Oncology fellows represent the future of cancer care, bringing the best and brightest young doctors into a rigorous training environment that molds their future career paths. Due to an impending workforce shortage in cancer care, the public health-care demands placed on today’s oncology fellows will be greater than ever. To give our readers insight into the life of an oncology fellow, The ASCO Post spoke with Bishoy Faltas, MD, who began his hematology/oncology fellowship this past July at Weill Cornell Medical College in New York.
I was born and reared in Egypt; I received my medical degree from the University of Asyut, located about 250 miles south of Cairo. After graduation, I pursued training in the United States because I was determined to become the best physician I could be. The high quality of medical training in the United States offered me that opportunity. I was also attracted to the idea of living in a “meritocracy” where advancement is based solely on the quality of one’s work.
So I decided to come to the United States in 2006 and started my internal medicine residency in Rochester, New York. I was already leaning toward medical oncology during medical school, after losing my father to laryngeal cancer. During my residency, I found that I truly experienced fulfillment from taking care of patients with cancer, and this drew me more toward oncology.
Finding My Way: Guidance by Mentors
During my residency, I was very fortunate to have wonderful mentors. Not only were they excellent role models, but they also helped me realize that oncology was my true calling. In particular, Dr. Paul L. Bernstein, my residency program director has left an indelible mark on my career. He taught me that the good physician is the one who is present at the bedside until the end. I remember for instance one time when he took me along with him to the funeral of one of our patients who had just passed away, to console the patient’s family.
His high regard for continuous scholarship truly inspired me. During my residency, we worked together to develop a rotation for medical residents to spend 2 weeks learning about the molecular basis of different diseases including cancer, while getting hands-on training in basic molecular techniques like polymerase chain reaction (PCR). It was an innovative course that helped me appreciate the biologic complexity of human disease, and it was a lot of fun!
Dr. Bernstein encouraged me to follow my passion in oncology. So when the time came, I applied for oncology fellowships, interviewed at multiple places, and finally matched at Weill Cornell Medical College. One of the reasons I chose this program is the very strong mentorship culture that starts at the highest levels of the department and trickles down to the level of fellows, residents, and medical students.
Exciting Times
Fellowship is a very exciting time for me. I’m just 6 months into my 3-year combined hematology-oncology fellowship. The first year of fellowship is composed entirely of clinical rotations, purposely structured in a way that will allow for protected time for research later on. From the second year through the first half of the third year, the focus is on laboratory research, and the last 6 months of the fellowship is composed of electives.
In the first year, my weekday schedule and duties are based largely on each specific clinical rotation, varying from day to day. The breadth and richness of the pathology I see is tremendous. On-call duties are infrequent, but the nature of problems one would encounter on the “front lines” is unpredictable.
Last weekend, as I finished rounding on the solid tumor service, I received an emergency call to the ICU for a patient with acute leukemia, admitted with a white cell count of 200,000/mm3. He had severe metabolic acidosis and was intubated. We put in a nasogastric tube and administered hydroxyurea. We started leukapheresis to reduce the blast count. Unfortunately, despite our best efforts, the patient succumbed to the disease and by the end of the day had passed away. Days like this can be difficult, especially when you lose a patient. Learning how to cope with this is an essential part of becoming an oncologist.
Oncology is an ever-changing field; one of the biggest challenges of the first year is to master that huge body of knowledge while staying abreast of the new literature. Finding time to read could be challenging, but the numerous didactic occasions give us a “critical mass” of knowledge necessary to take care of patients.
Looking Ahead
After completing my first year, I am very excited about the prospect of conducting laboratory research for the following 18 months. It is an opportunity to really get a deeper understanding of the biology of cancer. As I see patients everyday in the clinic, I see how cancer affects their lives. However, working with cancer cells up close and personal in the lab is quite different, bringing a new dimension to my understanding of cancer—a chance to “know thy enemy.” I am very grateful that my program offers the opportunity of “protected time” to pursue laboratory work.
Although my career path is not set in stone, I’m fairly certain that I want to be an academic oncologist. I want to engage in research in pursuit of new and exciting ways to diagnose and treat cancer.
Choosing Oncology
Now is a great time to go into oncology, There is growing concern about an impending workforce shortage in oncology. Cancer is poised to overtake cardiovascular death as the nation’s top killer. We need more oncologists, and I would encourage medical students and residents to consider a career in oncology. No doubt, an oncology career can be emotionally challenging. You deal with desperately sick patients, but helping these very vulnerable patients is very fulfilling.
We are on the verge of seeing the fruits of the explosion of knowledge about the molecular basis of cancer. It is thrilling to be part of a forward-looking medical field that is rapidly advancing its knowledge base and its ability to cure and palliate the world’s most dreaded disease. I can see it happening before my eyes, and I’m just at the beginning of my career! The prospect of being even a small part of this is very exciting.
Winding Down
It takes passion and commitment to pursue a career in oncology. As rewarding as taking care of cancer is, our profession is very demanding, and one needs to use downtime to decompress and to refocus on one’s goals. For me, spending time with my family is the best way to unwind. Whenever I can, I try to spend time with my 3-year-old son George, and my wife Mary, who is studying to get into dental school. Although she is a full-time student in a very demanding program, she is always there to support me as I move into new and more challenging phases of my career.
Burnout is a real phenomenon in oncology, so I’m fortunate to have a supportive family. When time permits, I take advantage of the numerous cultural attractions New York City has to offer. I have just started golf lessons, although I’m not sure how far that will go. Golf courses are hard to come by, but there is always a driving range nearby. ■
Disclosure: Dr. Faltas reported no potential conflicts of interest.
