Dr. Matthew C. Breeggemann is an Assistant Clinical Professor in the Division of Nephrology at UCSF. His clinical focus is management and prevention of kidney stones, and he heads the UCSF Kidney Stone Prevention Clinic. Dr. Breeggemann is the Nephrology Deputy Editor at theMednet.

At a young age, Dr. Matthew Breeggemann knew he wanted to become a kidney specialist. He experienced several bouts of kidney stones and the physicians who cared for him - notably a Dr. Michael Mauer - became his role model. Matthew admired how Dr. Mauer picked up on his curiosity, even at such a young age, and taught him about kidney stone prevention and management at every visit. His mother, a nurse, also inspired him to pursue a career in medicine.

Later studies at Creighton University School of Medicine and training at Dartmouth-Hitchcock Medical Center exposed him to various medical specialties, but nephrology continued to resonate as his true calling.

“Nephrology is intellectually stimulating. It's such a cerebral field, with a focus on tackling challenging questions, all to help and support the sickest patients in the hospital,” said Dr. Breeggemann. “Nephrologists see some of the most medically complex cases. From a physiology and patient complexity standpoint, there's no better field.”

When Dr. Breeggemann was recruited to theMednet, there was no existing nephrology section. At that time, he was in the research phase of his fellowship training and recognized that theMednet would be an invaluable resource and guide as he established the kidney stone clinic. He had previously contributed to First Aid, a publisher of study materials for board exams.

In a bold career move, Dr. Breeggemann became co-director of UCSF's Kidney Stone Prevention Clinic immediately following his training in July 2023. In spearheading and pioneering the subspecialty clinic, he had to navigate challenges given the scarcity of individuals with an interest in the niche field of kidney stone disease. He sought advice from seasoned UCSF nephrologists, reached out to professionals from other institutions he had met over the years, consistently asked questions, and immersed himself in extensive research and literature, much like what he’s accustomed to at theMednet.

He notes that people living with recurring kidney stones are just looking for answers and he hopes that, over time, he is helping them.

He is active in his free time with weightlifting, biking, running, and golf, and relishes his passion for travel with recent trips to Bhutan, Cambodia, Thailand, South Korea, Jordan, Lebanon, and New Zealand.

We asked our experts what advice they'd share with trainees about what they wish they knew then.

1. Daniel E. Spratt, MD

While this seems like such a simple question, it is so complex as if I knew the things I know now I am sure my actions would have changed...which would lead me to a different life today; the great butterfly effect: https://en.wikipedia.org/wiki/Butterfly_effect.

Trying to put that aside, a few pearls/maxims I often share with students, residents, and fellows:

1. Always try to align your "needs" and your "wants". Don't blindly just do what is asked of you. Proactively shape what fills your day up as much as possible. Master the art of creating your own path respectfully and professionally.
2. It is ok to say no, and you need to learn how to say no in a manner that is professional and respectful and that demonstrates you are saying no for a reason and not because you are lazy, but rather, that task is not aligned with your purpose or current goals.
3. Stay humble and know we are all replaceable. That doesn't mean we don't have value, but one must understand the tiny role any of us have in the scope of a huge multi-billion dollar institution.
4. Never lose track of your purpose. Mine is to provide a positive impact on cancer patients' lives. Stay focused. If you don't actively think about your purpose, you will end up on someone else's path in life heading down a road you don't want to be on.
5. You will be criticized on your journey. Attendings, leaders, program directors, Chairs, random people, etc may tell you that you are doing it all wrong over and over. You must have enough self-confidence and introspection to identify when you have failed versus others trying to tear you down to benefit themselves. This is not easy. Try to listen to the people that matter in your life (family, friends, patients, trusted peers, etc).
6. Don't expect the same from others as you do yourself. Everyone's goals are different.
7. Meetings can be 10-15 minutes. Don't agree for every meeting with your attending to be 30 min or 1 hour unless it really needs to be.
8. Know the currency of the stage you are at in life. If you are a resident then usually the currency is working hard, having a positive attitude, reading and knowing your craft, and getting the work/job done. This will typically be the most important thing that your attendings can use to help you get a job. If you want to be a physician-scientist, you likely will also need the currency of a focused scientific path and scholarly work (papers, grants, etc)....or at least a real potential for these in the future. Publishing a bunch of random junk rarely will help you get a job. Complaining, laziness, being demanding, etc will surely be a great way to make it hard to get hired.
9. Leaders, attendings, Chairs, PDs, etc...just having a title doesn't mean they are smarter than you, are always right, or are a better clinician than you. You must take the good from each person in training and try to filter out the bad or the style that doesn't fit with your personality. You can be a great clinician in dozens of ways, and you need to figure out the kind YOU want to be.
10. Read the book Multipliers. One of the few books I read in residency that opened my eyes to many terrible leaders I have worked under and the many amazing ones. The philosophy of this book changed the way I work in all aspects of my life. Be a multiplier and work with multipliers. Avoid diminishers at all costs.
11. Getting a job is more about "fit" on both ends than it is about a big CV. Do not underestimate the power of your attending or mentor picking up the phone and calling their peers at the center you want to work. That goes a long way.
12. There will be conflict/drama as a resident at some point, but remember this usually disappears within days and is forgotten.
13. Try to keep perspective. As hard as you may work in training, remember that in oncology, on the other end are often suffering, scared, and dying cancer patients. Don't lose perspective (as I type this I am near our pediatric cancer treatment area and heard a child scream in fear who has cancer...).
14. Success is 100% relative. You get to define success. However, your definition of success may not match others and that is ok.
15. Enjoy the ride! We are all so blessed to be physicians and help patients. I still keep in touch with many of my co-residents and it was an amazing time. With everything said above, I likely wouldn't change any of it as my failures helped shape who I am today.

