In this installment of The ASCO Post’s Global Oncology series, Guest Editor Chandrakanth Are, MBBS, MBA, FRCS, FACS, spoke with Kevin Billingsley, MD, MBA, FACS, Chief Medical Officer of the Smilow Cancer Hospital and Yale Cancer Center.
Although interracial marriage is common in the United States today, for the better part of the 20th century, it was largely a social taboo, even illegal in some states across the nation. Dr. Billingsley, who was the product of one such marriage, grew up in Boulder, Colorado, in what he described as an interesting academic household.
Kevin Billingsley, MD, MBA, FACS
“My parents are of mixed racial background; my dad is Black, and my mother is White. They came together in an interracial marriage in the late 1950s, at a time when that was a great challenge in this country. I was privileged in many ways to have a ringside seat on the evolution of race relations in our society. But Colorado was a wonderful place to grow up, and I had terrific exposure to outdoor activities, the wilderness, and athletic pursuits,” said Dr. Billingsley.
Asked whether the difficult social dynamics of his youth have had an impact on his current work, Dr. Billingsley responded: “I do count that part of my life in an interracial household as a blessing, because I think there is no substitute for the lived experience. And I’m pleased to say that throughout my career, I’ve seen much progress around issues of diversity, equity, and inclusion—in the workplace, in our professional culture, and in our service to patients and their families. But every day, I’m struck by how much we still have to do, how many of our patients remain vulnerable, and how difficult it is to provide outstanding cancer care to the entire spectrum of our population.”
Spreading His Academic Wings
A self-described faculty brat, Dr. Billingsley spent a lot of time on the University of Colorado Boulder campus, where his father was an English professor. It was an enriching experience, but when he was considering colleges, he decided to spread his academic wings.
“I left Colorado and went to Stanford as a biology major and had a wonderful experience there. But I am a person who has always pursued a variety of experiences and encourage that in my own students and trainees. I think that’s how we grow and bring new skills into our repertoire. It was a great experience, but after 4 years in California, I decided to go to the East Coast and pursue my medical degree at Johns Hopkins,” said Dr. Billingsley.
I am a person who has always pursued a variety of experiences, and I encourage that in my own students and trainees.— Kevin Billingsley, MD, MBA, FACS
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Asked about his decision to become a surgical oncologist, Dr. Billingsley replied: “I had considered oncology all along and decided in medical school that I wanted to be a surgeon because I liked that intensity of care and the opportunity to make a very direct impact on patients’ lives. I was also drawn to the challenge of a perpetual pursuit of mastery that comes with surgery. I actually went into general surgery as a resident, thinking that would be my path forward, but very quickly I found that when I was caring for patients with cancer, I loved the relationships I had with them. I loved talking to them, I loved their stories, and I loved the richness of the interaction that one gets when you have the privilege of taking care of someone with a life-threatening illness. You tend not just to be with them in that acute episode, but deep into their care. And that’s something that I’ve continued to enjoy.”
Dr. Are then drilled down to Dr. Billingsley’s subspecialty, hepatopancreatobiliary (HPB) surgery, a very demanding clinical setting. “I think I was drawn to HPB—particularly liver surgery—because of the technical challenges, the mystery of operating on the liver, and the fact that it is a large organ with all of this hidden anatomy that you have to somehow divine using your eyes as well as the ultrasound and preoperative imaging. But I also fell in love with HPB because of the complexity of the disease process and, again, the intensity of the relationships that you have with patients. But then again, I think I would’ve been happy in any surgical discipline in oncology,” explained Dr. Billingsley.
Finds Research Rewarding but Not a Passion
After attaining his medical degree, Dr. Billingsley did his internship and surgical residency at Oregon Health & Science University. He had an early interest in research, which accelerated in 1992, during a 2-year clinical fellowship at the National Cancer Institute (NCI).
“I started doing research as a clinical fellow in the metabolism section of the surgery branch at the NCI, where I gained great appreciation for the work, insight, and perseverance that is necessary to do basic and translational scientific work. And if I can share one observation with any of our trainees who may be reading this, it’s that as you go along, you have be honest with yourself about where your true calling and ability may lie. As much as I liked basic science research, it was not my true calling,” he said.
Chandrakanth Are, MBBS, MBA, FRCS, FACS
“So, I went on to finish my clinical surgical training. When I was in a junior faculty role at the University of Washington in Seattle, I developed a wonderful research collaboration with a very experienced health services and outcomes research group. And we developed a pretty big study looking at the multidisciplinary treatment of patients with colon cancer, which gave me a real appreciation of the power of large administrative data sets to gain an understanding of how patients are treated in a complex health system—where the opportunities are, where we fall short,” he continued.
