Meeting the challenges of today’s evolving medical landscape often requires creative skills far beyond clinical expertise. Some individuals seem uniquely suited to this task. Jamal Rahaman, MD, is one of them.

“My path in medicine? Medicine picked me,” said Dr. Rahaman.

Dr. Rahaman was planning to pursue engineering when he received a scholarship to go directly from high school into medical school. That unorthodox beginning proved a bit of a harbinger. In addition to being trained in obstetrics and gynecologic oncology, Dr. Rahaman also is a trained cardiothoracic and vascular surgeon. “So I have a very broad background,” he said.

Dr. Rahaman feels lucky to have trained when he did, being exposed to new approaches while laying down a foundation of traditional techniques. “In my career, I’ve been able to master open surgery, laparoscopic surgery, and now robotics,” Dr. Rahaman said. “I am very fortunate that I have been able to span all 3 elements of surgery.”

His inclination toward diversification in surgical techniques offers insight into Dr. Rahaman’s choice of specialty. “Gynecologic [oncology] is very unique in that it is the only oncology specialty—and one of the few specialties in all of medicine—that is truly comprehensive,” he said.

Gynecologic oncologists manage all aspects of patient care from precancer diagnoses, surgery, chemotherapy, and radiation therapy coordination to pain management and palliative care. Within the surgical arena alone, “it’s one of the few specialties where you do everything yourself,” he said. “The same surgeon does the urologic surgery, bowel surgery, and vascular surgery, as well as the cancer surgery and gynecologic surgery. So it’s very appealing if you’re looking for a comprehensive and broad discipline.”

With only 500 to 600 board-certified specialists, OB-GYN oncology also is a very small and highly competitive field. “At this point, there are only 42 fellowship programs in the United States, and we have about 1,200 residents graduating every year,” Dr. Rahaman said. “If you are planning on getting into the field, you have to start early to make your application competitive.”

Because so few fellowship slots are available, some candidates do not get matched for a program at the end of their residency and have to do another 1 to 3 years of research to gain a competitive edge. “It’s a long haul,” Dr. Rahaman said. “Medical school, 4 years of residency, and if you’re lucky you go straight to fellowship—it is still a minimum of 11 years.”

The length of the fellowship is a minimum of 3 years—2 years of clinical and 1 year of research—but some programs have a longer research component. The path to board certification is similarly arduous. “You do a written examination, which is given every 2 years; and then you have to collect your cases and present [a] research thesis for your oral exam, 2 to 4 years after you finish your fellowship,” Dr. Rahaman said.

“I think that you have to be very clear about whether you want to pursue it. And because it’s so competitive, you have to position yourself early.”

Dr. Rahaman’s practice today runs broad. “I have a very busy surgical practice, a very busy chemotherapy practice, and I’m the director of the fellowship training program, so I have a lot of academic responsibilities,” he said. Add to that directing the chemotherapy infusion unit at Mount Sinai, directing clinical trials, and running a robotic surgical training program. “There are a lot of different elements with a lot of moving parts,” he said.

“Fortunately, we structured the chemotherapy infusion center within the office practice, which is in the same facility as the OR [operating room],” Dr. Rahaman said. “So you can run from the OR to the office to the chemotherapy suite, and the academic offices and patient practice offices are all within the same campus. We do everything simultaneously.”

Team efficiency also is aided by their reliance on a Web-based electronic platform. “It integrates everything,” Dr. Rahaman said. “We can write chemotherapy orders and access patient records from anywhere in the world. It’s a very efficient system.”

The ability to conduct portions of their work anywhere the Internet is available allows Dr. Rahaman and his colleagues to have a bit of flexibility in their personal lives. “You can backlog a lot of work and catch up with it nights and weekends,” he said. “That way, you’re not stuck in the office late at night. It’s the same volume of work, but you can shift it around to accommodate other aspects of your life.”

The electronic platform also helps Dr. Rahaman and his colleagues to be compliant with the ever-evolving regulations and mandates. “Every year, there are different regulations, different fiscal constraints, and different challenges,” he said.

Meeting those challenges sometimes requires the recruitment of experts outside of medicine who can propose alternative models for problem solving. “We do that a lot,” Dr. Rahaman said. “We’ve been very lucky and successful in our creative teams. When you look for synergy, it gives you efficiency. And that’s how you survive.”