Podcasts about wisdom don't

Session 107 Emergency medicine residency training requires lots of interpersonal skills. Dr. David Snow has been out of training for 6 years now. Today, he tells us more about the acuity, variety, and steep learning curve in EM. Meanwhile, be sure to check out all our other resources on Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:15] Interest in Emergency Medicine Coming to the end of the third year in medical school, David was choosing between surgery, psychiatry, and emergency medicine. Ultimately, there were things about EM that appealed to him. [Related episode: What is Emergency Medicine?] [04:22] Traits that Lead to Become a Good EM Physician When you get to a shift, it can get as busy as any other time during any other shifts in their life. They sometimes work at 5 am and 11 pm and it doesn't matter what comes before that. They just have to be ready as they walk in the door. This is not unique to EM at all, but it is unique across all the fields of EM. As an EM doctor, you have to understand the unpredictable nature of the specialty.  Additionally, interpersonal skills are important as you could be speaking to patients from all walks of life. Alongside, you'd also be networking with clerks, nurses, medical students, and division chairmen. You have to be able to work with the challenges of that environment and do so with a smile on your face. David has been evaluating residency applications for 7 years now. A few years ago, they added a new piece to the application for emergency medicine called the Standardized Letter of Evaluation. In any of the rotations you do, you will have one of these letters written for you. This is a movement away from the Letter of Recommendation that students ask from an EM physician. It compares you to applicants from the current cycle and the previous year. The letter also lists a set of attributes that talk about your success within those attributes as well as your work ethic, professionalism, etc. There are also specific pretext parts to the document where people speak very candidly about the applicant. Emergency physicians are looking for the same things. They somewhat know what to write.  [Related episode: Looking at Emergency Medicine Match Data and Surveys] [10:50] Pass-Fail System Evaluating Students David thinks there are so many facets to a pass-fail system. He believes it could be hard from the student's standpoint as a sub-average USMLE Step 1 score can be very detrimental to an applicant. Programs can use filters based on USMLE or COMLEX scores and that one score can be very hard for them to move past to ensure the reviewer doesn't get stuck on that. There's no recommendation an applicant needs to have taken Step 2. But if the Step 1 score is below the mean, it's encouraged that they take Step 2 so they can work past that. This being said, it adds a lot of pressure to all of it. [Related episode: What Step 1 Score or Level 1 Score Should I Try to Get?] [13:40] How to Stand Out in Rotations David recommends getting in touch with EM faculty and to start interacting with them as early as possible so they can start asking questions. Most medical schools that have EM departments have some way to get shadow shifts with EM faculty. Nevertheless, he doesn't think there should be pressure for students to get in front of PD during their second or third year. You just have to do what has to be done to figure out that EM is for you. If meeting with a program is the way to do that then fine. But don't feel like you need to do that in order to bolster your application. Ultimately, just enjoy your rotations during third year as your learnings are all going to be very useful for your future training. Donald underlines understanding the key attributes of an EM physician. They are hardworking. They don't complain about the work before them. They try to enjoy as much as they can. It's important to have that positive outlook and the desire to come in and take care of patients. Be able to come in wiith those attributes without trying to be held back by your nerves. Understand you're still a student and not a resident yet so your level of knowledge is obviously below the residents. Donald notices how many students come in during rotations where they feel this need to prove they know what they're doing. He advises students to step back from this. ED is challenging itself. Just find your team and enjoy your time. Anything you can do to help out a resident would be golden. They would thank you and love you for that. Try not to think about the importance of the rotation and just be yourself. Be that motivated and driven medical student on the rotation who's there to learn and work. Being so focused on proving and performing would only limit yourself from feeling what it might be like to be that person in the field. [24:55] The Biggest Misconceptions About Emergency Medicine Many students are drawn into EM by trauma and acute resuscitation. Although this is a huge part of what they do, it's far from being a true EM clinical life. It's a big part but it's not a huge part of an EM physician's life. Another misconception about Emergency Medicine is the idea of burnout. David believes that so much of this is born out of the habits formed during residency. You might do all of that right and end up in a job that makes you very unhappy but then you must change jobs because if you don't, you'll fit in that burnout spectrum. David