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Pearls for Securing the Dream Radiation Oncology Career

Today, our blog post is an interview featuring Dr. Reshma Jagsi, a leader in the radiation oncology field. She advises on preparing for and mastering your interview as well as securing and starting out in your dream radiation oncology job!


Dr. Jagsi is Professor and Deputy Chair in the Department of Radiation Oncology and Director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. She completed her undergraduate, medical school, radiation oncology residency, and ethics fellowship training at Harvard and her doctorate in Social Policy at Oxford University as a Marshall Scholar. An active clinical trialist and health services researcher, Dr. Jagsi’s medical research focuses on improving the quality of care received by breast cancer patients, both by advancing the ways in which breast cancer is treated with radiation and by advancing the understanding of patient decision-making, cost, and access to appropriate care.

Her social scientific research includes research into issues of bioethics arising from cancer care and research regarding gender issues, including studies of women's representation in the medical profession. Dr. Jagsi has devoted a substantial portion of her scholarly effort to investigations regarding gender equity and success in academic medicine. A frequently invited lecturer on this subject, her research in this area has been funded by grants from the National Institutes of Health, the Robert Wood Johnson Foundation, the American Medical Association, the Burroughs Wellcome Fund, and the Institute for Research on Women and Gender. She currently serves as the national PI of the program evaluation of the Doris Duke Charitable Foundation’s Fund to Retain Clinical Scientists. A former member of the Steering Committee of the AAMC's Group on Women in Medicine in Science, Dr. Jagsi now serves on the Board of Directors of the American Society of Clinical Oncology, the Steering Committee of the Early Breast Cancer Trialists Collaborative Group, the editorial boards of the Journal of Clinical Oncology and JAMA Oncology, and numerous other influential national professional committees. Her contributions have been recognized with her election to the American Society of Clinical Investigation.


Section 1: Securing the Interview

1. What is the best way to "put our feelers" out to potential employers, without being overly invasive/persistent?

Beginning early is a good idea, as is using your network. If a former graduate from your program is working somewhere that interests you, try reaching out to that person in addition to submitting a formal cover letter and CV.

2. What is an appropriate timeline to start reaching out to employers for the first time? What are appropriate intervals for follow up communications?

Many practices and institutions schedule interviews during ASTRO, so the summer is a good time to get initial cover letters and CVs submitted to prospective employers.

3. How do you recommend a resident construct their cover letter?

Cover letters need not be overly lengthy. Ideally, the letter helps to convey your priorities and personality. Remember that finding the right job is like finding the right life partner—it’s about two-sided fit. If you are genuinely passionate about treating a certain disease site or being in a teaching position, be sure to articulate that. That said, remain as flexible and open as you can be, while still being true to yourself. Don’t close yourself off to serendipity.

Section 2: Interviewing

1. ASTRO interviews: how do we stand out during these quick preliminary interviews? What would be appropriate follow-up on our end?

Prepare. If you care about a job at this institution, you should do your research. What are the interests of the physicians in the group and the strengths of the environment, and how will you add something by joining the practice? Stalk the physicians in the practice a little bit using internet searches (not in a creepy way!)—find out as much as you can before you interview because then you can ask informed questions and really show them why it’s a good fit for them as well as you. Also, as hackneyed as it sounds, be yourself. You shine your brightest when you are talking about the things that genuinely drive you. Be sure to follow up with a nice note (e-mail is perfectly fine) to thank the interviewer.

2. Formal interview: What are some key things that impressed you about residents who you have interviewed in the past?

The interviewees who stand out are those who have done their homework and who clearly bring a complementary strength to our team. They have taken the time to learn about our department and to evaluate how they would make us stronger. They speak sincerely and illustrate their answer with specific examples of prior experiences in which they have demonstrated their abilities, resilience, and kindness.

3. For academic careers, is it okay to be flexible when asked about disease sites you wish to treat or is it better to have an idea going into the interview?

It is far better, in my opinion, to be flexible—as long as you’re willing to be flexible. I say this with an ironic smile because I myself was not flexible—I would not have wanted a job doing anything other than breast cancer. So it would not have been a good idea for me to have suggested I was flexible. But I also took a big risk in being inflexible. If there is an institution that is otherwise an optimal home for you, unless you’re truly committed to a particular disease site as your only calling, having some flexibility is better.

4. What are some “red flags” for women to be aware of when interviewing for a practice/department that may suggest suboptimal support of women faculty?

