Some career paths are straightaways, cleared and paved. Others are rocky and winding or take sharp, unexpected turns.
For David Schenkein, MD, it was a bit of both. When he finished medical school in the mid-1980s, Schenkein set out on the only path he had envisioned.
"My career path and aspirations at that time were 100% academic medicine — from the start until they take me out in a box," he said.
His first stop on the road to academia was an internal medicine residency at New England Medical Center, now known as Tufts Medical Center, in Boston.
Next up was a hematology/oncology fellowship and a postdoctoral stint in a molecular retrovirology lab there. Naturally, he joined the New England Medical Center faculty after that, working mainly in a clinical role and specializing in malignant hematology.
By 2000, Schenkein headed the lymphoma service at the center and ran a small research lab focused on translational research — mainly on bone marrow and transplant issues. He did some teaching and took on other academic responsibilities at the medical school, and that year, after serving as a full-time faculty member for more than a decade, he was named head of the Tufts University Cancer Center.
"I had a very thriving academic hematology practice as well…and I was an associate dean at the medical school. I was very much on a career trajectory."
He hoped to one day become chair of a department or dean of a medical school.
"That's how I always thought about it, and never really thought about anything else."
But 10 years into his career, a cup of coffee and a conversation changed everything.
He moved to a biotech start-up and has been working in the pharmaceutical industry ever since, going on 19 years now.
Medical oncologist Neal Meropol, MD, also left academia for industry.
Meropol completed his residency at Case Western Reserve University in Cleveland, followed by a fellowship in oncology — including a "bonus year" to focus on clinical research — at the University of Pennsylvania. He pursued a career as a clinical investigator, landing first at Roswell Park Cancer Institute in Buffalo, where he spent 6 years establishing himself as an early phase clinical investigator focused mainly on gastrointestinal cancers.
Next, a chance meeting with the chairman of oncology at Fox Chase Cancer Center in Philadelphia led him back to Pennsylvania.
"With that move I was given more scope and opportunity to build in the areas I was interested in, and so I was able to have a role in the population science division as well as [in] drug development and in developmental therapeutics," says Meropol.
Within a week of the move, a "serendipitous" funding opportunity from the National Cancer Institute changed his life course.
"Suddenly, I was funded for investigations in patient decision-making," he explains.
Over the next decade, Meropol developed a GI cancer clinical program, a risk assessment program, and health services research program.
"After 11 years, I was thinking…what's an interesting next step for me? Really, my career up to that point…was pretty linear; the next step for a guy like me was to become a division chief, to become an associate director of a comprehensive cancer center."
He returned to Cleveland where he had completed his residency. There, he was named professor and head of hematology and oncology at University Hospitals Cleveland Medical Center and Case Western Reserve University, as well as associate director for clinical research at Case Comprehensive Cancer Center. He also maintained a role in multidisciplinary clinical care.
But after 8 years in these positions, Meropol found himself once again looking for a new challenge. His search took him to Flatiron, a healthcare technology and services company.
So how — and why — did these physicians change career paths? Both talked about their decisions and described their respective journeys at the recent American Society of Clinical Oncology (ASCO) virtual annual meeting, during a professional development panel discussion.
Schenkein says he had never imagined leaving academic medicine and going into industry because he had not come across many examples of others doing so.
It really wasn't even on his radar — until the winter of 2000, that is.
That's when he agreed, as a favor to a friend of a family member, to that fateful cup of coffee and a chat with the CEO of a biotech start-up, Millennium Pharmaceuticals.
He was intrigued.
The genomic sequencing company was growing, and in its pipeline was "a very interesting small molecule that was able to inhibit the proteasome" and was considered to have potential in the treatment of multiple myeloma.
"They therefore had determined they needed to build a hematology-oncology department at Millennium to see if this drug could be developed and eventually brought to market," he explains.
Schenkein was in his mid 40s and he says he realized two things: First, most of his time as cancer center director was spent cutting budgets and space, as well as fielding complaints from frustrated faculty members about all those cuts.
Second, as a clinician caring primarily for patients who were having bone marrow transplants, he was "perhaps a little emotionally drained." At the time, advances in care meant more people were being cured, but the prevalence of toxicities and graft versus host disease was harrowing.
The thought of being part of "a really exciting young biotech company…with a lot of resources and, potentially, a very interesting drug that could make an impact," was the turning point.
