From Growing Survivorship Programs to Practicing Self-Care: A Day in the Life With Oncologist Alicia Morgans, MD, MPH

Successful and sustainable oncology careers are built upon everyday practices, according to Alicia Morgans, MD, MPH. These practices include balancing focus with flexibility, a concept she applies by compartmentalizing tasks to dedicate focused time to prioritizing patient care, diving into projects of personal interest, and discerning next steps for growth.

“It’s a special practice of medicine, and it’s also a special group we work with,” Morgans said in an interview with OncLive®, where she expanded on her typical work week as an oncologist. “We should be appreciative of that and keep in mind on the good days and the bad days that we can all work together to lift each other up.”

Throughout the interview, Morgans emphasized the importance of good communication, setting boundaries for self-care, and practicing gratitude to prevent burnout. She also underscored the significance of trusting in the power of supportive teams.

Morgans is the medical director of the Survivorship Program at Dana-Farber Cancer Institute in Boston, Massachusetts, as well as an associate professor of medicine at Harvard Medical School.

OncLive: What does a typical work week look like for you?

Morgans: It’s easier to describe a work week, because a day is going to look different depending on whether it’s a clinic day or a day when I am doing more administrative or research work. On a clinic day, I try to devote myself completely to clinic and keep every other bit of interfering input out of that day, so I can focus on what the patients need. This lets my brain work a little more effectively. Clinic days can be so busy that it’s nearly impossible for me to put other things onto those days. Those days are set aside for clinic.

On the other days, I try to do minimal activities associated with clinic, just to focus all my attention on administrative work, research, mentoring, collaborations, [and other] things outside of clinic. I do intermittently have to focus on some clinical pieces, but separating things as much as possible helps me focus on what’s important. There are interesting data on multitasking [showing that] we always do a little better when we can focus our energies and efforts on a particular task. On non-clinic days, I end up having meetings usually for about two-thirds of the day. I then try to block off at least one-third of the day to get work done, which is often going to be writing or responding to emails, thinking about new projects I want to put together, and putting together ideas to try to launch new initiatives and new projects with teams.

A lot of the work I do on non-clinic days is research devoted and thinking about my own projects or projects I’m working on with my mentees or collaborators. However, a fair portion of that work is also devoted to the survivorship program at Dana-Farber, which I lead as the director. We are often thinking about daily clinical activities and making sure things are running smoothly. [We are also] program building within that center: identifying needs for patients across the cancer institute to try to make sure we have the clinical faculty or other faculty to meet those needs, making sure we have workflows in place, and making sure we understand how to best adapt as things like faculty or patient volumes change across the institute.

For example, one of the newer things we’re working on is trying to support women who have vasomotor symptoms associated with their cancer care, whether that’s breast cancer treatment, ovarian cancer treatment, or high-dose chemotherapies used in the treatment of leukemia or lymphoma. Many of these patients develop hot flashes and other complications associated with hormone dysfunction that need therapy. We’re putting in place a program to address those vasomotor symptoms and hormonal dysfunctions with an emphasis on non-hormonal interventions, because many patients with cancer can’t receive certain hormones because it could be problematic for their cancer care.

[Overall], in academic medicine, we have the opportunity to devote our minds, efforts, and energies in many ways across a week. That’s one of the things I enjoy, because it keeps [the job] interesting and allows us to flex. If there’s something more important going on in one area, [we can] devote ourselves to that and increase or decrease our dedication to different areas across time as our interests or needs change.

How do you try to set boundaries between your clinic and administrative tasks?

To be clear, this is what I wish to do perfectly, but it isn’t perfect. However, good communication with your team is important. My clinical team is amazing, and they deal with so many things; whether I’m traveling or on a research or administrative day, they are the first line for all clinical things if I’m not there. They own that, because they’re fantastic clinicians and wonderful partners in this. I’m clear [to communicate that] I’m not necessarily going to see an email if I’m in back-to-back Zoom calls, so if they need me urgently, I need them to text or call my phone or page me. We try to set up ways to [communicate] so everyone’s aware of what all our goals are and so we can try to keep those boundaries.

When I’m in clinic, I’m devoted 100% to clinic. I will try to support [my team] if they need extra things, and I will do that on days when I’m doing other administrative things. It’s just that [we set] goals at the beginning of the day. My administrative support knows that if I’m in clinic, we can’t schedule meetings on that day; even if it looks like I have an opening, my brain is not going to be focused on discussing the next poster for a meeting coming up, and instead I need to focus on clinic. There’s always something to do for clinic, so I will be able to fill a day [with clinical responsibilities], even if I have half an hour or an hour where [a task] is not blocked.