A Surgical Highlight
During the discussion, Dr. Are asked Dr. Billingsley to touch on his time as a surgeon at the Seattle Veterans Affairs (VA) Medical Center. “One of the things I am most proud of about that phase of my career was that I was a full-time VA surgeon. And for any of our trainees reading this, I encourage you to consider service in the VA system. Not only is it a wonderful group of people who have made great sacrifices for our nation, but it is a system that truly supports the missions of academic medicine that we’re all committed to. So you can provide clinical care in a supportive system, but faculty also have the opportunity to do research and teach at a variety of levels.”
Dr. Billingsley continued: “One of the things I focused on during that period was system development in cancer care across a large geography, which would become a theme throughout my career. That particular VA hospital in Seattle serves veterans from Alaska to Montana, Idaho, Washington, even Nevada and California. So, there was a clear unmet need for providing high-quality multidisciplinary complex specialty care to a group of people who lived in a very dispersed geography. Before telehealth became fashionable, we established a telemedicine cancer program that had its hub in Seattle and provided linkage to the rest of Washington, Idaho, Montana, Anchorage, and several other smaller outreach areas. It proved to be a valuable service for our veterans.”
[A]s you go along, you have be honest with yourself about where your true callings and ability may lie. As much as I liked basic science research, it was not my true calling.— Kevin Billingsley, MD, MBA, FACS
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No Workweek the Same
Among Dr. Billingsley’s many current responsibilities at Yale, he oversees quality and patient safety initiatives, evaluates and optimizes the multidisciplinary team structure, assists with facilities and space planning, supports the center’s research mission, and interacts and coordinates with Yale New Haven Hospital’s clinical leadership structure.
“Despite my heavy administrative workload, I continue to have a half-day clinic every week. And I usually operate at least 1 day a week. The rest of the time, I have a series of meetings with other physicians and physician leaders as well as my nursing colleagues. We spend a lot of time developing multidisciplinary programs with our faculty leaders in the surgical disciplines, medical oncology, and radiation oncology. I usually try to round and get to the front-line workplace, either in the hospital in New Haven or at one of our care centers throughout Connecticut or Rhode Island. And then I round on my own patients sometime during the day and spend a little time with the residents,” he said.
Mentoring the Next Generation
Mentorship in oncology can be the cornerstone of professional development and career satisfaction—a philosophy embraced by Dr. Billingsley. “I reflect on this often because although I’m in an administrative role, I still commit a significant amount of time to educating the Yale surgery residents as well as the medical oncology fellows here at Yale. And one of the things we think about a lot in surgery is optimizing the technical training and experience of our trainees. I certainly spend time doing that, but I really make the point to our residents that they are going to be leaders and that the call for leadership in the coming years is going to be greater than ever, with the pace of change in health care, the challenges we’re facing, and the need to drive forward efforts in diversity, equity, inclusion, global health, climate change, and cybersecurity issues. Those of us who are in health care are going to have lots of complex organizational work to do. And we’re going to have to come together in ways that we have not before,” said Dr. Billingsley.
Wellness Among Oncology Professionals
As a leader in oncology who is responsible for a large and diverse group of hard-working oncology specialists, Dr. Billingsley is acutely aware of physician burnout. “I personally believe that clinician fatigue, burnout, and disenchantment were escalating before the pandemic, but after you put 2 years of a pandemic and displacement and strain and family challenges on top of that, I feel every day that our folks taking care of patients on the front lines are tired,” he said.
“I was just making rounds today, and several of the residents on one of our teams are out with COVID. They’re not particularly ill, but we continue to face ongoing operational disruptions, and those repeated stresses just wear us all down. So, it is really a job for us as leaders to be candid about the challenges we’re facing and paint a picture of the path forward,” he added.
“We have a number of initiatives we are pushing forward that I’m really pleased with,” he continued. “One of the things we are doing is a series of what I would call small-group offsite retreats, which sustain us in our work and connection at a deeper level with our colleagues. We also have a number of other initiatives moving forward relating to all of the things we know are tough for physicians, like building a capacity for managing the electronic medical record. It’s not just the physicians who are under great strain; it is also our nursing colleagues. And we have a number of programs here at Yale to support the nurses.”
As the conversation was wrapping up, Dr. Billingsley commented: “I think that as oncologists, regardless of our discipline, we have probably one of the best jobs in the world. The opportunity to meet with people and families and provide care and service at a truly pivotal point in their lives is such a privilege. And I’m enormously excited about the future of oncology, which is incredibly bright, given the explosion of new therapeutics and surgical and radiation techniques that have evolved in the past 5 to 10 years. But I think we are going to have to put our shoulders to the wheel and think together as a community about how we deliver those therapies, in a way that they are broadly accessible and affordable—not only to the people we care for here in North America, but throughout the globe,” he said.
“Finally, I will say that one of the things we do really well in oncology is collaborate for the welfare and betterment of our patients. We collaborate across all kinds of boundaries of time, space, and geography. And I think we should role-model that for other leaders in the world who may not do as well.”
DISCLOSURE: Dr. Billingsley reported no conflicts of interest.