a med-onc's perspective

[IRISH22]

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I was recently talking to a well-respected professor of medical oncology at my school, who nearly chewed me out after he found out I was interested in rad onc. Needless to say he doesn’t have the highest opinion of radiation therapy or the doctors who provide it. (Ironically, I am at one of the centers that is regularly listed as one the high tiers on this board). He painted it as a field that will be progressively marginalized in the coming years as more and more immunotherapy becomes available, and he cautioned me about going into a “dying” field. He also ripped rad onc for not working weekend and suggested that not giving RT for 2 consecutive days might actually be detrimental, etc, etc. wow. Why is it that so many other doctors (med onc’s included) scoff at my decision to go into RT?

 

[Gfunk6]

It's probably just institutional bias. At some places, MedOnc and RadOnc do not play together well. I could make blanket statements about MedOnc like,

"The chemotherapy for small cell lung cancer has not changed significantly in 40 years."

But this is not productive and purely inflammatory rhetoric.

Also, immunotherapy is by no means under the sole purview of medical oncology. Link: http://www.theabr.org/NRC_Final_Reg_RO.htm Furthermore, immunotherapy (assuming he is referring to radio-labeled compounds) is hardly the panacea that it is billed as.

In my own personal experience, virtually every single person I've met have complimented me on my decision to go into RadOnc. Your mileage may vary, do not be put off by nay-sayers.

 

[chuwoods]

I have received positive feedback from non-medonc physicians when I tell them I am interested in rad onc. It is usually something like - "great field", "smart choice", "I wish I had known about rad onc when I was a student".

But interestingly when I did a heme/onc rotation this year they just smiled but didn't say much about it and did not provide any encouragement.
I think that what rad oncs do on a daily basis is a mystery to many people in the medical field.

 

[cdf95cro]

"If immunotherapy should prove useful in human cancer, the ability to cure the common tumors may be further increased . Probably, new and different drugs will be required in order to control
all of the common cancers, and yet, current clinical trials using drugs
already known may indeed show that the goal is much closer than had been
anticipated ."

Zubrod, C G
Present status of cancer chemotherapy.
Life Sciences
Volume 14 Issue 5 Date 1974-03-01 Pages: 809-18

 

[stephew]

because people love to dig into the other fields. Surgeons hate med folks. Med folks hate ED. Everyone hates the surgeons. its the mark of a poor mind to buy into that. Anyway the next time your med onc calls for an
urgent rad consultation tell him there is no rush for such an unimportant modality.

BTW if you really want ot know the stereotype is the radoncs know more oncolgoy than the medoncs. They hate that though its true for the training. But I will say the the stereotype ofr radonc that is negative and true is that they let themselves become rich technicians, not doctors. That element is as real as the "dumb but arrogent surgeon" or the neurologist who "knows everything but does nothing".

I was recently talking to a well-respected professor of medical oncology at my school, who nearly chewed me out after he found out I was interested in rad onc. Needless to say he doesn’t have the highest opinion of radiation therapy or the doctors who provide it. (Ironically, I am at one of the centers that is regularly listed as one the high tiers on this board). He painted it as a field that will be progressively marginalized in the coming years as more and more immunotherapy becomes available, and he cautioned me about going into a “dying” field. He also ripped rad onc for not working weekend and suggested that not giving RT for 2 consecutive days might actually be detrimental, etc, etc. wow. Why is it that so many other doctors (med onc’s included) scoff at my decision to go into RT?

 

[stephew]

i will say this: i know several medoncs and IM people who switched to rad onc. Only this year i heard about a radonc who switched to medonc. do you do the math.

I would wager that immunotherapy will not replace any modality in our lifetime. See the FAW> better yet show it to your ignorant medonc.

 

[QuantumMechanic]

He also ripped rad onc for not working weekend and suggested that not giving RT for 2 consecutive days might actually be detrimental, etc, etc. wow.

He sounds jealous.