Hard to be profound in the 10 minutes I have free between meetings, but I hope this resonates with someone.

Best,
Dan

2. Debu Tripathy, MD

I wish I knew that one can develop a synergistic clinical expertise and research focus by simply asking questions. The most ponderous questions you generate as you go through your training can drive your career - whether you will focus on the clinical, the research, or both aspects of your queries.

Hypothesis-driven research yields clinical breakthroughs. The riskier questions bring high rewards, and the more straightforward ones may bring quicker answers. Results that benefit your patients are the most elevating. For me, team science is more fun and interactive - and in my opinion, more productive while allowing you to share responsibilities and fruits of labor. Finally, I really enjoy sharing my research with my patients (yes, my clinic tends to run late) - they appreciate the fact that our profession is really looking after them, and that we are passionate about change.

My research question as a 2nd year fellow at UCSF (in 1989) was, "why does this newly discovered gene named HER2/neu make cancer cells more aggressive?" I used anti-sense DNA to knock down HER2 expression and needed a positive control antibody, which I got from a colleague at Genentech. This antibody (named 4D5) worked much better than anti-sense! A colleague fellow, Jose Baselga at Memorial Sloan Kettering, was studying the same antibody in mice bearing HER2+ breast cancer xenografts with encouraging results. Our respective faculty mentors lobbied Genentech to develop this antibody as a drug (which they did reluctantly), and together we ended up conducting and publishing the first humanized 4D5 (trastuzumab) clinical article, a Phase II monotherapy trial in refractory HER2+ breast cancer 7 years later (1). I continue to ask questions that naturally jump out even with the most casual observations - I find those that resonate with others, and we are off to the races. I wish I knew what a good question was worth earlier.

1. Baselga et al., PMID 8622019.

3. Simon M. Helfgott, MD

Wholeheartedly endorse Dr. Daniel E. Spratt's Fifteen Commandments - very applicable to Rheumatology Practice as well.

4. Paul Harker-Murray, MD, PhD

I will work harder than many.

I will be compensated less than many, but enough.

I will love the work I do.

5. Michael Auerbach, MD

My residency was 40 years ago. I wish I know the outcome of my then future work with intravenous iron, the truth about safety and administration, and its role in the management of earth’s commonest malady. It has been a rewarding path, the last 40 years, but at least half of those years were spent learning about the inaccurate folklore of danger.

We’ve all seen examples in recent months of what ChatGPT and other early generative AI systems can write – news articles, songs, computer code, to name a few – with varying degrees of success. Yet strong medical guidance is not among them and likely won’t be anytime soon.

As a practicing radiation oncologist at Yale School of Medicine and the co-founder of theMednet.org, a leading Q&A platform for physicians, I’ve been running clinical questions by ChatGPT to compare its answers to those we receive from actual doctors on theMednet.org, a leading Q&A platform for physicians.

