By Paul E. Wallner, DO, FASTRO and Naomi Schechter, MD
The following interview of Bruce Haffty, MD, FASTRO, was conducted on January 24, 2017, by Paul E. Wallner, DO, FASTRO and Naomi Schechter, MD.
Paul Wallner: So, could you start out by telling us where you were born?
Bruce Haffty: I grew up in Worcester, Mass. I went to high school there. I was born there. My parents were born there. Then I went to public schools in Worcester, Mass.
Naomi Schechter: What is it like there?
Bruce Haffty: It’s your typical kind of mid-sized city. Worcester used to be an industrial town, but it actually kind of evolved to be a college town. So there are some five major colleges there - Holy Cross, Worcester Polytech, UMass Medical, Clark University, Worcester State College.
Paul Wallner: Worcester is where? It’s between Springfield and Boston?
Bruce Haffty: Yeah. It’s about 40 miles west of Boston.
Paul Wallner: Okay. Did you have siblings?
Bruce Haffty: I have half-siblings. I’m my mother’s only, but my father had been remarried and so I have two half-sisters and one half-brother.
Paul Wallner: And college was where?
Bruce Haffty: I went to UMass in Amherst. After that I actually came back and went to Worcester Polytech Graduate School in biomedical engineering. I actually worked as an engineer for three or four years before I went to Yale Medical School.
Paul Wallner: Wow. Well, then the question is interesting. Why did you decide to leave biomedical engineering and go to medical school?
Bruce Haffty: Worcester Polytech, their program which is a master’s degree program, a part of it is very much a practical kind of engineering program. We had to do a project, kind of hands-on projects, that was part of their program. Even as an undergraduate, there you had to do hands-on projects. They have a nice network of practical places to do projects in biomedical engineering. A lot of those were linked to the hospitals in the region. So I did my project working at one of the hospitals, St. Vincent’s, which is a major teaching hospital of UMass Medical School.
I was working in cardiovascular signal processing. I was really doing research more than I was doing engineering. It was really biomedical research. I was working for the chief of cardiology, Dr. David Spodick who was very influential in my becoming a physician, and a significant mentor for me. We were doing signal processing of various signals, from EKGs to pulse waves, and analyzing them and correlating them with clinical outcomes and clinical things. So that’s basically how I -- and I thought I was going to be a cardiologist actually.
Naomi Schechter: I was about to say did you ever think about cardiology.
Bruce Haffty: Yeah.
Naomi Schechter: What changed your mind?
Bruce Haffty: When I was in medical school, first of all, I also knew about radiation oncology because at the hospital that I worked in I did some -- I didn’t do radiation oncology research, but I knew that it existed. I knew a little bit about it. I rotated through it in medical school. I enjoyed it and just decided that that’s what I wanted to do so when I was in medical school, the cardiology market was thought to be flooded. Now that actually was false. I mean it was true in a sense. People were talking about, well, if you want to be a cardiologist, you’re going to end up just being an internist and taking blood pressures because there are many cardiologists out there. Well, it turned out that wasn’t the case. That was one thing that probably drew me away from cardiology. The other thing was that I enjoyed the technical aspects of radiation oncology. I thought it was kind of a good fit for me. I enjoyed the rotation.
When I had gone to medical school, I was a little bit older than the average medical student. So if I was going to do something like cardiology, it was going to be three years of internal medicine and another three years of cardiology fellowship. So it was practical decisions like that, plus I really enjoyed my radiation oncology rotation and I knew a little bit about it.
Naomi Schechter: How did you get introduced to it? Not everybody knows about it.
Bruce Haffty: Well, I knew about it only because when I was working at the hospital and before medical school, in my research I just knew that that specialty existed. I knew the system, the department. We had worked together a little bit on some collaboration as I was doing my own research in cardiology. I just knew the specialty existed, and so when I was in medical school I decided to do a rotation in radiation oncology.
Paul Wallner: You ultimately trained at Yale in radiation oncology?
Bruce Haffty: Yes. Yes. So once I finished medical school, I just stayed at Yale.
Paul Wallner: Right. Was Jim Fischer chair at the time?
Bruce Haffty: Yes, Jim was actually our chair.
Paul Wallner: Who were some of your peers and some of the faculty?
Bruce Haffty: My peers were actually the most influential because, one, my chief resident was Lou Harrison.
Naomi Schechter: He was one of my attendings at Memorial.