"As a clinician, I was making an impact one patient at a time, one family at a time, and I love doing that," he said.
But he was swayed by the thought of "developing a new medicine that could help tens of thousands — maybe hundreds of thousands — of people."
Six weeks later, he told the Tufts leadership that he had accepted a position as vice president and head of hematology/oncology development at Millennium.
"They thought I had grown 12 heads and that I was crazy," he recalls.
"I did ask if I could keep my faculty appointment so that I could continue to see patients one day a week, and they agreed to that." He says it was important to him to stay connected because he wasn't sure what he was getting into or if the drug would be a success.
It turned out that the drug was a success, a huge success in fact. The drug was bortezomib (Velcade), approved by the FDA in May 2003. A first-in-class proteasome inhibitor, bortezomib has quickly become accepted as a mainstay of treatment for multiple myeloma, and is now included in standard-of-care regimens.
"It hit me, the responsibility, but also the impact we were about to make on the field of multiple myeloma," he recalls. "I realized…that as a physician, I could still make a huge impact, maybe even more of an impact, on the side of industry. It made me realize I want to do more of this."
His path then led to Genentech, where he was head of oncology development for a 4-year period that saw new approvals for trastuzumab (Herceptin), bevacizumab (Avastin), erlotinib (Tarceva), rituximab (Rituxan), and "put a whole series of new molecules in the clinic that have now become approved drugs."
His next stop was at Agios Pharmaceuticals in 2009, where he and his team discovered, developed, and obtained approval for two isocitrate dehydrogenase (IDH) inhibitors — enasidenib (Idhifa) and ivosidenib (Tibsovo), both used in acute myeloid leukemia.
Two years ago, he was ready for another change. He transitioned to become chair of the board for Agios and then sought out an opportunity in the "venture world," where "one can help build new companies that can, hopefully, make new medicines."
He joined Google Ventures, now known simply as GV, "a venture arm that invests in new companies, either in the digital space or the life science space."
He also remains on the faculty at Tufts, where he is an adjunct clinical professor and can "teach a little bit with the Fellows."
"I'm not doing much patient care anymore, but it's kept me off the streets at night," he jokes.
The "Itch to Leave"
For Meropol, the move was propelled by an "itch to leave" the academic world and be part of something different.
"I was sort of feeling like I didn't really want to be a cancer center director. I didn't want to spend so much of my time herding cats and fighting for resources," he explains. "There is a lot of great stuff about being a cancer center director — don't get me wrong — but I realized it was not for me."
His foray into the private sector was a bit more intentional than Schenkein's.
"I took inventory of the things I like to do and the things I didn't like to do, and what my skills were that might bear on a future role — and what were my 'must haves' and my 'nice to haves,' and I had it all laid out," explains Meropol.
Next, he contacted oncologists he knew who had made the leap, whether to government, Big Pharma, biotech, diagnostics, or elsewhere.
He made cold calls to places that he thought could be of interest. One of those places was Flatiron Health, a company that processes real-world oncology data with a mission "to improve lives by learning from the experience of every cancer patient."
"We shared a vision about what Big Data in oncology from real-world cancer care could do in terms of helping cancer patients," he said.
He decided to join the company in 2017 and is currently vice president and head of medical and scientific affairs.
Making the Move
Both Schenkein and Meropol acknowledge that leaving academic medicine is a big move, and that it involves both risk and reward. After describing their own career paths, they offered some advice to any doctors who may be contemplating a similar move.
Road Sign 1: "Share the Road"
Industry is more of a team sport, they both commented.
"That's a little different from academia," Schenkein says. "If you're going to be successful in making new medicine, given the track record and now hard it is, you really need an extraordinary team and you really need to challenge yourself to do something you didn't think you can do."
Moreover, promotions in academia are based on how many first-author papers you had, how many patients you saw. In industry, it's about whether your team can be successful, he adds.
"When I interview people, I probe to see if they've ever played a team sport or if they've ever played in an orchestra or something where you're not just on your own," Schenkein notes.
"Particularly for physicians — who tend to have big egos — you need to be able to come into an organization, leave the ego at the door, and be part of a team.
"If the team doesn't succeed, no one succeeds."