clarifies it's not a false label as this is what's being shown on the survey. But he doesn't think this should preclude you or stop you from going into a career in emergency medicine. [29:20] The Training Path What differentiates EM from other programs is that by Day 1, you may have the sickest patients of your residency training. In most programs, the system is set up to where you might not be going to an operating room or ICU during your first year. They would still build up your knowledge and experience before you're exposed to that. In emergency medicine, the learning curve is steep. It can be truly overwhelming in terms of the knowledge needed and every patient encounter you have for the first several months. But there will be an attending physician with them throughout the process. You will also be doing 5-7 off-service rotations during the first year. You will go to ICU's and do orthopedics, anesthesia, and obstetrics. On your second and third year, it will progress to increased patient care responsibilities. You will start to lead teams. There will be teaching and mentoring aspect to that. When you get to your third year, you will start to lead the areas you're working in. And when you're done with your training, you need to be able to handle whatever comes through those doors at any point of the day. [32:33] How Students Can Evaluate What Programs They Can Apply To David thinks the program has become so competitive that there's no standardized way of mentoring an applicant as no two applicants are the same. That said, the applicants themselves don't know where they stand on the bigger scale of applicants. Because of the varying degrees of mentoring, students are picking up a lot of interview spots early when they probably don't need to. Then they cancel a lot. So there's a whole bigger issue here. David recommends that students seek someone who has experience in reviewing applications. They can look at your file and compare you to other applicants to give you a clear sense of what's important and where you might fall on that spectrum. This way, you can start thinking about how many applications you should be submitting. Ultimately, David outlines two things to know if this is something for you. First is to get into EM if you really think that EM is right for you. Second, experience at least two different types of EM programs. This could be an affiliate with the college of medicine. Or there could be close ties between the medical school and the ER department. There's also a community program that doesn't have a medical school in the area. There are also hybrid models that exist. At the end of the day, see if the message of the chair is something you would put your faith in. Pay attention when they're speaking. Then try to see if you like the residents and you fit in. [39:30] Bias Against Osteopathic Students David doesn't think there is any negativity that needs to be overcome. He believes allopathic and osteopathic students are viewed in the same way. However, he feels there may be still some programs that will require a USMLE score. Because of this, it could be hard for them to mentor an osteopathic student and tell them they need a USMLE score. He hopes there is some way to measure this going forward where programs are moving away from requiring USMLE scores. [Related episode: 6 Myths of Osteopathic Medical School] [42:45] Final Words of Wisdom Don't be afraid to reach out to people and residency leadership to ask for advice. They want to find people that can do the work that's put before them. Most importantly, just be yourself and enjoy the time in the clinical setting. He assures you will get way more out of this. Links: Meded Media

Session 98 Dr. Stephanie Graff is a breast oncologist who has been out of training for 8 years. Today, she talks about her journey – what got her into the specialty, the training path, and the most and least liked things about her specialty. Meanwhile, please be sure to check out our whole host of podcasts on Meded Media as we seek to help premed students and medical students along their path towards becoming a physician. [01:38] Interest in Oncology Stephanie decided on oncology in the early rotations of medical school. One of her high school teachers used to tell them that whatever they decide to do in life, they have to read about. She now finds this as true advice, especially in medicine. And she just couldn't put down the book about oncology. When she moved to clinical rotations, everything just seemed to fit for her. With oncology, it allows physicians to connect with patients in a longitudinal way. You're going through something intense and emotional. Then you also get to see them into long-term survivorship. "Whatever you decide to do in life, you have to read about." In-patient oncology covers dying or very ill patients. But Stephanie clarifies this is just the minority of their patients. Most of her patients are working their full-time jobs on their chemo so they're not sick. It's not a depressing job. Of course, people die, but so do with heart failure and other kinds of diseases. That said, every field has those highs and lows. [04:02] Going Through Oncology Training Stephanie started doing lung cancer research, primarily because she got attached to her first mentor. But she ended up leaving her training program during the scope of her fellowship. The next mentor she attached herself to was the breast oncologist. So for the