Chapter 03: Specializing in Radiation Oncology

Chapter 03: Specializing in Radiation Oncology

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Description

Dr. Buchholz begins this chapter by talking about the scholarship he received through the Air Force to support his medical studies [Tufts University School of Medicine, Boston, Massachusetts; MD received in 1988]. He discusses the dimensions of radiation oncology that convinced him to specialize in that field and talks about the research project on lung cancer he participated in during medical school. He notes that today it is very competitive to find fellowships in the field and talks about finding his opportunities at the University of Washington. He explains why he preferred a clinical focus to research in a laboratory.He then alludes to his first teaching position as an Adjunct Associate Professor in Radiology (non-tenure) at the University of Texas Health Science Center at San Antonio, San Antonio, TX, [1/1994-6/1997]. He notes that the Radiology Department in San Antonio started the first stereotactic radiology program in the Department of Defense.

Identifier

BuchholzT_01_20180110_C03

Publication Date

1-8-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Professional Path; Professional Path; Military Experience; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Character, Values, Beliefs, Talents; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; The Researcher

Transcript

Tacey Ann Rosolowski, PhD:

So how did you choose your medical school?

Thomas Buchholz, MD:

Again, I tend to choose the best, you know? So I think I got—I went to Tufts Medical School, and I think that was kind of the best medical school that I got into. I got into a couple state university schools. I got waitlisted at Cornell. I think I got waitlisted at Stanford, but I got rejected at a lot of medical schools, too. And Tufts had the appeal of being in Boston, which my wife was from Boston. My girlfriend, I guess, was from Boston, and would feel comfortable going back to Boston, although we weren’t at that time certain we were going to get married or anything. Tufts was expensive, but that wasn’t such a concern, because I got a scholarship with the Air Force to pay whatever costs were associated with the school.

Tacey Ann Rosolowski, PhD:

Now, I didn’t ask you if you had military service.

Thomas Buchholz, MD:

Yeah, I did.

Tacey Ann Rosolowski, PhD:

Okay, so tell me about that.

Thomas Buchholz, MD:

So I competed, and got a scholarship for medical school, with the United States Air Force. And that affords you to get free tuition, and books, and most of your expenses. You do get commissioned as a second lieutenant as you start in school, and you serve 45 days of active duty a year during your medical training. As you get into third and fourth year, that’s just doing a medical school rotation, just—so I did OB/GYN, for instance, in an Air Force hospital as a medical student. But the first couple years is more introduction into the Air Force. It was just camps with other scholarship medical students, and you learned what it is to be an Air Force officer, and some of... And then the second year you learned a little bit about aerospace medicine, and medicine of flight, and g-forces, and blacking out, (laughter) and other things. And we did some survival training, and got to fly airplanes, and learn how to parachute, and kind of fun things. So we had kind of two summer camps the first couple years, and then—but most of the time you didn’t really have much connectivity, other—but they gave—I think I was making $16,000 a year, in addition to... So you come out of medical school pretty much debt free, or I did.

Tacey Ann Rosolowski, PhD:

Yeah, yeah. That’s huge.

Thomas Buchholz, MD:

After medical school, I applied and was granted what’s called a deferment, where they just essentially said, “You’re free to do whatever you want for five years,” or not whatever you want, but I applied to train to be a radiation oncologist, and they let me do that, completely on my own, with no obligations to the military. And so I was, just like any other resident in my program, I was paid by the University of Washington. I went to Seattle for my residency.

Tacey Ann Rosolowski, PhD:

Now, tell me about the process of choosing radiation oncology.