 

[Doctor&Geek]

I was recently talking to a well-respected professor of medical oncology at my school, who nearly chewed me out after he found out I was interested in rad onc.
...
Why is it that so many other doctors (med onc's included) scoff at my decision to go into RT?

Actually, you stated one physician's opinion, and but you make it out to be "so many other" doctors. 🙂 So is it really institution-wide reticence towards radoncs at your school, or the opinion of one bitter attending?

 

[radonc]

the 'opposition' with radiation oncologists are surgeons, not medoncs. surgery and radiotherapy both provide local control, which probably does affect survival (see EBCTCG), whereas chemo provides systemic control. he should applaud radiation, because his chemotherapy acts as a radiosensitizer in a lot of sites.

it will take some time, but you will learn the biology behind radiation, the theory of fractionation, rbe, let, a/b, etc. once you start quoting hall, they usually become like a deer in your headlights.

as an aside, i organize the medonc fellows rotation at our institution and made them come to our physics/biology lectures and they were like, 'huh?'. they didnt realize how technical our field is...and how evidence based theirs isnt. a clinical trial in medonc is like cooking...lets see if we can add a pinch of a targeted agent and throw it in with this and that.

 

[3dtp]

as an aside, i organize the medonc fellows rotation at our institution and made them come to our physics/biology lectures and they were like, 'huh?'. they didnt realize how technical our field is...and how evidence based theirs isnt. a clinical trial in medonc is like cooking...lets see if we can add a pinch of a targeted agent and throw it in with this and that.

This is a great idea.

I don't think I can convince them to come to our radiobiology/physics lectures, but I think I can convince our rad-biols to give a med/onc grand rounds lecture and a physics lecture to take the mystery out of it and show the capability.

I gave a lecture to several of our interdisciplinary conferences to show what we can do and how we do it. I like your idea better, If I can pull it off.

 

[stephew]

two things; the surgeons are NOT our "opposition". though youre right that our field is more technique oriented like surgery than medicine. But surgeons need us as we need them. Surgery med and radon are complimentary modalities.

In some places radonc is a mandatory rotation for pedoncs or medoncs or neurosurgeons. its a good idea. unfortunately the neurosurgeons have just learned that all radonc is is contouring a perfectly round met or brilliantly enhancing mening or acoustic neuroma. They then ironically understand less about radonc than the medoncs or pedoncs who rotate through.

 

[Thaiger75]

In my experience at the various institutions that I have exposed to, I will have to say that rad oncs are far from being and viewed as just technicians. During tumor board, no one from other subspecialties knows the literature and evidence-based oncology more than the rad onc docs.

 

[stephew]

In my experience at the various institutions that I have exposed to, I will have to say that rad oncs are far from being and viewed as just technicians. During tumor board, no one from other subspecialties knows the literature and evidence-based oncology more than the rad onc docs.

those two things arent mutually exclusive. radoncs tradiationally knwo the literature better than most (and let me say its another topic but I HATE this phrase "evidenced based medicine") They are also increasingly percerived as tehcnicians in spite of this, and outside in the communitiy particuarly. as a resident who has only sat in tumor boards, you aint seen nothing yet. I wish this werent true but it is. You really are entering at a pivot point in time. how our generation deals with this issue will shape the future of the field. I will say there are some who are looking into the issue who already things its too late to turn the tide.

 

[StanGetz]

I found this thread a little too interesting to not chime in. We've had this debate several times amongst our residents as well. The reason I think we rad oncs will be increasingly viewed as secondary is for one simple reason: We do not manage inpatients. We're viewed as technicians because we only handle one aspect of a patient's care: radiation and the small spectrum of toxicity related to that radiation. When things get complicated or the patient needs hospitalization, the first thing we do is find a med onc to pawn the patient off on. Like it or not, because we can't "get our hands dirty," other specialties will always look at us as pseudo-doctors (or technicians). Of course, you and I know that our ability to manage sepsis has no bearing on our ability to know how a patient should be treated for cancer. But it's the same phenomenon with patients who falsely believe that your skills as a doctor are tied to your bedside manner. If you're a jerk, you're not a good doctor, but if you're charming, you can do no wrong.