second half of her oncology fellowship, she was mentored by the fellowship program's breast oncologist. She found it as a good fit. "A lot of it is just finding your niche when you start your practice. There's no breast oncology sub-boards." For instance, sarcoma is an exceedingly rare tumor so you won't probably be going to be a full-time community sarcoma expert. But Stephanie is part of a large group of oncologists with 15 partners in her group. Stephanie exclusively sees breast while one of her partners does 90% GI. Two of her partners are heavily subspecialized in lungs. And one of her partners exclusively sees GU malignancies. They have a niched subgroup specialty across her practice. They also have clinical research sites where they're principal investigators on their disease types. [06:55] Traits That Lead to Becoming a Breast Oncologist "Oncology is definitely a communications-heavy field." Stephanie thinks that the lay public's understanding of cancer and cancer treatment is infantile in its development. So you really have to talk them away from the fear into the treatment, why the treatment, how to manage the side effects, etc. You have to do this concisely in the construct of the clinic appointment. You have to be resilient as there's still death and dying in oncology and you have to be optimistic by that nature. [08:33] Types of Patients Stephanie also runs their high-risk women's programs. So she sees a fair number of patients identified either by their primary care, GYN, or just the breast imaging center. They usually have a striking family history or other significant risk factors. They're being referred to her in their high-risk women's capacity to talk about risk production and genetic testing. So she gets patients this way. She has a great relationship with the breast surgeons, primary care, gynecologists in their study. She sees patients even before they're diagnosed with breast cancer. She would often be called to manage even the workup of a lump. Since the fear of having breast cancer already creeps in at this time. Breast surgeons are her number one referral source. She attends all of the breast cancer tumor boards at two different hospitals. She participates in conversations about optimal care. Stephanie is involved in clinical research so she gets referrals from all over the country for their open trials and patients connect to them. "The metastatic oncology patient community is very well-informed. They are very engaged and educated about their disease and their disease process." [10:55] Running Clinical Research Oncology is a bit different than a lot of other career tracks. In oncology, there are large academic groups and most of the research happening is sponsored by pharma. But some of them are also sponsored by the big cooperative groups like SWAG and Alliance. These are all government-funded research programs. There's a lot of oncology drug development happening that's entirely funded by pharma. They want networks that can put a lot of patients on trial, do it effectively and efficiently with good, high-level expertise and experience. "There are several nonacademic cancer research networks that are centralized cancer networks." Pharma typically contracts with non academic research networks. Their aim is to broaden the reach of their trial and improve accessibility for patients. However, they need to maintain that academic level of experience and expertise in the actual design and delivery of the trial. [13:30] Diagnosis vs. Treatment and Procedure Time The vast majority of her patients come to her with the diagnosis. She estimates 15% of patients coming to her without a diagnosis. The other 85% come to her with the cancer diagnosis. In terms of procedure, Stephanie doesn't do breast biopsies and the breast surgeons do this. She did love procedures as a medical student and resident but this is something that she really doesn't miss at all. She hasn't really done one since she graduated from her internal medicine residency. [15:05] Typical Day, Taking Calls, and Work-Life Balance Stephanie leaves her home at 7:30 am and she's at the hospital by 7:45 am. But her clinic doesn't technically start until 9 am. So she uses her 8-9 spot as his add-on spots for her nurses. When somebody calls with problems, she can take care of it. She then sees her patients in 15-minute spots. She normally sees 2-3 new patients a day while the rest are follow-ups. She keeps her lunch hour to close down her mind for a bit, follow up on emails, and eat. So she sees patients from 9 am to noon. Then resumes her clinic from 1-4 pm. Stephanie doesn't usually have a lot of in-patients. It's not unusual for her to have no patients in the hospital. Her inpatient rounds are super quick at about 30 minutes. The rest of the afternoon is spent on signing charts and running clinical trial meetings. And she'd be home by 6 pm. Being part of a large group, Stephanie is on call one week in a month. It's usually half-day. She's very much in control of her hours. She has three kids and family comes first. So she makes sure she sees her kid's soccer game first before doing rounds. Her weekend hours are normally 4-5 hours. She very rarely has any emergencies in the middle of the night. She can almost always handle everything through a phone call. All that being said, Stephanie feels like she has really good work and family balance. "Most oncologic emergencies aren't actually medical oncology