Women in Oncology: Trending in the Right Direction 

A Conversation with Sandra M. Swain, MD, FACP

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Recent statistics show a substantial increase in women in oncology fellowships over the past decade but a low proportion of women in leadership roles…. We can help steer this talent into leadership positions.

—Sandra M. Swain, MD, FACP

According to ASCO President ­Sandra M. Swain, MD, FACP, an important part of her Presidential theme, “Building Bridges to Conquer Cancer,” is finding creative ways to ensure that we have enough oncologists to care for our burgeoning cancer patient population. Adding more women to the oncology workforce is one way to help stave off an impending shortfall of cancer specialists. And it’s a mission close to Dr. Swain’s heart.

The ASCO Post recently spoke with Dr. Swain about how her own experiences helped shape her vision of the future of women in oncology.

Medical School and Mentors

What was the atmosphere like in medical school, especially for a woman who wanted to pursue oncology?

I went to medical school at the University of Florida in the 1980s, and there were few women in my class. Not surprisingly, there were even fewer women in my internal medicine residency program. In fact, I was the only woman in my fellowship group at the NCI. So, I had no female mentors in oncology, but I had some great male mentors who supported me during the early stages of my career, which was invaluable for a young doctor.

Naturally, there were some men who didn’t support my career choice, suggesting that I’d be better suited for family practice. That sounds unbelievably paternalistic by today’s standards, but that’s the way it was.

Nevertheless, let me be clear about something: A mentor is a mentor, whether it’s a man or woman. My career was enhanced by terrific mentors who happened to be men but recognized my inner drive and dedication to the field, such as Dr. Warren Ross of the University of Florida, Dr. Marc Lippman of NCI, and Dr. Bernard Fisher of the NSABP, to name a few.

Then vs Now

What is the most notable change since your days in medical school?

There are simply more options today for women entering a medical career, and society has certainly become more flexible to the needs of women in medicine. For instance, there are far more opportunities to work part time, or work in an environment with more controlled hours. Also, more men today are stay-at-home dads, which gives women more room to pursue a career in oncology. In all, there are a lot of different choices, and we’re in the midst of a culture change that will benefit everyone.

I didn’t marry until I was 40 years old. My career was the driving factor in my life, so I needed to meet someone who not only appreciated that, but also welcomed it. It took a while to find the right man, one who was strong and confident enough to embrace having a successful career-oriented wife.

That said, it is very important that women who are looking to assume leadership roles factor in the demands of that type of career with their private life. It can be a difficult balancing act. But it’s worth it, so go for it.

Career Path

Medical school debt has been shown to shape career directions. Was it a factor in your career path?

No, I’m a hard-driving perfectionist and never satisfied with the status quo, so the academic environment was a better fit than community practice. The heavy workload in academic medicine is compounded by writing and teaching, talks, travel, and research. It’s very demanding. And the pay is less than in private practice, which wasn’t a determining factor for me at the time I made my career decision.

However, times have changed. Medical school is incredibly expensive, and young graduating doctors have a debt burden that naturally affects their career choice and their lifestyle. Young doctors might postpone getting married and starting a family until their careers are well underway and they’ve paid off some of their debt.

I went to a state school that was very inexpensive, and I graduated with a very small debt. One enters one’s career with a different frame of mind when buried under a mountain of debt. I feel for young doctors today. In my case, my career choices were made out of love for what I was doing, especially my research days at the NCI, when I was working with true giants in the field. So I’m lucky that money has never been a motivating factor in my career.

Current Trends

What does the current picture of women in oncology tell us?

It tells us that we’re trending in the right direction. Recent statistics show a substantial increase in women in oncology fellowships over the past decade. However, we continue to see a low proportion of women in leadership roles. This might very well be due to a perception problem; in other words, talented young women might perceive a lack of opportunity in moving up the oncology ladder. It isn’t exactly clear, but it is something we want to work on, so we can help steer this talent into leadership positions.

It may also be a timing issue; women may want to wait for their children to get older and then be able to devote more time to their career. On the other hand, not everyone wants to be a leader, so it is just as important to keep all of these talented, educated women in the workforce at some level.

ASCO Presidency

Being one of ASCO’s women presidents must be very satisfying.

In the Society’s 49 years, we’ve had 6 women presidents, and yes, I’m very proud to be in that group. It’s worth noting that 4 of the past women presidents took office during the past decade, and 9 of our 19 current board members are women. I’m gratified about the growing influence women have in ASCO. It is a credit to the Society’s constant self-examination and forward-looking vision.

Advice for Young Women

If you were addressing a group of young women entering medical school, what reason would you give them to considerer a career in oncology?

I would tell them that, from my experience as an oncologist, there is nothing more rewarding than having the honor and privilege of talking to people who are in such a difficult part of their life’s journey after a diagnosis of cancer. I learn something from every patient I see.

I would also tell them that although oncology is a demanding career, you can find a balance between your work and your personal life. And the fact that you spend your day caring for patients who need and recognize your humanity and compassion will add to the completeness of your life.

Closing Thoughts

Any last comments on women in the oncology workforce?

We have problems on a societal level. For example, there is a severe lack of affordable child care in the country. Lacking that one component puts enormous stress on women in medicine. We simply don’t do enough to help young working women who have children. This is a part of our national infrastructure that needs attention. When women are comfortable knowing they have a safe and affordable environment for their children while they’re at work, it has proven benefits for society as a whole. It’s a big question and I don’t have an answer, but it’s something we really need to think about. ■

Dr. Swain is Medical Director, Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC. 

Disclosure: Dr. Swain reported no potential conflicts of interest.