It's funny when I hear about talk of eliminating our preliminary year. You mean get rid of the one opportunity in our entire training to actually learn some general medicine and be able to manage things that, though they may not be related to cancer, can also be very important to the patient?

I know many of you will react by saying how at your institution you guys go the extra step a lot of times in your clinic and find yourselves giving out meds for general health issues. But keep in mind you're likely training at an academic center, you're closer to med school and internship so you have a bit more knowledge, and you're in training and not bogged down by the burden of keeping an efficiently run clinic to maximize profits. How do you think the majority of private practice rad oncs (and academic ones to be sure) are in the average practice in the US? I highly doubt they would want to take the time to deal with anything not related to radiation, so the first they'll do is find some med onc or medicine doc to turf the patient too at the nearest sign of trouble.

That's the reason I believe we will always be fighting for respect among surgeons and med oncs. They know if the code blue alarm goes off in our clinic, we'd freak. That one med onc listed at top who can't respect us because we don't work after hours is the perfect example. Plus, I freely admit that I don't feel comfortable managing lots of things that come my way in the clinic that are non-rad onc related, but I'm not saying I'm ready to do a medicine residency just to overcome this deficiency or start moonlighting in the ICU. This issue is something I think that's important to be aware of though as a source of the negative perception of our field. What good is quoting the literature verbatim if the other docs don't respect the person quoting it?

 

[Zap]

I find this thread pretty amusing. I did not realize how much angst some among us feel about what other MDs think about them. Why do I have trouble envisioning a similar thread on a dermatology board? Personally, I feel very comfortable about my role as a physician. I wield a therapeutic modality on a daily basis that has the capability to cure if delivered correctly and to kill if delivered incorrectly. If that doesn't deserve respect, I don't know what does.

I'm glad there are people who enjoy taking care of inpatients so that I don't have to do it. Actually, in my experience, the "joy" a medical oncologist displays about a new admission is quite muted. Why don't they thank us profusely when we send sick patients their way? Could it be that taking care of inpatients is really not that much fun? Nah, that's crazy talk. Taking care of inpatients is "real" medicine. How could I even suggest such blasphemy?

I don't think that the lack of inpatient care is marginalizing our field. By the nature of our specialty, we are primarily consultants. In most cases, we are not the patient's primary cancer doctor (I know there are exceptions). There is nothing wrong with that and I actually think that it's a beautiful thing. It saves us a lot of headaches and allows us to focus on what is fun about our field. It is unrealistic to think that we will ever be primary cancer doctors. If that's what people are looking for, don't go into radiation oncology. If anything will marginalize radiation, it is the emergence of better drugs. But, as has been stated here before, it is also quite possible that radiation will play an even bigger role in the future, particularly if screening is improved and/or if micromets are better controlled so that local control becomes an even bigger issue. I'm not holding my breath waiting for the day that we retire our linacs.

As general (but admittedly hard to follow) advice, don't look to others to define what makes you happy. Look inside. I am willing to bet that the lack of respect some think they feel is significantly tied to other MDs' envy about our jobs. There is no glory in working weekends. If this isn't apparent to anyone yet, just wait a few more years. Life is short and there is much more to it than your job.

 

[temujim]

He painted it as a field that will be progressively marginalized in the coming years as more and more immunotherapy becomes available, and he cautioned me about going into a “dying” field.

This dying field stuff has been told to med students interested in Rad Onc for the last 60 yrs. But here we are.

I have a slightly different perspective: as chemotherapy agents become more targeted and theoretically less toxic, it will be the med oncs who will have to watch out. Why refer to med oncs if the surgeon or rad onc feels comfortable prescribing the drug?

 

[chuwoods]

With hospitalists being the fastest growing group of docs, it seems that many other specialties are planning to get out of the inpatient biz-internal med and peds included.