emergencies. Their either radiation oncology or surgery emergencies." [19:20] Acting Like Primary Care A lot of people connect with their subspecialists as a primary care physician. This is because a lot of patients need regular follow-up and monitoring because of the nature of the diseases, the long-term risks, and the side effect profile of the medication. So they're scheduling 3 or 6-month follow-up appointments every time they leave the office. For healthy adults, they're not scheduling their annual follow-up or being seen every 3-6 months by their primary care doctor. So they just develop this longitudinal relationship with their subspecialists. This is one of the things she really loves about her career. But when a patient is admitted to a hospital with a totally unrelated disease, she often gets consulted. She loves this though and she's glad to cheer for her patients. [21:28] The Training Path and Competitiveness After medical school, you do an internal medicine residency. After your internal medicine residency, you do an oncology fellowship. Most fellowships are a combination of medical oncology and hematology. But there's a handful of training programs in the country that you can just medical oncology or just hematology. "In 2019, it's probably more employable to go through a training program for both medical oncology and hematology." Stephanie recommends taking both oncology and hematology, especially if you're still unsure about where your career path goes. You need to be able to see everything and help cover call for your group. A lot of weekend calls are about hematology stuff and a lot of hospitalized medical oncology. And hematology consults are thrombocytopenia, anemia, and a lot of blood stuff. So it's good to have that training. In internal medicine, cardiology and GI are the top two competitive specialties. And hematology is a close third probably. [24:00] Subspecialty Opportunities There are true, dedicated bone marrow transplant sub-fellowships. You can graduate and have another diploma and other board certification in bone marrow transplant. "In basically every organ system, you can subspecialize in." You can do neuro-oncology fellowships out of neurology. You can also do gynecology oncology, although there are medical oncologists that specialize and treat gynecologic malignancies. There are gynecologists that do gynecology oncology fellowships and manage GYN-Onc malignancies, both surgically and medically. Whereas with medical oncology, you would still need a surgeon to handle that surgical piece. Following down the academic path, there are GI oncologists, breast oncologists, sarcoma experts, lymphoma, multiple myeloma, acute leukemia, myelodysplastic syndrome. There are also breast, lung, genitourinary, etc. A lot of what subspecialty you choose depends on how rare the tumor is and the size of your practice. If you join a practice of three oncologists, it's going to be hard to be super specialized. If there's going to be more diversity in the caseload, you'll have to help your partners manage. But if you join a large group, there's a great opportunity to find a subset of patients you have a particular interest in. "An increasing percentage of private practice oncology physicians are in large groups." [26:35] Academic vs. Community Setting When Stephanie started looking at opportunities, she knew she wanted to stay in Kansas City for personal and family reasons. She interviewed out of several groups and the private practice group was just a great fit for her. Her internal medicine residency was split between two hospitals. One was a private for-profit hospital that had residents from the academic site in every single field rotating in that center. So it was an education-heavy environment in a private practice hospital. They also had a more traditional academic site. For internal medicine residency, they had two internal medicine chiefs. One was the chief of the private practice facility and the other was the chief of the university. Her current practice she joined felt home when she interviewed. She connected better with her now-partners. She liked the opportunities and growth developing at that time. [28:45] Bias Against DOs Stephanie doesn't really see any bias against DOs. There are several DOs that are very well-respected nationally in the field of Oncology without any particular bias. There are DOs in her group. Oncology has a really strong international medical graduate community. She doesn't feel there's any bias there either. [29:40] Working with Primary Care and Other Specialties If primary care physicians have questions about particular mutual patients but just oncology in general, Stephanie says that what they're here for. Other specialties they work the closest with are radiation oncologists, plastic surgery, pathology, and radiology, neurosurgeons, interventional radiology. "I work a lot with our neurosurgeons because a lot of breast cancers metastasize to the brain or the spine." Additionally, they have a really robust nurse navigator program. Nurse navigators help their patients move between their diagnostic imaging and their surgery as well as the systemic therapy for their cancer diagnosis and radiation oncology to help connect all the pieces. [33:18] Plastic Surgery Side of Things For the plastic surgery side of things, there are a lot of options for patients including breast reconstruction and mastectomy. With her mastectomy patients, they