Good communication is important, as is giving oneself the grace to say: "I do need to have this meeting. It’s a clinic day, but I’ll put it at the end of the day, and I need to make every effort to be there." [This system is] not perfect. After this interview, it’s a non-clinic day, but I’m going to go into my charts and answer some patient messages that my team has left for me, because they’re specific and important for me to answer. Having that flexibility is important. However, the goals help me ensure I get everything done, because there are so many tasks, and there are always more. And this is just professional tasks. There are also personal tasks, and kids, and everything else, but having goals helps me make sure it all gets done.

What advice do you have for up-and-coming oncologists about balancing clinical and administrative roles or integrating more career opportunities into their workflow?

At the beginning of [my] career, I found it important to always try to say yes to opportunities, be open to them, and think: How can I, even with what seems like a small opportunity, use this to make a new collaborative relationship, find the next question I want to answer, or become a collaborator on that next invited review? Whatever it is, how can I use the opportunities I have to make connections throughout the oncology community and advance the work we’re trying to do? However, over time, it’s also important to understand that everything you say yes to means you have to say no to something else, whether that’s a professional opportunity or a personal opportunity with your family, your partner, or your kids.

We only have so many hours in the day. We all know that rationally, but sometimes it’s important to remind ourselves, as we are getting invited to here, there, or somewhere else, that we can’t be everywhere. It is important to ultimately learn how to pick and choose. Then, if you do a good job and maintain those relationships you made from the beginning, even when you have to say no to something because of another obligation or responsibility or because it’s not the right thing for you, you will have other opportunities that will come along that you will be able to say yes to next time. It’s a marathon, not a sprint, which I know is a cliche. However, it’s so important to remember when you have a lot of pressure on yourself as a young oncologist that you can’t do everything at once. If you give yourself time, you’ll realize you’ve done a ton of things over the course of a career.

What has been your experience trying to balance your personal and professional life as an oncologist?

I heard from someone about a year ago that work-life balance is probably an impossible thing to ever achieve. [It probably looks more like] work-life integration or a melding of these worlds, with an ebb and flow from each direction. However, it’s also important to have good communication with your professional team and in your personal life, so that everybody knows that when something is important for you personally, you might miss something professionally. Or, when everyone knows [you have an] important obligation professionally, your partner or your loved ones can pick up the slack at home if that’s needed.

For me, that will always be a work in progress, because I am somebody who likes to try to do everything. I’m trying to be better at ensuring I remember that if you say yes to one thing, you have to say no to something else, and you can’t be everywhere at all times. It is an ongoing negotiation. However, having good communication and good people in your life, both on your professional side and your personal side—people who forgive you but also encourage you to keep going—is critical.

How do you try to avoid burnout?

Burnout for most of us is almost inevitable at certain points. We have to [learn] how to recognize burnout in ourselves and [find] what helps make us personally feel rejuvenated from that, because many of us will push ourselves to the point of burnout. We’re [usually] almost there because of who we are and who we’ve been trained to be in medicine; we’re always pushing to the last minute.

I set aside the morning, and I ride a Peloton. I ride my Peloton every morning when I’m not traveling. If I’m traveling, I go to the gym wherever I am, and I set aside about an hour for myself. I don’t answer email, and I don’t pay attention to anyone else. I try to do that every day. That helps keep me feeling balanced. It helps me acclimate to wherever I am when I’m traveling, and it helps me start my day in a way that keeps me in a better mood for my kids and my family, as well as for my work. Everybody’s going to have something different. Maybe that’s reading, taking a walk, exercising, or playing a video game. Knowing what it is that helps you right yourself is important.

It’s also important to remember to schedule vacations, because we get to a point where, especially through training, your vacation time is extremely limited and dictated by the schedule of everyone around you. Even as you’re a young attending, your vacation time is often dictated by the people you work with. That is okay, but make sure to schedule [vacation time], and make sure that when you’re on vacation, you are actually on vacation. Tell your team you’re away and separate yourself.

For me, it’s important to feel like the weight of the people’s lives that we carry in clinic are lifted for a bit of time so I can feel a little recharged. Maybe not everyone needs that, but I think it’s important. [It’s also important] to model that for the people around us, [showing] that it’s okay to take a step back for a week, for 2 weeks, whatever the vacation period is, remember yourself and your happiness, and then come back to [work]. That separation is important for preventing or reversing burnout, which can happen when we carry so many heavy things.

What is your message for colleagues about staying motivated while facing the ups and downs of a career in oncology?

We are fortunate in oncology to have amazing colleagues. The communities we build within oncology—within our smaller groups if we’re specialists, or within the larger oncology community—can be powerful in giving us opportunities and helping us if we’re having a down day or a period where we feel overwhelmed. [They also] remind us why we do what we do.