 

[Thaiger75]

I'm pretty surprised at it too. At my institution experience at least, I don't get that feeling at all that we're not respected, looked down upon, or viewed as technicians. At tumor boards, we every much a part of the multi-disciplinary management as the surgeons and med oncs, particularly in cases where we're the primary treatment modality (ie. locally advanced HNC, lung, etc.).

Perhaps in the private practice setting or in an acadmic environment where there isn't a cohesive multidiscplinary team approach...that's when you get the outside negative views...dunno

 

[stephew]

stan makes some very worthwhile points.

Its is VERy true that by not managing patients in house we limit our scope. And limit our tendency and ability to competantly handle medical issues more than we tend to. And he's right, out of residency, you run the risk of doing less if you arent careful

But it breaks down a little ther;e part of the issue is that we dont have nursing and other ancillary resources to support us to do these things. For instance I used to manage DVTs and PEs in residency but my hospitals policy is that our nursing doest do that in our dept so there you go, i dont mangage it now. i diagnosis it all the time, but sned them off for management.

Also, radoncs often do get respect for their knowledge base at least in academic centers. but again in practice it varies a lot.

Radiation oncology care varies wildly. but just to put in perspective: when you get out in the world you will be flabberghasted by what is done by others in medicine. things that seem "obvious" to you are dropped and missed by others. why? because in training youre with the best people on the cutting edge. the further you go from training the more at risk you are too. so don't get to arrogent about it. Its easy to do.

 

[stephew]

well youd be wrong to think that other docs dont think about these issue. all docs are criticised by their peers in some way. for not having rigerious hours; for not being a procedural person. for not seeing patients. For BEING procedural and not doing "medicine". etc.

if you still can't fathom why someone could hate admissions but stil snark at services that dont do it, you've been blissfully unencumbered by human nature. its easy to hold both views. no one should care too mcuh about that though. they should care about losing the respect of being seen as an *oncolgoist* which is what we are.

I find this thread pretty amusing. I did not realize how much angst some among us feel about what other MDs think about them. Why do I have trouble envisioning a similar thread on a dermatology board? Personally, I feel very comfortable about my role as a physician. I wield a therapeutic modality on a daily basis that has the capability to cure if delivered correctly and to kill if delivered incorrectly. If that doesn't deserve respect, I don't know what does.

I'm glad there are people who enjoy taking care of inpatients so that I don't have to do it. Actually, in my experience, the "joy" a medical oncologist displays about a new admission is quite muted. Why don't they thank us profusely when we send sick patients their way? Could it be that taking care of inpatients is really not that much fun? Nah, that's crazy talk. Taking care of inpatients is "real" medicine. How could I even suggest such blasphemy?

I don't think that the lack of inpatient care is marginalizing our field. By the nature of our specialty, we are primarily consultants. In most cases, we are not the patient's primary cancer doctor (I know there are exceptions). There is nothing wrong with that and I actually think that it's a beautiful thing. It saves us a lot of headaches and allows us to focus on what is fun about our field. It is unrealistic to think that we will ever be primary cancer doctors. If that's what people are looking for, don't go into radiation oncology. If anything will marginalize radiation, it is the emergence of better drugs. But, as has been stated here before, it is also quite possible that radiation will play an even bigger role in the future, particularly if screening is improved and/or if micromets are better controlled so that local control becomes an even bigger issue. I'm not holding my breath waiting for the day that we retire our linacs.

As general (but admittedly hard to follow) advice, don't look to others to define what makes you happy. Look inside. I am willing to bet that the lack of respect some think they feel is significantly tied to other MDs' envy about our jobs. There is no glory in working weekends. If this isn't apparent to anyone yet, just wait a few more years. Life is short and there is much more to it than your job.

 

[deleted4401]

We are approaching a threshold here ... That survey that was sent to rad-onc residents makes this very clear.

It's sad (or not sad, depending on one's perspective) but true that we are not going to be thought of as the 'primary oncologist' for a patient that has cancer - by other physicians. But, to many patients, we serve that role. And, as our inpatient skills erode, we will have to turf to medicine or med-onc. And I think that is a strength of a good clinician - to realize when you are out of your element. I don't think patients have any less respect for you when you say, "Hey, this isn't something I can handle. Let's get you to someone who can." I don't think it's because of laziness or disinterest, rather it is the way our field is.

