What Does It Take to Be a Surgical Oncologist?

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Session 119

Dr. Tania Arora specializes in surgical oncology, and she’s here to tell us about workflow, lifestyle, and what’s on the horizon for this interesting specialty.

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[01:10] Interest in Surgical Oncology

The decision to go into this field came more gradual to her than her black-and-white decision to go and become a doctor. As a medical student, she had earlier experience in cancer surgery.

She got to see a variety of general surgery cases and also got her first foray into cancer surgery. She just knew she loved to be in the operating room. 

In the first year of residency or intern year, you’re usually overwhelmed with the management of patients on the floor. You get into the operating room here and there and doing one-month rotations at a time. For Tania, there were so many things coming out so there weren’t real insights into what she wanted to specialize in.

'You feel like a ball in a pinball machine.'Click To Tweet

Her decision came clear in the latter years of her residency where she felt the most satisfied and rewarded. She felt she was making more difference from patient encounter than being in an another environment like a vascular surgery clinic or in the trauma bay. All of those areas in surgery were interesting and fascinated her. But nothing left her with a long-standing satisfaction of being able to manage and take care of patients, and sometimes, cure cancer.

[Related episode: What is Hematology/Oncology? An Academic Doc Discusses]

[03:27] Traits that Lead to Becoming a Surgical Oncologist

Being a good surgical oncologist means being able to take care of the patient as a whole and want that long-term relationship. 

The type of cancer they treat in the operating room is sometimes a very extensive postoperative course. 

'The relationship with the patient and their family is really fragile sometimes and sort of sacred.'Click To Tweet

Patience is an important aspect. First of all, you have to be patient with yourself. You can’t fix everything but you do the best you can. Sometimes, the cancer has already spread and it’s even more devastating. You have to be patient with the patient and their families. 

At some point, you will have to navigate very complex surgeries with them. This takes a longer time than a standard appendectomy or biopsy with a skin lesion. Sometimes, the conversation can be very in-depth and complicated because you’re facing life-threatening issues.

[Related episode: OB/GYN Oncologist Shares Her Journey and Career]

[05:35] Types of Patients

Surgical oncology is a two- or three-year fellowship after one completes a five-year general surgery residency. You do a fellowship to subspecialize and train in surgical oncology. 

As the name implies, it’s cancer surgery but it’s still within the bounds of the thyroid-parathyroid surgery of the breast, gastrointestinal surgery of the esophagus, pancreas, liver, stomach, small intestine, large intestine. It also involves the management of soft tissue cancers like melanoma and sarcomas.

'You learn a multitude of skills in the different parts of the body but all centered around the treatment of cancer.'Click To Tweet

The typical patient that comes to the clinic has been referred because of either a new finding or a new diagnosis. The vast majority of patients that come to their outpatient clinic setting have a diagnosis. Someone has already led the workup whether it’s a gastroenterologist or a primary care physician. 

There are also cases in the hospital and inpatient settings where the diagnosis isn’t a known entity. Then they help facilitate the right next step coming from the differential diagnosis.

[007:50] Typical Week

For Tania, her typical week is a balance between the clinic and the operating room time. She can be in the operating room depending on availability, usually 2-3 days a week. She can also be in-clinic at about the same amount of time.

Tani also hands administrative and teaching roles. She is the associate program director at Agusta University.

[08:38] Taking Calls

Calls may vary depending on the training environment. Geography, competing hospitals,  and the number of partners you have can also play into that. 

Prior to working at Augusta University, she came from Geisinger Health in Pennsylvania. She recalls having a decreased number of partners. As a result, they did the evening night call every other week. They also had a shared weekend call.

There are some surgical oncologists depending on the practice environment that will take some general surgery call. In Tania’s case, the majority of her calls are centered around the cancer patients they have in-house as well as the new cancer patients.

The weekend call has the same setup where she takes a shared call with her partners. Then she shares calls with two other partners during the week. Every third week, she’s covering the new consults and other things that come up.

[11:00] Academic Setting versus Community Setting

Tania chose the academic setting primarily because she always been interested in teaching. For her, training the junior residents was one of the most rewarding parts of being in that environment. 

She wanted to continue to practice in an environment where she was operating with residents and being in a learning environment with them.

[12:00] The Training Path

Depending on the program, the training path for a surgical oncologist may vary. There’s always research time whether it’s two or three years.

To make yourself competitive for fellowship, research is important. Many specialties wax and wane in the level of competitiveness. In more recent years, surgical oncology has become quite competitive. 

