Nancy Tarbell

By Theodore Phillips, MD, BS, FASTRO and Eric Gressen, MD

The following interview of Nancy Tarbell, MD, FASTRO, was conducted on April 4, 2016, by Theodore Phillips, MD, BS, FASTRO and Eric Gressen, MD. 

Theodore Phillips: I am Ted Phillips. Today is Friday, April 4, 2016 and on behalf of the ASTRO History Committee, I will be conducting an interview with Dr. Nancy Tarbell. So, tell me about where you grew up?
Nancy Tarbell: I grew up in Hudson, MA, a small town about 30 miles west of Boston. At the time I was growing up, there wasn't even a major highway that connected the city to Boston, so it was a pretty tiny town.
Theodore Phillips: What did your parents do there?
Nancy Tarbell: My mom was a reporter for the Worcester Telegram & Gazette, a local paper.   She could do her writing from home. My dad was a mechanical engineer. We moved from Hudson to Binghamton, New York when I was in high school and then my mom became a realtor.
Theodore Phillips: That's very interesting. That probably had some influence on you, the fact that your mother was involved in the workplace and not just at home.  Do you think that influenced your career?

Nancy Tarbell: Probably it did, but a greater influence was being one of six girls and no boys. That had a pretty significant impact because you had no gendered division of labor. It wasn’t as though the boys emptied the trash and mowed the lawn.  We had to divide up among the six of us who was doing trash, lawn, and dishes.
Theodore Phillips: You had to do the lawn and fix the car too?
Nancy Tarbell: You had to do it all.
Theodore Phillips: Where were you in the six? Were you the first or the last?
Nancy Tarbell: I was right in the middle. I was number four.
Theodore Phillips: Number four. Okay. So, you had it from both ways.
Nancy Tarbell: I did. And somehow, I did get the lawn mowing task! In terms of gender stereotypes, I think having a house where you divided labor among a single sex, out of necessity, helped us all think differently than we might've during that generation.
Eric Gressen: Your dad survived seven women in the same house?
Nancy Tarbell: I know. My dad lived to 93 despite having six daughters!
Eric Gressen: Wow. That is amazing.
Theodore Phillips: What did your sisters end up doing?

Nancy Tarbell: Oh, they're all different. It's interesting. One is a real estate agent in New Hampshire. One's an eye doctor in New Jersey.
Theodore Phillips: Okay. Where did you go to high school?  I guess you went to two different places because you moved.
Nancy Tarbell: I did. I went to Hudson Catholic in Hudson, MA and then Vestal High School, which is just outside of Binghamton, New York.
Theodore Phillips: Did you specialize in anything in high school or just pre-academic?
Nancy Tarbell: I didn’t specialize in anything in high school. We moved -- that was a major influence, moving from a small town to a larger place. I was in my sophomore year when I started in New York. The move helped me to be less provincial, thinking a little differently, being exposed to a new environment. Moving as a teenager was a formative experience.
Theodore Phillips: What did you do when you started thinking about college?  Where did you think of going and then where did you go?
Nancy Tarbell: Believe it or not, my parents told us college was optional. We were expected to get married and college was optional.  I picked University of Rhode Island to live on the ocean but did manage to graduate summa cum laude and put myself through school. Since my parents hadn't saved for our college, I worked teaching minority students and I worked as an RA in the dorm. I worked multiple jobs to get through college, and then ended up doing my pre-med courses as a post-bacc student at Columbia. 
Theodore Phillips: What do you mean by post-bacc?
Nancy Tarbell: Post-baccalaureate. Since I was a psychology major in college, I had none of the pre-med requirements. I literally went to URI to live on the ocean and to have a great college experience which –
Theodore Phillips: And meet your spouse.
Nancy Tarbell: Yes and to meet my husband and get married. And that didn't quite turn out as planned. There was a post-baccalaureate program that started at Columbia University for people who had done something else and wanted to go to medical school but still needed the pre-med requirements. I graduated from the University of Rhode Island, then I went right to Columbia that summer and started organic and inorganic chemistry and physics.
Theodore Phillips: How long was that course?
Nancy Tarbell: That was a year and a half.
Eric Gressen: Could you explain why you chose medicine? Because you were a psych major. It didn't sound like you were moving in that direction. What made you now choose medicine as a career?
Nancy Tarbell: That's an amazing story. I had a friend from Long Island who came up to see me my senior year and learned about this post-bacc program because her brother was going to do it. She asked me, "What are you doing with your life?  You're a psych major." I thought I wanted to be a kindergarten teacher and she said, "You don't even have a boyfriend, let alone a husband. You might need to support yourself. I know you'd be good at medicine. I called the dean at Columbia. I made an appointment for you in June. Go take organic chemistry and if you get a “C”, you'll know that medicine is not for you. But you’ll never have to look back when you're 35 and say “could've, would've, should've."  I think part of what I love about faculty development now is, I think how lucky I was, I had a friend see something in me that I didn't see and she profoundly changed my life from being a psych major at University of Rhode Island to going pre-med at Columbia.  I'm very lucky and I never looked back after that. I obviously didn't get a “C” in organic chemistry!
Theodore Phillips: Well, did you see something more in medicine except that your friend really thought you should do it?
Nancy Tarbell: Yes.  Once I heard about the possibility and thought about it, of course the idea of something so gratifying, of being lucky enough to take care of patients and having that privilege, of course the idea sounded wonderful and I did like the thought of having a profession rather than a job and a passion rather than a job. And all of that was very exciting, and I'm lucky that she lit that fire.
Eric Gressen: And interestingly, you were considering kindergarten teacher, so obviously you already had an interest in children, which you ended up doing anyway.