But, I do agree with the point above that as drugs get targeted, we can become primary oncologists, if we are willing to share the burden. With the use of Erbitux, treating head and neck cancers is gettiing messy again. The rashes and mucositis is something that we see daily, and the med-onc (or their PA) may see weekly.

I'm thinking of one day specializing in treating HNC, and I know that it may seem foolish, but my thinking is, since I'm managing the complications of Erbitux day-to-day, I may as well just be the one prescribing and delivering it. However, that will necessitate me applying for admission privileges and with that ownership of an inpatient panel. That will be the price I pay.

In any case, I think your level of involvement will dictate whether you are viewed as a technician vs. primary oncologist. I think technician is a term thrown out with a negative connotation, and I think that is unfair. If one prefers that role, it won't make you less of a physician, as long as you know when to treat and when not to. If you want to be primary oncologist, grab the bull, b/c no one is going to say no. It just means that your weekends and evenings won't be as free.

I do agree that worrying about what other docs think is silly and wasteful. I do think it is important to not get bullied, and to make your recommendations clear and evidence-based, even if you are regarded as a technician. An excellent technician is still excellent.

At the end of the day, we are making a difference, be it in curing a prostate cancer or palliating an esophageal mass, patients are grateful. Can't spend our time worrying about what Dr. Chemo thinks.

-S

 

[StanGetz]

The issue of our field dying is completely irrelevant to the point I was making earlier and has been discussed at length elsewhere. I think most of us think that notion is pretty ridiculous, as is the hopes by med oncs that some magic drug will be the panacea of cancer in the near future.

My point of being marginalized is not in regards to the role of radiotherapy, but rather with the role of radiation oncologists. Again, go back to the med onc mentioned at the top of the thread who disrespects us for not working weekends. His disdain is not based on how knowledgeable or competent we are as doctors. It's based on the perceived notion that because we work between 9-5 on weekdays, our jobs cannot be that tough. And if you carry that thought process further, surgeons and med oncs will begin to feel that they can pretty much do what we do. Then you get uro-rads facilities popping up and radiosurgery centers that are run completely by surgeons who call the shots and just need to hire rad onc "techs" to sign off on the prescriptions.

Believe me, I love not having to deal with primary care issues and inpatient issues like all of you. That's the reason why I chose this field, to focus primarily on the oncology stuff. But you can't have it both ways by demanding respect as an equal by surgeons and med oncs while still going home at 5 o'clock M-F (or in some cases M-Thu). As wrong as it may be, there's still the old school thought process by the "battle-hardened" surgeons who feel that you can't be a real doctor if you don't put in the hours. How do you think they would react if a rad onc who just got back from a 3 day weekend tells a surgeon who just got out of an 8 hour surgery late in the evening (that was completely wrong or unnecessary) that they screwed up?

I know the question we always throw around is whether or not our field will be dead in 20 years, but the real question we should be discussing is if our field will be usurped in 20 years by other doctors who think they can do our "easy" 9-5 job. So it may not be as silly as you think to worry about how you're perceived by other docs.

PS An extension of this theory is likely the reason why radoncs are never directors of cancer centers and they are always heme-onc. It's strange that chemo docs are viewed as the "oncologist," yet chemo for the vast majority plays an adjuvant role in the treatment of cancer while radiation and surgery are the true primary treatments.

PPS Probably another really important reason we're viewed as secondary is because we don't get the patients first (but that's a pretty obvious reason).

 

[deleted4401]

There's a lot to reply to, but as far as leadership, Hellman ran the cancer center at UChicago and for a while was Dean of the medical school. I believe he was chair of oncology at Sloan for a stint, as well. Halperin is running the entire medical school at Louisville. These are clearly few examples, but not the only ones, and I'm sure others have more. Again, it's a matter of involvement, intervention, and desire to lead rather than the fact that one is a surgeon or chemotherapist or whatever.