Having yourself stand out as an applicant is important. Get great letters of recommendation coming from the right people who can say nice things about you is important.

'Most fellowships in surgery look at the standard letters of recommendation and obviously getting them from the right people.'Click To Tweet

Be able to sell yourself. Have a good foundation during residency where you’ve proven some reliability. Fellowships will often take into account the in-service exam scores. They’re a part of your application process.

In terms of research, it can be in different fields, not necessarily in surgical oncology. As long as your research has been fruitful, meaning it has resulted in you being able to demonstrate either a presentation, a poster, publication, etc. 

[14:40] What Osteopathic Applicants Can Do to Stand Out

Tania recalls a DO student years ago and wanting to apply to surgery. Someone told her that she wasn’t going to be a competitive applicant. One reason was that part of the stipulation was that you couldn’t sit for the board of surgery exam and this was going to hurt her application in the long run. 

It’s not clear if some of those rules have changed. But Tania has noticed a period of transition in the accreditation of DO programs as well as integration in the last couple of years.

[Related episode: Let’s Talk About Osteopathic Docs and What You Need to Know]

[16:00] Subspecialty Opportunities

More and more academic facilities have compelled surgical oncologists to pick one or two anatomic areas or types of cancer to specialize in. There are surgeons who only do melanoma and breast and have a broad research track in this area.

'The type of research you can entertain in residency and fellowship can guide your practice.'Click To Tweet

Picking a niche or a skillset like the robotic surgery or minimally invasive surgery, or any area where you become an expert in is possible. But this may lead you to a path of being in an academic environment.

[17:35] Working with Primary Care and Other Specialties

Tania wishes that primary care providers would not hesitate in picking up the phone and calling them. Whether it’s looking at a fil or taking an exam on the patient or they’re just not sure what the right next step is, just call.

'The phrase 'it takes a village' couldn't be truer anywhere than in the field of medicine.'Click To Tweet

Secondly, they understand that if somebody hears the word “cancer,” they want it taken cared of. There is that urgency to get to the diagnosis and work it up for treatment. But this can be underestimated. Hence, reach out to them as partners and colleagues in taking care of the patients.

Other specialties they work the closest with include medical oncology, radiation oncology, pathology, radiology, genetics counselors, and interventional radiology.

[20:50] Special Opportunities Outside of Clinical Medicine

There are surgical oncologists that have relationships and partnerships with the industry in terms of technology or speaking opportunities. Sometimes, they can also serve as liaisons to the community, participating in community events, doing outreach talks in churches and community centers.

[21:55] What She Wished She Knew

It’s a tough field emotionally and physically. It involves long hours. Tania admits that she isn’t even sure if she would have done it knowing everything she knows now.

On the other hand, she feels lucky and blessed every single day to be able to do what she gets to do. She wouldn’t trade it for anything.

[23:20] Standing Up for Yourself Being in a Male-Dominated Field

There is an increase in dialogue, interaction, and sensitivity in terms of gender issues in a lot of industries, surgery included.

Tania’s advice to other women who might be interested in the field is to just go do it. There’s now more support from men in the field, although there’s still much more room for improvement. Women not only are able to be successful and thrive, but also reach leadership positions.

'We're on that road to having an environment where women are really treated with respect.'Click To Tweet

You should always choose what you love. Women who have forged a path before Tania have created an environment where she was empowered along the way by both men and women who mentored her. And you will see the same.

[25:30] Most and Least Liked Things

Tania loves the variety in the field with new challenges each time. She loves her patients and being able to take care of people in a very vulnerable state is very rewarding for her. Not to mention the mental stimulation she gets from the field.

On the other hand, what she likes the least is when she’s not able to do what she’s been trained to do. Either the patient is too sick or too frail to go through the surgery or the cancer has really just gotten to a level where they can’t do anything about it. 

[27:10] Major Changes in the Future

There are multiple changes in multiple levels. Technically, there is a bright future for robotic surgery as it continuously evolves.

'As we learn more about the behavior of cancers at an intracellular level, those research and clinical trials that have changed our treatment and surgery are now impacting.'Click To Tweet

Moreover, the drugs for cancer treatment have blown away some of the surgeries they used to do.

[28:55] Final Words of Wisdom

Shadow as many different kinds of physicians as you can to really figure out what you’re passionate about. The earlier you can expose yourself to different learning and training environments, the better you’re being drawn to what’s right for you.


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