Nancy Tarbell: Right, the pediatric part.
Eric Gressen: Yeah.
Nancy Tarbell: Right. And I have always thought that everything did come back together again.
Theodore Phillips: So, where did you apply for medical school after you were finishing the post-bacc?
Nancy Tarbell: I applied to 12 medical schools, got into 10, and almost went to Columbia.  But, the cost was a big issue. I didn't want -- my parents really couldn't afford to put me through school, one of six kids, so I went to Upstate Medical Center in Syracuse on a full scholarship, which was terrific, and that's how I chose Upstate.
Theodore Phillips: So, your med school was in Syracuse?
Nancy Tarbell: Yes.
Eric Gressen: And just I don't remember if we stated this, did you say you did any sports or activities when you were a psych major in college?
Nancy Tarbell: No. I went to school before Title IX and there really were very few sports open to women at that time. That would've been a great opportunity but they didn't really have that. There really weren't sports for women.
Eric Gressen: Okay.
Theodore Phillips: Did you have some sports interest in high school?

Nancy Tarbell: I played a little basketball and a little bit of tennis and later on I took up golf but that's much later in my life, in the last 10 years. But as a kid, no.
Theodore Phillips: You’re probably pretty athletic after all that lawn mowing.
Nancy Tarbell: Yes. But no. I was a cheerleader, but I often keep that secret. Cheerleading was a sport, but if you were a feminist, it became somewhat of an embarrassment to say that you were a cheerleader.
Theodore Phillips: I guess so.

Eric Gressen: It’s no longer a secret.
Nancy Tarbell: Yeah.
Eric Gressen: So, where did you do your internship?
Nancy Tarbell: Beth Israel, here in Boston at Harvard Medical School.  And I did that because I already had decided on radiation oncology.  Sam Hellman was the head of radiation oncology here at that time, and he encouraged me to come to one of the Harvard hospitals to do the internship--to already be familiar with the hospitals for residency.
Theodore Phillips: Well, you must’ve gotten interested in radiation oncology while you were a med student.
Nancy Tarbell: I did.  Radiation oncology came up as a med student. I actually did a rotation with Bob Sagerman who was –
Theodore Phillips: Yeah, Bob was there at that time.
Nancy Tarbell: Yes. He was the Chief at Upstate. And he sent me to Bob Cassady (Dr. Robert Cassady) to do a rotation and that's how I ended up in Boston and in radiation oncology. It was really because of the mentorship of Bob Sagerman. I did a rotation as a student and Sagerman was just a wonderful teacher and mentor. And not too many students knew about radiation oncology. That was before radiation oncology was popular. He spent an enormous amount of time teaching and mentoring a student who did pick radiation oncology as an elective. And he said to me, "You have to go to Boston for your training. If you’re interested in pediatrics, I'm sending you to Bob Cassady," who had of course trained under Sagerman.
Theodore Phillips: And so, he sent you down to Boston for the clerkship with –
Nancy Tarbell: With Bob Cassady. And that was the end of that.  I never had to think again about what I wanted to do or where I wanted to be. But that's how I ended up coming to the Joint Center for Radiation Therapy. And at that time, radiation wasn't that competitive. I really wanted to come back to Boston having grown up in Hudson, so I applied to Tufts, to Mass General, and to the Joint Center. Those were the only three schools I looked at.
Theodore Phillips: So, you trained at the Joint, not at the General?
Nancy Tarbell: I trained at the Joint, not at the General.
Theodore Phillips: What years were you a resident?
Nancy Tarbell: I was a resident from 1980 to 1983.
Theodore Phillips: Oh okay. I was there on a Sabbatical in ’74 but that was before you were there. Who were the residents at the same time you were?
Nancy Tarbell: Jay Loeffler was a resident a couple of years behind me. Eric, you may not know this but Jay Loeffler later became by husband.
Eric Gressen: Oh. You guys got along?
Nancy Tarbell: Not at the beginning, but eventually. Jay was a resident a couple of years behind me.  Dave Larson was a resident with me. Bruce Minsky. Kathy Griem was also a couple of years behind me. There were almost no women in the field.   Kathy Griem was three years behind me.  Most classes still had no women. Ed Halperin was the Mass General resident that did the peds rotation with me with Cassady, because all the Mass General residents rotated over at Boston Children's Hospital. I got to know Ed well and that's how we ended up doing the book together, the pediatric book.
Theodore Phillips: So, did Sam leave? I understand from Dave Larson that Sam left during his last year as a resident. Did that happen to you too?
Nancy Tarbell: I was the last resident that graduated under his leadership in 1983. I have the last diploma that he signed. I have that carefully framed. David Larson, who'd been a physicist before entering radiation oncology, he was older but he was a year behind me in residency, so he --
Theodore Phillips: So, he finished the following year?
Nancy Tarbell: Right.
Theodore Phillips: Sam was gone.
Nancy Tarbell: Sam was gone; same with Jay. Jay was two years behind. They lived during that transition. When Sam left to go to Memorial and we had an interim phase of Jay Harris, and then Norm Coleman came.
Theodore Phillips: Okay. Who were your main mentors during residency?  I assume Cassady was. Who else?
Nancy Tarbell: Cassady was absolutely my main mentor. And Sam Hellman. He was an amazing mentor.
Theodore Phillips: While you were doing your residency, did you get involved in research at all, clinical or laboratory?

Nancy Tarbell: Yes. I went into Sam's lab and did a lot of the total body radiation experiments. Sam was ahead of his time before we really knew as much as we know now about stem cells. But Sam's area was bone marrow stem cells. He was funded for over 25 years in that area. I used to radiate the mice with different dose rates and fractionations to help figure out the best scheme for a total body radiation.
