At seven years old in Montgomery, Alabama, Sharmila Makhija knew she wanted to be a physician.
“My dad was a college chemistry professor and my mom was a high school teacher, but in India, my grandfather and uncle were doctors, and on my mom’s side of the family there were lots of physicians. Now my brother is a physician and my sister’s a dentist, so we joke that it skips a generation in our family,” she says.
As a child, Makhija wanted to spend more time with family in India, but the distance was too great. “I finally convinced my parents to let me fly there, and I spent time with both sides of the family. I went with my grandfather on his rounds to see patients, and that’s when I decided to be a doctor. Since then, I’ve focused everything on that. I volunteered at a hospital, worked the front desk and just about every job within a doctor’s office before I went to medical school.”
Today, Dr. Makhija is an oncologist, professor and chairman of the Department of Obstetrics, Gynecology and Women’s Health at the University of Louisville School of Medicine in Kentucky.
ONCOLOGY & WOMEN
“When I was in medical school at the University of Alabama at Birmingham (UAB), I covered an oncology rotation for someone who was sick,” she says. “As soon as I did that rotation, I knew that was the specialty for me.”
During her training, Dr. Makhija says the strong connection she felt to the women she treated led her to enter obstetrics and gynecology.
“Women are so used to taking care of everyone else, and oncology patients are in a vulnerable state after receiving a cancer diagnosis. What amazed me as a medical student was that these women were still focused on how it was going to affect their families rather than themselves. I was just drawn to that population of patients. I felt as if I needed to be the person to help them through it.”
WOMEN IN MEDICINE & GYNECOLOGICAL CANCER
Dr. Makhija treats women with gynecologic cancers with surgery and chemotherapy treatments.
“Operating as a gynecologic oncologist is a different type of surgical subspecialty, because we operate on a patient and also plan and administer the chemotherapy,” she explains.
Today, although most OB/GYN residents are women, gynocologic oncology is still a male-dominated field, says Dr. Makhija. However, that may be evolving.
“Physicians in my particular subspecialty of oncology are still predominantly male because it’s a surgical specialty,” she says. “After four years of residency, you must do another three to four years of fellowship. Many women don’t want to pursue training for that long if they want to start a family. But times are changing, and we are seeing more women in this specialty.
“The men I have worked and trained with in gynecologic oncology are a special breed, for they care greatly for their patients and have been excellent. I’ve never felt that they weren’t sensitive to the patients’ needs. On the flip side, I do think that some female patients may be drawn to having a female doctor; they may feel more comfortable talking with a woman physician.”
THE BUSINESS OF MEDICINE
In 2008, Dr. Makhija became division director of gynecologic oncology at Emory University School of Medicine in Atlanta. She says she soon realized the necessity of strong business skills.
“I had to balance the budget and reallocate resources. I was at Emory, and the business school was literally one block from my office, so I applied and was accepted.
I was one of two doctors in the group of about 45 in our MBA class. A number of doctors asked me about the program, and the next year’s graduating class had eight doctors.
“It’s interesting; physicians are realizing they need to understand how to run their businesses efficiently. I was careful to pursue a general business program, because I didn’t want something too focused on healthcare. I wanted to know what all businesspeople need to know, at least the fundamentals, and then build on that to focus on health care.”
Dr. Makhija earned an executive MBA degree from Emory University’s Goizueta Business School in 2011. She says it has helped her incorporate business fundamentals that benefit her as a physician and researcher.
“Physicians are in the business of taking care of patients, and while we are trained to be morally grounded and ethical in how we give care, we haven’t been taught how to manage the practice — and that is a business. I’ve watched businesses fail within the realm of medicine.
Academic centers must watch finances carefully because of the current economic situation. Relationships between physicians and pharmaceutical companies have changed, and unrestricted grants are rarely available anymore, so physicians must manage their finances carefully to conduct research. That’s one aspect where we don’t get training; and most doctors don’t feel at ease discussing the financial side, either.”