recommend that every patient talks to a plastic surgeon even if they want to stay flat. "Information is power. It's not going to hurt to talk to a plastic surgeon and find out what's available." They have patients that don't think it's for them and just come back and they're amazed by the way science has advanced the techniques. Patients look amazing after breast reconstruction. That being said, tons of her patients work with plastic surgery. Mastectomy and lumpectomy followed by radiation are roughly equivalent in terms of cure and survival. So very few patients need a mastectomy. Tumors that are very large sometimes are only candidates for mastectomy. But with neoadjuvant chemo, they can oftentimes shrink a large tumor and they're still a candidate for lumpectomy if they're highly motivated. They also consider mastectomy, even bilateral mastectomy in patients with genetic mutations, but this is only a minority of breast cancer patients. Only about 5-10% will have genetic mutation. The minority of her patients need a mastectomy but nationally, statistics tell that half of them choose a mastectomy. They try to educate patients that the outcomes are the same and that removing more breast tissue doesn't increase their likelihood of "beating it." However, there is just that inner voice that drives most of their patients to feel like they just really want a bilateral mastectomy. [36:20] Special Opportunities Outside of Clinical Medicine First, you can be an educator. At their hospital, there are lots of opportunities for education in terms of trainees. Especially in oncology, there are a lot of opportunities to educate the broader community about cancer. She does a lot of speaking events for cancer-related organizations. She does education events about what cancer looks like or what's happening in cancer. Second, you can do volunteering. Stephanie serves on the American Cancer Society Board for their region. She also volunteers with the American Society of Clinical Oncology, their large, national organization for medical oncology. You can also do international mission work in oncology-related fields. You can also do clinical research. All those being said, there are a lot of opportunities to do different work within the scope of oncology. You can do work on the governmental side for oncology. The NIH and FDA employ medical oncologists. "There's a pretty broad spectrum of oncology-related careers you can consider." [38:00] The Most and Least Liked Things About Being a Breast Oncologist Stephanie feels very happy with her specialty and she wouldn't choose anything different. As a trainee, she worried about how she was going to be a doctor and a mom. But she assures it just magically works itself. She had worried about some sense of emotional burnout but she had never felt that. It can be saddening to have sick and dying patients. But the ability to be a part of their life and be able to play a role to help prolong their life is powerful. "The things I was worried about have not manifested in my practice. It just really reinforces that this is the right career for me." What she likes the most about being a breast oncologist are her patients. She loves connecting with them and hearing about their life outside of medicine. She loves helping them through their cancer experience regardless of what that looks like. What she likes the least about her specialty is a peer-to-peer call. Sometimes, they might order stuff and insurance has to authorize them to pay for it. But the default with insurance is no. So you have to make a peer-to-peer phone call with either a medical oncologist or sometimes a retired pediatrician. You have to explain why you want this particular test for this particular patient. But this is just a small part of what they do everyday. [42:00] Major Changes in the Future of Breast Oncology Immunotherapy and the way they're treating cancer is changing a lot instead of the traditional chemotherapy drugs. They're now using more medicines that target the patient's immune system specifically. They also do a ton of genomic profiling. Rather than treating lung cancer as one cancer, they're treating it based on the genomic subset and tailoring treatment. This is going to continue to evolve. This is an exciting time to be an oncologist. "It's going to get more complicated in terms of matching drugs with the signature of the cancer." [43:50] Final Words of Wisdom Don't be shy about asking for mentors. A lot of times, your faculty in your medical school don't know that you're considering that career path or looking for that advice. Just reach out and send them an email. Get connected and get more advice about how you can get your foot in the door and see what opportunities arise. Stay on top of what's changing in your career in medicine. Make sure you're really connecting with the science of oncology and the data of oncology is going to help you succeed in the field. Links: Meded Media