Theodore Phillips: I know Sam did a lot of work on that. That was an interesting experience. Was that when you decided to go into academics rather than a private practice?
Nancy Tarbell: Yes. And that was actually because there was a time of transition. I would say at least half of the class went into private practice at that time, because of that lack of leadership, that transition of losing Sam before we had anybody new. You know, those times of turmoil impact careers in a very profound way, as I'm sure you've experienced over the years and seen. I stayed in part because of Cassady. He stayed another year. Then he left and part of that whole transition meant I came on the faculty to work with Bob and --
Theodore Phillips: And he left for Arizona.
Nancy Tarbell: He left for Arizona, so I became the chief when I was really still a junior faculty. That transition was pretty quick. I'm jumping ahead. We can get to that. But in terms of mentors, I will say that's when I met Sarah Donaldson. She was a great mentor for me even though it was from a distance. From the time I came on the faculty in 1983, 1984, I met her in what was originally pediatric oncology and then the Children's Oncology Group, and she quickly became a great mentor for me.
Theodore Phillips: Did you go straight from your residency at Joint to your faculty position?
Nancy Tarbell: Absolutely, yes, straight there. And it was to work with Bob. I had a profound experience-- it really was Bob -- Bob was such a great teacher and so charismatic and took such great care of children, the opportunity to work with him and to partner with him made the career decision very easy. I was very happy being his junior partner.
Theodore Phillips: Were you at the Joint or at the –
Nancy Tarbell: I was at the Joint and at Boston Children’s Hospital.
Theodore Phillips: Did you eventually move to the General?
Nancy Tarbell: I didn’t move to the General until 1997.
Theodore Phillips: Okay.
Nancy Tarbell: I was a senior associate professor about to go to full professor when Herman recruited us to Mass General. And that was a very interesting joint recruit because he recruited Jay Loeffler to run the proton center and me to build up the pediatrics program. He recognized that probably pediatrics would be important and Mass General really didn't have a peds program. They still sent their residents over to Boston Children's. So, my job was to build the pediatric brain tumor program, to write the section of the NCI funded proton grant and to build the pediatric proton service for MGH to be ready for the proton machine to become operational.
Theodore Phillips: So, was there much pediatric oncology at the General when you went over there?
Nancy Tarbell: No. We had to really build that. There was very, very little.
Theodore Phillips: I mean, not radiation but even the chemotherapy part of it?
Nancy Tarbell: Even the chemo part. A year before I went there, Howard Weinstein was recruited from the Dana Farber as a national leader in pediatric oncology. And he's still the chief of pediatric oncology at MGH. He was brought in a year before I was, to build up the pediatric oncology service, and I was brought in specifically to build up the piece that would be related to pediatrics and protons.
Theodore Phillips: I know you have a big job as the dean but do you still do clinical work?
Nancy Tarbell: Oh, yes. I still see new patients. We have fellows and residents and I have mentored Torunn Yock and she has taken over my job as chief of pediatrics there, and Shannon MacDonald, another young faculty member there, now are both associate professors. So, they cover extremely well. But if something comes up, I get back over there and carry my beeper, but they are very good at covering something onsite on the days I'm not there.
Theodore Phillips: Now Jay is there of course full time in running the proton center, right?
Nancy Tarbell: He doesn't run the proton center anymore. Tom DeLaney does that. He's the chief of the department.
Theodore Phillips: So, he runs the whole department?
Nancy Tarbell: Right. So, he took Herman’s job.
Theodore Phillips: You have always focused on pediatrics and brain tumors. I guess that came from your work with Bob. Is that how you got into that?
Nancy Tarbell: Yes. Actually Bob was really good at -- so, originally I did the total body radiation because Bob said, "Look, you need an area that people will recognize your work as separate from my work." He had done so much on Wilms tumor, he said, "you should pick what interests you. But, you know, total body radiation and the brain tumors make sense to develop," and I thought that was very good mentoring advice, to make sure that we were collaborators and he was going to be my mentor but that we pick slightly different areas of focus within the pediatric tumors.
Theodore Phillips:  Could you comment a little bit more on how one should develop faculty members? I've always been very interested in that. I think it's extremely important to focus your faculty and get them known just as you said, but could you expand on that a little bit more?
Nancy Tarbell: Thank you. I think that's true, Ted. I think that one of the really important pieces is the young faculty need to focus. And that's hard because often you need to do multiple things in our field and still be able to treat multiple different kinds of tumors and sites. Bob felt that it was important that clinically we were able to cover each other and treat all sites but that in a small specialty or a large specialty you still needed to pick enough of a way to differentiate yourself.  He was such a household name at that time, everybody knew Bob Cassady. He recognized that if he didn't tell me to pick a unique focus that was different than his name recognition, that it would be very tough for me to develop and get promoted academically. He took that part of his job very seriously. He wanted to help me pick areas that were still open for academic potential and where there was work left in radiation to do, but weren’t his areas of expertise or focus.
Theodore Phillips: I think that's extremely important. You and Bob should write a paper on this in order to teach the new department chairs how they really should handle their faculty, because many of them don't do it right and the faculty gets disappointed, and leaves, and goes on to the dark side. But what Bob did with you was wonderful and I think it's not well known that that's what's got to be done.

Nancy Tarbell: It's a great thought. You know, you take these things for granted. But you're right, he really was pivotal in that regard. And I do think that getting promoted in the Harvard system, as you know, is not so easy. It's not easy at any of the top institutions. And that was smart advice.  So, you're right, we probably should follow up on that.