Bruce Haffty: Yeah. Lou was my chief resident. Lou was also there as a first and second year resident when I was a medical student rotating through, so I knew Lou then. And Tim Mate from Seattle. Tim Mate was also my chief resident, and he was very influential in my career. And Jim Fischer of course, the chair. The other influential people there - I guess mentors of sorts - would be Dick Peschel who was the program director, and Jim Fischer obviously who was the chair, and a radiation oncologist on faculty Joe Weissberg.
Joe Weissberg was I would say probably the model that I look to the most because he was a clinician who did some research, but he ended up going into private practice during my last year of residency. He was very articulate and a good clinical researcher. He was the one who did breast and head/neck, which I ended up doing. But my most significant mentor was actually the cardiologist that I had worked with before medical school, Dr. David Spodick, who taught me a lot about clinical research.
Paul Wallner: Was Len Prosnitz there at the time or had he left?
Bruce Haffty: So Len had just left when I came in. I graduated from medical school in ‘84, and I think Len went to Duke in around ‘83.
Paul Wallner: What about Stan Order? Had he already left?
Bruce Haffty: Oh, no. Stan was way back, way before that.
Paul Wallner: Way before that?
Bruce Haffty: Yeah.
Paul Wallner: Okay. Had Vince DeVita come from the NIH at that point?
Bruce Haffty: Not yet. Not yet. He came to Yale toward the end of my residency and beginning of my attending time.
Paul Wallner: So you did work with him there?
Bruce Haffty: Oh, yes. Absolutely.
Paul Wallner: What was it like to work with him?
Bruce Haffty: Vince was great. I mean Vince, obviously he’s a medical oncologist. He wasn’t directly in my department, but he was head of the cancer center. He was very friendly from a radiation perspective. He had his battles mainly with medical oncology and the administration because he didn’t have as much authority as a cancer center director as I think he thought he should. But it was great working with him. I think he brought a lot to the institution. I worked with him and I think he was a great influence for Yale.
Even though some of my predecessors, Len Prosnitz was gone and Sam Hellman had left, one of the very interesting things was that oftentimes, when I was reviewing charts in my early years particularly in the breast world, it was not uncommon to see the notes of Sam Hellman and Len Prosnitz and Stan Order and Morton Kligerman. All of them were there.
Paul Wallner: I forgot about Mort.
Bruce Haffty: Yeah. Mort was there. All of them were there.
Paul Wallner: When did Mort leave to go to Los Alamos? While you were there?
Bruce Haffty: No. No. That was in the ‘70s, I think. Yeah, that was way earlier.
Paul Wallner: To get to Naomi’s point, how did you get involved in breast cancer and then head/neck as a second choice?
Bruce Haffty: Initially, when I was a resident, I had started just doing various research projects. Again, I think this gets into a little bit, you know, I want to kind of focus back on Len Prosnitz. Because I think that when Len was at Yale, he along with a couple of surgeons were very much ahead of their time in doing breast-conserving surgery in Connecticut - before it was fashionable, so to speak. In fact, before it was even considered the standard of care. It was very interesting that, looking back, there were people who thought that they were committing malpractice by doing breast-conserving surgery and radiation. You know, people insinuating that these patients should have been on trials. They should not be experimenting on patients or whatever.
But Len Prosnitz and a couple of surgeons - one who was before my time, Goldberg I think was his name, I forget; Charlie McKhann who was another breast surgeon; Malcolm Beinfield who was another breast surgeon - were breast surgeons in the region who were very much into doing breast-conserving surgery. Because of that, in the early ‘80s Len had started the breast conserving database. So when I was a resident and I had started working on that database, Len had gone. I think it was Joe Weissberg who had picked it up.
Then, just as I became an attending, Joe Weissberg left. So I picked up the database. What I did was I just built it up even bigger. That’s kind of how I really built my academic career, was on the breast-conserving surgery database. So a lot of the credit, how I feel somewhat, I owe a lot to Len Prosnitz and the two surgeons that really have been pioneers in doing this work because basically almost anything that I wrote about from the database was novel because it was new.
We had one of the original databases, along with the Harvard group, which Sam Hellman had built up there - a database early on from those surgeons. So if you had a few hundred patients treated with breast-conservative surgery and radiation, well, that was a big deal back then.
Paul Wallner: Well, I’ll give you a bit of historical perspective. In 1975 or 1976 the first large multi-institutional study -- and this is how I became friends with Len and a couple of the others involved. Len, Jay Harris, Barbara Fowble and I did the four-institution study. It was the first report out of the United States, the first large report.
Bruce Haffty: Sure. So as you can see, I mean anything you said - you could talk about margins, you could talk about different histologies, you can talk about whatever - it was a unique experience. So that’s how I built my career in breast.
