Healthcare leaders have pointed to persistent gaps in business and operational training during medical school and residency across all specialties, with many saying the transition into practice catches physicians off guard.
These broader training gaps come as cancer programs are already struggling to recruit and retain oncology talent.
As cancer care grows more complex, Becker’s asked nine oncology leaders what skills new oncologists are missing on their first day on the job.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What skills are oncologists missing for their first day on the job?
Andrew Chapman, DO. Director of the Sidney Kimmel Comprehensive Cancer Center; Executive Vice President of Oncology Services at Jefferson Health (Philadelphia): The experience and clinical judgment that’s gained through leading the treatment decisions for patients facing serious, yet highly treatable cancers. This privilege and responsibility has potential to improve outcomes for these patients.
Andrew Curran. VP of the Oncology Service Line at Hackensack Meridian Health (Edison, N.J.): Although new oncologists begin their careers with exceptional clinical expertise, they often need to develop several essential professional, personal and holistic skills on their first day. They lack knowledge of the “business” of healthcare, requiring them to learn about revenue cycle management, insurance authorizations, local EHR systems and how to effectively network with referring physicians.
They must refine their advanced communication skills to navigate sensitive conversations with empathy, while also developing the leadership abilities necessary to guide collaborative care teams.
Furthermore, their clinical perspective must broaden to encompass holistic patient care, meaning they need to understand how individualized lifestyle factors — such as mental health, diet, exercise and alcohol use — affect a patient’s unique treatment and recovery journey.
To manage the intense emotional demands of the field, new oncologists must cultivate personal resilience, utilize peer support and establish a sustainable work-life balance to ensure a long, impactful career.
Don Dizon, MD. System Chief of Hematology at Tufts Medicine (Burlington, Mass.): I have long thought that physicians are not trained to look at contracts, let alone negotiate terms of employment. We don’t learn about this in medical school or during residency and we are not empowered to do it, especially when we’re looking at our first jobs out of training.
In essence, the skills that entering clinicians lack include a lack of training in business administration. This is not to say that clinical training is any less important today than it was when I trained. But demands are high and people should know that when it comes to a new position, you have to speak up for yourself and what you believe you’re worth.
Ron Gagliano, MD. System Physician Vice President of the Oncology Strategic Service Line at CommonSpirit Health (Chicago): I view physician skills in terms of the six core competencies: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice.
Of these, I most often find if there is a gap, it is in systems-based practice, especially for new graduates. The reality of clinical practice and the expectation of clinical practice seem to conflict more than with other competencies.
Laura Goff, MD. Executive Medical Director of the Cancer Patient Care Center at Vanderbilt-Ingram Cancer Center (Nashville, Tenn.): Oncologists come out of training with broad knowledge and deep clinical expertise. Overwhelmingly, they are great communicators and demonstrate tremendous compassion. They are often well-versed in quality improvement and education. By the time they have completed subspecialty training, they have had quite a bit of experience leading teams, problem solving and working across disciplines.
However, it is unusual for physicians to come out of training with the skills necessary to navigate the business of medicine. Trainees are often insulated from the implications of payer impacts on care delivery. It can be quite opaque to trainees how oncology care is paid for and how that impacts both patients and practices.
Oncologists are very invested in caring for and advocating for their patients. Understanding the financial aspects of the healthcare system allows them to navigate for their patients much more effectively and with significantly less frustration.
Still, this is knowledge that is typically gained on-the-job. Ideally, new physicians would have a better understanding of payment models, payer contracts/network status, coding and compliance. Streamlining practice operations and budgeting for staffing and growth are key skills that very few new physicians gain in training.
Shalom Kalnicki, MD. Associate Director of Clinical Affairs at Montefiore Einstein Comprehensive Cancer Center; Chair of the Department of Radiation Oncology at Montefiore Einstein (New York City): The greatest opportunity for new oncologists after training is to foster an appreciation for and infrastructure around collaboration and multidisciplinary care. We all learn the basics of chemotherapy, surgery and radiation, as well as the management of prescriptions and side effects, but in patient care no man or woman is an island!
At Montefiore Einstein Comprehensive Cancer Center, we are committed to continued education and strongly encourage presentations and participation in tumor boards to build skills and collaborative care recommendations. This cross-discipline work is promoted by scientific bodies, but it isn’t a national standard for new oncologists of which there is no process map for. Through these multidisciplinary meetings and clinics, new and seasoned practitioners can expand their knowledge, form relationships and enhance patient care.
It is of the utmost importance that we permeate the structure of training with education centered on the patient and choosing the best treatment for them regardless of the subspecialty. So much goes into being a great oncologist — the more and earlier we broaden our focus to the multispecialty care required (primary care physicians included), the better doctors we’ll be and better care our patients will receive.
William Oh, MD. The Jean and David W. Wallace Medical Director of the Smilow Cancer Hospital at Greenwich (Conn.) Hospital: Oncologists are trained incredibly well on the rapid pace of change in clinical care, new technologies and the science of cancer care. They are smart and enthusiastic. However, there remain gaps in training for many clinicians in their long journey to their first professional role. Some examples include: the U.S. insurance system and how it impacts patient care, how to find mentors in clinical practice, how to strike a work-life balance and manage their time, how to understand the financial models underpinning clinical practice. To some extent, this is an on-the-job learning process for all new oncologists but workplaces should be prepared to offer support as physicians are onboarded.
Diane Reidy-Lagunes, MD. Chief of the Division of Medical Oncology; Vice President for Oncology Services at Duke University Health System (Durham, N.C.): The biggest gap is not clinical knowledge. Our oncologists are exceptionally well trained in the science and delivery of cancer care. What they are often less prepared for is how to operate efficiently within a large, complex academic health system.
Medical training doesn’t teach you how to manage an inbox effectively, coordinate care across multiple specialties and sites, work within a large multidisciplinary team or understand the operational side of medicine. Yet these skills have an enormous impact on both the physician and patient experience. Learning how to prioritize, delegate, communicate effectively across teams and build efficient workflows is essential, but much of it is learned on the job.
Technology plays a role in supporting that work, and tools such as AI hold promise for reducing administrative burden and improving efficiency. However, technology alone is not the solution. We also need to teach the next generation of oncologists that they do not have to do everything themselves.
Ultimately, we need to give physicians better technology, stronger teams and the operational support to practice efficiently. The goal should be to take the friction out of medicine so physicians can spend more of their time doing what they were trained to do: caring for patients.
Theodoros Teknos, MD, PhD. President and Scientific Director of the Seidman Cancer Center at University Hospitals; Deputy Director of the Case Comprehensive Cancer Center (Cleveland): Young physicians often learn on the job how to lead without relying on a title. They are the leaders of their practices and the team members look to them for direction. Much of healthcare depends on influencing multidisciplinary teams whose members do not report directly to you. The ability to listen, build credibility, articulate a shared goal and create alignment is often what determines whether a good clinical idea actually becomes better care for patients.
Time management becomes one of the greatest challenges when moving from fellowship to independent practice. There are countless exciting opportunities to build a practice, conduct research, teach, network and continue to learn the science, but there are only 168 hours in a week. Young physicians need to become intentional about their priorities and learn that saying “yes” often means saying “no” to another. A sustainable career must also leave room for family, fitness and a life outside of medicine.
The art of building an outpatient practice is rarely taught during fellowship. New physicians need to understand how to develop relationships with referring providers, communicate their areas of expertise, provide timely access and become part of the larger healthcare ecosystem. Just as importantly, they must close the loop by communicating well and sending patients back to the referring physicians when appropriate. A successful practice is built on trust, responsiveness and reciprocity.
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