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Apr 21, 2020

Guest host Dr. Miriam Knoll, radiation oncologist at the John Theurer Cancer Center at Hackensack Meridian Health, interviews oncologists about the decisions and extraordinary moments that have shaped their careers in this special podcast series. In this episode, Dr. Knoll speaks with Dr. Suzanne Cole, director at University Hospital Simmons Cancer Clinic at UT Southwestern Medical Center, about her early-career leap of faith to move from academia to a remote community oncology practice.

 

TRANSCRIPT:

Dr. Miriam Knoll: Welcome to the ASCO Daily News Podcast. I'm Dr. Miriam Knoll and I'm delighted to be the Daily News guest host for a special podcast series that explores a full spectrum of oncology careers. I am an early career radiation oncologist. And in this series, I'll bring you interviews with a wide range of oncologists to hear about their diverse experiences, greatest challenges, and the unforgettable moments that shaped their careers.

 

Dr. Miriam Knoll: In today's episode, I'm thrilled to welcome Dr. Suzanne Cole, a medical oncologist at UT Southwestern Medical Center. She serves as a director of the University Hospital Simmons Cancer Clinic at the UT Southwestern Medical Center at Richardson/Plano. Dr. Cole and myself report no conflicts of interest relevant to this podcast. Full disclosures relating to all Daily News Podcast can be found on our episode pages. Dr. Cole, welcome to the podcast.

 

Dr. Suzanne Cole: Thank you so much for inviting me.

 

Dr. Miriam Knoll: So I'm so excited to have you here. You and I met on social media, which is becoming way more common nowadays. Would you agree?

 

Dr. Suzanne Cole: I totally agree.

 

Dr. Miriam Knoll: So I'm going to ask you about the HEME/ONC women's Facebook group a little bit later. But right now I first wanted to ask you about your career trajectory. Because I know that you first started off after you completed your training working in the community and more recently joined UT Southwestern.

 

Dr. Suzanne Cole: That's true.

 

Dr. Miriam Knoll: How did that come about for you?

 

Dr. Suzanne Cole: So I think that my story is not unlike other women who may be considering, you know, various options coming out of fellowship as far as what do they want to do or where do they see themselves. But I think I also had some kind of just normal life family pressures that pushed me in a certain direction. So I did my fellowship at MD Anderson.

 

Dr. Suzanne Cole: And when I went there, I thought I might be a stem cell transplant doctor. And I spent my first year in clinic kind of embedded in a transplant clinic and doing a lot of inpatient. And, you know, I kind of learned during that time that transplant probably wasn't the right fit for me. And I really didn't love any particular other tumor type enough to kind of then switch gears and dedicate my life to like one specific type of cancer.

 

Dr. Suzanne Cole: And so I told my program that I thought I was probably going to end up being a generalist and go back into the community. Most of my family is in Dallas. And that's where I was kind of hoping to land eventually. And I focused the last couple years of my fellowship on just really getting a very broad education in all of the tumor types.

 

Dr. Suzanne Cole: And then also, I think that this is important for women and men, but I'm the breadwinner of my family. I have four children. My husband is a musician. And when I was coming out of fellowship, I was probably about $250,000 in debt. And my oldest son was kind of getting close to needing to go to college.

 

Dr. Suzanne Cole: And, of course, like, I'd been in training and med school and residency for most of his growing up. And I had nothing set aside for his college. So I really needed to be in a place where I could be in a situation where I could pay off my loans and also save money for college. And, to be quite frank, a lot of the entry level academic positions just would not allow me to financially get my loans out of the way and also prepare for college, which was coming in a very short period of time for my oldest son.

 

Dr. Suzanne Cole: So I ended up taking a job in Charleston, West Virginia, where I was able to kind of get a loan payment situation taken care of. And I worked in this underserved area and was able to, basically, get financially straightened out within the first four years of my career. And it was a really fantastic place to cut my teeth as an oncologist.

 

Dr. Suzanne Cole: Because I was working for a very large hospital system called CAMC. And they have this network of hospitals in Charleston that basically serves the entire southern half of West Virginia. It's a huge patient population that filters into this kind of safety net hospital.

 

Dr. Suzanne Cole: And when I joined that practice, I was one of nine oncologists. So I had a lot of great partners to just help me and mentor me. But we took care of anything that walks through the door from acute leukemia to rare sarcomas to bread and butter breast cancer, prostate cancer, colon cancer. And also benign hematology, we had the hemophilia center for the state. And it was a really fascinating, busy, very robust and varied type of first practice.