Session 79 Dr. Brittany Davidson is an academic OB/GYN Oncologist practicing at Duke Health. She joined us to share the specialty she chose and why it’s great. Please help up find more guests for this podcast by sending an email to team@medicalschoolhq.net and write the subject: Specialty Stories Intern. [01:40] Interest in Oncology Brittany has always been interested in women's health even back in college. She then followed the path to medical school, realizing she loved being in the operating room as well as the people and the OB/GYNs she worked with. She saw how they were happy at work - something she wanted to be like. After her third year rotation as a medical student, she was pretty cemented to OB-Gyn and didn't realize she was going to do Oncology until 2nd-year residency. Going into OB-Gyn she was thinking it was all about delivering babies and bringing joy to the world. In fact, she remembers telling her medical school tour guide that she didn't want to do Oncology. However, after first rotation as a 2nd-resident and coming back from honeymoon and a day in the clinic, she just fell in love with patients and the operating room, taken by surprise. "There's always something and that's the fun part is figuring out what that something is sometimes." [05:18] Traits of a Good Gynecologist You have to be interested in being in an operating room but you also have to be great listener. By not talking and letting that patient have that time is very important. With the information you get from them, you can help potential treatment options. "Listening is an under-recognized, underutilized field that I'm really starting to do more of myself and trying to instill that in the people that I help train." It's hard to be quiet as silence is really awkward but that's where sometimes the best and most information comes through. As physicians, we don't learn enough about how to communicate as physicians but it's a ubiquitous skill across fields. [07:30] Types of Patients and Treatment Process As a GYN/Oncologist, they're referred to as oncologist below the belt. They take care of female reproductive cancers - ovarian, uterine, vulvar, vaginal, cervical cancer. They also take care of pre-cancer, the precursors to those cancers such as cervical dysplasia or vulvar dysplasia. They also get referrals for difficult or extensive benign GYN surgery like difficult endometriosis patients, although they still see some benign gynecology in their practice as well as female pelvic cancers. Benign OB/Gyn or general OB/Gyn practitioners these days are jack of all trades as Brittany would describe it. They do a little bit of obstetrics and a bit of gynecologic surgery. But a lot of them don't operate enough these days to feel comfortable doing some of these very difficult GYN surgeries. And a lot of times, they don't have the volume to feel comfortable trying to do these surgeries. In terms of patients coming to her already diagnosed versus those she still had to diagnose, she'd give it a ratio of 50-50. They get a lot of referrals for ovarian masses to help triage whether this is high suspicion of cancer or not. They also see cancers of the uterus. Unfortunately, with ovarian cancers, the vast majority of them are diagnosed with advanced disease. They have a lot of symptoms as well as anxieties or evidence of metastasis on imaging. In short, they see a little bit of everything. [10:27] Typical Day and Percentage of Procedures As an academic OB-Gyn oncologist, they have some research time. She starts clinic at 8 AM and sees about 30 patients, running the gamut of diagnosis. Mostly, she sees patients who are post-menopausal, though she does see some younger women too especially for uterine cancers. "It's never a dull moment because each patient is different." On a surgical day, OR starts at 7 AM. Never a dull moment as well -- she could have a whole day of cancer cases. Some days, she could have benign days. Again, it's always something different that she truly enjoys. As to the percentage of patient ending up going to an operation room, Brittany says that one of the best things you can learn from their practice is when to decide to take someone to the operating room. Operating is not the right thing to do for everyone and sometimes, it can be really hard to make that decision especially there's a lot of grey area in the middle. Factors they consider are indications, other ways of diagnosis, and using the surgical risk calculator. And sometimes, not going to the operating room is the right answer. "One of the best things that they can learn from their practice is when to decide to take someone to the operating room." [13:25] Taking Calls and Work-Life Balance Brittany is in a practice of 7 Gyn Oncologists so she's on call once in every 6-7 weekends. On her call week, she rounds on the weekends, then she goes home and doesn't take in-patient call. Being an academic OB/Gyn oncologist, she works with fellows so they take the patient phone calls, not typical of academic practice. That said, it's very uncommon to get surgical emergencies in the middle of the night. At their institution, she takes 1-2 nights of benign gynecology call with the residents for cases like ectopic pregnancy and such. In terms of work-life balance, it's about trying to find the right spot on the work-life continuum. Balance is really a misnomer. There are challenges definitely and there's no right answer for everyone. But she's cognizant of the fact that this is very important. Nevertheless, she loves her job and she feels very fortunate to be passionate about her career. [16:00] Choosing Academics vs. Community Even as a resident, Brittany has always loved teaching as she finds it very rewarding. Her favorite part of the day as a Fellow was teaching. Coming into the specialty without a strong research background, she found some amazing research mentors and have found a niche and research passion. And this was where it all developed