Advice for the Graduating Hematologist

Richard T. Silver, MD
Dr. Silver is professor of medicine, attending physician, and emeritus director of the Richard T. Silver, M.D. Myeloproliferative Neoplasms Center at Weill Cornell Medicine in New York.

When I was asked to collect some thoughts to share with hematology/oncology trainees upon completion of their fellowship, I thought back on my experiences and the attributes that are essential to a successful career in medicine.

Later, when you reflect on what I’ve said, I hope you don’t discard it as “the same old stuff.” However, if you do hear familiar points, that is not an accident. There are generational truths that are true now and were true for our forebears, physicians or not. And, if you hear something new, it is because my professional and personal life is colored by my own unique features – as yours will be in the coming years.

Hopefully – and more likely – you’ll find that the advice I offer is a combination of both, because the more things change, the more they remain the same. But they do change. As physicians and human beings, we all share a common core of values that is modified by our own personal experiences and beliefs. And that is as it should be.

The Three A’s

Through my years of observation, I developed a list of important attributes, what I call “the three A’s,” that I feel are necessary to lead a successful career and that I believe will sustain you as young physicians.

The first of “the three A’s” is availability. When a patient or colleague has a problem and asks “Who should I call?” the answer is to call the doctor who is always around and who is a nice person. No one ever recommends calling someone because he or she reads all the latest medical literature each month or graduated at the top of his or her medical class.

Recently, I tried to call one of our service’s busy gastroenterologists to discuss a patient she referred to me. I wanted her opinion about starting ruxolitinib in a patient who had myelofibrosis, splenomegaly, and ulcerative colitis. I am still waiting for the call back. I assure you that this is not a good way to maintain a consultation practice, let alone develop one.

The second attribute is affability. One of the most successful attending physicians I ever encountered as a young clinician was dapper, charming, and impeccably dressed. He had a huge practice! He knew little about medicine, but he loved to practice it. He accompanied his patients to a consultation whenever possible.

Today, we would say he had a concierge practice: He was always available, and he was super-affable, but he really lacked the last “A”: ability. Of course, you all have ability – you wouldn’t be graduating if you didn’t.

Ability is related to “smartness.” Never worry about whether people are smarter than you, or if you know enough. I guarantee you, there are many people smarter than you. You will likely never consider yourself smart enough to satisfy your own expectations. Indeed, in The New England Journal of Medicine, Suzanne Koven, MD, published a “Letter to a Young Female Physician” describing the problem as “imposter syndrome.” This insecurity rears its head when young physicians are convinced that everyone else but them understands secondgeneration sequencing or the coagulation cascade. You may think you aren’t smart enough or you don’t know enough, so accept the fact that you will certainly never know everything.

Many years ago, I thought the guy who was constantly asking questions and admitting when he didn’t know something was the dumbest guy in my medical class. How surprised we were when he gave the AOA address as the top member of our class.

Just realize that you live in a world of ignorance, and don’t be frustrated by it. If someone makes a snide remark because you didn’t know something, don’t take it personally. No matter what your rank or position, never be afraid to say, “I didn’t know that,” or “Thanks for telling me that.” I still do it all the time.

Never Stop Exploring

Remember that, even after all your great training, you are just at the beginning of your careers. And, one of the remarkable things about a medical career is the number of opportunities available to you. So, keep exploring and trying new things.

The best opportunities happen by chance and often you don’t realize they are coming. On the other hand, if you push too hard for things to happen, most often they will not.

For instance, when I was a second-year resident, I was absolutely convinced that I would become a great cardiologist. Mandatory military obligation for all physicians during the Korean War, however, led me to the General Medicine Branch of the National Cancer Institute (NCI). Because I was not able to serve in the armed forces, the compromise was that I serve as an intern on the leukemia service – an unpleasant prospect for a second-year resident from a hot-shot, white-shoe hospital who wanted to be a cardiologist. At that time, the NCI’s clinical program was considered the gulag of all the institutes, but it was a “take-itor-leave-it” situation, so I took the opportunity and worked hard. My mentors were Emil J. Freireich, MD, Emil Frei III, MD, and James Holland, MD. It was the dawn of chemotherapy, and they were the fathers.

After I completed my training, I was asked to go to Salvador, Brazil, to help set up a residency program at the Federal University of Bahia. I had the opportunity to go to on an expedition to the Mato Grosso, the Upper Xingu region, where we discovered the third allele in the Kidd Blood Group system. Because of this, I was invited to join The Explorers Club, one of the most interesting clubs on earth. Here I’ve met Sir Edmund Hillary, all the astronauts, and the deep-sea divers who discovered the wreck of the Titanic. Through my adventures in medicine, a new unexpected dimension had been added to my life. So, remember that your lives are a series of experiences. Embrace and take advantage of new things as they occur, by chance or otherwise.

An Unavoidable Truth

As Mark Twain said, “The only place where success comes before work is in the dictionary.” Obviously, you have worked hard to get to this point; that hard work doesn’t end with fellowship.

If you want to build your career, be prepared to go through dark and painful moments. Engage in the struggle. Nothing comes out of easy days. Be very conscious of how you spend your professional time and try not to waste this precious commodity. Make your work meaningful and do not fool around. If you do any research as clinicians, plan how you will be included as a co-author – not as a footnote – and how your effort related to the paper will be included before you get involved.

Remember: Success is not a race. You should always feel that you are continually growing. In fact, I have done some of my best research work after I turned 60. But, when you try new things, and you have done your level best and it is still not working, learn when to let things go – especially before you turn 50.

In closing, if you believe you have found a meaningful calling, and you commit to it because of your enthusiasm for your work, all good things are possible in medicine. Nothing is more meaningful, and if you can adjust to the external trivia of today’s climate and its limitations, you will have a satisfying professional life. Not many folks can say that.

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