For example, when I asked ChatGPT about offering consolidative thoracic radiation for patients with oligometastic NSCLC following upfront immunotherapy, it provided a series of definitions of the various terms in the question and some basic information about how an oncologist would make a decision. In other words, it told me what any oncologist would already know. On theMednet.org, we received detailed responses from physicians with specific medical references to inform treatment decisions.

For sure, AI has the potential to benefit both my clinic patients, as well as the more than 20,000 physicians who use theMednet platform, two-thirds of whom are the oncologists AI is expected to impact first. However, rather than replacing doctors, artificial intelligence almost certainly would make human medical intelligence more important than ever.

There are two major reasons for this: knowledge and trust.

Today AI solutions are good at aggregating data that already exists and placing it at the point of care. In other words, assembling what’s already out on the internet, what we call known data. It can tell me what’s in textbooks and guidelines or has been published. However, data is not knowledge, and many patient cases don’t fit neatly into what’s known. For that, we consult with colleagues and academic medical experts. It’s their real-world experience that differentiates data from knowledge, helping us make better informed decisions when diagnosing and treating patients.

AI solutions are good at...assembling what’s already out on the internet, what we call known data. It can tell me what’s in textbooks and guidelines or has been published. However, data is not knowledge, and many patient cases don’t fit neatly into what’s known.

Recently I saw a patient with lung cancer whose case illustrates this concern. She has a lesion in her brain that looks like a benign lesion. If an AI-based system were to interpret her scan, it would almost definitely find a benign brain tumor. But in the context of having lung cancer that is currently progressing in her lung and an old MRI that showed a smaller spot in her brain, it is more likely we’re looking at lung cancer that metastasized to the brain.

The second reason is trust. There are complexities to what information an AI surfaces and what it doesn’t. Today, there is too little transparency as to how AI models are programmed and this will be critical for AI to expand its role in clinical practice–especially for physicians to be comfortable with treatment recommendations versus surfaced insights. If we understand AI’s limitations, we can work alongside AI experts to ensure algorithms are informed by good clinical practice and real-world expertise.

That said, I do see enormous potential for this technology to help clinicians and patients alike.

In a recent poll we conducted on theMednet, 77% of physicians surveyed said they believed AI would help their jobs with decision-making, treatment planning and administrative burdens, among other things. But it’s still early days for most. In a separate poll asking how they’re using AI today, 70% of physicians surveyed said they weren’t using it at all. That percentage will certainly go up as the technology evolves.

In a recent poll we conducted on theMednet, 77% of physicians surveyed said they believed AI would help their jobs with decision-making, treatment planning and administrative burdens, among other things.

By employing this technology, we will be able to screen more patients for cancer because AI will help radiologists interpret CT scans and mammograms. In developing oncology treatment plans, today the work of drafting detailed radiation plans for my patients is all done by hand. I spend hours a day manually going through each slice of a CT scan to highlight a patient’s organs and the tumor. AI will do this automatically, freeing me up to see more patients and spend time necessary on cases requiring more attention.

Additionally, AI will also help modify treatment plans on a daily basis, so as a tumor shrinks or if a patient loses weight, the radiation dose can be modified in real time to reflect those changes.  There is still a lot of research being done on these technologies, currently not in widespread use but the potential is there.

At the end of the day, medicine is a human endeavor. Any technology and platforms that make it easier for physicians to interpret data and improve patient outcomes will benefit our profession and patients in a profound way. Yet there’s a level of medical insight that comes from sitting in a room with a patient and understanding not just the details of their medical condition but their lifestyle, emotional health, economic situation, support system, and more. The combination of the two would be powerful.

The better the AI gets, the better we’ll get as physicians.

Dr. Jennifer Miao, Cardiology Fellow at the Yale School of Medicine, recently accepted a position as Deputy Editor of Cardiology at theMednet. Her work helps medical trainees, academic physicians, and non-academic physicians discuss nuanced questions/topics not otherwise included in guidelines or textbooks. With its recent Cardiology launch, theMednet platform now features seven fields in Medicine, including Oncology, Dermatology, Rheumatology, Neurology, Pulmonology, and Hematology.

