On Opportunities and Obligations

One of things I like about academic oncology is the chance to collaborate with others, both within my fields of specialization and outside of them. For three years now, I count Nate Pennell as one of those I’ve had the privilege to work with on behalf of the American Society of Clinical Oncology’s Annual Meeting Education Book, which we both have the privilege of editing. We are also members of the Editorial Board of The Oncologist, which is an added plus for me.

During one of our many conversations, Nate and I discussed our paths in academics–he as a specialist in thoracic oncology and I in women’s cancers. We started talking about our careers and the opportunities offered to both of us, some of which we accepted and others that we turned down. It was the latter that sparked my curiosity, for we both had chosen paths based not solely on what would further our reputations and improve our chances of academic success, but also taking into consideration an equally important factor–what was best for our families.

When I was a student (and I’ll admit, even today) I marveled over the journeys taken by some of my mentors. Oftentimes, they were men, established luminaries in oncology. Some of these men had traveled from coast to coast, accepting positions in myriad institutions that had taken them from Instructor to Assistant Professor to Associate Professor and Division Director to Full Professor and Chair and then to Cancer Center Director. These men seemed to uproot every three to five years, always accepting positions that would lead to a larger role and more prestige (very much well deserved). Yet I often wondered what their families felt; that it must be hard to uproot, to move so many miles every few years. Yet, it was not something we talked about. These were role models, after all, not contemporaries.

As I have grown up as an academic, I have also moved institutions: from Memorial Sloan Kettering to Women and Infants’ Hospital/Alpert Medical School of Brown University, and now to Massachusetts General Hospital/Harvard Medical School. Yet, this path has never been dictated solely by my own ambitions. The decision to leave New York City was based on a promise I made to my partner–that we would raise our family in Massachusetts. So when we had our first born, and a promise being what it is, we moved. We were located between Providence and Boston, so my next two positions never required our family to uproot. Even still, although I may have been tempted to look at other opportunities, whether in the Southern United States or North of Boston, I haven’t because we are very much settled in our home, and moving away is not an option. Period.

Nate:
This is a difficult topic to talk about, because it involves the two most important elements of our lives: our careers and our families, and the uncomfortable reality that their interests are not always aligned. When I was in training, like Don, I always assumed that moving from job to job was simply the way it had to be to advance in academic medicine. You trained at the best possible place you could get into, you took the job that gave you the best mentorship and chance at an early career grant, and eventually when it was time to become a leader in your field, or to make the move into administrative leadership like chairing a department, you had to move to an open job somewhere else.

When you’re young and don’t have a family, these choices are much easier, and I have lived in 8 different cities over my lifetime, so I really don’t mind moving around. I moved to Boston to train at Brigham and Women’s Hospital without a second thought, but then I met my wife-to-be who didn’t consider Boston our long-term home. When it came time to choose a fellowship, I wanted to stay in Boston but that decision wasn’t just mine to make anymore. Eventually together we decided to stay but that after fellowship we would look to leave, even if that wasn’t the best thing for my career.

When I did start to look for a first job out of training, we had to consider not just my interests but hers as well, which were much more focused on what the best place was for us to raise a family and potentially live long term. She is not in a medical or academic field, and doesn’t have that same expectation of moving as a natural part of life, so I decided to look not necessarily for the best short-term position but for something that could be a “destination” job I could grow into over time.

I think we were really fortunate to be able to move to Cleveland, which just happened to be both where my wife grew up and also the best opportunity for me at the time. However, as I enter my mid-career, I am starting to be approached about opportunities elsewhere, and it is really hard to think about uprooting my family. Don’t get me started on the look I get from my wife if I bring it up!

Of course sometimes a move isn’t by choice, or perhaps an offer comes along that is just too good to be passed up. Who know what will happen? But when you have two competing but equally important things in your life, you have to make some compromises because your choices affect so many people beyond just yourself. I also feel like most of the academicians I know who have moved recently have been older and their kids have all left the nest, so perhaps this attitude is becoming more common in our field. If so, I don’t think that’s a bad thing.

And with that, it dawned on me that academic oncology has shifted–it’s no longer only about the next best opportunity. Nate and I have embraced the dueling objectives of work and life: to find balance, while still pursuing our chosen fields. We each are fortunate to have found spouses willing to let us grow, the proverbial “wind beneath our wings” as it were. It does mean letting some opportunities pass, even though some sound quite amazing. But ultimately, I agree with Nate–in the big picture, that is not a bad thing.