Radiation Onc. and Medical Onc?

[SupergreenMnM]

I've seen some professors out there who list being board cert. in both radiation oncology and medical oncology. Are there fellowships out there for radiation oncology after residency (if not why? Is internal med residency that necessary for the fellowship?) or did these people do two residencies plus a fellowship?

Do Radiation oncologists ever treat patients medically? I'm wondering because clinical oncologists (UK) supposedly treat patients both with chemo and radiation, but that doesn't seem to be the case here? Thanks for the answers!

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[QuantumMechanic]

if not why? Is internal med residency that necessary for the fellowship?

You'd think that the base IM knowledge and skill set is critical to the medical oncologist since they essentially assume a primary care role for their patients.

 

[SupergreenMnM]

And its THAT different from what rad.onc residents do that they would be lost in a med.onc fellowship? I also thought most oncology was referals? (note: I'm asking here, not asserting)

 

[QuantumMechanic]

I also thought most oncology was referals?

right, oncology is all referrals, but during cancer treatment, the medical oncologist essentially fills the role of the primary care physician (here for a special set of pts). The medical oncologist manages the patient's treatment plan and will refer to radiation oncologists and surgical oncologists and any other specialists that are relevant for care, so that the pt can receive the appropriate treatment.

 

[stephew]

actually no medical oncologist dont typically act as pcps. they do have a medicine base but typically will NOT take over as the pcp for these patients as they are specialized. they are not the people who should be playing with your cardizem.

 

[QuantumMechanic]

actually no medical oncologist dont typically act as pcps. they do have a medicine base but typically will NOT take over as the pcp for these patients as they are specialized. they are not the people who should be playing with your cardizem.

from the IM subspecialties FAQs thread (http://forums.studentdoctor.net/showthread.php?t=199551)

Hematology/Oncology
Heme/onc is a combined fellowship program that is 3 years long, with a minimum of 18 months of clinical training time during the fellowship. At the end of the fellowship, graduates can be double-boarded in hematology and oncology. A less common path for fellows to pursue is to do a separate heme or onc fellowship. The separate heme and onc fellowships are 2 years each, with 1 year minimum of clinical training time during the fellowship. Heme/onc physicians mostly manage patients with cancer, and will decide on treatment options and chemotherapy regimens for their patients. They will also manage any complications that arise from the chemotherapy and the cancer itself, and pretty much become the oncology patient's primary care doctor while they are undergoing active treatment. In addition, oncologists do bone marrow biopsies, and bone marrow transplants. They also treat benign hematologic conditions, such as sickle cell anemia, the thalassemias, and TTP. The setting that they practice in is mostly outpatient, although physicians who specialize in hematologic malignancies or BMT often spend a significant amount of time in the inpatient setting.

the point is that to do med onc, you need to be able to manage a wide range of IM issues to appropriately treat cancer patients. I'm no onc expert, but I thought that would be rather obvious?

 

[stephew]

a good med onc doesnt try to manage what he doesnt speciallize in. Just like a good cardiologist wont be managing your hemeonc related issues. That's how it works real world, as it should.
Yes medoncs know more IM than radoncs. radoncs typically are a bit better versed in oncology than medoncs.

 

[deleted4401]

I think I had a similar impression until I was an intern on an inpatient onc service. Yes, you are their "primary" physician, but you are by no means their "primary care" physician. You may manage them for neutropenic fever, infections, thrombocytopenia, TLS, acute hyper/hypotension, etc. But, you will not be tweaking their metformin and lipitor, nor will you be performing Paps or performing DREs to screen for prostate cancer. If they get the sniffles during treatment, you may write them for some Allegra, or if they have trouble sleeping, you may write for some ambien. There's a subtle difference between "primary" physician and "primary care" physician.

-Simul

 

[Adawaal]

a good med onc doesnt try to manage what he doesnt speciallize in. Just like a good cardiologist wont be managing your hemeonc related issues. That's how it works real world, as it should.
Yes medoncs know more IM than radoncs. radoncs typically are a bit better versed in oncology than medoncs.

I'm not even sure about the Med Onc knowing more than Rad Onc concept. Med Oncs have to know how to multiply a patient's weight by a dosage to do their "treatment planning." They tend to know virtually nothing about radiation and even less about surgery/anatomy/staging/pathology. I find that Rad Oncs tend to be much better versed about chemo than Med Oncs are about radiation. We also know much more surgery/anatomy/staging/pathology than the chemo gods do as well. Of the three oncological specialties, I've found that Rad Onc is best-versed with the literature as well.

 

[stephew]

no, medoncs know more internal medicine overall. but frankly like the radonc, over time they lose some of their general medcine as their specializing.

 

[SupergreenMnM]

So...back to my first question, are there (or do you ever see in the future) medical oncology fellowships that will be open to rad oncologists so they can do both (i.e. like clinical oncologists in UK)?? Does a radiation oncologist ever also give chemo?

 

[stephew]

no, but there was a presentation recently about how the field should change to keep its turf and reestablish repspect and doing chemo was one of the issues (along with reestablishing inpatient service). i dont see it happening though, not cytotoxic drugs anyway.

 

[Thaiger75]

So...back to my first question, are there (or do you ever see in the future) medical oncology fellowships that will be open to rad oncologists so they can do both (i.e. like clinical oncologists in UK)?? Does a radiation oncologist ever also give chemo?

I know some places in Asia (Japan) that the rad oncs are more like oncologists and do give chemo

 

[stephew]

in many places outside of the us this is the case.

 

[SupergreenMnM]

Sarcasm aside...and I'm not looking to put any med oncs out of business, I'm just split between medical oncology and radiation oncology and want to have my cake and eat it too

 

[stephew]

choose based on what you like doing. they're very different fields. A fundemental difference is that Radonc is more comparable to surgery in that its a technique related approach. Medonc is more medicine-like and based on supporting the patient throughout treatment. Obviously ther eis more to both but this is a core difference.

 

[salmonella]

Just out of curiosity, are you guys concerned about occupational safety of working with cancer patients? Studies have shown that patients who are on active chemo excrete cytotoxic drugs through their urine and sweat. Nurses who come in contact with them and those who handled chemo had increased chance of getting leukemia and bladder cancer. Since rad onc have to see cancer patients daily in clinics, I wonder if chemo substances could get into us by physical contact or inhalation/aerosol.

 

[stephew]

no, dont worry about it.