And I think one should be cognizant of the fact that we were even more marginalized before radiation became "hot" (pun intended). Think about the geeky guys in the basement in the 1970s vs. the leadership roles that many now hold. Plus, face it, and I hate to brag because I'm nowhere near most of the candidates, but we get the cream of the crop in oncology. If 25% of hem-onc fellows were PhDs, no other specialty would have very many of them. Now, I think rad-oncs are looked up to as 'true' oncologists and academics more than ever before.

The desire not to be marginalized will overcome the other obstacles, because they are not great. This is not CRNAs trying to take over anesthesia (although, I'm sure someone will make the argument that it will happen to us, as crying wolf is as akin to medicine as is complaining about nursing).

-S

 

[3dtp]

There's a lot to reply to, but as far as leadership, Hellman ran the cancer center at UChicago and for a while was Dean of the medical school. I believe he was chair of oncology at Sloan for a stint, as well. Halperin is running the entire medical school at Louisville. These are clearly few examples, but not the only ones, and I'm sure others have more. Again, it's a matter of involvement, intervention, and desire to lead rather than the fact that one is a surgeon or chemotherapist or whatever.

-S

And Allen Lichter moved UMich's rad onc department from a Co-60 in the basement with bugs to a brand new center, developed the first clinical implementation of conformal imaging based CT planning, became dean of UM Med School and is now president of ASCO, Not bad for a radiation oncologist to be head of a major society not focused specifically on radiation oncology.

 

[Doctor&Geek]

PS An extension of this theory is likely the reason why radoncs are never directors of cancer centers and they are always heme-onc. It's strange that chemo docs are viewed as the "oncologist," yet chemo for the vast majority plays an adjuvant role in the treatment of cancer while radiation and surgery are the true primary treatments.

An interesting observation - but again, the reference to what the public perceives as the "cancer doc" has more to do with who is the doctor while one is on the inpatient service - namely that of the surgeon or the internist. And whilst surgeons don't have the time (nor some say have the desire) to manage a cancer center, that leaves the management to the internists.

As far as cancer centers are concerned, since pro forma most of the leaders of cancer centers are researchers, or even translational researchers, by both the size of the enterprise and the perceived future of cancer treatment in a molecular direction, oncologists have the upper hand. There are simply many more physician scientists in oncology and a better developed research program vis-a-vis radiobiology research programs at nearly all cancer centers, and it is from that cadre that leadership is selected.

 

[radonc]

An interesting observation - but again, the reference to what the public perceives as the "cancer doc" has more to do with who is the doctor while one is on the inpatient service - namely that of the surgeon or the internist. And whilst surgeons don't have the time (nor some say have the desire) to manage a cancer center, that leaves the management to the internists.

As far as cancer centers are concerned, since pro forma most of the leaders of cancer centers are researchers, or even translational researchers, by both the size of the enterprise and the perceived future of cancer treatment in a molecular direction, oncologists have the upper hand. There are simply many more physician scientists in oncology and a better developed research program vis-a-vis radiobiology research programs at nearly all cancer centers, and it is from that cadre that leadership is selected.

good point
and the number of radonc docs in these positions is not a good marker of the strength of the field as whole...

when it comes down to it, radonc docs are consultants, and just as the OP alluded to, are not held in high regard, across all oncologic subspecialties. its the nature of the beast.

however, we shouldnt accept this...and by our participation in multi-disc conferences/clinics, research activities, hospital administration, etc, wecan overcome this disregard. i think this field is already on the right track...given the competitive nature of the field (smart people, high board scores, high number of md/phd candidates), it may be another 10-20 years to see the change in perception.

 

[temujim]

An interesting observation - but again, the reference to what the public perceives as the "cancer doc" has more to do with who is the doctor while one is on the inpatient service - namely that of the surgeon or the internist. And whilst surgeons don't have the time (nor some say have the desire) to manage a cancer center, that leaves the management to the internists.