Thomas Buchholz, MD:

Well, my older brother, Dan, went to medical school, too, so he’s three years older than I am. So when I was applying to medical school, he was in medical school. And when I started medical school, he was, I guess, graduating from—I guess we must have been in medical school one year together. And Dan told me during his fourth year of medical school he found out about radiation oncology, which was at that time a real small profession, and not one that’s brought into the curriculum of your first- and second-year students. So it’s not unusual to start finding out about it during your fourth year. So he said, “Wow, this is a great profession. Tom, you should look into it.” He found out a little bit too late for himself, but... So I kind of checked it out, and I went down to the Radiation Oncology Department my second year, and hung out down there, and I ended up doing a little research with their faculty, and really learned about the profession. And indeed, it is a really neat profession in many respects. I think, for me, I was attracted to it because it gives this true human interactive connectivity with people, that most of your job as a radiation oncology doctor is helping people in their journey, and treating cancer. I liked it because you’re really interacting with patients during a vulnerable and meaningful period in their lives. It’s high stakes for them. And if you’re effective at providing support and education, and helping them, you could have a really big impact on their lives in a way that’s different than treating a rash or something. So I really liked oncology. And then, quite honestly, it’s a very intellectual field, too. It’s really governed by science. There’s the discipline of how do you get the radiation to the target, and miss the normal tissues, which is physics, and computer science, and really neat technology. And then there’s the biology, too, of how do you kill the tumor cell and not the normal cell. So it’s a very strong scientific discipline, and it’s a discipline that’s very evidence-based, too, and rigorous. And it was a discipline that I kind of liked, because nobody else knew what went on, right? Very few doctors, even, truly understood radiation oncology, and you became kind of a real expert, then. You had a unique skillset, and various audiences that was differentiated. It was kind of special. So I thought, yeah, this is great. Now, subsequently my brother, ironically, also had a military scholarship, and he, too, liked radiation oncology, and Dan decided to go and pay back his Navy obligation, which was three years he was in the Navy. And so he was a general-practice ship doctor. And so he came out of the Navy, after fulfilling his obligation, right when I was getting out of medical school and was granted this five-year deferment. And so we actually—he applied and got into radiation oncology, too. And we started our residency program the exact same year, then, because we got synchronized. I went to the University of Washington, and guess where he went.

Tacey Ann Rosolowski, PhD:

University of Washington?

Thomas Buchholz, MD:

No, MD Anderson.

Tacey Ann Rosolowski, PhD:

Oh, he came to MD Anderson!

Thomas Buchholz, MD:

He came to MD Anderson, yeah. So that’s how I got first introduced to MD Anderson.

Tacey Ann Rosolowski, PhD:

Oh, wow, that’s amazing. Huh.

Thomas Buchholz, MD:

So we went through the same residency period together, and it’s been great. We’ve never worked side by side in the same building together, but we go to conferences together, of course, and we took our Board examinations, National Board examinations together. And University of Washington is kind of a small program relative to MD Anderson, and I would always hear about MD Anderson—they were so dogmatic, and University of Washington was unstructured and free-flowing and crazy. I’d come down for Thanksgiving or something, and I’d come into the department. You had to wear your white, pressed coat, and very formal, and we were eating pizza in the breakroom (laughter) and doing crazy things. So I never thought I’d like it. It was very... And my brother’s kind of black-and-white. I’m kind of more of a grey person. So even when it got to our exam—national examinations, he would say, “Oh, you have to know this. You have to know this. Well, we have all the notes from 50 past examinations. You have to know this.” I was like, “I’ve never heard of that.” (laughter) So we were a little bit more on-your-own in Seattle. But it was fun. Of course, perspective changes as you mature in your own independent thought, so...

Tacey Ann Rosolowski, PhD:

Of course, yeah. Tell me about that research project that you did when you were still in undergrad—or, I’m sorry, medical school.

Thomas Buchholz, MD:

Well, yeah, in medical school I remember I thought it’d be helpful to have something on your résumé, and so I tried to find something within radiation oncology. And so I worked with a doctor in the VA, and we looked just at kind of the patient records, and an approach where they were using radiation before surgery for lung cancer, and then going on and doing surgery, and trying to describe kind of their outcome and their toxicity. And it was a relatively simple project that wasn’t earth-shattering, or some major discoveries, but it was my first introduction into trying to collect data and analyze data and make a story that has some relevance to a field.

Tacey Ann Rosolowski, PhD:

And it was cancer-related. I mean, was that—had you thought about oncology prior to that?