The other thing that was going on at Yale at the time was the mitomycin head and neck trials. I got very involved with those because Joe Weissberg - who, again, I was kind of replacing because Joe was leaving and I was coming on - along with Jim Fischer who really started the trials were involved. I became involved immediately in the mitomycin head and neck trials, and so that’s how I got involved in those two areas. When Joe left, even though Jim Fischer was the chair and really the head of those trials, I was the clinician who was pushing those trials and putting the patients on them more than anybody else. So I kind of became the mitomycin head and neck trial person.
Paul Wallner: Right. How long did you stay at Yale then after you finished training?
Bruce Haffty: I started as an attending at Yale in 1988 and stayed there until 2005 when I came here to Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School.
Paul Wallner: And when you came it was pretty much of a wasteland I guess to Robert Wood Johnson, and you built a superb department. Do you want to talk a little bit about that experience?
Bruce Haffty: Yeah. So when I left Yale, Robert Wood at the time - at least the one in New Brunswick - was really a non-academic department. There were two or three physicians, two physicists and two LINACs. There was no biology. There was no academic program. No residency. That’s why I came. After a lot of negotiations with the institution about what resources they were willing to put in, and they were willing to do a lot, we were able to build it. That’s been the fun part of it. That’s kind of like I could view my legacy here was building the department. We now have 14 clinicians, an equal number of physicists which seem to multiply every year more and more. We have five basic science labs and a residency, eight residents, and a physics residency. So a real academic department.
Paul Wallner: And now a proton facility?
Bruce Haffty: And a proton facility, right. Those had been so much fun, doing that over the past ten years. A lot of that is getting the right people to come and stay, and so a lot of the junior faculty and people who are hired right out of the residency are now almost at the full professor level. They’ve stuck around for ten years and still going strong.
Naomi Schechter: I have a question. Because we’re doing a similar thing at USC, how did you entice people to stay? Because it is hard in a non-academic center to start all those academic programs. I’m sure you had to build the IRB_access and other things at the center as well.
Bruce Haffty: Yeah. Well, I mean a lot of it just is that they built their careers here - a lot of them. We did encourage and have a lot of trials that we’re able to do out of the resources in the institution. So they didn’t have to get funding to do a trial, that sort of thing. Again we have an NCI-designated cancer center. We have a medical school. And we have a major teaching hospital. So I think the material is there for them to kind of build and do things. To do an academic practice, the environment was here. All the ingredients were here. They just needed to take advantage of it, and they did.
Naomi Schechter: So it was just the department itself that needed to be built? The other departments were already academic?
Bruce Haffty: Right. Right. Absolutely. Yeah. I mean the cancer center was here. I think medical oncology and surgical oncology were already functioning reasonably well as academic places. The medical school was here. Obviously the teaching hospital was here. Just radiation itself was in kind of a community hospital setting.
Naomi Schechter: After being at Yale for so long, it must have taken a lot for you to look to leave.
Bruce Haffty: Yeah, it was a very hard decision. In fact, I almost didn’t leave. One of the stories that I often tell when I’m talking to people is, after five months of negotiation, the dean and the cancer institute director said we have to have an answer by December 1st I think or something like that. And I said okay. This is kind of a comical story. So December 1st came and I couldn’t make up my mind. I had told my wife that I was probably going to take the job. But I still couldn’t make up my mind, so I called the dean and I said, well, I can’t make up my mind so I’m going to turn down the job. Then I went home that evening and I said to my wife I turned down the job. She said: What? I thought you were going to take the job? I said: Well, I couldn’t. I was confused. I didn’t know what to do and they wanted an answer, so I just said no.
So I got into my car and I drove around, which was how I was going to try to think about things. It was now about midnight and I decided. I changed my mind, I was going to take the job. So I called Bill Hait who was the cancer center director. I said, Bill, did you hear I turned down the job? He said: Yeah, we did. Bruce, I’m very disappointed, but you got to do what you got to do. I said, well, I changed my mind. And he said, oh, okay. I said, should I call the dean? He said, Bruce, it’s midnight. So I said okay. He said why don’t you see if you feel the same way at 8:00 in the morning and then call us then, and so I did. When I called them I told them I changed my mind. I took the job and that was it.
Paul Wallner: How much of an influence on your decision was it that Bill Hait and Mary Todd had both come and worked with you at Yale?