Eric Gressen: Yes, he's right. I could reiterate. I certainly know a lot of chairs that really did not mentor their junior faculty. And I do think it's funny that Ted calls anyone that's in private practice the dark side. But I'll make sure that stays in there.

Theodore Phillips: Once you go to the dark side, you can't come back.  The only person who ever came back was Gerry Hanks.
Nancy Tarbell: Well, actually, we had Tim Russell for years.
Eric Gressen: Oh, there you go. That’s good trivia. If we ever have ASTRO trivia, that’ll be one of our trivia questions.
Nancy Tarbell: He just retired but he did an amazing job the last 10 years in our GYN oncology at MGH.
Theodore Phillips: Yeah. He did come back. But he was at a semi-academic private practice and so was Gerry Hanks.
Eric Gressen: Okay.
Nancy Tarbell: Okay.
Theodore Phillips: You know, his practice at Sacramento at that time was almost like an academic practice. So, all your faculty jobs have all been at Harvard.
Nancy Tarbell: Right.
Theodore Phillips: And how did you get started in the dean business?
Nancy Tarbell: Well, I'll tell you, I think most things in life -- and I hope this comes out okay -- but most things in life do have a push and a pull, right? You have to be ready to do something, there has to be reason or you don't look for another opportunity. When Jay Loeffler became the chief of the department and took Herman Suit's job in 2000, it became clear that it would be in some ways better for Jay, for the department, and probably for me as well. You don't necessarily want to mix being married to the boss. You know, that's complicated. And we had the best of everything when we were young faculty that were in the same field. We could run things off each other, we could give each other advice, and we could share the patient issues and complicated cases and the academic piece. 
But once one of you becomes the chief of a department in academic medicine, and especially in a large place like Mass General, it's tough to be the senior woman and also be married to the chief. It changes your voice in a way that, out of respect for Jay, and for the department, and for the young faculty, I didn't want it to. I didn’t want anyone to feel as though the power base, or the ability to have a conversation, would change, as the result of two of the very senior people being married to each other. That dynamic would've been different for the department.
So, I think that got me interested in faculty development and the mentoring piece, not to mention my interesting past with how I got into medicine and what an influence a friend had. I thought, you know, I could help young people understand the promotion process. I could help with the mentoring piece, and I could make a great difference here at Harvard Medical School and have a separate career that I could keep a small presence in what keeps me grounded and where my passion started, which is pediatric cancer. But I could also do something broader and have this greater impact that would really have our career paths diverge. And that's what got me interested in that. 
I ran the Office for Women's Careers at Mass General.  I was the first director of that program. And then that evolved to faculty development at large at Mass General. And that made it very logical in 2008 then, to come to the dean's office. At that time, Harvard was famous for having the most byzantine senior promotion process in the country. I think, Ted, this would be factually correct. Is that fair to say?
Theodore Phillips: Yeah. It’s even worse than the University of California.
Nancy Tarbell: Right. So, I think we were definitely at the bottom for promotion process. And again, if you care about your faculty and you care about faculty retention and keeping the best and brightest, it made sense to come over here and fix it. And actually we took over a process that was completely byzantine. It took over three years for faculty to get to be a full professor before I got here. But now, from the time you start someone's promotion process until you complete it, the median time is under 12 months. So, that may still sound very long but it's very different than what it was.
Theodore Phillips: Well, I think it's obvious you've been very successful at that. I mean, you got elected to the National Academy not only because you're pediatrics but because of the great job you did at Harvard in that area. You plan to keep on doing this for a long time?
Nancy Tarbell: I think so. I think what I like most besides taking care of patients is thinking I can be a change agent. You know, seeing something that needs fixing like a broken promotion process. And sure, you're not going to make it perfect but making it better. And in that way, positive passion takes something that's not working and says, "Okay. Let's get the right people in the room, because we do really ultimately all care about the right things and let's stay mission focused and let's make it better."
Theodore Phillips: Okay. Maybe we should go a little different direction now. A big impact on Mass General has been the proton program. Could you talk to us a little bit about that, how you see it how it impacted the whole department operation and your role in it?
Nancy Tarbell: My role was definitely to build the peds. We started from very little and then we started by just making sure we put the team together. One of my favorite expressions is "you're only as good as your team." And I know that's a question later but I'll say that now, you're only as good as your team. So, it was quickly apparent. Luckily, we needed pediatric oncology, we needed good team members, we needed to collaborate with the Dana-Farber across town and Boston Children's Hospital where there were more patients, and we needed to build something very special for children to come from around the country and around the world, We built this from the social work, to the nursing, to the therapist on the machine, to all the right members of the team -- neurology, neurosurgery. 
We started a neuro-oncology conference and a brain tumor clinic, and now that's evolved into a survivorship clinic as well. To make sure we could put all those pieces in, so that it wasn't just designing a protocol to treat patients with protons, but that if people came, some of them might be sick, some of them might need their shunts fixed, some of them might need other things, that we would have the full package to take care of patients well. So, that was really my job in '97 when I came to MGH. And I'd say it did take us 10 years to build the program to that degree. But I think we have done that.
Theodore Phillips: When did the machine come online?
Nancy Tarbell: We started in '97 and the machine didn't come online until the end of 2001. But by the time it came online, we had all the protocols written and we had the grant funded. Jay was the PI on the grant and I was the PI on the pediatric section of the grant. And the very first trial we started just finally got published in The Lancet Oncology 10 years later. It was on medulloblastoma. Torunn Yock, again who's taken over my job there at MGH, was the first author on that study. So, it took us 10 years. But I think you're right, that was a major, major focus and opportunity for us at MGH.