Dr. Jennifer Miao's story is one of determination, perseverance, and a deep appreciation for the sacrifices her parents made as international medical graduates. Growing up in a family of physicians, Dr. Miao witnessed firsthand the challenges her parents faced as they navigated residency and fellowship in a foreign country. “Thinking of their achievements especially early in their careers is inspiring for me as I'm constantly looking for ways to push myself further.”

In addition to her passion for medicine, Dr. Miao is a classically-trained pianist and also has a background in literary criticism and non-fiction writing. She graduated from Vanderbilt University with degrees in Music, specializing in Piano Performance, and English Literature. Dr. Miao went on to pursue her medical studies at Vanderbilt University School of Medicine, where she was accepted through the Early Decision Program during her sophomore year of college.

After earning her M.D., Dr. Miao completed Internal Medicine Residency at Vanderbilt University Medical Center in 2021 and then moved to New Haven, CT, for Cardiology Fellowship at Yale, where she is currently one of the chief fellows.

Throughout the course of her training, Dr. Miao discovered that cardiology fuels her desire to learn as she finds solutions to difficult problems under challenging circumstances. “It’s complicated work, but as I advance through my training, I become more and more inspired by my patients. Helping them through complex disease processes has always been an honor for me, and it’s intellectually stimulating as well.”

Despite its rewards, Dr. Miao has come to accept the varying levels of uncertainty that exist in medicine. “This is especially inevitable for critically ill patients, when you are still gathering information without knowing full well what their trajectory or clinical course might be,”  she says. “We encounter uncertainty often, and it's humbling. At the same time, it's also a privilege to be able to take care of sick patients, and to work with other specialists in coordinating their care.”

As a fellow, Dr. Miao has been witness to how theMednet can be used in clinical practice. “Having backup support when you’re uncertain is incredibly important. When we face a challenging clinical scenario in which solutions are not presented in certain guidelines, we refer to the wealth of knowledge available on theMednet.” It is a valuable resource for those in medicine, where new discoveries and advancements are constantly being made, and where the ability to adapt and learn quickly can make a significant difference in patient outcomes.

Dr. Miao has been working with theMednet as a Deputy Editor since October 2022. Besides its capacity as a question and answer platform, Dr. Miao says that theMednet provides an opportunity for physicians to build a sense of community. “It’s rewarding to see how multiple generations of trainees and attendings have been able to reconnect. As a user of the platform, I’ve been able to work with mentors that I haven’t talked to since medical school.”

“I think that from a trainee perspective, the amount of knowledge that's being shared and the quality of the discussion across these topics is incredibly valuable” says Dr. Miao. She refers to theMednet as a constantly evolving network of physicians. For a community that was restricted to textbooks, journals, and conferences to stay informed about the latest medical developments, it provides a collaborative environment and can have a positive impact on medical education and patient care.

“theMednet gives physicians easier access to their community, allowing them to feel more secure in the knowledge that it will be there to support them through complex clinical scenarios. I am thrilled to join the team.”

In line with theMednet's mission of improving knowledge sharing among physicians, we are proud to introduce another specialty--Rheumatology. Questions and answers that were once shared among peers and colleagues in a closed room or via email are now shared amongst a community on theMednet. We began with radiation oncology, and have since expanded into medical, gynecological, and pediatric oncology. Over the years there have been 4,000+ questions asked and the community now includes over 11,000 oncologists in the US. Currently, there are over 900 experts on theMednet who have contributed their knowledge, opinions, and research.

Rheumatology is unique in that the new treatments are rapidly outpacing guidelines. The development of biologics have greatly advanced the care of patients with autoimmune disease. Currently, there are new drug approvals every few months. With all of these changes, rheumatologists have more questions than ever. theMednet is filling that gap with a Rheumatology specific community. The Rheumatology launch has been greeted with overwhelming support, with nearly 600 members, including over 100 experts in all subspecialties from osteoporosis to vasculitis. The COVID-19 pandemic has created unique challenges in patients with rheumatic conditions and having quick access to expert opinions has become even more useful and relevant.  We are pleased to launch the Rheumatology section of theMednet and continue to enhance the knowledge and practice of medicine.

Every day, oncologists are confronted with increasingly challenging clinical situations, and we often find that current research and practice guidelines cannot be applied to many of our patients. We look for guidance, affirmation, judgment, and feedback from experts when we catch them in hospital hallways, via emails, and or through phone calls. Valuable expert knowledge is often incredibly helpful in treating our patients, but those conversations we have with experts typically stay between two people, and don't benefit anyone who is not involved in the conversation or email chain.

