Session 98 Dr. Stephanie Graff is a breast oncologist who has been out of training for 8 years. Today, she talks about her journey – what got her into the specialty, the training path, and the most and least liked things about her specialty. Meanwhile, please be sure to check out our whole host of podcasts on Meded Media as we seek to help premed students and medical students along their path towards becoming a physician. [01:38] Interest in Oncology Stephanie decided on oncology in the early rotations of medical school. One of her high school teachers used to tell them that whatever they decide to do in life, they have to read about. She now finds this as true advice, especially in medicine. And she just couldn't put down the book about oncology. When she moved to clinical rotations, everything just seemed to fit for her. With oncology, it allows physicians to connect with patients in a longitudinal way. You're going through something intense and emotional. Then you also get to see them into long-term survivorship. "Whatever you decide to do in life, you have to read about." In-patient oncology covers dying or very ill patients. But Stephanie clarifies this is just the minority of their patients. Most of her patients are working their full-time jobs on their chemo so they're not sick. It's not a depressing job. Of course, people die, but so do with heart failure and other kinds of diseases. That said, every field has those highs and lows. [04:02] Going Through Oncology Training Stephanie started doing lung cancer research, primarily because she got attached to her first mentor. But she ended up leaving her training program during the scope of her fellowship. The next mentor she attached herself to was the breast oncologist. So for the second half of her oncology fellowship, she was mentored by the fellowship program's breast oncologist. She found it as a good fit. "A lot of it is just finding your niche when you start your practice. There's no breast oncology sub-boards." For instance, sarcoma is an exceedingly rare tumor so you won't probably be going to be a full-time community sarcoma expert. But Stephanie is part of a large group of oncologists with 15 partners in her group. Stephanie exclusively sees breast while one of her partners does 90% GI. Two of her partners are heavily subspecialized in lungs. And one of her partners exclusively sees GU malignancies. They have a niched subgroup specialty across her practice. They also have clinical research sites where they're principal investigators on their disease types. [06:55] Traits That Lead to Becoming a Breast Oncologist "Oncology is definitely a communications-heavy field." Stephanie thinks that the lay public's understanding of cancer and cancer treatment is infantile in its development. So you really have to talk them away from the fear into the treatment, why the treatment, how to manage the side effects, etc. You have to do this concisely in the construct of the clinic appointment. You have to be resilient as there's still death and dying in oncology and you have to be optimistic by that nature. [08:33] Types of Patients Stephanie also runs their high-risk women's programs. So she sees a fair number of patients identified either by their primary care, GYN, or just the breast imaging center. They usually have a striking family history or other significant risk factors. They're being referred to her in their high-risk women's capacity to talk about risk production and genetic testing. So she gets patients this way. She has a great relationship with the breast surgeons, primary care, gynecologists in their study. She sees patients even before they're diagnosed with breast cancer. She would often be called to manage even the workup of a lump. Since the fear of having breast cancer already creeps in at this time. Breast surgeons are her number one referral source. She attends all of the breast cancer tumor boards at two different hospitals. She participates in conversati