As far as cancer centers are concerned, since pro forma most of the leaders of cancer centers are researchers, or even translational researchers, by both the size of the enterprise and the perceived future of cancer treatment in a molecular direction, oncologists have the upper hand. There are simply many more physician scientists in oncology and a better developed research program vis-a-vis radiobiology research programs at nearly all cancer centers, and it is from that cadre that leadership is selected.

I think it's more of a numbers game for leadership roles. There are a lot more med oncs running around than rad oncs. Besides, the med oncs hate their day/night/weekend job so doing research and admin is a welcome relief 🙂

 

[stephew]

And Allen Lichter moved UMich's rad onc department from a Co-60 in the basement with bugs to a brand new center, developed the first clinical implementation of conformal imaging based CT planning, became dean of UM Med School and is now president of ASCO, Not bad for a radiation oncologist to be head of a major society not focused specifically on radiation oncology.

and guess who is leading the way to reinstate radoncs as primary oncologists?

 

[Butch]

...

 

[imable24]

Is it possible to be do two specialties and become a medical/radiation oncologist? Are there combined internal medicine/radiation oncology residency programs? If so subsequently could you do medical oncology fellowship? Would that give you the ability to do inpatient stuff and as an medonc and do technical stuff as a radonc?

 

[Gfunk6]

Is it possible to be do two specialties and become a medical/radiation oncologist?

Theoretically, yes. There are a couple of big-names in the field that went down this path. This only happens if someone does MedOnc and then changes their mind and does a RadOnc residency.

Are there combined internal medicine/radiation oncology residency programs?

No and if there were, they would be on the order of ~ 10 years. Who would want to do that up front?

 

[deleted4401]

Oh, I don't know if that's true ... both medicine and peds have 'fast-tracks' into subspecialties cutting the clinical years down to two years; pure med-onc (with no boarding in hem) fellowships are 2 years - including 1 year of research, so we can cut that to 1 year. Rad-onc is 4 years, but 36 months clinical and only 27 months clinical for Holman pathway types). I'm not skimping too much, in fact, I'd be going with the same total months of clinicals for the minimum requirements for both (med-peds actually cuts out 1 year of both; med-derm cuts off a year; peds-neuro cuts off 2; EM/IM cuts off 1; etc).

So ... 2 years of internship/residency + 1 year med onc + 2.5 year of clinical rad onc and 0.5 year research; you got yourself a 6 year training program for a chemoradiotherapist; 7 if you throw in an extra year of research.

I think it'd be pretty dumb. But feasible to do it in much less than years, if we follow some of the other combined programs.

-S

 

[Gfunk6]

Oh, I don't know if that's true ... both medicine and peds have 'fast-tracks' into subspecialties cutting the clinical years down to two years

Well "fast-track" is not really fast.

2 yrs IM + 2 years Med Onc + 3 years post-doc = 7 years

Ironically, it would be one year shorter (or two years if you forgo heme training) to do it the old-fashioned way.

So minimum, would be 3 IM + 2 Onc + 4 RadOnc = 9 yrs

Though I agree with you that no sane person would do this, but it makes for interesting dinner conversation.

 

[deleted4401]

I don't mean to quibble, but the point I was trying to make was that if one takes the 'accepted' amount of time for board certification/practice in that specialty (i.e. 2 years for IM if you fast track, 1 year for med-onc, etc.) that a combined program need not take 10 years. It is true that a fast track takes 7 years for certification including the 3years for post-doc, but the amount of clinical time is still 24 months for IM certification. And again, the rad-onc clinical years required are 36 months for the majority, and only 27 months for Holman Pathway. What I was saying is that if you went by minimum clinical requirements and tossed in a 1.5 year requirement, it would be equivalent to NSG. That's all ...

-S

 

[3dtp]

and guess who is leading the way to reinstate radoncs as primary oncologists?

Indeed!