Theodore Phillips: And what proportion of the proton patients now are pediatric?
Nancy Tarbell: It’s just under twenty percent.
Theodore Phillips: Twenty percent? Okay. Are you convinced that protons are the way to treat pediatric tumors in all?
Nancy Tarbell: I think most pediatric tumors, yes. I think it's still an area to study. It should be cautiously done on studies, whenever possible. Torunn is overseeing a consortium where all the national pediatric patients can be registered to make sure that the learning curve around protons is taken very seriously, because there really is a learning curve. It's not the same, as many doctors are not really trained to understand all the subtleties of protons. You know, we had that old Harvard cyclotron before the new facility, so we had some good physicists to help train us, if you will, when we first got there. But I think I would say with a certain amount of humility that I'm excited and positive about protons and pediatrics, but I think you definitely need that continued academic rigor around moving that field forward.
Theodore Phillips: You're so good at organizing these new programs and mentoring and so forth. Have you ever thought about becoming a chair somewhere?
Nancy Tarbell: No. You know, what's funny, I think because Jay -- I think that maybe is a spousal issue too. Once your spouse becomes a department chair, the only way to really do that would be to live in two different cities.
Theodore Phillips: Or go to a different medical school.
Nancy Tarbell: Right. I guess we could've done that too but it was hard to leave something so great to go to a whole foreign system, if you will, without moving towns. So, I'm going to say even when the Penn job came up, it crossed my mind, it's such a great program. It would've been interesting. I think I should've been a department chair, Ted, before I became a dean. That would've been a more normal trajectory.
Theodore Phillips: Yeah.
Nancy Tarbell: Right?
Theodore Phillips: That’s what Sam did.
Nancy Tarbell: Right.
Nancy Tarbell: It's nice to keep your hand in a little bit of the science where you originated, which is neuro-oncology. So, that is a Dana-Farber/Harvard Cancer Center -- we call it DF/HCC -- brain tumor SPORE that's run through the Farber but it's an extraordinarily collaborative Harvard Medical School-Mass General-Boston Children's program -- all of our Harvard affiliates really work very closely and the PI is Tracy Batchelor who is an adult neuro-oncologist. So, we’re making sure we're doing something in the pediatric area and making sure we're thinking of the science there and stay active. I think that's extremely important for me intellectually. Even as a dean, you know, it's important -- because part of the job of a dean is to make sure our hospitals are collaborative, because I'm sure you both know that sometimes each hospital is also somewhat competitive.
Theodore Phillips: When I was there on Sabbatical, they wouldn’t let me go to the General. I sneaked over there.
Nancy Tarbell: Sam wouldn’t let you go?
Theodore Phillips: You bet he didn’t want me to. But I wanted to see what Herman was doing so I went over a couple of times.
Nancy Tarbell: Because it's interesting. They now will tell you that they were somewhat collaborative, that they developed different areas of expertise. So, that's interesting.
Theodore Phillips: I have one question. Is Daphne now involved in that sport?
Nancy Tarbell: No, but she probably will be. It's interesting.  She's the logical person to -- it's funny, I thought of her this last meeting. She's the logical person to pass this on to now that she is here in town.
Theodore Phillips: Because she was very active in the one at UC.
Nancy Tarbell: Yeah. I'm giving her a little time to get up to speed. I mean, she's come into a complex system, taking over the Brigham -- she's chair at Brigham and Women's Hospital, Boston Children's Hospital, and Dana-Farber. So, that's a big job.
Theodore Phillips: Big job, yeah. Well, I think she can do it.
Nancy Tarbell: Yes. She’s great. She’s wonderful.
Theodore Phillips: Can you tell us a little bit about what you've done with ASTRO?
Nancy Tarbell: Oh, boy, I'll have to go look up my CV. I was much more active, I think, before I did the dean's role than I've been able to do now. I taught the refresher course either on pediatrics or on total body radiation for years, was involved in the education committee, was involved early on in just about everything. But I really feel that that's been much tougher to do in the current position. For the last few years I feel it's been much tougher to be as active in ASTRO.
Theodore Phillips: Have you been active in the COG?
Nancy Tarbell: That I'm still active in. I've been in active in COG for 30 years, from its transition from Pediatric Oncology Group to when it combined with CCG to becoming one group, the Children's Oncology Group. And I'm still involved on the brain tumor committee. There would also be a right time to transition that to some of the younger investigators.
Theodore Phillips: And do you have some more questions in this area, Eric?
Eric Gressen: No. You've been doing a great job and I liked the flow so I kept my mouth shut.
Theodore Phillips: Okay. Right now, could you tell us a little bit about your home life, your family, husband, children?
Nancy Tarbell: Okay.  I think I've told you a little bit about Jay. We got married…
Theodore Phillips: Yeah. We all know Jay.
Nancy Tarbell: You all know Jay. Eric, do you know Jay?
Eric Gressen: I don’t know him personally but obviously by reputation.
Nancy Tarbell: Okay. It's interesting that you didn't know we were married. I think it was great that we were in the same field but we picked different areas of expertise, even though I do pediatric brain tumors and he does adult brain tumors, so there's some synergy there. But I think it was smart, again, to have different career paths so that we were allowed our independence that way. That was probably a good thing.
I have three children -- Brian, Steven, and Avery.  Brian has his MBA and works for Ocean Spray. Ocean Spray, believe it or not, is locally based. All the cranberries, you know, are grown near the Cape. He's in marketing and innovation there. And our second son is Steven, and he works with MidOcean Partners in New York City. He's in private equity. And our baby, Avery, is our daughter and she just graduated last May from Bowdoin and she's now working in New York City as well. She's working for Korn Ferry, learning about executive searches.
