MedicalPhysician Q&A

20 Questions : Karen M. Winkfield, MD, PhD, Radiation Oncology

Karen M. Winkfield, MD, PhD, is a radiation oncologist with Massachusetts General Hospital, and she divides her time among clinic research in health equity and hematologic malignancies, teaching as assistant professor of radiation oncology at Harvard Medical School, and a clinical practice treating patients with lymphoma, leukemia, myeloma, myelodysplastic syndrome and other blood cell dyscrasias, and breast and gynecologic malignancies.
Dr. Winkfield received her bachelor’s degree in biochemistry from Binghamton University (1997), and her PhD in pathology (2004) and MD (2005) from Duke University. She completed an internship in internal medicine at Duke and a residency in radiation oncology at Harvard. Dr. Winkfield co-founded and directs the Association of Black Radiation Oncologists, and she’s been published in numerous journals, including the Journal of Biological ChemistryJournal of the National Medical AssociationInternational Journal of Radiation Oncology – Biology – PhysicsOncologyJournal of the American Academy of Dermatology, and New England Journal of Medicine. She also currently chairs the Health Access and Training Subcommittee for the American Society For Radiation Oncology and is chair-elect of the Health Disparities Committee for the American Society of Clinical Oncology.
When did you first decide to become a physician? Why?
It wasn’t until I was actually in medical school that I decided to become a practicing physician. My intention entering medical school as an MD-PhD student was to understand human physiology and disease processes so I could better focus my research. However, I fell in love with medicine during my clinical rotations and decided that I wanted to be an oncologist.
How/why did you choose the medical school you attended?
It was important for my research career to be related to whatever clinical practice I elected to pursue. I chose Duke Medical School because of its unique curriculum. The core clinical rotations begin in year 2, allowing me to experience several aspects of medicine prior to starting my PhD.
What surprised you the most about your medical studies?
I was surprised by how much I loved practicing medicine. I really thought I was going to cure cancer in the lab, not in the clinic.
Why did you decide to specialize in radiation oncology?
One of my very first research projects in grad school evaluated the impact of radiation therapy on the G2-checkpoint in breast tumors and normal tissue. As I learned more about the use of radiation therapy in cancer therapy, the field intrigued me. There were so many research questions related to radiation biology; I thought about the many pathways involved in radiation response that could potentially become therapeutic targets. I thought it would be a wonderful way to marry my research and interest in becoming an oncologist.
If you had to do it all over again, would you still become a radiation oncologist? Why or why not?
Yes. I absolutely love what I do. The field combines compassionate medical care with state-of-the-art technology. It requires expertise in imaging, anatomy, biology, physics and oncology… and it’s so much fun.
Has being a radiation oncologist met your expectations? Please explain.
My practice has actually exceeded my expectations. I love what I do. It is an honor to care for patients with cancer. As a hematologic radiation oncologist, I learn something new every day.
What do you like most about being a radiation oncologist?
I love the teamwork. There is no way to practice radiation oncology in a vacuum. In addition to the radiation oncology team, comprised of radiation therapists, dosimetrists, physicists and nursing, multi-disciplinary specialty care is required, so I often interact with surgeons, medical oncologists, pathologists, and radiologists.
What do you like least about being a radiation oncologist?
There’s too much paperwork. I sometimes feel like a scribe or secretary more than a physician. But that is [the same issue in] all of medicine.
Describe a typical day at work—walk me through a day in your shoes.
I staff two multidisciplinary clinics during the week with my medical oncology colleagues. My Monday multi is a cutaneous lymphoma clinic that is co-run by a dermatologist. I see all of my patients who are on active treatment every Friday; clinic starts at 7 a.m. From 8 to 9 a.m., I try to get to our weekly lymphoma multi-disciplinary conference; I don’t always make it if a patient needs to be seen. At 9 a.m., I begin to see new and followup patients, in addition to my on-treatment patients. I may also have to develop or check treatment plans. Clinic runs until about 5 p.m. and then I have the dreaded paperwork to do. My goal is to leave the office by 8 p.m.
On average, how many hours a week do you work? How many hours of sleep do you get per night? How many weeks of vacation do you take annually?
I work 50 hours a week. I sleep six hours a night.I’m supposed to have four weeks, but I take one to two; I also travel a lot for meetings related to work.
If you have family, do you feel you have enough time to spend with them? Why or why not?
I sacrificed a lot of family time during training. Now it’s complicated since my husband is ill.
How do you balance work and your life outside of work?
I don’t do it well. My spouse has significant medical issues, so that requires a lot of my time/energy outside of work. To do something for myself, I recently started singing at church again. My schedule doesn’t allow me to sing every week, but it is such a thrill when I can serve in this capacity.
Do you feel you are adequately compensated in your field? Please explain.
Yes and no. I truly cannot complain about my income, but you always take a hit financially when you elect to remain in academia.
If you took out educational loans, is/was paying them back a strain? Please explain.
Loan repayment was a pain but I did not incur as much debt as some of my colleagues, so I am lucky. Plus, my research in health disparities garnered me a loan repayment grant from the NIH. This grant enabled me to pay of my loans much quicker than I would have otherwise.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
I would tell myself to pay more attention in statistics class.
What information/advice do you wish you had known prior to medical school?
I wish I had known more about health disparities before starting medical school. This knowledge may have impacted the courses I took and perhaps even the focus of my PhD.
From your perspective, what is the biggest problem in health care today?
Inequities in health and health care. This is truly a social justice issue. Blacks (“descendants of slaves”) and Native Americans have the poorest health outcomes across all disease entities. These communities have been marginalized and disenfranchised for centuries. This has led to the inability to build wealth. Socioeconomic status is the greatest health determinant. Lack of wealth equals poor health. Combine this with ongoing racism and, in my view, the black health crisis is the most pressing and costly problem in health care today.
Where do you see radiation oncology in five years?
The field has seen tremendous change with improvements in imaging and treatment technology. I expect to see continued improvements that allow the safe and effective delivery of radiation while reducing risk to normal tissue.
What types of outreach/volunteer work do you do, if any?
My outreach is focused on educating black men and women about the tremendous health inequities that plague our community. I encourage folks to develop individual and family health plans; this includes a focus on finance. I frequently give talks in the community about cancer disparities and discuss prevention, screening, and treatment, including the importance of considering enrollment in cancer clinical trials. This is particularly important for communities of color since they are traditionally underrepresented in most prospective studies. I volunteer in a leadership capacity at several national organizations, including American Society of Clinical Oncology and American Society for Radiation Oncologists. My focus within thesegroups has been galvanizing efforts to eliminate health and health care disparities. A huge component of this effort is spent trying to improve workforce diversity in oncology, meaning training more physicians from backgrounds that are traditionally underrepresented in medicine (URM) – black, hispanic, native american/pacific islanders. Both organizations have fellowships for URM students; I help organize those fellowships and have acted as mentor for student recipients.
What’s your final piece of advice for students interested in pursuing a career in radiation oncology?
Spend time shadowing a radiation oncologist to make sure the field is right for you, find a good mentor, and study hard.

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