This is where theMednet stepped in six years ago. We have been able to not only capture expert knowledge, but also share it with the entire oncology community, so that these one-on-one conversations can benefit physicians (and patients) everywhere.

What are tumor boards and why are they important?

Tumor boards are regular multidisciplinary conferences where challenging cancer cases are discussed and peer expertise is sought out. At National Cancer Institute Designated Comprehensive Cancer Centers (NCI-CCC), tumor boards are more than a place for decision-making. They are a place for knowledge dissemination from experts, ideas that lead to research projects, discussions of clinical trials, multidisciplinary education, and discussions of existing controversies in treatment alternatives. Unfortunately, tumor board insights from experts at NCI-CCCs are not systematically documented and disseminated in a way that is easily accessible to physicians in the community. This represents a lost opportunity to capture and share real world questions, thoughtful discussions, and clinical expertise that can impact patient care in community centers, as explained in this ASCO Post video below:

theMednet is bridging the knowledge gap between academic and community physicians across the country.

theMednet is, first and foremost, a knowledge sharing community. With over 11,000 oncologists ranging from every type of institution and oncology discipline, theMednet is in a unique position to disseminate tumor board discussion and information. In 2017, theMednet started working with NCI-CCCs to turn tumor board conversations into searchable Q&A online.

Here's how that process works: a faculty member from an academic institution is selected as a site leader (SI), who is then tasked with distilling a discussion about patient management into a question. Faculty at the participating NCI-CCs are then asked to respond to the question on theMednet. Answers are peer-reviewed, indexed, and stored on the platform. Finally, the entire discussion is sent via email newsletters to registered oncologists. Using this strategy, tumor board discussions at NCI-CCCS catapult from 15-20 oncologists who were present at a single tumor board conference, to over 11,000 on theMednet! Watch the full report here:

The program quickly expanded to 15 NCI designated cancer centers focused on breast, thoracic, and GI tumor boards across the US, including MD Anderson Cancer Center, Ohio State, Yale, Columbia, and UCLA. By the end of the pilot program, tumor board Q&A was viewed by oncologists nearly 60,000 times, with answers coming from 70 academic physicians and peer reviewed by 88. Viewership of tumor board Q&As on theMednet increased 419% over three years. Additionally, 90% of all tumor board Q&As are viewed every month, meaning there is a long-lasting potential benefit for these discussions.

Popular Tumor Board Discussions on theMednet

Oncologists shouldn't have to digest new data and struggle through complex cases alone. theMednet connects experts at NCI-CCCs and community oncologists around the country. All of our patients benefit when expert knowledge is effectively documented and shared. Check out some of the latest tumor board questions below:

Will you recommend abemaciclib in combination with standard adjuvant endocrine therapy in patients with high risk hormone receptor positive, HER2 normal early breast cancer?

How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?

Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?

What would you use as adjuvant endocrine therapy for a patient who developed an invasive, hormone receptor positive breast cancer while on raloxifene for almost a decade prior?

After WBRT, what systemic therapy would you favor for maximal CNS penetrance in a patient with triple negative metastatic breast cancer and multifocal CNS disease?

Would weak PR positivity make you consider adjuvant endocrine therapy for a young pre-menopausal woman with a HER2 positive ER negative breast cancer?

What neoadjuvant therapy would you choose for a post menopausal woman with ER negative, PR positive high grade node negative breast cancer?

What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?

What is your strategy for a patient who develops an enlarging ipsilateral axillary lymph node shortly after undergoing mastectomy and ALND for a pT2N3 ER+/HER2+ right breast cancer?

In light of the recent approval of Nivolumab and Ipilimumab for metastatic NSCLC with PDL1 >1%, what is your preferred first line treatment option for a fit patient who is PDL1 positive (<50%) with no driver mutations?

What is your strategy for ovarian suppression if unable to achieve goal estradiol levels with leuprolide 3.75mg monthly dose?

In which group of patients you would send for RNAseq for translocations/fusions that might be missed by NGS in advanced NSCLC?

