In a panel discussion this week, four cancer centers directors described how their experiences as immigrants have shaped their approach to oncology and the U.S. healthcare system.
The “International perspectives in U.S. cancer center leadership” panel, hosted by the Cancer History Project April 20, included:
Narjust Duma, associate director of The Cancer Care Equity Program, thoracic oncologist – Lowe Center For Thoracic Oncology at Dana-Farber Cancer Institute, and assistant professor of medicine at Harvard Medical School, who served as moderator,
Kunle Odunsi, director of University of Chicago Medicine Comprehensive Cancer Center, dean for oncology within the University of Chicago Biological Sciences Division, and AbbVie Foundation Distinguished Service Professor of Obstetrics & Gynecology,
Peter WT Pisters, president of MD Anderson Cancer Center,
Leonidas Platanias, director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University and the Jesse, Sara, Andrew, Abigail, Benjamin and Elizabeth Lurie Professor of Oncology in the Departments of Medicine and Biochemistry and Molecular Genetics, and
Cornelia Ulrich, executive director of the Comprehensive Cancer Center at Huntsman Cancer Institute, Jon M. and Karen Huntsman Presidential Professor in Cancer Research, and professor in the Department of Population Health Sciences at University of Utah.
“When you leave your country, especially if your country is far and you immigrate here, your whole world changes and things are more difficult,” Platanias said. “You change completely. You do that because you want to do it, but this is something that defines you too. You understand more the difficulties that your patients have, too. You can relate more when you see other people and other problems.”
Odunsi agreed, breaking down the skills he gained on his professional journey from Nigeria, to the United Kingdom, and then to the U.S. into three parts:
“The ability to be able to interact, work, collaborate with people from all kinds of backgrounds, that’s number one. Number two is tenacity. How do you persist even when you encounter disappointment and failures? How do you keep going? How do you pick yourself up? How do you learn from your experiences?” he said.
“The very long path that I have taken has prepared me well to be able to deal with both success and failures. Then number three, it’s just the breadth. I think the breadth and depth of experience, of people skills, that comes with the long training.”
International backgrounds have given these oncology leaders perspective on the U.S. health care system.
“It pains me to see so many wonderful things in the U.S., but then how many patients do not have the access they need, cannot receive the care they need, have not the ability to get the treatments in many cases as well,” Ulrich, of Germany, said.
“The big difference between Germany and the U.S. is health insurance is universal. It’s not just public, it’s also private, but pretty much everything is covered, and everybody knows that,” she said. “Our billing is about 4% of the cost. All that money can go into healthcare, and it avoids this huge administrative and billing overhead. That’s where I would love for this country to go, for the benefit of all.”
Pisters agreed that insurance coverage is a benefit to the health care system in Canada.
“The strength of the system is universal access that’s based on residency. Of course, the fundamental flaw in our system in America, is that insurance and therefore access is linked to employment,” he said. “That creates tremendous challenges in large groups of individuals who do not have access to the front door of American medicine, because they don’t have employment or their employer doesn’t offer insurance.”
Pisters, who was previously CEO of University Health Network in Canada, acknowledges the pros and cons of both systems.
“I could see both the strengths associated with universal access, as well as a lot of the limitations associated with that as it relates to the ability to perform research and the ability to see centers of excellence, such as MD Anderson,” Pisters said. “You don’t see institutions of excellence or elite institutions in an environment that really is designed to elevate the medium, but not to support our pathway to excellence.”
Odunsi and Pisters said healthcare systems in Canada and the United Kingdom allow for better screening and earlier detection of cancers.
“The system in the United Kingdom, similar to the system in Ontario, also has this national call and recall system, whereby you get reminded that it’s time for your screening,” Odunsi said. “That kind of system is likely to enhance earlier detection of cancers. I see that type of model, along with the one that Peter described, as potentially a model that we should try and shoot for in the United States.”
The panelists said international medical graduates (IMGs) face barriers that American medical students do not. Platanias raised the issue of training grants for international students.
“Training grants right now do not allow people from other countries to participate, unless they become U.S. citizens or get their green card,” he said. “I think there should be an appeal to NIH to change that.”
Odunsi recalls facing discrimination when he applied for fellowships.
“I think there were two or three people in my residency class that were applying for fellowships. I was an IMG. I’m also Black. When I applied for a fellowship from Yale—I think I got only three invitations for fellowship, whereas my counterparts got like 20 invitations for fellowship,” he said. “So, what’s the explanation for that? First of all, my name maybe, is not familiar, my medical school is outside of the United States, all of those strikes.”
Odunsi, however, did not back down.
“Tenacity, persistence, don’t give up, drive through whatever barriers and obstacles that stand in the way,” he said. “I did not let that detract me from the big picture, from the goal of what I wanted to accomplish, and I was fortunate to get my fellowship done at Roswell Park Comprehensive Cancer Center.”
Duma said it’s important to alleviate barriers for IMGs, and called for action.
“We have seen an exodus of brilliant minds leaving academia. If we continue to put obstacles for international brilliant minds, the exodus is only expected to continue,” she said. “I just can’t tell you how many of my friends have left, and it’s sad. I hope that people find this inspirational, but also an opportunity to take action and advocate.”
Registration for Cancer History Project virtual panels is free. The next panel will take place May 9 on the topic of health equity.