Thomas Buchholz, MD:

Yeah, it was purposeful that that’s—it was kind of during this period where I thought I’d be applying for a radiation oncology residency, and so I did that for—I took a research month, and focused that, in an effort to help gain me credibility of applying to radiation oncology programs. And it was—today, radiation oncology, I think, is the most competitive residency to get into.

Tacey Ann Rosolowski, PhD:

Really?

Thomas Buchholz, MD:

It was very competitive at that time, but not by today’s standards. Today, we’re fortunate to have, I think, the best graduating medical students in the country come here for our residency program, so number of MD PhDs who’ve done fantastic laboratory research, and have published in the world’s top journals, as—made major discoveries, and... So we have a lot of those people now in our residency programs from the best medical schools in the country. When I look back—and everybody has a very clearly defined career path and goals and objectives. Ironically, when I look back, it was a little different then. There was no residency match. So you’d write and get paper applications from all these programs throughout the country. We were in Boston. We were married at the time, and I’d say, “Oh, Mara, look, let’s go to Pittsburgh. Look, they got a great downtown.” (laughter) So this was before the internet, and so you’d just look at those brochures. And I kind of felt like, let’s try something new, and my upbringing of moving around all the time, it gave me freedom to say... So I got in my head I wanted to go to Seattle, for some reason. And it was kind of a crazy game, because I ended up getting an offer from Tufts to stay in their residency program. And I had spent some time at Mass General, too, and they were in the process of wanting me to come for an interview, thinking that they were going to give me an offer. MD Anderson wanted me to come for an interview. But there was—it was more like applying for a job. There’s some real advantages to the match currently, because you get to check everything out, and they get to check everybody, and make it fair. This was wheel and deal, because you didn’t—someone would give you an offer, and they’d give you a short period of time to say yes or no, and if you said yes to this, you couldn’t go on and interview any other places. But I was a competitive candidate. I graduated top of my medical school class, and I was... I had that little experience of doing a little bit of research. So I did my medical school rotation with the Air Force out in California, so that kind of brought me to the West Coast. And my wife would get calls from Tufts and say, “Have you given him the message?” (laughter) She says, “I think he’s in survival training. No, we...”

Tacey Ann Rosolowski, PhD:

So she was helping with the wheeling and dealing. (laughter)

Thomas Buchholz, MD:

She was helping. And so I interviewed at Stanford, and then I went up to Seattle, and I said to Seattle, “Hey, I really like it here, but I got this offer from Tufts.” And they said, “Oh. Well, okay, you can have an offer here.” I said, “Okay, I’ll take it,” and that was the end of it. (laughter)

Tacey Ann Rosolowski, PhD:

So what was it that you liked about Seattle so much?

Thomas Buchholz, MD:

It was just gorgeous. I mean, the mountains. Again, I wish I could say that, oh, I thought it strategically would be best for my career path, but no, I think it was just, hey, this would be a fun adventure for a newlywed couple, getting away from all of our known friends, and getting out there in the world, and boy, we could go out in the North Cascades hiking this weekend, and the Olympic Peninsula. And so it was just a fun start for Mara and me as a young couple that... And it was. It was a great, great experience. We were there for four years, and...

Tacey Ann Rosolowski, PhD:

Wow. And what does your wife do?

Thomas Buchholz, MD:

She was an economics major, and worked for a bank in corporate lending in Boston, and then when we moved to Seattle she worked in insurance, and then in pension management, not necessarily finance but kind of managing pensions. And then right when we were about to leave Seattle we had our first child, and so then she became a stay-at-home mom for—

Tacey Ann Rosolowski, PhD:

And your child’s name?

Thomas Buchholz, MD:

Alex is our oldest. We have two kids, Alex and Erin.

Tacey Ann Rosolowski, PhD:

And that’s Erin or Aaron?

Thomas Buchholz, MD:

E-R-I-N.

Tacey Ann Rosolowski, PhD:

Yeah, Erin, okay.