Which adjuvant chemotherapy regimen would you recommend for a peri-menopausal woman with synchronous stage IA primary breast tumors, one that is ER+HER2+ and the second ER+HER2-?

Would you consider chemo-radiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?

How do you plan to use the data regarding abemaciclib in combination with standard adjuvant endocrine therapy in patients with high risk hormone receptor positive, HER2 normal early breast cancer?

Do you recommend routine surveillance MRI brain for asymptomatic patients with metastatic HER2+ breast cancer?

In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?

How do you approach a stage IIIC triple positive IDC, s/p neoadjuvant TCH and P, lumpectomy, and ALND with significant residual disease at the time of surgery?

How would you approach a stage 1 HR+/HER2- pre-menopausal patient <50 years old with Oncotype DX RS of 24?

How would you treat a patient with metastatic NSCLC on pembrolizumab with a sustained complete response, now with 2 isolated small liver lesions?

Dr. Jessica Zimmerman is a third-year pediatric hematology/oncology fellow and soon to be Associate in Pediatrics at the University of Iowa Stead Family Children’s Hospital. She is also a Pediatric Oncology Associate Editor at theMednet!

Dr. Jessica Zimmerman, a hematology oncology fellow at the University of Iowa Stead Family Children’s Hospital, always held an interest in healthcare. She grew up on a farm in western Iowa, where her father is a farmer and her mother works as a nurse. This was Dr. Zimmerman's first introduction to medicine, and so for much of her early childhood, she wanted to follow in her mother's footsteps by becoming a nurse. In middle school, however, came a kind of revelation. "I realized, hey, girls can be physicians too. There were only male physicians in my hometown growing up, but I figured out that didn't have to be the case. So my dreams switched to wanting to be a pediatrician," Dr. Zimmerman recalls.

Until she started her undergraduate degree at the University of Iowa, Dr. Zimmerman volunteered for her hometown American Cancer Society Relay For Life. During her time in undergrad, she got involved in Colleges Against Cancer (now American Cancer Society on Campus), a collegiate-based group supporting the programs and fundraisers of the American Cancer Society. Dr. Zimmerman was also a four year member of the University of Iowa Hawkeye Marching Band!

After graduating with a focus in biology, Dr. Zimmerman attended the University of Iowa Carver College of Medicine. During a rotation in pediatric hematology oncology, she knew she had found her dream specialty: "the thing I really love about pediatrics is you get to know the kids and their families very well; you follow them through their journey of growing up. You get to be there for them in uncertain times. In hematology oncology especially, I see my patients sometimes weekly for their treatment. You become like their family they never wanted," Dr. Zimmerman says, "and that means we go through their treatment together."

After her pediatrics residency at the University of Iowa Stead Family Children’s Hospital, Dr. Zimmerman started a fellowship at the same institution. Initially, her focus was to be in clinical practice. But after a particularly memorable experience with a pediatric patient in the ICU, her focus shifted once more: "[My patient's mother and I] were having this conversation, and she asked me what I do for research. So I told her how I'm trying to figure out how to make steroids work better to treat B-cell ALL. She was enthusiastic, and told me I should continue my work and further my research. I think that conversation highlighted how big an impact research can have on patient care. It isn't all just about the clinical side of things." Dr. Zimmerman then decided to focus on lab work; she's most excited about the ongoing studies in leukemia involving targeted therapies, and front-line trials including immunotherapies.

And the world of oncology is a constantly evolving one: "everything in medicine requires continuous learning, and a lot of hard work," Dr. Zimmerman explains. She takes solace in the fact that having a focus on research means more time to delve into the latest studies and papers, at the cost of less time seeing patients. However, she expresses how tight knit the pediatric oncology community is in the US. "You get to know your colleagues and the experts very well," Dr. Zimmerman explains, "many of them are excellent doctors willing to give advice in challenging clinical situations to help us take the best care of the kids. What's so different about pediatrics is how we take a big team approach to our care: everyone, including the patient and parents, needs to be on board with your treatment plan."

One of Dr. Zimmerman's interests is in medical education, which made her the perfect candidate for becoming a Pediatric Associate Editor at theMednet! "Especially for the Adolescent and Young Adult (AYA) population, theMednet is invaluable. We're learning especially in leukemia that young adults tend to fare better when treated under pediatric protocols, and theMednet is a great way to bridge the gap between adult oncology and pediatric oncology."

