About surgical oncology fellowships

[Med0123]

I have 2 questions about surgical oncology subspecialty:

1- Are research years pretty much mandatory to land one of these fellowships?

2- I am Canadian and up north, surgical oncologists prescribe themselves chemotherapy w/o the assistance of a medical oncologist for cancers inside the scope of practice of the general surgeon (breast, colorectal, gastric, pancreas, liver...). Is this situation common in the US? Would any US surgical oncology fellowship prepare me by being "the cancer guy" inside my group and give me the tools to play with all these chemotherapy regimens?

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[Dr.LeoSpaceman]

1) Unless you already have your PhD, yes. There may be exceptions, but I wouldn't count on it.
2) The surgical oncologists I work with have a very good understanding of the available regimens, and are involved in the planning of multimodality therapy. However, when it comes to the "nuts and bolts", the patients still get referred to a medical oncologist to handle the actual administration/monitoring of the chemo. I'm unsure if any of the surg onc fellowships in the US would provide you with the background necessary to do that, as medical oncologists are going to keep a pretty firm grasp on it given that its one of their revenue streams.

 

[Med0123]

I didn't realise surgonc fellowship was that much competitive. What is the norm, 1 or 2 years off for research?

From what I've seen, due to the relative low population density in Canada, regional hospitals tend to be smaller, with waaaay less specialists than in other countries. Therefore it is not uncommon for trained general surgeons to implant pacemakers, perform Head and Neck stuff, prescribe their chemotherapy and so on... In most small hospitals, hospitalists are Family Practicionners, Internists act as consultants only, they may have a field of interested in oncology for example and share the task of administrating and following chemotherapy with other internists or general surgeons. When trickier cases present, these MD can always count on Tele-tumor boards with usually university-based experts to help them in their decision making process.

Pretty cool way of allowing Canadians to be treated close to their home despite the geographic challenges we experience I think.

Thank you for your contribution FaytlND

 

[Winged Scapula]

Surg Onc is one of the more competitive General Surgery fellowships, and is probably the most academic. The norm would be 2 years in the research lab.

My fellowship, under the auspices of general Surg Onc, required time spent on Med Onc and I've certainly become facile with treatment regimes. However, that does not generally translate to being able to write chemotherapeutic orders. Nor would I want to especially given the turf issues it would raise (as noted above, administering chemo is a source of revenue for medical oncologists).

 

[Dr.LeoSpaceman]

I didn't realise surgonc fellowship was that much competitive. What is the norm, 1 or 2 years off for research?

It is quite competetive. There are only 18 ACGME programs in the US that would make you eligible to sit for the surgical oncology boards. There are 3 others in Canada that are not ACGME accredited, but are recognized by the SSO. The ABS was supposed to rule on whether grads of those programs are going to be board-eligible, but I'm unsure if that's happened yet. Among all of those programs, I think there are something around 50-60 spots (someone who recently applied probably has the real number), and I thought the match rate was something around 50%. Not the level of pediatric surgery, but not too far behind.

As WS said, it's generally two years.

That is an interesting way to handle it, and probably makes a lot of sense especially for smaller/rural hospitals. I will say, however, that while actually planning regimens is interesting, I'm glad I won't have to deal with dose adjusting for toxicities, etc. Though you'll find the same thing in the US with regard to pacemakers, ports, PEGs, etc. The community general surgeon (or thoracic surgeon) will still often have those procedures as part of their practice.

 

[jasb66]

I think there are something around 50-60 spots (someone who recently applied probably has the real number)

56 spots in 2013: http://www.surgonc.org/training-education/surgical-oncology/op-case-log/match-results-2013

 

[Med0123]

Thank you everybody, much appreciated.