for her. She loves hos academics keeps her on her toes both from a data standpoint but also from the clinical practice perspective. "It's just fun to have trainees and it's one of the bright spots and one of the many great spots of my day." [17:22] The Residency Training Path and Competitiveness The OB/Gyn residency is four years and Gyn Oncology Fellowship is three years long. There are a few programs that incorporate an extra year of research totaling four years. You basically start your application as a 3rd-year resident then you match into your fellowship the October of your chief or last year. Sometimes, a cohort of residents doesn't realize they want to do oncology until much later on in their residency. Residency is fairly competitive with around 80 people a year that apply for a Gyn-Onc fellowship with maybe 40 spots. In order to be competitive, it helps to have some research background to show some research effort. Basically, you have to show passion and dedication to these amazing women you get to take care of. Gynecology fellowship is hard and the hours are long so having a degree of resiliency is important as well as flexibility. It's a different ball game compared to a surgical oncologist. So you have to be able to do that medical aspect as well. For further sub spec opportunities, you could get into clinical trials or some rare tumors and sort it out with your colleagues or institution based on the need and what your desires are. In terms of bias seen towards DOs, Brittany hasn't really seen this. If there were some bias, she thinks this has changed considering there are really amazing osteopathic candidates out there. [21:55] Working with Primary Care and Other Specialties Brittany wished primary care physicians knew that they exist. A lot of larger urban centers with academic institutions, gyn/onc may be well-known as a field. But in the more rural areas, this is not the case. So if you have a concern, then have them get a referral to see GYN/Oncologists. If you're doing pelvic exams and pap smears and the like where you run into problems, they're always happy to help out and they're available. "Patients with ovarian cancer and uterine cancer when they're cared for by GYN/Oncologists." Other specialties they work the closest with include palliative care (by far and away). In fact, she'd joke around that she'd do a palliative care fellowship if she had to do it again, as they help them a lot throughout the entire cancer continuum. After that, they'd work with medical oncologists. They'd see a lot of patients for repressed cancers who would need their ovaries removed as part of their breast cancer treatment. There could be some overlap in terms of rare tumors so they work closely with them as well. Unfortunately, palliative care is very under-utilized and under-appreciated while they work they do is amazing. Brittany admits it can be very hard to sell to get her patients to see the palliative care team. So it takes some convincing. [24:55] Special Opportunities Outside of Clinical Medicine You could join the pharmaceutical industry which they work closely with as they're trying to develop drugs to cure and treat these cancers. People have also left the field to go work in the industry. There are also some who have done palliative care training and now see patients as palliative care physicians. There are also some who have stopped operating and do strictly the medical side of it like the chemo. And vice versa, who only operate now and don't do the chemo anymore. "There is some latitude in terms of what your practice looks like." [26:00] What She Likes the Most About Being a Gyn/Oncologist Brittany loves being able to take care of these awesome women who are dealing with some hard stuff. She feels like she's able to learn so much from them. And she feels it's a great privilege. She's learning new skills constantly and there's never a dull moment. She's constantly adapting and thinking outside of the box. It keeps her on her toes. On the flip side, what she likes the least is charting, which is apparently a problem for most physicians. [28:18] Future Changes Coming Brittany says the treatment landscape is always changing which is a blessing as they have new therapeutic options for their patients and it keeps them on their toes. They've been fortunate in the last few years to get a few approvals for various GYN-related cancers. Surgical changes are a bit slower but they had a big study coming out this year that is going to change the practice potentially. If she had to do it all over again, Brittany would still choose the same specialty. The one change she would have made though is doing a palliative care fellowship right after doing a GYN/Oncology fellowship. It was hard but she loves her job! [30:10] Final Words of Wisdom Don't let any negative feedback deter you. There's always something to be said but when you're loving your job, and you love what you do, it doesn't feel like work. Find something you're really excited about then do it and don't let the naysayers get to you. "You've got to do what you love at the end of the day." Links: team@medicalschoolhq.net

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.

Wisdom: Don't ever underestimate its value. It's too important. It's too valuable. It's too precious. Looking through Proverbs, Ecclesiastes and Song of Solomon; we will spend the summer gaining wisdom from the wisest man to walk the earth; King Solomon.