Bruce Haffty: Well, that was a huge thing. I mean it was not only Bill Hait and Mary Todd but half of Yale was down here. Bill had recruited a lot of people from Yale. One of my fellow interns when I was an intern at Yale, Joe Germino, was a clinical scientist here in medical oncology. David August in surgery. Michael Reiss. There were probably a dozen Yalies here at the time, so it kind of felt a home to me in many ways. That was a part of it.
But the bigger part of it was that the opportunity to build a program from scratch and at least having them write down on paper what they were willing to support - a residency, expanded faculty, added machines, three or four basic science labs. Those things, which was huge, at the time they said it would cost somewhat. This was over ten years ago and it cost them $15 million to $20 million in terms of the total package to set up the basic science labs, add the machines, a residency program, adding faculty and that sort of thing.
Paul Wallner: Did they ultimately fulfill all the commitments they made?
Bruce Haffty: Pretty much they did. Yeah, pretty much. Most things they did. There are a few things that never came to fruition. But almost everything they really did, yeah. In fact, the protons were not even part of that. I didn’t even ask for the protons.
Naomi Schechter: Who did you look to for advice when you had to present the plans to them and what you were going to ask for? How did you develop that?
Bruce Haffty: Well, a lot of it was what I knew I had available at Yale. So a little bit was that. I mean I talked to a couple of other chairs, but a lot of it was kind of just copying the Yale model. For example, in the basic sciences, I said I needed three basic science laboratories and they wanted to give me one. They said why do you want three and I said, well, Yale has six so I want three.
Naomi Schechter: How did you figure out how much it cost to do this?
Bruce Haffty: Well, that data was pretty available. I mean at the time it was known that a basic science package was between $500,000 and $1 million. Probably at that time closer to $500,000 to $750,000 because you’d have to support that person for three years. Before they got grant funding, you have to give them. So those kinds of things. I knew from just talking to other chairs like what a basic science package cost. In terms of equipment and upgrading equipment, I had talked to people about what the latest technologies were and what we needed and a few minor things like that. But a lot of it was basically just me kind of replicating what we had at Yale.
Paul Wallner: How did it feel and what was it like taking the lead from being a department chair to a center director even though it was just interim?
Bruce Haffty: It was interesting and it was good. I enjoyed. I think it was good in the sense that I got exposure to a larger part of the university. I mean as chair you have pretty good exposure to people in the medical school, but not necessarily throughout the entire university. As a center director, a center director here is really a dean’s level job because the center is almost independent of the schools. So as a center director you get exposure to all the other deans of the pharmacy school, the other medical schools, the Rutgers University.
So as a radiation oncologist, I think it was good both for me personally to get exposure. People now know who I am and what I’m about. Also, from a specialty point of view, I think it’s good that people saw a radiation oncologist actually did a reasonable job of running the institution. And I didn’t have to live in a basement, anyway.
Paul Wallner: Right.
Bruce Haffty: Right. So yeah.
Paul Wallner: How does it feel stepping back away from that?
Bruce Haffty: Well, first of all, it’s good because the guy who came in I’m very happy with and I have a very good relationship with. What happened though is a lot of the things that I took on I’m continuing. Even though I had a leadership role in a cancer center before, I have more of a leadership role now because of certain things that I’ve done that he wants me to continue to do. I have kind of a new job in the cancer center so it’s not entirely stepping back. But yeah, I’m happy too that he’s here. Because the biggest issue is the cancer center support grant and that’s going to be a huge undertaking, writing that and putting that together. Certainly he has the stronger skillset to do that than I did. But on the other hand, running the clinical operations and other things and dealing with some of the clinical issues are some of the stuff that I’m going to continue to do.
Paul Wallner: How much time do you have personally for clinical care now?
Bruce Haffty: I try to do one day a week. You know, 20 percent of my time.
Paul Wallner: Just breast?
Bruce Haffty: Pretty much.
Paul Wallner: Can we switch gears a little bit? You’ve been incredibly involved organizationally over the years. I may not have even listed all of the various organizations. Do you want to sort of compare and contrast? Tell us a little bit about your experiences, disappointments, challenges, successes with some of them.
Bruce Haffty: Sure. I think some of my most memorable experiences were with the ABR. I enjoyed that because I think that in the ABR we had a tremendous opportunity to impact the practice and impact on the specialty. I really enjoyed that and I enjoyed working with people outside of strictly radiation oncology, so our physicist colleagues and our diagnostic radiology colleagues. I found that experience very rewarding on multiple levels. I felt honored that I was able to serve as president of that organization as well.
