An Epiphany During Fellowship Led to a Career in Geriatric Oncology for Heidi D. Klepin, MD, MS

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Geriatric oncologist Heidi D. Klepin, MD, MS, was born and reared in Pearl River, a hamlet on the west side of the Hudson River in New York. “My parents are German immigrants who came to the United States in the 1960s looking for prospects. Growing up in post-war Germany, neither had the opportunity to go to college. My father was a machinist, and my mother was a stay-at-home mom who took care of the household and my brother and I as we grew up,” said Dr. Klepin.

Dr. Klepin’s interest in medicine may have been sparked by her parents’ emphasis on the importance of education as the key to opportunity in life. “I was a good student who enjoyed most subjects, but in high school, I absolutely fell in love with biology. My AP biology teacher really brought the lessons to life in ways that were truly inspiring. Being able to bring a half-dissected fetal pig home for extra credit was just really cool. I became immersed in the subject, which, looking back, had a big influence on my later career decision,” said Dr. Klepin.

Heidi D. Klepin, MD, MS

Heidi D. Klepin, MD, MS

A Stint in the ER

In 1990, Dr. Klepin entered the University of North Carolina (UNC) at Chapel Hill to do her undergraduate work, based on the recommendation that it offered a strong biology program. During college, Dr. Klepin wanted to pursue a career in the biologic sciences, not knowing exactly what specific discipline.

“I spent 2 years doing laboratory research, which I really enjoyed, but I also knew I wanted a career that involved working with people. My turning point came while volunteering in the UNC emergency room. That’s when my focus on medicine occurred. I knew I wanted to become a physician so I could couple my love of science with my need to be in a profession where I could help people as well,” she shared.

Drawn to Internal Medicine

After receiving her undergraduate degree in 1994, Dr. Klepin attended the Medical University of South Carolina in Charleston. “From day one, it was an amazing and eye-opening experience. I loved all of my rotations but was drawn to internal medicine, as I liked the problem-solving challenges it offered. I liked surgery, too, but I’m not a morning person, so I didn’t think it was for me,” she joked.

Dr. Klepin continued: “During my early clinical rotations, I shadowed a private practice internist who cared for patients across their lifespan. I followed him as he saw patients from the clinic to the hospital to the nursing home. I became enamored with the idea of creating long-term relationships with my patients. So, at that point during medical school, I’d pretty much decided to become a primary care internist.”

Dr. Klepin met her husband-to-be during medical school, and they serendipitously matched for internal medicine residencies at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. “I entered with the plan of becoming a primary care provider, with a particular interest in caring for older adults. I really enjoyed talking to older patients and listening to their stories. So, I planned to train in geriatrics. But during residency, I rotated multiple times on oncology services and I really connected with the patients. I also observed the incredible and unique bond between oncologists and their patients with cancer. As a resident, I got to spend a lot of time talking with older patients with cancer who shared their experiences navigating difficult decisions and dealing with the side effects of their treatments,” said Dr. Klepin. “Although the experience working with patients with cancer was profound, it strengthened my resolve to pursue geriatrics, and oncology still wasn’t on my radar.”

An Epiphany Leads to a Career Move

After completing residency, Dr. Klepin and her husband enrolled in a geriatric fellowship program at Wake Forest. “I loved the holistic approach to care, with an emphasis on function and standardized tools to measure and deliver personalized care. During my fellowship, I was also inspired by the collaboration between researchers on aging and the clinicians in our geriatrics program. I remembered my terrific residency experience on the oncology services and thought how valuable it would be to integrate geriatric care principles into that setting. As I was ruminating, I had what I would call an epiphany and realized that my calling was to become a geriatric oncologist,” said Dr. Klepin.

According to Dr. Klepin, the environment at Wake Forest was a perfect fit for her to mature into her calling as a geriatric oncologist. “As I pursued an oncology fellowship here at Wake Forest, I also completed a second year in geriatrics as an attending, to fully immerse myself in the clinical geriatric experience.”

Valued Mentors

During her oncology fellowship, Dr. Klepin participated in a master’s research program to develop the skills needed for her ultimate career goal of becoming a clinician-researcher. “The experience was invaluable because it gave me the opportunity to identify some critical research mentors such as Ann Geiger, PhD, who gave an incredible seminar in one of my master’s classes. After researching her publications, I realized she could help me develop my research skills in cancer. So, I met with her and explained my aspirations and goals and asked if she’d take me on as a mentee, which she did; I am eternally grateful because it was instrumental in my career development. Other key mentors including Stephen Kritchevsky, PhD, at the Wake Forest Claude Pepper Older Americans Independence Center, and Bayard Powell, MD, Section Chief of Hematology and Oncology at the Wake Forest Baptist Comprehensive Cancer Center have been critical in supporting my development as a geriatric oncologist,” said Dr. Klepin.

Growing along with the Cancer and Aging Research Group has really been the highlight of my career as a clinician-researcher.
— Heidi D. Klepin, MD, MS

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Dr. Klepin noted that her mentors were influential in helping her achieve her initial goal of acquiring the necessary funding to investigate geriatric assessment as a predictor of outcomes for older adults with leukemia. “A pivotal time in my early faculty career was meeting Arti Hurria, MD, FASCO, at an Alliance for Clinical Trials in Oncology meeting. I introduced myself, and, remarkably, during that first encounter, she asked me if I’d be interested in joining as a collaborator in her first multisite study. At the time, we were all early-career faculty, and Arti, in her wisdom, realized that the only way for us to design and execute geriatric oncology trials was to all work together. That moment established the momentum and trajectory for my career,” said Dr. Klepin.

Enthusiasm Built a Movement

“Arti was so much a part of my life,” said Dr. Klepin, “that it’s actually difficult to refer to her as the late Arti Hurria. She had received a career development award and basically asked doctors like me if we’d like to get aboard. It’s important to note that the conduct of that first multisite study led to the development of the Cancer and Aging Research Group (CARG), which Arti then grew into a national collaborative. For me, to have the opportunity to join with her at that early stage was career changing.”

Asked to elaborate on her current work, Dr. Klepin replied: “Growing along with CARG has really been the highlight of my career as a clinician-researcher.