Thomas Buchholz, MD:

So, and—yeah, in Seattle I finished my residency. I ended up spending the year in the lab. That’s when I really got into doing some academics. I got --my first paper I wrote won a Young Oncology essay award that afforded Mara and I to go and present in this conference. I had a couple other successes toward the end of my residency that brought me into the national stage. And you’d say, wow, this is exciting, and it was a big deal. Not too many people from Seattle did it. And nowadays our residents do it all their first year, and they do about 40 of them before they graduate from residency, but for me it was a big deal. I remember writing my first paper. I remember going to the library and checking out a biostatistics book, and I remember trying to program Excel, which was a new software tool of how to do your own statistics, and I just kind of did it all on my own. And it was fun. And I kind of caught the bug of, hey, this is kind of fun, you know? So that became a component of my life. And again, I think just this natural tendency towards leadership also drew me in to wanting to work in an environment that was complementary to the patient care aspect, but gave something a little bit more, whether it was education with residencies, or academics with some discoveries, and ability to be part of a bigger group and a leadership focus. And so I was destined for that. So I thought I’d do a year in the laboratory, which was a great experience, but I’m not someone who just is enthralled with petri dishes and animals that bite and urinate on you, (laughter) and other things like that. And there was certainly a lot of frustrations over the course of that year, scientific frustrations, and convinced me that I don’t want to be a hands-on PhD lab researcher. I’m much more inclined to be more clinically focused, although I loved the science. I really did love the science of oncology. So it was good to do that extra year. Subsequent to that, I felt as if, well, my world is handicapped because now when I have all this momentum and I’m having such fun in Seattle, I could get an assistant professor job at the University of Washington, which is the best place in the world—of course, it’s the only place I’ve been—and now, instead, I have to go into the Air Force. And I thought that would be, oh, what a bummer, what a setback. But it proved to be great. I went in to—I was stationed at San Antonio, which is the flagship, at that time the flagship medical center in the Air Force, Wilford Hall Medical Center. And I joined a group, and there was a great guy who had been there a longer time, and he outlasted me, too. He had a commitment that probably included college and medical school or something. But he was a great guy, and he was fun to work with, and innovative. And so we were able to do fun things, like start the first prostate implant program in the Department of Defense, the first stereotactic radiation program in the Department of Defense. And it was fun, because I joined a group of really intelligent cancer doctors, and they were trained all over the country. So this person was trained at Stanford. I was trained at the University of Washington. We had someone trained at NIH, someone trained at MD Anderson. And it was a very enriching diversification of your own thought. And you’re on your own. You’re an autonomous doctor at that point. And so you come in with confidence, but then you’re making decisions without any backup, and people’s lives are at stake. And so it was great to have a variety of different approaches, and to learn—it’s kind of like doing a clinical post-doc, almost, for four years of assuming that responsibility. The other—

Tacey Ann Rosolowski, PhD:

I was just going to ask if there was a particular incident with a patient that you can tell me about that you went to somebody and they helped you see something differently. I mean, I know it’s a while ago, and I’m just curious if you had one of those in your back pocket.

Thomas Buchholz, MD:

Well, I think when you’re trained in a residency program, at least, particularly, at MD Anderson, you do it the MD Anderson way. In Seattle, it was less structured like that. You could work with two different attendings, and they might have different opinions, and treat people differently. But clearly, when you went to the Air Force, the diversity of backgrounds, even within radiation oncology, every one of us over my four years trained at a different place. Was kind of opening that there are different ways of approaching this problem. And the nice thing, you have great plasticity in your brain, because you’re just young, and you’re starting out. You’re not set in your ways. And the openness to, again, hear and appreciate—and I’m getting back to my relationship thing. It’s really helped me be a better doctor. And the Air Force also loses 25% of its workforce and the cancer doctors every year, and get 25% in, because most people have a four-year commitment, like I did. And so it’s always interesting in turning over, too. I tried to continue to do academics, too, in the Air Force, which is a little bit more challenging, because it’s hard to assemble the data, etc. But I’d learned, too, about being autonomous, and writing papers on your own without having a mentor, and publishing, and picking good, doable projects.

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Chapter 03: Specializing in Radiation Oncology

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