Obviously ASTRO has been a huge influence in my life and is the major organization that I kind of identify with because I see ASTRO as the more all-encompassing societyin terms of moving the research and the education forward, as well as our political advocacy. This is how I see I guess the one thing in looking at kind of a political view of our specialty of what’s happened, is that at what point in time – and, Paul, I think you would identify with this - ASTRO was to some degree our scientific and research and educational arm. RSNA was the diagnostic radiology’s scientific and research and education arm, and there was a little bit of radiation in there too. And ACR of course was our kind of political and advocacy arm.
What’s evolved over the years is that ASTRO became this overarching organization that did all of those things. RSNA I think, which I’m very involved with now, is more strictly a research and education body. It doesn’t get into the political things as much. But radiation oncology, as a component of it, has gotten smaller and smaller and smaller. So our relationship with them, it’s very difficult to understand where that’s going to go given how our specialties have evolved. But once in a while there’s these things that happen in the field that bring us a little closer together - whether it’s image-guided radiation, or quantitative biomarkers and imaging biomarkers and things like that that kind of bring the imagists and oncologists closer together. But we identify a little bit more now with our colleagues in medical oncology than we do with our colleagues in diagnostic radiology. So that’s all very confusing and an evolving area.
Paul Wallner: From an organizational perspective over the years in your leadership role, were there successes you’d like to highlight or disappointments or lack of successes, if you will, that you’d like to mention?
Bruce Haffty: In the organizations?
Paul Wallner: Yeah.
Bruce Haffty: I think a success of the organizations is ASTRO’s collaboration with other organizations in guidelines and consensus statements that help to guide practice. Collaborations with ASCO, SSO, ACR, AUA and others to create practice guidelines is very important in moving the field forward. I think a disappointment or challenge has been some tension between ASTRO and the ACR that’s occurred as priorities of the organizations and our specialties have changed over time. I’m not sure how to rectify it because I think that there are just naturally areas that we have drifted apart or are conflicting like our accreditation programs. On the other hand there are clearly areas in practice guidelines and advocacy where we continue to collaborate.
Naomi Schechter: What do you think is going to happen with the accreditation program?
Bruce Haffty: I don’t know. I really don’t know. My guess would be that the APEx program will predominate over time. I don’t know that. We still work very closely, however with our diagnostic radiology colleagues in the ABR because the mission was the same with certification. Granting the certification and details of certification are a little different, but the processes were the same. So we had a similar goal and a similar mission, that was to do quality certification and recertification. We seem to work it out within the ABR despite the very different aspects of our specialties.
Paul Wallner: Let’s switch gears a little bit again. Putting on your seer and prophecy hat, where do you see ASTRO and radiation oncology in the next five or ten years?
Bruce Haffty: Well, I think the challenge for ASTRO could be one potential challenge. First of all, I think ASTRO, because it really is our major journal society and our major organization for an annual meeting, it will still be the preeminent society for radiation oncologists. It will still be a big part of everybody’s professional lives. I think the one challenge will be subspecialization and whether individuals will begin to identify more with their subspecialty and; therefore, become more involved in the multidisciplinary meetings and that sort of thing.
So will it come to a point where as a head and neck radiation oncologist you don’t identify as much with ASTRO and going to the ASTRO meeting as you do with going to a multidisciplinary meeting with your medical oncology and otolaryngology colleagues? Or, if you’re a GI person, do you go to GI with the surgeons and the medical oncologists? Is that more important to you at least from a professional perspective?
To some degree we start to see a little bit of this happening at the various larger cancer centers where people are aligning more by tumor and sites and identify more with their site than they’re with their discipline. So that’s something that I think will be an interesting evolution over time. Whether people become more subspecialized, that is more important. Even departments are starting to -- I mean we’re finding this in all of them. You’re starting to see a little bit of this in all of medicine where service lines are becoming more important than disciplines.
So the cancer service line is - which means surgical oncology, medical oncology, radiation oncology all together – becoming more important than the separate disciplines. As these service lines become more and more important, the actual specialty people start to identify more with what they’re doing. You end up being part of the GYN group or the breast group, and not necessarily identifying with being a radiation oncologist. It’s more that you’re identifying with being a breast specialist or a head and neck person.
Paul Wallner: Do you see any challenge to the specialty from the scientific developments that are taking place now and presumably will explode over the next few years?
Bruce Haffty: Yeah. I mean there’s always that possibility. But I do believe that the tool that we have, radiation against cancer, is the most powerful tool against cancer. That because of that, and just because of the nature of what radiation is, we are the only ones that learned how to use that tool well. So I think we’re protected to some degree. But we have lost ownership of the patient, as we’ve all talked about that. Even now, for DCIS, you see the patients go to the medical oncologist first or whatever. So that issue of losing ownership of the patient has been a problem.