Outside of work, Dr. Zimmerman spends time with her husband and almost three year old! "I think it's important to set aside time, especially on the weekends, for yourself and for your family. As busy as it gets, scheduling free time for yourself is vital."

Dr. Dwight Owen is an Assistant Professor of Internal Medicine in the Division of Medical Oncology at Ohio State University Comprehensive Cancer Center. His research and clinical focus is thoracic oncology, and understanding mechanisms of secondary resistance to targeted and immune-based therapies. Dr. Owen is the thoracic malignancies Associate Editor for medical oncology at theMednet!  

Dr. Dwight Owen recognized from an early age the terror that patients face when given a diagnosis of cancer. "Patients sometimes feel that their providers are at a loss of what to do for them, and that makes it difficult to take ownership of what's going on. What drove me to oncology was the human connection...the idea of helping someone even when the traditional metrics of "fixing problems" in medicine isn't achievable. At the end of the day, patients need to feel cared for and connected to their provider team." Dr. Owen always knew that an internal medicine and oncology focus was the right fit for him, as those specialties allowed him to be his patients' "home base". That human connection was readily available in oncology, he explains, "[because] we can form long term, special relationships with patients."

In his first year of fellowship, Dr. Owen had an unforgettable patient experience that helped shape his impressions of medicine. He was treating a patient with advanced disease who had an unlikely prospect of survival. After a few intense days of treatment, in the middle of the night, Dr. Owen got a call from the overnight team. "They told me the patient wanted to make sure whatever they were recommending was OK'd by me," even though he was just the first-year fellow on the team. What followed was a difficult conversation between Dr. Owen and his patient that his attending later called, "an important, vital conversation." Dr. Owen remarks, "that whole experience really sticks with me. I think about it and that patient often."

Those experiences also bring some of the toughest challenges Dr. Owen and other oncologists have to face. "We [as physicians] constantly find ourselves trying to hold out hope for new treatments, and that they'll arrive in time for our patients. The unfortunate truth that we must face is that won't be the case for many. Even two years makes a difference. There will be patients I meet today that won't be able to see the next advance in treatment." What keeps Dr. Owen going strong is how swiftly oncology is advancing. Immunotherapy for lung cancer, for example, has been, "transformative," he comments. Dr. Owen's team currently investigates new approaches to immunotherapy, some of which target a multitude of pathways. Combining immunotherapies has given researchers hope that they will overcome some cancer's ability to evade destruction by the immune system.

Innovations like theMednet are helping Dr. Owen and other physicians keep pace with larger quantities of research and information. "When I first read about theMednet, it seemed like a really interesting venue to bridge community and academic centers, but also different fields of oncology. There's so much expertise in the US, to not have that disseminated seemed like a huge limitation. Also, we [as physicians] hold ourselves to the impossible standard of trying to know everything. You always want to make the best decision for your patients, but when it comes to research, it's a never-ending effort. That's why tools like theMednet make things easier on the medical community."

Seeing patients make it through to the end of treatment makes the process of research and tough calls in patient care worth it: "some of the most memorable moments I have include exchanging cards with patients, seeing them go on vacation, and seeing them spend time with their loved ones. It's important to protect and hold onto the good times."

Additionally, Dr. Owen recommends getting, "as much experience as you can as a med student," to understand the specialty and medicine as a whole. He says the growing clinical demand in both in- and out-patient institutions is a concern for physicians in the US. The Association of American Medical Colleges, in partnership with IHS Markit, a global information company, released a 2019 reporting confirming, "the United States will see a shortage of up to nearly 122,000 physicians by 2032," due to demographic shifts, retiring physicians, and specialty demand. Dr. Owen laments, "it's something I wish I could change about medicine if I could. We're just going to need more caretakers."

Outside of work, Dr. Owen relies on the support of the community who understands the struggles and victories he and other oncologists go through. "I have a tight knit group of six other thoracic oncologists who are really supportive of both me and my work." He spends his free time with family, playing guitar, reading, and traveling—his recent trips were to Munich, Barcelona, and the Azores. While living in a small New York apartment during residency, Dr. Owen even tried his hand at brewing his own beer with a friend who had picked up the hobby in Israel, of which he says, "we tried to make IPAs and stouts, and in the worst case scenario, it's still beer!"