Also, success is largely based on goal achievement, Schenkein says, suggesting that anyone considering the move should "write down on a piece of paper what you like to do and what you think you're good at.
"If you're not good at being on a team and you're not good at someone holding you to your goals, it's going to be a rough ride in industry," warns Schenkein.
Meropol adds that he appreciates the team-based focus of industry.
"You're building your brand in the context of doing a great job, achieving this unified vision, and moving the ship in a single direction," he says. "It's really great to be part of something [bigger]."
Road Sign 2: "Multi-lane Road Ahead"
Twenty years ago, it seemed like there were only a few "swim lanes" for oncologists, Meropol recalls.
"Now it feels like the world is our oyster given the skills that one amasses over time as an oncologist. There are myriad ways to have an impact as an oncologist."
With some creative thinking, an open mind, and good research and networking, possibilities for contributing in a new and different way will present themselves, he notes.
At Flatiron Health, for example, the oncologists on the team help "connect the dots for everyone."
"We're a mission-driven organization and the technical folks working at Flatiron — who could be working at Google as engineers — join Flatiron because of the mission. [Oncologists] are the ones connecting the dots" of why and how everything that they're accomplishing day to day is ultimately impacting cancer patients.
"That important skill — the skill of talking to laypeople about medicine — is inherent in patient care and translates well into an industry setting," Meropol says.
There's a broad range of opportunities where such skills can be applied, Schenkein adds.
In addition to companies that are making new medicines, some are developing new diagnostics and devices, "so there's a wide range," he says. "And the next one is the world I'm living in now, which is the world in helping to create new companies — the investing side of the world."
Furthermore, within each different type of industry job, there are subtypes, and each has different areas where oncologists can play a role, such as research and development, medical affairs, or communications.
Road Sign 3: "Danger: Falling Rocks"
There is definitely a level of risk, and taking an unknown road can be pretty treacherous, Schenkein and Meropol agree.
"It was a jump into the unknown," says Meropol of his move to Flatiron. "Kind of what I was weighing was where I was in my career, what level of risk could I assume."
The potential was great, but so was the risk, he says.
Ultimately, he decided the potential outweighed the risks, and he could dodge any falling rocks.
"My calculus was that the job would last at least 2 years. I knew that the skills I would gain and the new contacts and the new sort of ecosystem that I would be part of would open up a lot of opportunities for me should I decide to move on.
"I felt that the opportunity was just enormous in terms of the impact that we could have on the world of cancer patients."
Schenkein adds that "everyone has different things that drive them."
For him, the drive was a desire to "get on a steeper part of the learning curve." Therefore, the direction toward industry made sense.
But that doesn't mean it was easy.
"It was both really exhilarating and also pretty frightening," he says, noting that most moves involve sacrifice; the thing he misses most is patient care.
"I love taking care of patients and that's why I still go over and try and do a little bit of it. I do feel, from an impact perspective, I've made a bigger impact [from industry], but certainly, when I introduce myself at a conference, I start off by saying I'm a hematologist-oncologist, and this is what else I do."
For many physicians considering going into industry, their identity as first and foremost a person who takes care of patients is the biggest roadblock.
"How much do you really like taking care of patients? That should dictate how long you stay in medicine before making the jump," Schenkein advises.
One of the biggest mistakes people make when it comes to a career switch is rushing into a decision without fully researching options and vetting companies.
Meropol stresses the importance of running toward a new job rather than away from the prior job, which is a particular risk among those seeking a career change because of burnout.
Burnout is really a challenge, says Meropol, but he advises against "jumping ship just to get out of there."
"There are a lot of reasons why a situation may not be great, and you don't want to run the risk of it being re-created or existing in your next role."
He also suggests making a pros and cons list, which can help "in crystallizing the opportunity."
Schenkein agrees that too many of those making the leap neglect to perform "due diligence."
"Meaning, they didn't pick up the phone and call people, and say, 'What do you know about this company?' or 'Hey, you used to work for this company. What's it like to work [there]? What's the culture? Do they care about patients?' All those kinds of things," he says.
"Take your time and explore all the opportunities out there before you make your decision," Schenkein advises.
Sharon Worcester is an award-winning medical journalist at MDedge News, part of the Medscape Professional Network.
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Cite this: Sharp Turn in Career Path: Leaving Academic Medicine Behind - Medscape - Jul 20, 2021.