PREPARING FUTURE PHYSICIANS TO MANAGE PAIN & BUSINESS
Now a full professor at University of Louisville, Dr. Makhija educates and and trains medical students, residents and fellows.
“A major component in building a strong educational and clinical training program centers around selecting leaders within the department that I trust to meet our goals and objectives,” she says. “Our tripartite mission includes providing the best patient care in the Louisville area; exemplary training for medical students, residents and fellows; and outstanding service to our community through advanced biomedical research and outreach educational programs benefiting our patients. I enjoy the hands-on element of developing our educational programs.
CANCER & THE PAIN MANAGEMENT TEAM
As an oncologist, Dr. Makhija sees many patients who live with chronic pain, and she’s passionate about helping them.
“Pain management is an important aspect of caring for our cancer patients. When physicians train, we learn how to take care of basic physical needs. We learn to treat the disease, but there are also social and quality-of-life issues that must be addressed. There is a push for cancer trials to include and implement these quality-of-life initiatives addressing pain management.
“I understand and support pain management options. I work collaboratively with our team, which includes physicians trained in anesthesia, pain management and neurology. Pain management is one of the most important aspects of treatment. If you’re in pain, you can’t function; nothing else matters.”
Dr. Makhija believes that each member of the pain management and medical team is valuable, particularly nurses, and enjoys her collaboration with them.
“My patients are the reason I chose this career, but I also really enjoy working with the team. I appreciate the nurses who are involved in caring for patients. I think they’re always the ones who are overlooked when the praise is passed around. A doctor is nothing without his or her team, and nurses are a vital part of that team. They get the brunt of the complaints when patients are frustrated, and they must be good managers because they’re dealing with so many different personalities and responsibilities. They hold the key for taking the best care of patients. I like to talk about nursing care and applaud their efforts whenever I can, because I think nurses are greatly undervalued in our health care system.”
GIVING BACK: ADVANCING RESEARCH & RAISING AWARENESS ABOUT THE HPV VACCINE
According to Dr. Makhija, one of the highlights of her career has been advising pharmaceutical companies regarding the development of the human papillomavirus
(HPV) vaccine and helping them bring it to areas of greatest need.
“With Merck, I helped with the HPV vaccine approval process and assisted in the process of initiating use of the vaccine in India. Since the vaccine has shown in research studies to help prevent the spread of HPV, it also ultimately helps prevent cervical cancer, which affects women in developing countries tenfold, and also in underdeveloped areas in the United States, especially in the South, where there is a higher rate of cervical cancer,” she explains.
“I’ve also worked with Genentech, writing cancer protocols and running the clinical trials. At Emory, I was a Georgia Cancer Scholar, so I was funded to continue my research, which I’m also continuing in Louisville.
“What I try to do is bring awareness; we should certainly take care of our local patients, but I believe in sharing our knowledge in a respectful way in other countries where less fortunate women desperately need health care. I’ve enjoyed this work and feel that I’ve contributed in a special way.”
CHANGES IN ONCOLOGY
The approach to cancer treatment has evolved rapidly due to advances in research and development of new drugs, says Dr. Makhija.
“When I began medical school at UAB, Taxol was a new drug on the market. Now, Taxol, made from the bark of a Pacific yew tree, remains our routine, standard drug. In 15 years, I’ve seen this drug evolve from ‘We hope this works’ to ‘Yes, it works.’”
“Take ovarian cancer, for instance, where we have the highest rate of death, because it’s typically discovered in an advanced stage or has spread to other organs. We’ve focused on diagnosing it early, because if we can do that, a patient has a 95 percent versus a 60 percent survival rate. That’s one exciting area of research, but progress takes time.
“We are working on devising more targeted therapies, paying attention to a patient’s quality of life. We now view cancer as more of a chronic illness than a death sentence,” Dr. Makhija says. Patients today have higher survival rates than ever before, which Dr. Makhija says she finds rewarding.
“Patients are living longer with their disease; we’re looking at their quality of life today. If we have their cancer and their symptoms under control, and they have good quality of life, that’s what matters most.”