When asked, "What does a hematologist-oncologist do?" Gary Schiller, MD, professor of hematology-oncology at the David Geffen School of Medicine at UCLA, responds that, in addition to diagnosing and treating blood cancers, these specialists also focus heavily on clinical research.
Becoming a hematologist-oncologist
In the United States, the road to a career in hematology-oncology begins with a general residency following medical school, typically in either internal medicine or pediatrics. Subspecialty hematology training follows by way of a three-year fellowship. According to the American Society of Hematology, hematology-related fellowships include hematology-oncology, adult hematology, coagulation, pathology and pediatric hematology-oncology (there are no pediatric hematology-only programs).
Dr. Schiller finds that hematology-oncology appeals to students who feel an affinity for the basic sciences but also want to take care of patients with serious illnesses. "To do well in this field, you can't be afraid of serious conversations. A healthy dose of spirituality is helpful," he says. "Our patients confront life-threatening illnesses and often need spiritual support. You can't leave it all to the (hospital) chaplain. You've got to have some of it in you, too."
It took Dr. Schiller, director of the UCLA Hematologic Malignancy/Stem Cell Transplantation Program, some time to settle on hematology as a medical student, but once he did, he never looked back. "Cardiology and hematology both draw similar personalities — those who are energetic and intervention-oriented — but it was really the bone marrow itself that drew me in," he says. "It's one of the largest, most diverse organs in the body, which means that hematology presents clinicians with an extremely broad range of diseases and interventions."
Dr. Schiller was drawn to clinical research from the early days of his career. Today, he has many duties as a clinician, faculty member and administrator, but research remains a cornerstone of his work. "I currently have 40 trials under my purview, so running my lab is a huge part of what I do," he says. These trials focus mainly on two diseases: multiple myeloma and acute myeloid leukemia.
What does a hematologist-oncologist do?
Dr. Schiller covers UCLA's inpatient hematology-oncology service for two months a year. During these stints, he makes patient rounds from around 8:30 to 11:30 am each day. The midday hour is usually spent on research-related paperwork in his lab. He then holds clinical hours each afternoon. "About three-fourths of our clinical work is on the outpatient side, despite the life-and-death nature of our work," he notes.
Evenings are generally reserved for writing papers and preparing for professional meetings. Dr. Schiller prefers to do this work at home whenever possible. "As all-encompassing as this career is," he says, "it's important to make time to see your family."
Even when he is not on service, Dr. Schiller keeps clinical hours three afternoons per week, and he is on call for his outpatients 24/7 unless he is traveling. Additionally, there are always students, residents and fellows to oversee.
Dr. Schiller notes that hematologists in academic medicine seldom have to come in after hours due to in-house trainee coverage. "That's not true in private practice, though," he notes. "Patients tend to run fevers at night, so that's when they come into the ER."
Then again, doctor-patient continuity is one of the field's biggest draws for Dr. Schiller. "I like to be deeply involved in all levels of patient care and I want to have longitudinal relationships with my patients," he says. "And the pace of progress in our field has been serendipitous for our patients and exciting for us."
By Darcy Lewis