An Oncology Fellowship Is a Dynamic Process

Richard J. Bleicher director of the breast fellowship program at Fox Chase Cancer Center in Philadelphia, Pennsylvania, derives great satisfaction from working with fellows and trainees. He likens the experience to being a parent.

“I just love the teaching. There’s enormous gratification in taking someone who’s interested in a particular area and teaching them what you know and watching them grow and develop,” he said. “You invest in a trainee, and you watch them grow and go out into the world to do what you’ve taught them to do. It’s extraordinarily gratifying.”

Bleicher also serves as a professor in the Department of Surgical Oncology and leads the breast cancer program. Fox Chase is one of just 59 breast fellowship programs in the United States and Canada accredited by the Society of Surgical Oncology (SSO). In addition, Bleicher is chair of the SSO Breast Fellowship Program Directors Training Committee.

He earned his MD at Temple University’s Lewis Katz School of Medicine in Philadelphia and did his fellowship at the John Wayne Cancer Institute in Santa Monica, California. Bleicher returned to his native Philadelphia to work at Fox Chase about 14 years ago, and he’s directed the breast fellowship program for the past 10. He unabashedly loves his job.

“You need to have a special, caring personality type to go into oncology because it’s a difficult field, and the actual clinical care cannot be separated from the emotional aspect that cancer care requires,” Bleicher said. “The personality type—[an appreciation for] the multidisciplinary nature, the affinity and love for fellow human beings—is common throughout the oncology specialties and, for the 14 years I’ve been at Fox Chase, has been completely ingrained in the atmosphere. The patients see it, they comment on it, and it’s something that makes the job very, very enjoyable.”

Bleicher talked with Oncology Fellows about the importance of working closely with a mentor, avoiding burnout, and what to do if your interests change during your fellowship.

OncLive: With the benefit of hindsight, what do you wish you had known going into fellowship?

Bleicher: You should try to formulate an idea of what you want to get out of fellowship before you start. Everybody says they want to get a good job or absorb a lot of knowledge, but there are a lot of things that can influence what you absorb during training and a lot of things you may not necessarily focus on in fellowship but that you might want to have exposure to…It’s helpful if you develop a relationship with a mentor and talk out your short- and long-term goals with them. This will help you develop a sense of career objectives and interests beyond the specifics of job opportunities that become available. All these things are important to flesh out in advance and can be done with a mentor even before fellowship, while you’re in residency.

It’s important to get as much of a sense of your personal goals as your career goals because they interact. It’s particularly important to look for mentors during your fellowship who will help you flesh out those goals. Fellowship is very short. The things that you may want to learn or focus your time on might be different if you want to go into academics versus private practice or want to be an administrator versus a clinician providing patient care.

Your mentor or program director needs to know those details so they can tailor your exposure during training and maximize your likelihood of success. Your motivations, your goals, your concerns, even your fears, are specifics that can be helpful to talk out with a mentor. As you go through fellowship, your faculty will usually help you gain exposure based upon these details, and a good mentor will prioritize these areas. One of the things I was always told as a fellow is that your “report card” is what you accomplish, get exposure to, and gain knowledge about. That report card? It’s up to you to fill it. But you can ask for guidance in doing so.

Did your interests change during fellowship?

Completely. I did a surgical oncology fellowship, and when I went into it, I thought was interested in GI [gastrointestinal] cancer. As I continued through fellowship, my interests shifted into breast cancer. I felt that it was my own responsibility to figure out what to do with my life and what my interests were, and to try, at the same time, to fulfill my commitments. I felt that everything was on my shoulders, and I didn’t think that faculty would play any major role in that. So I didn’t go to my mentors as often as I should have to get feedback and help.

Throughout your training, you’re influenced by your own personal interests, the cases you’re exposed to, the faculty who train you, the mentorship you’re given, and the research you do. All these things shape your interests and steer your path forward. Most people’s path to what they do eventually is not a straight line; it’s a winding road.

What did you have to learn when you went into the job market?

What I used to tell fellows when I was a chief fellow and what I tell my trainees now is, “We may tell you that your job is going to be 80% clinical and 20% research when, in fact, it’s going to be 20% clinical and 80% politics.” There are always political aspects that you can’t know about until you are knee-deep in your job. There are human resources nuances that you can only learn on the job because every job is different. These include how specific people interact, what they’re sensitive to and what their biases are, the politics of the institution, who is the gatekeeper for things that you want to get done, and many other behavioral oddities. And this isn’t isolated to medicine. This is true of every job on the planet.

As a fellow or as a trainee, you’re usually shielded from the politics and the human behavior and even some of the more difficult relationship skills that you need to develop at work to get things done in whatever role you’re in. You can’t possibly know that before you start your job. A good mentor during fellowship with whom you have bonded can sometimes help you from a distance after you enter the job market or at least give you advice for a while after you start. And then sometimes you’re able to develop a relationship with a faculty colleague as staff mentor who can help you at your first job. Certainly, fellowship mentors often help long term with clinical questions or advice even many years after training.

How can fellows avoid burnout?

First of all, it’s important for the program director to know if you have personal situations that foster burnout. Faculty are pretty understanding. There are expectations of every job, including fellowship, that have to be accomplished. But if your faculty and program director are aware of these situations, they can usually provide advice or, in extreme situations, make accommodations.

That said, you as a fellow are the only person who’s going to know what you’re capable of doing. You need to estimate your own abilities realistically. Fellows frequently try to take on too many things because we’re all idealistic and new projects are always interesting. However, the reality is that you can only accomplish a certain number of things in a given amount of time. You have to be honest with yourself about what you can accomplish. This also may require a frank discussion with your mentor and/or program director. A good mentor will always be willing to have those discussions with you.