With a projected increase in demand for oncologists over the next decade, multiphysician hematology and oncology practices will be expanding to meet this rising need.¹

As they look to hire, partners in established oncology practices say they are looking for a few key qualities in new associates, and chief among them are the ability to communicate with colleagues and treat a wide variety of disease types.

“The most important thing in the community setting is the ability to communicate,” said Tom Sneed, MD, practice president of Arkansas Oncology Associates in Little Rock. “You cannot do business in the community if you can’t call up another physician and have a pleasant conversation and communicate what you need to communicate.”

This ability to converse with colleagues is especially critical in community-based care for 2 primary reasons. First, providing the best patient care often requires working with physicians at a number of different practices. Second, developing long-term relationships with physicians in other specialties creates the referral base that ultimately supports a financially successful community practice.

“In terms of personality, generally speaking we would like someone who is very motivated and is interested in making new contacts with referral sources,” said Timothy Byun, MD, a medical oncologist with Hematology-Oncology Medical Group of O.C. in Orange, CA. “And when dealing with other physicians, they need to be able to cordially but also intelligently converse, and be able to communicate effectively.”

Patient care is at the center of any community oncology practice, and the way a physician interacts with patients is particularly vital in this setting.

“What matters is what kind of person you are, how you communicate, and how much you care about your patients and are willing to go to bat for them and work on their behalf,” said Dr. Sneed. “The whole business about where [a fellow] trained is a little overblown, although you certainly hear about that from a lot of people. The truth is that you can be an oncologist whether you trained at a small university program or whether you went to Mayo or Sloan-Kettering.”

Clinically, multiphysician community practices seek fellows with the ability to manage a number of different disease types and clear experience managing patients from diagnosis onward.

“As a community oncologist, you are going to have to be good at many different cancers and that is just the reality of being a community oncologist,” said Dr. Byun. He added that he has developed a focus on gastrointestinal cancers; but that any subspecialization as a community oncologist is a very long-term goal, and that right out of fellowship “a good general knowledge and background to deal with day-to-day management of cancers” is prized over specialized knowledge.

That background comes only from experience. “What you want is someone who’s been at a program where they’ve actually been allowed to be the doctor, not just followed around other doctors for years,” said Dr. Sneed, adding that it’s not uncommon to find fellowship graduates who have little experience overseeing the total management of patients, either because they’ve relied too heavily on other colleagues throughout fellowship, or spent an inordinate amount of time on the research component of their fellowship.

Both Drs. Sneed and Byun said that research experience is valuable, however—particularly as clinical trials become more available in the community—because it can be one marker for intelligence and critical thinking skills. “In general, I think it’s a positive thing,” said Dr. Byun. “How much is it helpful in clinical practice? That’s debatable.”

From a business perspective, most fellows have little understanding of how a community practice actually runs, and it typically doesn’t play a role in hiring decisions, noted both Drs. Sneed and Byun (Table 1).

Decreasing reimbursements across medicine combined with higher costs for small businesses have radically changed the business model of community oncology practices in recent years. Despite this, very few young physicians understand the financial pressures facing multiphysician practices. “If I made hiring decisions based on knowledge of the business part of oncology, I’d never find a candidate who is appropriate,” said Dr. Sneed.

This disconnect can lead to problems between practices and new associates. “It’s been my experience recently that fellows come out into private practice and have fairly unrealistic expectations about how much money they’re going to make and how hard they’re going to work,” Dr. Sneed said.

“The economics of running a business is something that you have to learn,” said Dr. Byun. “Otherwise you could be a very successful oncologist in terms of knowledge base and patient care, but you could go bankrupt. And that’s a reality.”

Generally speaking, however, working hard will ensure the success of new associates as they get up to speed on the details and eventually attain partnership. “I think that when fellows graduate, they’ve been working like animals for years to get where they are and [in practice] some people rise to the occasion and jump right in, and some people sort of say, ‘now I can coast, now I’ve made it,’ which is definitely the wrong attitude,” said Dr. Sneed. “When you arrive and are employed by a practice, you had better expect to work hard or you won’t be around very long. After all, they’ve hired you for their benefit, not for your benefit.”

References

1. Forecasting the Supply of and Demand for Oncologists: A Report to the American Society of Clinical Oncology (ASCO) from the AAMC Center for Workforce Studies. http://www.asco.org/​ASCO/​Downloads/​Cancer%20​Research/​Oncology%20​Workforce%20​Report%20​FINAL.pdf. Accessed April 13, 2010.