But I do think that radiation as a tool is the most powerful cancer tool that will be around for our lifetime and I’m not really concerned that it’s not going to be used. It’s going to become more and more important as we see. Even in oligometastatic disease now, stereotactic radiosurgery is critical and local regional control becomes more and more important as systemic therapy gets better and better. So I’m not worried about the specialty going away. It’s still going to be very important.
Paul Wallner: So that would be your advice to me if I were applying as a young academic radiation oncologist?
Bruce Haffty: Yes. Yes. Absolutely. Yeah. There’s no issue with the future of radiation oncology in our lifetime being a viable specialty. I do think, however, that we could do a better job at ownership of the patient and becoming more the leaders on the team rather than the purveyors of the technology so to speak.
Naomi Schechter: What do you think that would require?
Bruce Haffty: Well, I actually am hopeful that there’s an interesting trend that is happening. Well, first of all, it’s somewhat personality dependent. I mean some people are leaders and some are not. Some people want to take more ownership of the patients and are more proactive, and others are not. I see that even among my own faculty.
Naomi Schechter: Do you think it might be that we need more medical oncology training in our programs?
Bruce Haffty: No, I don’t think so. This is something that I’ve recently thought about as an opportunity for our specialty, and that has to do with the emergence of the hospitalist as a specialist. I’ll tell you why that’s important. One of the reasons that we’ve lost control of the patient is that for the most part we don’t admit patients. And because we don’t admit patients, I mean the typical thing - this is a bad example - a patient is nauseous or whatever. They’re on radiation treatment and you send them to the medical oncologist so they can get admitted to the hospital. Or you’re taking care of a head and neck patient, or you’re doing brachytherapy. You have an overnight brachytherapy and a GYN patient, and you have to admit them to the GYN oncologist so they get admitted.
So an interesting thing is happening in all of medicine, and that is that even the primary internists and the medical oncologists are no longer admitting their patients as much - at least in major academic centers. What they’re doing is they’re admitting them to hospitalists. They’re still involved, but they turn them over to a hospitalist. There is an opportunity and we’ve done this a little bit in our institution. We’re looking at formalizing it a little more. But now, if a patient gets sick right now and they’re under radiation, you’re primarily taking care of them and getting them ready. You don’t have to call the medical oncologist. I mean you should call the medical oncologist to let them know what’s going on, but we can admit them directly to the hospital. So we can become more involved in owning the patient, if you will. I think that’s an opportunity that we really haven’t explored as much as we could.
For our GYN, the only reason that they’re admitting the patient is for brachytherapy, maybe we can admit them to the hospitalist. Now we still have to involve the GYN oncologists. We don’t want to upset our referring physicians by not involving them, but we don’t really have to dump it on them anymore by taking care of our problems. We can admit directly to a hospitalist, and I think that’s an opportunity that we can take advantage of over time. Because even your general internist, you know, he’s not stopping by and admitting patients anymore - at least around here.
Paul Wallner: Are your attendings and residents comfortable with that model?
Bruce Haffty: Well, we haven’t really formalized it yet. But yes, some of our attendings are doing that now. I mean they’re calling the hospitalist. What we’re trying to do is just arrange a relationship. I think once you develop a relationship with them and then they understand, okay, these are the kind of patients that we have problems with and once in a while we need to admit them, you get away from that mentality of just calling the other docs or sending them to the ER for every problem. I mean it’s a potential opportunity, but I think it needs to be developed within the specialty. But I think, again, it’s an opportunity for us to begin to take a little ownership. At least that’s something that I would like to see happen because I think we have lost a lot as opposed to - and Paul, you know this - early on we owned the patients. Right?
Paul Wallner: Yeah. When I started, we had 30 people in the hospital on our service.
Naomi Schechter: It might have come from your training program, because Dr. Harrison used to say that often to my training class.
Paul Wallner: It was a generational issue. Part of that, Bruce alluded to that. In the early days the number of beds you controlled were in some respect power. So if you wanted to gain equipment or personnel or resources which are from hospital administrators, you had to be large admitters. They didn’t really look much at outpatient technical revenue in those days.
Naomi Schechter: You didn’t mention the RTOG. Do you think we’re losing power with NRG? Or do you have any advice in that regard?
Bruce Haffty: Honestly I am not an active RTOG person. I really have never been an active part of RTOG with the exception of involvement in some trials. I’ve had the unique opportunity of working with the Alliance Group. I do think that many of the radiation trials obviously come up through the NRG now and so that’s a natural home for many, many radiation oncologists. A missed opportunity for many of us has been not being as involved and taking leadership roles in some of the other cooperative groups.