The best environments for women are ones in which women share equally in all levels of authority. If you see few women, or few women in leadership, it might be a sign that the institution is not the best fit. On the other hand, this may reflect a dearth of women in our field (with only a little over a quarter of residents being female even today). So give every place a chance—particularly if the broader institution has robust programming to support gender equity. It is certainly fine to ask if there is a women-in-medicine committee and whether that committee is active in hosting events, etc.

5. Is it okay to ask about future part-time opportunities during an interview (or during contract negotiations?)

This is a tough one, and I’m sure someone will pillory my response here, but I’m going to try to give you the best advice I can. I do think you should generally be transparent about your goals. If you really think you will want to go part-time in the near-term future, then I guess it would be best to ask about this from the outset. That said, I would caution young women to lean in. I myself once told the first two attendings with whom I did research in residency that I wasn’t sure they should give me the best project they had. In retrospect, it was one of the dumbest things I have ever said. One of them had said that they wanted to confirm that I was definitely committed to an academic career before assigning me the project they had in mind (it was such a good project that they wanted to make sure it went to someone who would have a future in the field). I actually said to them that I wasn’t sure they should give it to me, as I wasn’t sure I would even work full-time: “I want kids, and I hear that priorities can change after that, especially for women.” Thank goodness the other attending rolled his eyes at my answer and said, “Okay, your answer simply makes it apparent that we shouldn’t have asked you that. Yes, priorities can change, but we know you. You’re definitely always going to prioritize your work. That won’t change. And you have a natural inquisitiveness that is the best predictor of success in academia. We should just give you this project and forget this conversation ever happened.” And they were right. I was very lucky that they didn’t dismiss or discount me after I said that. I worry that not all folks would be as insightful or willing to take the risk that those two very kind attendings took on me, and I think that if you don’t know the interviewers, you are particularly at risk for triggering some unconscious (or conscious) biases against part-time workers being less committed or less likely to succeed or contribute to a practice or organization. Of note, I also don’t personally think that part-time work is necessarily the best choice to achieve work-life integration; often, women end up working 40+ hours a week for part-time pay when their male colleagues don’t think twice about occasionally leaving work a bit early to attend a soccer practice or do school pick-up and then making up the time later in the evening. Might going part-time be right for some women? Absolutely. But I think that in an era where technology can facilitate work-life integration, you shouldn’t assume that you will want or need a part-time position. And I do fear that those who inquire about part-time positions might be taken less seriously.

6. Any other important questions that women should inquire while on an interview?

I think asking about the activities of the local women-in-medicine group is a great way to get some connections who might not be in the department or group and who might be able to tell you more about some things you might care about, like policies and norms with regard to childbearing and childrearing leave, etc.

Section 3: Contract Negotiations

1. How (and when) should women broach the subject of maternity and/or paternity leave?

Funny—I just answered that above. I think it’s important information but doesn’t necessarily have to be acquired in the formal interview process—the local women-in-medicine group is likely to be able to tell you more (especially about norms versus policies) anyway.

2. Any advice on how to feel out the department’s support of maternity leave? (i.e. are other faculty members supportive of a 3 month leave?)

Ideally you’ll have a chance for some informal interactions with all of the physicians in the group. Never assume anything you say will not be conveyed to the decision-makers, but you can probably explore somewhat more safely the question of how the practice accommodates parental leaves in a casual conversation with a young physician in the group who has recently had that experience.

3. How do women get information on equal pay (and equal opportunity for career advancement) in the department/practice? Particularly if department is mostly male or even no females?

This is something that is not entirely within your control. Transparency and consistency with regard to compensation are ideally standard at the institutional level—but that is not always the case. The best thing you can do is to arm yourself with data that are appropriate for the position you’re seeking. If you’re applying for an academic job, get the AAMC data on salaries for assistant professors in that region of the country. What you also can do is at least make sure it is clear how compensation is determined. Is there a fixed base salary? Is the entire compensation or a component dependent on a measure of clinical productivity such as wRVUs? Are there bonuses for other activities?

4. Is it appropriate to ask what other starting salaries/expectations have been for other new hires?

I think you can ask whether the practice or institution benchmarks any national medians or has policies to ensure equitable compensation.

5. Any contract “red flags” to be aware of as a female physician?

I agree with Terry Wall that restrictive covenants are unconscionable, but you can’t avoid them in some settings.

6. What is the typical turn around from interview to offer?

This really depends on the individual situation. In some circumstances, the turnaround will be very quick. But don’t assume that you have been counted out even if it takes the group some time to get back to you. Some needs don’t become apparent until the season is well underway, and some practices have a policy of meeting a number of candidates before they make an offer.

7. How do you decide if the expectations for productivity are reasonable or appropriate?

This is another area where learning about national productivity levels can be helpful. Social media offers an opportunity to ask your peers about the number of consultations, simulations, follow-ups, and patients on treatment, as well as wRVUs they produce.