Theodore Phillips: Okay. So, they’re all well launched into interesting careers.
Nancy Tarbell: They've all launched and all graduated from college. We are truly empty nesters.
Eric Gressen: Well, just for the record, any publication I read from either you or your husband never writes "spouse of Nancy" or, you know. They don't actually tell you about the other person when you read the paper.  I guess they could put that in there.
I did have one question just because it had an impact on me. When I rotated, I went to St. Jude's with Larry Kun, and I had a young daughter and it was very hard for me to consider pediatric oncology for that reason. I didn't know if that had any impact having your own children and dealing with pediatric oncology.
Nancy Tarbell: I think it did. I think it is difficult sometimes if you have a patient that looks like one of your children. I remember I had a patient that looked like my son, Brian, and I used to go home and examine him like every day for a while. I kept looking for this perinatal sinus tumor. So, sure, you bring some of this home. I think the good part is that it's easy to keep your passion when you understand as a parent just how devastating the diagnosis is for family. It helps you keep grounded and keep your focus, and I think that part has been helpful. You don't need it. I mean, look at Sarah Donaldson who's done an amazing job as an unbelievable pediatric radiation oncologist and role model and she didn't have children and never lost her passion or her ability to have the right degree of empathy and compassion and patient care. But I think for me, it was helpful and also you never took being a parent for granted. You've always kind of appreciated that as crazy as it could be trying to do both, how lucky you were to be able to do both.
Eric Gressen: Okay.
Theodore Phillips: Do you have things that you and Jay do outside of medicine?  Do you have some kind of vacationing hobbies?

Nancy Tarbell: The only real hobby we have together, besides having raised the kids and gone to millions of soccer games and all the rest, is golf. Jay got me golf clubs about eight years ago. So, now that the kids are older and we have the time for golf, that's been a truly wonderful pleasure to get to relax and enjoy.
Theodore Phillips: What’s your handicap?
Nancy Tarbell: Oh, mine's terrible. I'm still terrible.  You don't want my handicap. Jay's got a great handicap. His is under 10.
Theodore Phillips: Oh, really. That’s pretty good.
Nancy Tarbell: Yeah.
Theodore Phillips:  He's an inspiration for you to get yours lower.
Nancy Tarbell: He's an inspiration and he's a great teacher. Believe it or not, everybody says don't play golf with your spouse. But if they're a great teacher…He can be pretty relaxed out there, so it works surprisingly well.
Eric Gressen: Ever get a hole-in-one?
Nancy Tarbell: No. I came really close. But even Jay has never had a hole-in-one. I have the Irish luck though. I'm Irish by descent, more Irish than anything else, although I'm a mixture as most of us are, but I think I have that Irish luck that he doesn't quite have. So, I might get one.
Eric Gressen: Well, good luck.
Theodore Phillips: The ball finds its own way to the hole.

Eric Gressen: My father was an avid golfer. My mom played very little and my mom had three hole-in-one's and my dad had one so that's a positive in their relationship.
Nancy Tarbell: Okay. So, there’s hope.
Eric Gressen: Yes, there is.
Theodore Phillips: Nancy, have you done any visiting professorships or Sabbaticals during your career?
Nancy Tarbell: I've done over 40 visiting professorships. That's such a part of our field, it's interesting. I think we both have done that a lot, throughout the world, but certainly throughout the country, and thoroughly enjoyed those. We don't get Sabbaticals, believe it or not, at MGH, so I've never had that. You could take one  unpaid Sabbatical, you could with special permission but we don't have them built into our system.
Theodore Phillips: They were very valuable to me at UCSF and pays for it and it got me to the Joint Center, and to Sloan Kettering and to NCI for a year, so it's extremely worthwhile. Maybe you could work on getting that available at Harvard.
Nancy Tarbell: Maybe we should. We really probably should because, in terms of the physician burnout issue that's coming up as a national problem, and just to get your faculty the sustainability and all of that. We have had some faculty take a few months' Sabbatical but that's the most anyone's ever taken. And I'm not sure that's the same as the six months to a year. I think that's probably a very different experience.
Theodore Phillips: The six months to a year lets you really get involved in the other department, learn how it works and bring back all those ideas. My first one was at Stanford. That's where I met Cassidy and those people, but it really was a big influence.
Okay. Can you sort of give us any reflections on your career, where you think you might've done something different or you think you did the perfect thing?
Nancy Tarbell: Well, I will say I think in some ways careers do have an element of luck. I know that they tell us not to say that when it comes to gender because they say women say they got lucky versus men will say, "Well, it's because I was so smart," or whatever, so, I'm always careful and hesitant to say that it was because of luck. But some of this is about timing and opportunities, right? I mean, I was very happy being Bob's junior partner. But he chose to leave once Sam left, and he chose to become a chair at Arizona, so early on I became a chief. Becoming a chief at Boston Children's Hospital as a junior faculty member then really led me to leadership opportunities that I didn't seek but that then led to other leadership opportunities. That did obviously have a profound impact on the roles that I ultimately was able to have and choose, in leadership positions at Mass General and ultimately at  Harvard Medical School.
I also think gender played a role. Looking back, I will say the gender piece is still a very important piece. You know that I was the first woman professor of radiation oncology ever in the Harvard system and probably in all of New England. I was trying to think of anybody else who might've ever been a professor that was a woman in New England, not counting New York but New Hampshire, Dartmouth, going through Vermont, Rhode Island, all of Massachusetts, I couldn't think of another woman professor that would've preceded me. It shows you it's really still a field where there's quite a dearth of women in academic medicine and that probably had a profound influence in many ways. 
