial research, and once an asset has a phase 3 trial, it comes into Dickler's purview.

Dickler says one of the things she enjoys most about the job is that it allows her to work on cancers other than her former specialty. "Now, I think about lung cancer, GI malignancies, and renal cancer, in addition to breast cancer, and how we can move the field forward in those areas," said Dickler. She also enjoys her colleagues, who bring training and experience from a variety of backgrounds, including physicians, scientists, chemists, and engineers.

"There are many aspects of drug development that I was not exposed to in my prior role in academia. Not only is there ongoing work in safety, pharmacokinetics, and pharmacodynamics, but there is also significant effort focused on drug formulations and drug delivery methods."

Dickler enjoys the big-picture aspect of her job, such as trying to design clinical trials that will be clinically meaningful when the data will read out, typically several years after initial trial design. This is a real challenge, because the landscape is changing rapidly.

Many physicians who make similar career moves to the pharmaceutical industry still care for patients in some fashion, and Dickler continues her involvement with patient care.

When asked for advice for other oncologists considering a job switch, Dickler said that making a career change is a positive thing and that physicians should "be bold" when considering new opportunities. "Taking on new challenges helps us grow as individuals, and I would strongly encourage it," said Dickler. "I think it's important to reflect on where we are in our lives and where we want to be, taking responsibility for our choices and not just letting life happen. I had to push myself out of my comfort zone to make a big move, and it was absolutely the right thing for me."

Dickler strongly advocates that everyone should have a mentor. "Everyone needs guidance as they navigate through training and professional life. And in turn, we should prioritize mentoring of our junior colleagues to share knowledge gained during our professional journey," said Dickler. "Mentoring is a skill that needs to be honed and prioritized, as it's crucial that we pave the path forward for our future leaders."

Quality of Cancer Care

Michael Fisch, MD, MPH, has served as medical director of medical oncology programs for AIM Specialty Health since February 2015. He works closely with the executive leadership team to provide clinical expertise for the expansion of the company's Oncology Solution.

Fisch's decision to switch lanes on the career highway was rooted in the fact that he had enjoyed 15 years at MD Anderson Cancer Center, in Houston, and foresaw a large amount of organizational heavy lifting but not much academic growth in the next 3 years of his work life. He had also been intrigued by some of the value-based care and alternative payment model issues in oncology that he saw flowing by out of the corner of his eye, from such publications as the Journal of Oncology Practice (JOP). When Fisch heard that AIM was searching for an oncology leader to work closely with Anthem on programs that drive quality and efficiency of care, he knew it was the right move.

The window for making the career transition was not going to be open forever.

"I was ready to take on a new adventure, get out of my comfort zone, and learn some new things, but I didn't feel like a new learner in any particular realm," said Fisch. "I had been consulting with Anthem, including serving as part of a panel of physicians who were evaluating clinical pathways in oncology. As a panel consultant, I became fascinated with the conceptual underpinnings of what was being done—the drive toward value-based care and looking at curated evidence. It has been a fabulous 3.5 years, a great time of growth and learning, and I have really enjoyed the transition. It feels like taking on a new fellowship."

When he was a medical oncologist specializing in genitourinary oncology at the University of Virginia, he developed a special interest in palliative care and quality-of-life issues, and was lucky to land a full-time palliative care opportunity at MD Anderson Cancer Center. Today, he said, that position would require a palliative care fellowship, and he felt that he was in a similar position taking the plunge at AIM.

"If I were to wait another 3, 4, or 5 years, this position would have different qualifications," said Fisch. "I had a sense that the window for making the career transition was not going to be open forever, and that this was a chance for me to come in tabula rasa and learn on the job, without having an MBA or a business or healthcare policy background."

Fisch's move to AIM was also spurred by a canary-in-the-coalmine moment. "Some of the most intriguing things in the field and the big opportunities for making strides in healthcare delivery are not all going to flow out of the academic space. They are going to come from various other areas," said Fisch. "The academic world will have a role, but they won't be the only ones involved or necessarily the leaders in certain key innovations."

