Session 38 Dr. Julie Krystal is an academic pediatric oncologist. Julie has been out of training now for two years. She discusses what she loves about her job, where she sees the specialty going and what you should do. Please be sure to also check out all our other podcasts over at MedEd Media for more resources. [01:00] Interest in Becoming a Pediatric Oncology Julie always knew what she wanted to do. Back in high school, she wanted to be child life person where you get to do arts and crafts with kids in the hospital. So she was volunteering at Stanford Children's Hospital where she grew up in California. She was working with a lot of oncology patients. She then realized that the more she got to work with the doctors and see the fellows, they were actually doing a way cooler job than the child life people. That's when she decided it's what she wanted to do in high school and stuck with that. She felt strongly better all throughout her training, through college and all the way through her residency. She did give other things a try since pediatric oncology as she describes is a tough path in many senses. So at some points, she tried to convince herself to like other things - better hours, better pay, etc. But nothing else was the right fit for her except for pediatric oncology which she felt was the one thing she really wanted to do. What she likes about the subspecialty is you get to have a sort of primary care relationship over long periods of time. They remove the kids from their pediatrician while they're with them and while they're getting chemo or treatment. So the relationship goes over many years because these kids get to stay with them. "You have that longitudinal sense that you get from primary care but you have much more interesting complex medical problems." Julie describes it as somewhat the best of both worlds. It's something really interesting subspecialty-wise and that relationship that's so important. Whenever she tells people what she does, their first reaction is almost always negative. They think it's awful and sad. So she always tell them that it's not sad actually. The majority of children are cured from their cancer and they go on and have wonderful adult lives. It's her privilege to be with the family during the worst, most horrible thing that's happening to them and to see them through to the other side. So this part of it just really appeals to her where there is challenge and mostly a happy ending. And if it's bad, it's really bad and really sad. But most of the time, there is knowledge that you're able to get the family over something that's really hard. Then you get to see their child go on and grow up and do wonderful things. So for her, it's a wonderful role as a physician to get to do that. [03:40] Traits that Lead to Becoming a Good Ped Onc Doc Julie cites a few things to become a really good ped oncology doctor. First, is being a sunny and optimistic person. There are sad and depressing moments. The lifestyle is tough. It's academic and it involves long hours. There's no money in it. If you're doing grants and you're fighting to the nail against everyone else to get funding, things can get challenging. So you have to be willing to devote yourself. This job involves long days and long nights. So you have to go into it knowing that. "You have to be accepting that this is your life and it's not a glamorous, fancy, sports car kind of gig." [05:18] Types of Patients and Doing Clinical Trials Julie mostly takes care of kids with brain tumors. In peds oncology, things can  be specialized these days. There's hematology and oncology. She's specialized to oncology and within oncology, there are doctors who do leukemia. Some doctors do bone tumors. While she mostly takes care of kids with brain tumors, like everyone else, they have to do a certain number of weeks of the year of in-patient service. When you're on it, you take care of admissions and all the new diagnoses that come in. Nevertheless, she keep