Do you know it took us 15 years after I became a full professor that we finally have our second and now Daphne is our third woman professor in radiation oncology at Harvard Medical School? I mean, that tells you we have a long way to go, don't you think?
Theodore Phillips: Yeah. I think it's going to change more rapidly now, half the residents are coming through.
Nancy Tarbell: Yeah. It's interesting. Seventy percent of our applicants are still men. So, we still have a slight gender imbalance, it's not quite 50/50, in the young people coming. Andrea Ng was our second and Daphne is now our third. So, I do think you're right, it's about to change. It won't be another 15 years. But I think that you can't reflect back on your life and not think about that because role models were important. My only real woman role model was Sarah Donaldson and she was 3000 miles away.
Theodore Phillips: Yeah. Now there's a lot more. Next week we're having Mary from Toronto coming as one of the guest speakers at the UC Conference and she's an astounding leader in Canadian radiotherapy.
Nancy Tarbell: It's great. It's nice that that is changing, and hopefully will change, as you say, Ted, more quickly. But otherwise I feel sure I probably was lucky enough to have many things I could've done and been happy, but working the dual career options and finding things that kept both of us happy and able to work in the same city, I have to say, we were pretty lucky.
Eric Gressen: Yeah. That’s another paper you could write.
Nancy Tarbell: Right. The dual career piece is very tricky. We see that now as one of our more complicated retention issues. How do you keep your best couples when both are valuable and one gets an opportunity to leave? How do you work on the retention or is it better for them to leave?
Eric Gressen: Absolutely.
Theodore Phillips: That's a very good question. What do you think about the current status of ASTRO and where it seems to be heading? I'm concerned that it's gotten too business oriented and not enough research and teaching oriented but that may be just my bias.
Nancy Tarbell: Well, the fact that you're doing this, I think this is wonderful. The fact that ASTRO is invested and cares about our history, which is so important, and takes the time and effort to do this, that speaks volumes about ASTRO's value of the academic history of the field and the specialty. So, I'd say that's a big positive. Hard to know. I guess you're right.  It's hard for me to know from the lens that I have about ASTRO per se, but you would probably have a better lens than I do on that.
I think in the field of radiation oncology, what surprises me the most is how popular the field has become and how competitive the field is. 10 years ago maybe one student from HMS every year or so went into rad oncology; now we get eight to 10 of our students that want to go into radiation oncology. That's extremely different. And actually, don't you find that somewhat surprising, Ted and Eric?
Theodore Phillips: Well, it’s the money, I think.
Eric Gressen: I think it's the money. I think it's the lifestyle. I mean, I have my own family and I'm happy to be an empty nester despite being very close to my children, but I love the fact that I often could see my children and a lot other fields don't offer that. And then you're right, there's money that is pretty strong in radiation oncology, so I think there's a lot of appeal for this position. And you're absolutely correct; it's amazing now the people that try to apply to Jefferson are stellar. They've published already in med school, they come from Ivy League programs and it's a very different atmosphere than it was for me, which was about 20 years ago.
Nancy Tarbell: Right. And I think that's energizing, seeing the young people coming in that are so smart and so bright and many of them I think are really academically motivated because they also see radiation oncology as a specialty where you can do academics and still have some balance. And the M.D./Ph.D.'s that we have in the pipeline, all that for the academic future I think is very promising. I don't know how long it will last because I think you're right, Ted, that some of this is driven by the financial part. But some of it is clearly not, because many of our graduates are staying in academics, so they see this as an easier way -- one of the careers, like dermatology, where you can have a more limited practice and still have protected time.
Theodore Phillips: One of the things that's concerned me is the retention of the M.D./Ph.D. people. An awful lot of them, at least in my experience, have gone out and come to this whole process of getting their M.D. and a Ph.D. and may or may not have done a post-doc.  And then they finish their residency and they go to private practice because they want the money and they're burned out. You're a retention guru. What do you think we need to do about that problem?
Nancy Tarbell: Well, I think first of all, it's very different if you take people who have re-trained in other specialties. There was that early period when Sam Hellman was still here where he took a fair number of people that were medical oncologists that retrained. They were M.D./Ph.D.s and most of them retrained and went into private practice. Again, they didn't have longevity. They'd already done something else. But more recently, I think some of the best and brightest M.D./Ph.D. students see the career opportunities and some of the funding opportunities in radiation oncology and they are staying. We just had Alec Kimmelman leave to be the chair at NYU. He was one of our M.D./Ph.D. brilliant young kids and stayed here 10 years and now he's going to be a pretty young chair in New York. So, I think in the last 10 years I'd say there is a trajectory of keeping some of these people.
Again, it takes an investment.  It takes really being willing to think differently about lab support and a minimal clinical load. You can't do the same kind of clinical work that you used to. Our generation tries to see lots of patients and still think we could do the lab work. You can't do that. To stay competitive in this day and age and to get funding, you need to be mostly doing research if you're going to make it along that trajectory. And we should have the flexibility to support all kinds, right? There are people that are going to be the busy clinicians and do more clinical research, and those that are going to do more basic research. And I think we learned our lessons early on. I think we're doing that better, but I guess we need to wait another 10 years to really be sure about that.
Theodore Phillips: But how do we pay for it? I mean, how can you pay somebody $300,000 a year and have only one day a week in the clinic?
Nancy Tarbell: Yeah, that's not going to happen, is it? You have to be willing to take less of a salary. You still make a very good salary compared to a Ph.D., say, right?
Theodore Phillips: Right.