 

Dr. Suzanne Cole: And I also was very fortunate that they had a pretty well-developed community oncology research program. And I was able to put patients on clinical trial, which was very gratifying. Because coming out of fellowship at MD Anderson, everybody was on trial. And I was very comfortable with having that access to research and giving options to patients that was beyond the standard of care. And so that was my first four years in practice.

 

Dr. Miriam Knoll: Wow, so can you tell us more, you know, logistically, you mentioned that you were looking for a certain type of, you know, let's say loan repayment or job security and compensation and that you were comparing your opportunities. You know, did you, you know, work with a recruiter or did people reach out to you? You know, what was that process like for you?

 

Dr. Miriam Knoll:  Because I think a lot of our listeners would be interested in hearing more about, you know, how does one look for different types of job opportunities if they're considering more than one type of practice? And I think that's something that a lot of people don't really admit when they're looking for a job. Because a lot of people say, "Oh, I'm only looking for academics" or "I'm only looking for private practice." And, you know, that isn't the case for all of us.

 

Dr. Suzanne Cole: Yeah, and I'll tell you, I felt like pretty on my own because I was in an incredibly academic environment. I was kind of the only fellow that I was aware of at that time that was saying, "I'm planning on going back into the community and not into academia." And so, you know, everyone around me as far as faculty members like really couldn't mentor me or help me navigate how to do that well.

 

Dr. Suzanne Cole: And so in my second year of fellowship, I actually started looking for jobs at that time. And my husband and I were kind of looking possibly to go back to Dallas. But at that time, this was in like the 2008 economic crash that was going on. And because I had done my residency at UT Southwestern, I had a lot of friends who were in practice in Dallas and in that community. And the jobs were just drying up.

 

Dr. Suzanne Cole: Like a lot of the private practice or community oncology programs were just not sure financially what was happening nationally. And so they weren't putting out new jobs because they weren't sure that they would be able to support bringing on another partner. And so when I realized that the Dallas market was not looking like a feasible option, I kind of thought, "Well, look, you know, I don't really have any ties to anywhere else. I'm going to cast a very wide net and I'll look, you know, from California to Maine and just see what's the best opportunity for me to get my loans taken care of and to get into a good group where I have like a feeling of mentorship from colleagues and a good vibe from the team."

 

Dr. Suzanne Cole: And I started looking at just kind of all kinds of random opportunities across the United States. And, you know, to be quite honest, when the West Virginia job came onto my radar, I thought, "Mm, you know, it's West Virginia. I don't have any connection to that place. You know, I'm not sure that this is going to be, like, Option A, B, C, or E, but it might be Option F."

 

Dr. Suzanne Cole: And then I went out to interview and I just, I really loved the people. I was actually quite impressed by the scale of their operation. I had trained at Parkland in Dallas for my residency. And so I was used to this kind of hospital system that was caring for underserved populations.

 

Dr. Suzanne Cole: And what I found very attractive about it was that in that hospital system, if you needed a cardiothoracic surgeon, if you needed interventional radiology, if you needed a GI endoscopist who could do stents or interventional things, those things were all in place. And so it was kind of the size of the system that was attractive to me, but then also the partners that I interviewed that lured me to kind of think about that job. And then I went for a second interview.

 

Dr. Suzanne Cole: And it came to the top of the list just because of the whole package. But it was a real leap of faith to pack up my family and move across the country by ourselves to, you know, a very remote part of the country where we didn't have a lot of support either from friends or family. And we were just kind of loners showing up in this city together.

 

Dr. Suzanne Cole: But it worked out. And it was I think it was one of the best decisions that I've ever made because I was able to like become very independent as a practitioner and really feel confident that I could handle anything that came through the door. And then it also just kind of launched my research career in community practice, which is not something that's easy to find or carve out for yourself. And so I just felt like it was a very fortuitous way everything came together.

 

Dr. Miriam Knoll: Can you tell us about your transition to UT Southwestern?

 

Dr. Suzanne Cole: So there was a little bit of a break in the middle of that. As my younger children were approaching elementary school, we started looking to try and get closer to Texas where both my husband and my family are in Texas. And so about four years after I had been in West Virginia, we started looking back in Dallas again.

 

Dr. Suzanne Cole: And, again, kind of the job market was still not where I was-- there was nothing there that was kind of interesting to me as far as having the clinical research component, but also general community practice. And so I kind of widened my scope again and found a job in Oklahoma City at Mercy Hospital where they also have this very robust community practice, I had multiple partners, and a very strong community-based clinical research program. And Oklahoma City is about three hours from Dallas.