I’ve had the opportunity to serve as vice chair of the Alliance breast group and be very involved in the trials there. It’s a lot easier path, if you will, because there aren’t as many radiation oncologists involved and if they’re interested in local and regional questions which they are. So ECOG, and Alliance, and SWOG are opportunities for radiation oncologists also to get very involved in designing trials. But, again, it’s personality driven. It’s going to the meetings and making sure you’re listening and making sure you bring your ideas up.
Naomi Schechter: I saw your update at the ASTRO meeting about the recent Alliance trial. How did you end up rising in that organization?
Bruce Haffty: Actually how I ended up in that organization, it was kind of a strange route, was I actually started being involved with ACOSOG which is the American College of Surgeons Oncology Group. What happened with ACOSOG is ACOSOG, when they restructured all the cooperative groups, ACOSOG became part of Alliance. So as an ACOSOG member, I kind of got absorbed into Alliance.
Paul Wallner: Do you think there’s any validity to what has been a long-standing criticism, that RTOG was more of a political entity than scientific and that a lot of the science was really soft?
Bruce Haffty: No. No. I think people will say that about all the cooperative groups to some degree because clinical trials are always a little bit of a negotiation and a little bit of a committee work and everybody kind of getting in so a lot of chefs are stirring the pot, so to speak. So sometimes the science might get watered down, but in the end RTOG has done some great trials. I think people criticize all the cooperative groups because, well, some of the trials answered questions that are not as scientifically valid or as scientifically rigorous as we’d like it to be. But I think NRG has done as good a job if not better than any of the groups, and certainly have done a better job of answering questions that are pertinent to us.
But Alliance now is one where we’re doing currently the axillary dissection versus axillary radiation after neoadjuvant. So that’s an Alliance trial. In Alliance also we just mounted - I haven’t started it yet, but it will be launched in the next few weeks - the post-mastectomy hypofractionation versus standard fractionation.
Naomi Schechter: Oh, great. Okay.
Bruce Haffty: Yeah. So I think there are opportunities outside of NRG that radiation oncologists can take advantage of. Because obviously at NRG - and RTOG, a part of it – you go up against all of the radiation oncologists. So it’s hard to get ahead sometimes. Whereas, in some of these other groups, it’s easier because you’re in with med oncs and surgical docs. So if you’re one of two rad oncs on a certain committee, you’re going to get your ideas across maybe.
Naomi Schechter: Was that your idea, the hypofractionated post-mastectomy treatment?
Bruce Haffty: Yes, that was our idea. I did that with two of my faculty actually. One of my faculty who’s actually now at the University of Utah, Matt Poppe, is the PI on that. Atif Khan and I are the co-PIs on that.
Naomi Schechter: It’s open now?
Bruce Haffty: It will be.
Naomi Schechter: I wanted to do that at our institution, but I’m glad you’re doing it nationally. That’s great. So is it a group made up of medical oncologists, surgical oncologists, and interdisciplinary. National or international?
Bruce Haffty: The Alliance group is national. It’s the old CALGB. Well, actually I shouldn’t say that. It’s a combination of the old CALGB, ACOSOG, and the old North -- whatever that was.
Paul Wallner: North Central Oncology Group, wasn’t it? North Central?
Bruce Haffty: Yeah, the North Central. So it’s those ones that came together; whereas, ECOG and ACRIN came together. Then RTOG and NASBP and GOG got together.
Naomi Schechter: Are you doing it at your own institution currently?
Bruce Haffty: We did a Phase II at our own institution. So yeah, we will open it. Yeah, for sure.
Paul Wallner: Changing gears a little bit again in the last couple of minutes because I don’t want to take too much of your time, how did you rectify all of your activities with family life?
Bruce Haffty: I think it’s a challenge. I think in the earlier part of my career I did stick around a little bit more with the kids when they were younger. I mean my older daughter was born in my second year of medical school. My younger daughter was born in my first year of residency. So in the earlier part of my career I was probably around a lot more. But I think there’s always a work-life balance.
Kathy is my second marriage obviously. My first marriage, my first wife was home with the kids for the most part. She didn’t have a competing career or that sort of thing. I think nowadays it’s very challenging for people with dual careers and families. I can’t say that I could have done what I did if my spouse had a career of her own. It would have been a problem. But there’s always a work-life balance and you still try to have your family time. You try to make it home for dinner.