Nancy Tarbell: So, the M.D./Ph.D. still has a salary advantage and more protected time and great opportunity. And if they're mentored well, that's a great career path and hopefully some of them therefore are picking it for all of those reasons versus some of the things you're talking about.
Theodore Phillips: Well, can you get them to work for $150,000 a year instead of $300,000.
Nancy Tarbell: I think you can. It's interesting, we've got a young faculty member, I won't give his name away, 10 years on the faculty, and he said to Jay, "I don't care about my salary. My wife's a physician as well. I would like to divert my salary to making sure I can -- I'm worried about my next RO1. I want to hire another tech in the lab. Can I divert my salary? Do you care?"  And of course the answer is, "Of course, that's okay if you don't want to take the salary." So, some of them are pretty devoted to the science and are here for the right reasons. And I think making the salary of $200,000 or something is an extremely competitive offer with the protected time that comes with that.
Theodore Phillips: That's the problem with not being able to sell very well in the West Coast is getting people to work for less in their lab rather than total clinical people. But that's going to have to happen or we won't be able to sustain it.

Nancy Tarbell: Oh, absolutely. There's just no way, especially with the pressure on clinical revenues, there's no way that that model's going to exist very much, right?
Theodore Phillips: Yeah. Do you have any favorite sayings?
Nancy Tarbell: Well, "you're only as good as your team" is definitely one of them. So, "join one or build one" is always my advice to young faculty. And the line that goes along with that is -- I was asking my team this morning and said, "What do I say all the time?"  They said, "You always remind us when we get a little siloed that the whole is greater than the sum of the parts." So, I guess that's another one of my favorite sayings. I think that's probably it. The other ones are probably not good to print.
Theodore Phillips: What do you say when the car in front of you won't move?
Nancy Tarbell: We'll keep that off the tape.
Theodore Phillips: Eric, anything we forgot to go over?
Eric Gressen: I'm just going over very quickly. I think you talked about just that little synopsis when you mentioned diversity enhancement. I can't recall -- yeah, you did work on behalf of women and minorities. I mean, you kind of talked about it throughout the interview but anything further you want to expand on how you worked on behalf of women and minorities and building programs?
Nancy Tarbell: That's clearly been a passion, and let's see, is there anything more to say about that? We ran a big initiative. We did two major things when I first got to the dean's office in 2008. The first was to streamline the promotions and that took us 18 months, believe it or not. Our system is so complicated, but we did do that.
The second was a larger task force on faculty development and diversity that included all of our 15 affiliates with representatives from our 12,000 faculty.  And ironically, Harvard Medical School is so decentralized and the hospitals are all run separately, so we had no centralized programs for faculty development and diversity. We had diversity initiatives but we had no centralized coordinated faculty development, recruitment, retention efforts towards women that were from the medical school and coordinating efforts with the hospitals.
So, we did a task force in 2010 and that whole document is actually available publicly on our website. And from that, we really did many things and that was very helpful. We made sure that everybody had access to each other's programs, that people were aware of each other's programs. You know, the Mass General is so large that you could have a program for women's careers there and the people at the Brigham and Women's Hospital wouldn't know what the best practices were. We helped with the tools that were developed on the websites to make sure that we communicated those more broadly. And we did more faculty orientation because our medical school is different than many where the hospitals are owned and operated separately, which is part of why they can be so competitive. The medical school itself hadn't yet done anything that really made you appreciate what the value was of this collaboration, of being part of something broad within the Harvard Medical School. So, that's been a major effort.
And that does help. I think when you do faculty development, you help everybody. You do help the women more, because most studies have shown that if you do something that helps men and women, it's the women who actually -- not that they needed more help, that's not at all what I'm trying to say, but it's the women who didn't necessarily have the role model or didn't know if they could try to balance work and family. Or they didn't know about these other mentoring opportunities or how to network as well. Some of these centralized programs have helped everybody and that specifically has helped the women. We still have a long way to go. Finally, almost 20 percent of our professors are women. So, considering our class has been 50 percent women for more than 10 years, we obviously still have a slower trajectory to get all the way to the senior level.
Eric Gressen: Okay. And the only other question, I think so you said you were the first female professor in radiation oncology at Harvard?
Nancy Tarbell: Yes.
Eric Gressen: Okay. And any other kind of specific accomplishments? I know you don't like to rave about yourself sometimes, but anything else you'd say really that separates, "I was the first of this or first of that"?
Nancy Tarbell: I don’t think so.
Eric Gressen: Okay. Just want to make sure.
Nancy Tarbell: Thank you though.
Eric Gressen: That's always something fun to -- I mean, Carl Mansfield just won the gold medal and I knew him because he was at Jefferson and he was the first African American to get the ASTRO gold medal -- I mean, he was the first in so many ways at Jefferson, so sometimes I get a kick out of just to see how some people end up being the pioneers whether they wanted to or not and their influence. But that was basically my only other question. Anything else?

Theodore Phillips: Anything we forgot, Nancy?
Nancy Tarbell: I don't think so. I hope we were relatively organized. I know we covered a lot of different territories and different parts, so hopefully this will have a theme that makes sense.
Theodore Phillips: I think the interview went very well. We really know who you are and why you got to be great and that's what we want people to learn from these interviews.
Nancy Tarbell: Well, it's great that you're taking the time to do these, Ted and Eric. It's wonderful.
Theodore Phillips: Okay. Well, we thank you very much and ASTRO thanks you. In a few months, you'll get the edited first draft to work on.
Nancy Tarbell: Okay. Thank you so much.
Theodore Phillips: Okay. Take care. Thank you.