Today is the day I live for as a hematology/oncology fellowship program director. There are balloons filled on stage, dinner buffet stations brewing in the back of the conference room, and fellows entering with their proud families in tow for the graduation ceremony. On average, our graduating fellows have completed 14 years of education and training since high school and are finally about to enter the workforce as full-fledged oncologists. Along with the dinner, ceremonial speeches, and the bestowing of diplomas, our faculty contribute a few parting gifts for our fellows as a gesture of appreciation for their hard work in helping to manage our patients over the past three years.
Among these gifts, every year, we give our graduates a copy of a book on financial literacy for physicians. We have already provided our departing fellows with the necessary skills to manage complex patient cases, deliver efficient and compassionate care, and access appropriate resources for evidence-based medicine. However, I wonder whether they have acquired crucial life skills this late in life to balance the demands of their career and personal life, such as creating a personal budget, saving for the future, and navigating the complicated U.S. tax system. Hence, we provide them with a book on financial skills, but is it possible for us to provide more instruction in this regard before they graduate?
There are a lot of knowledge boxes to check off during medical training. In addition to learning how to manage a broad spectrum of diseases, there are also procedural skills to acquire, journal clubs to attend to be able to interpret the medical literature, didactics, board review courses, and supervised teaching clinics where our fellows manage their own set of patients. To fill in gaps in learning, we created a lecture series on designing and implementing clinical trials. In addition, our associate program director teaches a longitudinal course on the transition to practice, which is a mix of lectures on other professional activities, such as medical billing, preparing a lecture, and professional use of social media. These experiences combined not only make our trainees more knowledgeable but also more effective in the clinical realm. During all of this, some of our fellows surprisingly find time for adulting activities such as family planning, obtaining a mortgage, or buying a car. Hopefully, they do not make the same mistakes that many of us make along the way.
Back to graduation, one of the other gifts we provide annually is a framed word cloud composed of praises from faculty and staff. These often capture the key positive attributes of each fellow, such as “kind” or “brilliant.” Still, I wonder whether we could provide longer-lasting gifts to make our graduates better prepared for the world outside of the infusion center, hospital, and cancer center to avoid mental distractions from practice, such as learning how to manage their loan repayments or how to save for retirement.
Often the first work-life conversations for which I am approached by our trainees are to discuss advice about the stipulations of their contract offer for the job they are pursuing shortly after their training is about to end. It is very common for trainees to have a sense of trepidation about this process, or even a lack of tools to facilitate artful negotiations, something I was guilty of at the time. None of this is to say that they are not successful at securing an ideal position; however, I am sure that having basic negotiation skills can serve them now and during many future personal and professional interactions. Occasionally, doctors pursue MBA degrees to gain more knowledge in business and personal finance that will benefit them in their private lives and medical careers as well. Yet after 14 years of higher education, can we really expect highly trained clinicians to commit to another two years to obtain business degrees? Perhaps we can provide a consistent version of basic business skills or at least direct trainees to a distilled set of key resources. Instruction on these topics is not tasked to ACGME-accredited training programs as a core competency, yet if we aim for our future attendings to achieve improved well-being and avoid burnout, then one could argue that there should be more standardization across training programs on navigating business affairs more confidently.
Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein.