 

Dr. Suzanne Cole: And so it was not that far from my family. So we decided to take that position. And we settled in Oklahoma and stayed there for four years. And I thought I would probably never leave. I was, you know, very happy. My job was really good.

 

Dr. Suzanne Cole: And then I got this flyer in the mail. It was like a super random thing where I get home from work one day and I'm kind of going through the junk mail. And there is this flier advertising UT Southwestern Community Oncology Practice in North Dallas, have access to over 300 clinical trials, you know, be connected to the university, but be embedded in your community.

 

Dr. Suzanne Cole: And, you know, I have like this huge allegiance and great love and respect for you UT Southwestern, which is where I did my medical school and residency. And it's a job in Dallas that is kind of-- if I could dream up on paper exactly what I would see myself doing for the rest of my life in a kind of hybrid setting, that was kind of what was on this flyer. And I told my husband, I was like, "I'm just going to like send them my CV and see what happens. I'm sure nothing will come of it."

 

Dr. Suzanne Cole: But they called me the next day. And I came to interview like maybe a week or two later. And it was just this kind of perfect fit. Because they really needed somebody who could do all of the cancers, benign hematology, you know, would be able to see anything that walks through the door in the community. But they also were looking for somebody that had kind of an academic mind as far as thinking about how to get clinical trials available to the patients, collaborating with the main campus, being part of tumor boards and presenting patients, and, you know, kind of leveraging the strengths of a University within the community practice. And I think like if I had written down my dream job, every kind of point that I wanted, you know, on paper, that is what has come to pass in the last year and a half that I've been here.

 

Dr. Miriam Knoll: Wow, that's really an amazing story. And thanks so much for sharing it with us. Dr. Cole, I wanted to ask you about your story about founding the hematology and oncology women's Facebook group, renamed the HEME/ONC Wolf Pack group after Abby Wambach's Barnard commencement address in 2018. So, of course, I'm a member of the group. And can you tell us, what were you thinking when you started the group? And were you thinking about it from a social perspective, from a career perspective? And what would you tell other oncologists who are thinking about potentially getting involved in social media?

 

Dr. Suzanne Cole: So I think that the social media stuff happened to me by accident. I mean, I was kind of like a partaker of social media. I used Facebook to stay in touch with family and friends. And I would say it was probably five years ago now that-- it might have been six-- the physician mother's group came about. And I don't know why, but for some reason I got added to that group when it was very young and very small.


Dr. Suzanne Cole: And I remember kind of seeing posts on the physician mother's group, which is now-- I don't how many people are on it. But it's probably close to 100,000 women physicians across the world. When I was first part of that, it was maybe 5,000 people were on the site. And I remember seeing a colleague of mine in Oklahoma City, who was an ER doctor, make a comment that, you know, on the physician mothers group ER subgroup, they had discussed this issue about emergency medicine.

 

Dr. Suzanne Cole: And I thought, wow, is there like a HEME/ONC group that I could join? Because I would love to talk with other women about issues that are specific to hematology and oncology. And the response that I got from the masses was that, you know, nobody was aware that there was any kind of physician mothers' group that had a HEME/ONC subset. And so I just decided to start one that day.

 

Dr. Suzanne Cole: And when I reached out to Hala who runs PMG she said, you know, we don't sanction any official physician mother group subgroups. And so if you want to make a HEME/ONC group, that's fine. But it'll be kind of separate from the PMG platform.

 

Dr. Suzanne Cole: And so I just basically went through my friend list and added every woman physician that I could think of that was on Facebook with me. And we probably started with like 25 people. And it has grown into this really amazing network, support, resource. You know, I'd say that the thing that people use it the most for is for advice on de-identified cases.

 

Dr. Suzanne Cole: You know, somebody posts a case about, "I have a lady with breast cancer and she's been through these three lines of therapy and, you know, she's progressing in this way, what would you say would be the next step?" And what I also find very cool about our group is that we have multiple experts in particular fields who will kind of weigh in and point out clinical trials that may be available or say, you know, in that situation, I would kind of reach for this drug next. And it's been also just very supportive from, like, a human being perspective.

 

Dr. Suzanne Cole: Just because, you know, we have patients that are critically ill. And we're constantly dealing with sad things happening to patients that we really care about. And it's become a little bit of a safe space for physicians to kind of say, "Hey, you know, one of my favorite patients died and today and I'm just feeling really torn up about that" and get a whole lot of support from people all across the world that identify with that. And just you don't have to explain it. Everybody understands where you're coming from.