Fisch said he was always more focused on quality of care, so he never considered moving to pharma. He was worried about how his colleagues would perceive him when he moved to AIM. Would he get kicked out of ASCO? Could he continue to serve on committees with the clinical trials group SWOG? "I wasn't sure whether this would burn any bridges to things that I really cared about," said Fisch. It turned out that it didn't. He negotiated a continuing role as a clinical specialist at MD Anderson, where he sees patients once a week; continues to present at ASCO meetings; and his SWOG colleagues embraced the new angle he brought to the table.

In his role at AIM, Fisch interacts with healthcare clients, including Anthem, to help them better understand how to improve the quality of care in oncology and manage the cost of care efficiently. "I work with a team of people to implement the clinical pathways program and curate the evidence, and keep up with the very dynamic changing space of the oncology clinical trials that inform pathways. I am frequently traveling," said Fisch. "I work with a panel of external experts, academic and community oncologists, to evaluate evidence and make judgments about the pathways. I really try to bring to life the ASCO Value Framework, and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale, and apply them."

An important part of being a medical director at a company such as AIM is interacting with health plan leaders and helping them to understand themselves and the members they serve. How are they doing with cancer care? What are they spending their money on? How often are their members getting cancer and what types of cancer are they getting? What is the quality of care? How often are they utilizing appropriate palliative care services? How are they implementing genetic testing and precision medicine? "These are things that are very complex and very dynamic, and as health plans try to understand it, we help them with clinical expertise and look at their data, helping them think through what they can do to improve the care of their members," said Fisch. "The job also includes getting involved with the physicians in the hospitals and the oncology practices that are doing this work and are affected by the programs, and working with their local health plans."

Fisch is still publishing actively in such journals as JAMA Oncology and JOP, as well as at conventions, such as the ASCO Quality Care Symposium and the Gastrointestinal Cancers Symposium. "It's one thing to implement a new plan, protocol, or quality improvement initiative, but it has to be evaluated," said Fisch. "We work with Healthcorp Inc., a brother company owned by Anthem. They have a lot of data and expertise at evaluating programs and doing comparative-effectiveness research. The beautiful thing about this change for me is that I haven't had to relinquish what I have most enjoyed all along in academic oncology, which is being curious and asking questions, collecting data, [analyzing it], and sharing those data."

Fisch advised oncologists pondering a career move to thoroughly assess their motivations and expectations. "It's an exciting time in medicine," said Fisch. "There are lots of ways to contribute to the healthy goals of improving care."

Health Insurance Industry

After training and a fellowship at MD Anderson Cancer Center, Roger Brito, DO, started a community practice in Palm Beach County, Florida. He says he had a good 18-year run and was looking for a change. In June 2017, Brito became one of the medical directors leading Aetna's Oncology Solutions.

Brito advises those interested in pursuing a position in the insurance industry to start with part-time consulting work, which is the path he traveled. In 2015, he started working for Molina Healthcare as a subject matter expert in oncology, and he got a feel for the payer side of oncology. "I interacted with oncology colleagues, and they were often very happy that there was another oncologist on the line reviewing certain drug regimens or radiographic studies, and I actually enjoyed that interaction," said Brito. "Sometimes it can be heated and challenging, but other times it can end up being collegial."

While working as an independent contractor with Molina Healthcare, first on oncology protocols and then with pharmacy and reviewing cases, Brito urged managers at Molina to establish an oncology-specific review, but the company didn't have the budget. When a colleague alerted him to the opportunity at Aetna, he jumped.

I am the go-to oncologist in this amazing enterprise, and there is never a dull moment.

