From Fellow to Attending: Lessons From Year One in Oncology Practice With Matthew Hadfield, DO, and Alankrita Taneja, MD

The Shift in Responsibility

One of the most striking challenges for new attendings is the weight of decision making. As Dr. Taneja explained, “Once you’re an attending, you have to put on your best game, and there’s very little scope for mistakes.” Similarly, Dr. Hadfield reflected, “In training, it’s easy to think things are more straightforward when you’re not the one owning the responsibility. Now, every decision carries that burden.” This shift highlights the need for humility, readiness to seek support, and a strong emphasis on collaboration, especially when patient care scenarios are complex and nuanced.

Mentorship and Decision Making

Both physicians highlighted how their previous mentorships continue to guide daily clinical choices. Dr. Taneja shared an example from multiple myeloma care: “My mentor always used prophylactic antibiotics, and while some may question whether every patient needs it, in my first year, I’d rather err on the side of protecting my patients.” For Dr. Hadfield, collaboration across specialties has been a crucial learning tool: “Patient care is rarely black and white. Collaborating with other specialists exposes you to perspectives you can’t find in a textbook.” Tumor boards and interdisciplinary input remain valuable resources for early-career clinicians.

Unanticipated Challenges

While fellowship builds clinical expertise, non-clinical responsibilities often catch new attendings by surprise. “Billing, relative value units (RVUs), chasing codes—none of that is covered in fellowship training,” said Dr. Taneja. Dr. Hadfield agreed, noting, “You start as an attending, and you’re just expected to know how to bill. Mentorship or formal courses on coding are critical.” Both emphasized the importance of proactively seeking out training or support in systems-based practice skills—areas that directly impact efficiency and satisfaction as a physician.

Maximizing Fellowship Training

Reflecting on their experiences, both saw missed opportunities during their fellowship training. “Fellowship might be the most flexible period of your career. I regret being on autopilot instead of actively asking attendings how they manage the day-to-day,” Dr. Hadfield admitted. Dr. Taneja added that exposure to a broader patient mix might have better prepared her for her hybrid role with both malignant and benign hematology. Additionally, adapting to new technologies such as AI-based scribes has been an unexpected benefit. As she noted, “It’s not perfect, but it has made my life so much easier.”

Patient Relationships and Team Support

While reflecting on the most rewarding part of their first year, both physicians decided that despite the administrative hurdles and steep learning curve, patient care remains the most fulfilling part of the job. “There is nothing that replaces caring for your own patients—it’s humbling and rewarding at the same time,” reflected Dr. Hadfield. Dr. Taneja agreed, highlighting the importance of support staff and navigators: “Going the extra mile for patients and seeing how much you can help—that’s what makes it all worthwhile.”

Key Takeaways for Early-Career Oncology Attendings

• Expect the first year to feel weighty as responsibility shifts entirely to you.
• Lean on mentorship and interdisciplinary collaboration for guidance and confidence.
• Proactively learn billing, coding, and workflow efficiency—skills often excluded from training.
• Use fellowship strategically to gain broad clinical exposure and observe practice habits.
• Remember that patient care—and the support teams behind it—remains the most rewarding part of oncology.

About the Speakers

Matthew Hadfield, DO, is a Medical Oncologist at Brown University/Legorreta Cancer Center. He recently completed his Hematology/Oncology Fellowship at Brown University. Dr. Hadfield’s clinical and research interests are in phase 1 clinical trials and developmental therapeutics, as well as cutaneous malignancies and immunotherapy-related adverse events.

Alankrita Taneja, MD, is a Hematologist at Jefferson Einstein Hospital in Philadelphia, Pennsylvania. She recently completed her Hematology/Oncology Fellowship at Roswell Park Comprehensive Cancer Center. Dr. Taneja is interested in multiple myeloma and cellular therapies and is passionate about humanism and equitable care.