I think we do have a specialty. As an academic radiation oncologist, you spend a lot of your free time doing the things like writing papers and doing reviews and weekend meetings and things like that which does take away from it. But, on the other hand, our specialty itself is not something where we’re on call coming in and working late, late hours all the time. So I think you can work things out. It’s just that you have to set priorities.
Naomi Schechter: Did you go back to work after dinner at home or at work?
Bruce Haffty: Yes, and I still do but I do it at home. I don’t go to work. I have my computer that logs into my office computer. So I’m sitting there watching TV, but I have my laptop on and doing stuff at the same time.
I think that’s another thing that I would have about advice for at least people going into academic practice, is that being a good multitasker is very important. I can go see a patient in clinic and be between patients and be reviewing a paper or doing something also and doing a lot of things at the same time. I think that’s part of the survival of my academic career.
Naomi Schechter: What are your children doing now?
My older daughter is a clinical psychologist, and my younger daughter is a hospital laboratory manager.
Neither of them are in strictly medicine, but they’re in that space a little bit. My step son is in the business software securities world.
Paul Wallner: Naomi, do you have any other questions?
Naomi Schechter: I don’t have other questions. But I’d like hearing his advice, if he has any other advice, for other radiation oncologists.
Bruce Haffty: Yeah. Well, my general advice is always do what your passion is and to be persistent I think is more important than making big splashes of things. In my early academic career, I had a very simple goal, and that was every year just try to write an abstract to present at ASTRO. That was just it. That’s what I want to do. I’m going to work on a project and I’m going to write that project up. Of course it ends up multiplying so you end up doing more than that over time, but it was persistence. It wasn’t like, oh, I want to get New England Journal of Medicine paper. It really was little kind of achievements that you kind of persist at and go to time after time. That’s how you succeed, unless you get really lucky or you’re really smart. But for most of us, it’s just a matter of persistence and continuing to work along a theme.
And I do think it is important to work on a theme. You can do maybe a couple of areas. At least in the academic world you can do maybe a couple of disease sites. But it’s very hard to succeed and make any great progress, move things forward or make a name for yourself if you’re doing ten different kinds of things. I mean early in my career I was doing a little GYN, a little head neck, a little breast. Eventually I’m kind of, okay, I’m just doing breast and I’m just going to try to make some progress, and write some trials or do some grants or write some papers on this and do it over and over and over again. That’s what I would consider it to be, how to at least succeed in the academic life.
Paul Wallner: What do you think about the importance of good mentorship?
Bruce Haffty: Well, I think it’s important because you need some guidance about whatever you’re doing. You need guidance to set your priorities and say, okay, this is the direction to go in. But I think that it still is very much up to the individual to succeed and to take the reins. I say that from personal experience. There are some of my own faculty of people that I have, quote, mentored - like Meena Moran, and Ben Smith, Lynn Wilson, Sharad Goyal, Salma Jabbour, and Atif Khan - who have all had very successful careers while I mentored them. But I only led them a little bit and open some doors, and then they took it.
There are other people who don’t quite make it in academics because they dropped the ball or shifted priorities. So mentoring is important. A mentor is going to show you the way. He’s going to open some doors. He’s going to give you a little guidance, but then the individual has to run with the ball.
I look at that myself with both Joe Weissberg and Jim Fischer and David Spodick the cardiologist, who I guess I would consider to be some of my primary mentors. I think they opened some doors and they maybe gave me a little guidance and gave me some opportunities certainly, but then I had to take those opportunities and run with them.
Naomi Schechter: Was it difficult being a medical student, resident and then attending at the same institution to make your own path and not be seen as a student of the others?
Bruce Haffty: Yeah. Well, it wasn’t so much for me because Joe left. I wasn’t always in his shadow. And Jim Fischer was very much a laidback kind of person and a lot of people didn’t even realize he was the chair. In fact, after a while, people thought I was the chair and they said I thought you were the chair. So it wasn’t at my institution. Although I will say that if you ask me what was a regret -- it’s not really a regret because it worked out well. But if you ask me about advice, I would say that going to medical school and doing training and then being an attending at the same institution, I’m not sure I’d give anybody that advice.
It worked out for me, but sometimes I look back and I say how would have things been different if I went to a different residency; or, when I finished residency, I went to a different attending academic job or whatever. So I do think there are some advantages and some positive things about mixing things up a little bit, and that’s one kind of regret that I would say I look back and say, gee, maybe I could have done that better. On the other hand, it worked out okay for me.
Paul Wallner: Any other parting words?
Bruce Haffty: No. No. This has been fun.