Is it possible to be do two specialties and become a medical/radiation oncologist? Are there combined internal medicine/radiation oncology residency programs? If so subsequently could you do medical oncology fellowship? Would that give you the ability to do inpatient stuff and as an medonc and do technical stuff as a radonc?

Turrisi is one. There are probably others. This is an important point. Our institution has a number of interdisciplinary conferences meeting weekly. If we know the med-onc literature as well as they do and the rad onc literature well, we do gain respect.

At our institution, there is a tremendous respect for rad oncs.

This is why I think it is important to be broad based in our knowledge and skill sets. It does not mean we need to know how to calculate a chemo dose, nor how to do a surgical reduction or thoracotomy, but I think it's important for us to understand our team-mates' approaches to oncology, lest we all view the world through multiple tunnel vision.

Right now, to most non-rad oncs, radiation is one big mystery. We can help change that by doing a very basic presentation at other departmental conferences. I've been invited to present what we are capable of and why it works at our medicine, peds and med onc grand rounds. We have presented our capabilities, the reality of conformal/shaped dose/stereotactic radiation which most people are clueless about.

Once our colleagues see what we do, it helps them understand that we don't just wheel a patient into a cave and and whip out a radioactive rock.

Every surgeon has had medical training. Every medical oncologist has been in an OR, even if it was only once as a third year med student. Not too many have ever been to a rad onc department, even as a med student. I have implemented interdisciplinary med-onc/rad-onc resident conferences at our institution. Right now, it is mainly journal article discussions, but I am working with our program and the med onc program to expand this and we now offer a rotation for med oncs in our department. Those who have, become more vocal advocates for the role of RT at the conferences.

...and it reduces the number of pre-radiation therapy cases diagnosed with radiation pneumonitis among bleo patients.😀

 

[stephew]

there are a few medonc/radoncs but i dont know anyone that practices both. -in other words though the radonc has a dual cert, the patients would still see a separate medonc. My first thought is that trying to practice both would be a very very bad idea. For one (big) thing the resources typically arent available to let you do so in any given clinic. Perhaps there are a (very) few who do it but the idea gives me pause.

 

[DrJT]

So, all this talk of respect from others, technician vs doctor etc is pretty interesting. But what I really would love to know is if you guys (i.e the radiation oncology residents/fellows among you) enjoy your work?

 

[Thaiger75]

So, all this talk of respect from others, technician vs doctor etc is pretty interesting. But what I really would love to know is if you guys (i.e the radiation oncology residents/fellows among you) enjoy your work?

Of course. Couldn't imagine doing anything else.

 

[Gfunk6]

But what I really would love to know is if you guys (i.e the radiation oncology residents/fellows among you) enjoy your work?

Every day I am tempted to get on my knees and thank my Maker that I have the privilege of working in this speciality.

Worst day in RadOnc >>>> Best day during intern year.

 

[stephew]

So, all this talk of respect from others, technician vs doctor etc is pretty interesting. But what I really would love to know is if you guys (i.e the radiation oncology residents/fellows among you) enjoy your work?

to call the radonc a technician would be like calling the med onc a chemist or a pharmacist (try doing that sometime and enjoy the reaction). a radonc is more akin to a surgeon in the sense that we approach plans that way. but those who imagine the radonc as a technician dont know or understand what we do. which is a lot of them. I enjoy my work enormously 99% of the time.

 

[clinonc]

Interesting discussion re combining medonc and radonc training. In the UK there are two types of oncologist: clinical oncologists, who give all the non-surgical modalities (radio- chemo- immuno- and hormonal therapy), and medical oncologists, who do not use radiotherapy and tend to have a greater involvement in translational work.

Most UK graduates spend six years at medical school but go straight from high school. We then do a two-year foundation programme with medicine, surgery and three other specialties. An oncologist would then do two years of internal medicine, followed by five years for a clinical oncologist and four for a medical oncologist, with the latter most likely taking three years to do a PhD in the middle.

So from medical school to final accreditation as a specialist:

MedOnc - 2+2+4=8, +/- 3 years PhD
CliinOnc - 2+2+5=9, +/- 3 years PhD