Brito sees his job at Aetna as "evolving and ever-changing." His main priority is to innovate oncology care and improve the care of Aetna members by managing 650 medical oncologists under an oncology medical home program developed in 2014. "The oncology medical home involves a move away from a fee-for-service setting to a value-based oncology delivery model that focuses on patients and providing the best care to those patients," said Brito. "We can do it in a cost-effective fashion without sacrificing quality, and we have data to show that. I visit many of these sites personally, and I interact with colleagues and oncologists at meetings and national conferences."

One of Brito's many hats at Aetna is reviewing tricky oncology cases. He also evaluates care-management issues. "One of our goals is to establish an oncology-specific care-management platform, so that a patient diagnosed with cancer can reach out to Aetna," said Brito. "If you get chemotherapy, there is a lot of physical toxicity, but there is also financial toxicity and behavioral health toxicity involved in the cancer diagnosis and cancer journey. Our goal is to holistically look at that [cancer patient] and establish a specific oncology resource."

This includes survivorship issues. "There are 15 million survivors walking around the planet, and those patients now have different needs," said Brito. Because of their treatment, for example, they may need to be evaluated for possible neuropathy or heart failure.

Brito estimates that he spends 1 week out of every month on the road. "I am the go-to oncologist in this amazing enterprise, and there is never a dull moment. The travel part for me is exciting, because I am older and my kids are out of college," said Brito. "It's a great time in my life to start a second career. I don't think this is a position that you can even begin to move the needle on [in regard to] what needs to be done unless you have already been in practice."

In moving from clinical practice to the health insurance industry, there is a huge learning curve. "My first 6 to 8 months here was like drinking from a firehose," said Brito. "All of the knowledge about how it works on this side is very informative and enlightening. The insurance world is often seen as the big, bad insurance company, and our popularity is below that of a cable company; but I can tell you being here for almost 2 years that clearly the focus is on the patient."

Brito says he feels honored to have touched thousands of patients' lives as a private clinician, but he has "the opportunity to touch millions of lives" working for a large company such as Aetna. He said he does miss the patients and the collegiality from his previous job. "I don't interact with colleagues as much as you do in a community or academic practice," said Brito. "That is something that is lacking, but it is made up by the fact that there is so much to do in the oncology world on this side of the healthcare continuum, that it keeps you busy."

He highly recommended second careers for practicing oncologists. "In a medical career, if you ever get the opportunity to spin off and start a second career once you have established yourself, it's great, so keep those opportunities open," said Brito. "There is a need [for oncologists] in the health insurance industry. You are still taking care of cancer patients, but just not in a direct clinical approach."

A Plethora of Options

James Mangraviti, Jr., Esq, is a principal of SEAK Inc., a continuing education firm accredited by the Accreditation Council for Continuing Medical Education. The company helps physicians who are interested in making a career change to explore their options, and its primary function is to offer training to physicians in side jobs they can do to supplement their income. These include expert witnessing, file reviews, independent medical examinations, consulting, life care planning, inventing, and writing. "There are all sorts of side gigs that physicians can do, and we teach them how to do them," said Mangraviti. "We give them a 2-day course, and when they are done, they are good to go."

The company also hosts an annual nonclinical careers conference. "We bring in approximately 40 doctors who have transitioned to nonclinical careers, some of them part-time, most of them full-time, and we expose the [audience of] physicians to all kinds of careers—a mind-boggling number of opportunities," said Mangraviti. "Most physicians wrongly think that there is nothing else out there for them to do, but when they leave the conference, they realize that there is so much opportunity out there that they feel like a kid in a candy store."

Mangraviti believes that oncologists have more opportunities than other physicians to transition to a second career. "There is also a tremendous amount of cost [and toxicity] involved in treating cancer, so there have to be oncology specialists managing whether something is medically appropriate for insurance companies," said Mangraviti. "Oncologists are also internists first and have broad medical knowledge, which is usually in fairly high demand."

For more stories of oncologists starting second careers in healthcare technology, the nonprofit sector, Wall Street, and other fields, stay tuned for Medscape's follow-up article on second careers for oncologists.

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