 

Dr. Miriam Knoll: Yeah, I've personally seen both those things firsthand and been a beneficiary of that. So and I think there is even more support that people can find, both in terms of job opportunities, job advice, you know, how to set up your clinic, you know, the electronic medical record, negotiating salary, right? Have you seen posts like that too?

 

Dr. Suzanne Cole: I feel like very recently there was a post about a woman who found out that her junior colleague was being paid, like, twice as much as she was. He was taking less call. You know, he had constructed his contract in a way that was very beneficial to him.

 

Dr. Suzanne Cole: And when she brought it to the attention of her employers, they kind of were like, "So, you know, what are you going to do about it?" And by her just kind of putting that situation out there to us, she got so much feedback from the group about like, "This is not acceptable. You know, there are all these other opportunities. You can be paid fairly. You can be valued."

 

Dr. Suzanne Cole: And within, I want to say, like two months, she had a different job. You know, she was like, "I don't have to put up with this because I'm not alone." and it was really cool to see that happen for somebody.

 

Dr. Miriam Knoll: That rallying around, right?

 

Dr. Suzanne Cole: Yeah, yeah.

 

Dr. Miriam Knoll: Even though it's virtual.

 

Dr. Suzanne Cole: It's virtual, but it's real, you know? And it's I think also the networking that goes on. Like I just, I know so many people who have given talks at different institutions who have had opportunities, you know, just kind of presented on our Facebook group. And they've snatched up the opportunity to be part of that. And it has helped them grow their network and their academic credentials. There's just a lot of things that could happen out of this if you are engaged and you take advantage of it.

 

Dr. Miriam Knoll: So how can somebody join the group if they're not in it yet?

 

Dr. Suzanne Cole: So because we are a private group, you have to know somebody who's already a member. And they need to kind nominate you to join the group. And then we verify that you are a physician in some type of hematology, oncology field. And we take HEME/ONC doctors, palliative care, surgeons, there's some dermatologists that specialize in skin cancers.

 

Dr. Suzanne Cole: And so anybody who takes care of cancer patients or does hematology is welcome to join. And the requirements are, you have to be a physician, you have to be a woman. And we vet everybody to make sure that they are who they say they are. And then they are added in.

 

Dr. Miriam Knoll: And radiation oncologists, right?

 

Dr. Suzanne Cole: Oh, yes, radiation, definitely.

 

Dr. Miriam Knoll: Don't forget about us. And actually now there is a separate radiation oncology women's Facebook group too. So if any listeners want to join that group, that's actually a group that grew out of the HEME/ONC group.

 

Dr. Suzanne Cole: Yes, and there's also a pediatric hematology oncology subgroup that has kind of split off. And we still have all of those members as part of the bigger group, but I love that there's an opportunity for people to network with each other and discuss things that are particular to their subspecialties.

 

Dr. Miriam Knoll: So what's the worst career advice you've ever gotten?

 

Dr. Suzanne Cole: I think the worst career advice is to do what your-- what everyone around you is doing. I think there's like an incredible pressure when you're in training to conform to what is expected and to sometimes ignore those inner voices that are telling you, you know, "Hey, maybe this is not the right fit for me." I personally have always really struggled with writing. Like I don't enjoy it.

 

Dr. Suzanne Cole: I love clinical medicine. I love seeing patients. I love participating in clinical trials. But I don't totally love writing them. So I think being browbeaten into pushing down a pathway that doesn't feel inspiring to you could be very, very detrimental to your long-term career.

 

Dr. Miriam Knoll: What's the best career advice you've gotten?

 

Dr. Suzanne Cole: So the best career advice I've gotten is know yourself and even if you're scared, go for it if you are excited and feel a passionate interest in something that may be a little off the beaten path.

 

Dr. Miriam Knoll: And last question for you this morning, what advice would you give to trainees and early career oncologists?

 

Dr. Suzanne Cole: So I would say really take time during your training and in the first one to two years that you're out of training to figure out who you are as a physician and what makes you happy. Because if you can find something that is setting you on fire, you're so passionate about this particular thing, it can carry you through the harder stuff that we all have to deal with throughout our careers.

 

Dr. Suzanne Cole: So also to seek out different options. If you have, you know, an interest in community practice but you're not really exposed to it as is usual in a fellowship-type program, network and connect and try to speak with other people who are practicing in a place that you think, "I might be happy in this place." And you really need to talk to people who are doing it.

 

Dr. Miriam Knoll: Dr. Cole, thank you so much for joining me this morning and for this amazing discussion. And thank you to our listeners for joining us for this episode of the ASCO Daily News Podcast. We'd love to have your feedback so please drop us a note at dailynews@asco.org. And rate and review us on Apple Podcasts.

 

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.