8. Do you recommend having a lawyer review your contract? Recommendations for how to find said lawyer?

Full disclosure: I am married to a lawyer who teaches contract law. I think having a lawyer review your contract is a good idea.

Section 4: Starting out in Practice

1. Do you have any advice on achieving balance between family and work, particularly during those very busy first few years? How to set boundaries for this?

Try to be present fully when you’re at work, and try to be present fully when you’re at home. Use technology to help you spend time with family when they need you, and then seize the chance to get some more work done when kids have gone to bed.

2. Understanding there is no “ideal” time to plan to have a baby / take maternity leave, do you think it is something you should discuss with your chair/practice partners if you are family planning?

You have the right to choose when you grow your family, but if you can, I think it’s great to try to talk with your chair and partners to try to optimize the timing (I mean after you’re already hired, not during the interviews). Of course, you can’t always time things exactly, and there is a biological clock, so don’t delay forever—but if you’re truly willing to put things off a few months, knowing that your practice partner has a sabbatical or a planned surgical procedure that will occur at exactly the time you would deliver if you became pregnant today might influence you to wait a tiny bit. Certainly, I think your colleagues will be grateful if they perceive that you appreciate that this decision does have impact on them and that you’re trying to make it as smooth as possible. In a practice or a department, everyone ends up covering for one another at some point—maintaining good relationships and being kind about it is important. Again, that doesn’t mean you should let someone tell you to wait years if you don’t want to wait years. But trying to accommodate relatively minor changes in timing that would really make things easier for others is just a decent thing to try to do.

3. How can one find a mentor that is supportive of female radiation oncologists succeeding in the workplace? Particularly if you are the only female in the department?

The good news is that studies looking at mentorship suggest that you don’t need for your primary mentor to be a woman. Many men are incredibly effective mentors to women. You should try to structure a mentoring network where you have at least someone on your team who understands some of the gender issues you might face, but you should not feel limited in whom you solicit to be your primary research or career mentor. Choose someone who is genuinely committed to helping you—a man can definitely be a great mentor!

4. Any tips on starting a family as a practicing radiation oncologist (or as a resident, for that matter?)

My best suggestion is to surround yourself with a community of people to help you. That ranges from staff who help at work to good child-care providers who help you out with your parental responsibilities. Outsource anything you don’t care deeply about. If you love cooking, by all means, keep cooking. But if you hate it (especially if you’re also bad at it, like I am), then don’t feel one bit of guilt about using one of the many healthy food preparation services you will be able to afford as an attending radiation oncologist! Don’t clean your own house. Have someone else drop off your dry cleaning and do your laundry. That allows you the time to be there for the things you and your kids value. Don’t get me wrong: I loved giving my babies a bottle and snuggling them. But I loved that when I did it once a day. When I tried doing more than that, I just ended up thinking of all of the more productive things I could be doing and being irritated; that didn’t benefit anyone. I honestly think a baby can be comforted by any loving person cuddling them and giving them a bottle. So I don’t feel guilty that my kids got most of their bottles from loving paid caregivers. They still love me; the nanny isn’t their mom. Things get more complicated when they get older; sometimes, only you can give the right advice—but that doesn’t mean you need to be the one who drives carpool. You need to be there when they need you, but there are many things that someone else can do.

5. How do you work on building your referral base? Do you have any tips for interacting with other specialties when you may be the only female physician in the room?

I’m glad you brought this up. One other thing you should do when you interview for a job is to make sure you get to meet the other members of the multidisciplinary teams in which you’ll be working. The relationships between radiation oncology and referring physicians can have an even greater effect on your day-to-day well-being than the relationships with colleagues within your department. I have heard many stories of challenging situations, and each situation is unique, so it is difficult to offer blanket advice. Being aware that gender stereotypes may color how you are perceived (bossy rather than assertive) can be illuminating. If you have a particularly thorny interaction, turn to your mentors to help you navigate the specific situation.

6. Do you have tips for studying for the oral boards if you’re starting out in a very busy practice?

Try to set aside some designated time for studying each week, so that it doesn’t become a big deal that you have put off. Slow and steady wins the race.

7. Any final words or additional general advice on job hunting / interviewing / starting a new career for women radiation oncologists not otherwise covered?

Sorry, that’s about all I have. Dying from jet lag after arriving home last night after a trip to Australia, where I was invited to speak. I took the kids. Work-life integration at its best. But they were up all last night from the jet lag, and I have been in clinic all day and now have to go to a faculty interview dinner. Such is life. Blessed.

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