Ask an Radiation Oncologist Anything

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Is Bracytherapy ever performed in a private practice setting? If so, how does a physician incorporate this into their practice? Is a fellowship necessary?

I have heard Bracytherapy is reimbursed more poorly than external beam. Is this true? If so why?

Thanks again for donating your time

 

[ScubaManD]

Is Bracytherapy ever performed in a private practice setting? If so, how does a physician incorporate this into their practice? Is a fellowship necessary?

I have heard Bracytherapy is reimbursed more poorly than external beam. Is this true? If so why?

Thanks again for donating your time

FWIW, the private physician owned practice I currently work at does brachytherapy.

 

[oncologydude2]

Can you give me more info on surgical oncology? I know its not your field but I didn't find much info on it

Surgical Oncology is a bit of a heterogeneous field. The "classic" surgical oncologist completes a fellowship after the end of a General Surgery residency. Usually this is done in a high volume cancer center like MD Anderson or Memorial Sloan Kettering. These types of surgical oncologists generally focus their practice on GI cancers (e.g. rectum, colon, stomach, pancreas, etc.).

Other routes to perform surgery on cancer patients include . . .

1. Gynecologic Oncologists - fellowship after OB/GYN residency
2. Pediatric Oncologists - fellowship after General Surgery
3. Neurosurgeons - if you train at a center which is high-volume for brain cancers you can practice straight out of residency without need for fellowship
4. Head and Neck surgeons - same as Neurosurgeons. If you train at a high volume center you will feel comfortable performing surgeries of the oral cavity, oropharynx, larynx, lymph nodes of neck, etc.

 

[oncologydude2]

Can you expand on proton beam therapy? Do you think it has significantly superior utility over IMRT and other other forms of RT? Does it have potential to be the next standard of care? I work at an institution that uses protons and my Dr. is absolutely in love with them, so it'd be nice to get another perspective. Also how do you feel about prostate screening with PSA? still standard? Should it be? Will carbon ion therapy ever catch on in the US?

Sorry if that's a lot at once. I really like Rad Onc and would love to pursue it.

Proton therapy for commonly used sites (especially prostate cancer) costs about 75% more than IMRT and (maybe) improves symptoms by 1%. This is not cost-effective nor is it sustainable. Protons are absolutely superior to IMRT for certain specific indications like pediatric cancers and skull base cancers. However, if you just used protons where they were clinically indicated you would go bankrupt.

PSA is a "loaded gun" type argument. The argument is that most men die with prostate cancer and not from prostate cancer; so many men are possibly getting inappropriately treated for very early stage disease which they could safely observe. I'm on the fence, personally.

Carbon ion therapy has a huge financial disincentive in the US under our current health care reimbursement. We are paid by the # of fractions we deliver; carbon ions can potentially compress treatment into a much shorter time frame. This means more expensive treatment but less reimbursement = no dice. Carbon ion therapy is available in countries with socialized medicine including Japan and Germany.

 

[oncologydude2]

Is Bracytherapy ever performed in a private practice setting? If so, how does a physician incorporate this into their practice? Is a fellowship necessary?

I have heard Bracytherapy is reimbursed more poorly than external beam. Is this true? If so why?

Thanks again for donating your time

Yes absolutely it is performed in the private practice setting. If you train at a high-volume brachytherapy center during residency, fellowship is not necessary. It reimburses less because it is delivered over one (or a few days) whereas comparable doses of external radiation are delivered over 5-8 weeks. Since we are reimbursed by "event" external beam reimburses more than brachytherapy for comparable indications.

 

[Lord Humongus]

1. No, ok to pursue. For all the song & dance about Rad Onc is "math/physics heavy," the reality is far more basic. All med students will be familiar with far more sophisticated math than is required to function daily as a Rad Onc. Physics is slightly different. In the course of residency and board certification, you need to know a lot more physics than you actually use. However, in practice you use it far less particularly since you have PhD level physicists to support you.

So you've spent 9 years of your life absorbing information, first in medical school and then in residency. What fraction of this knowledge do you actually apply in your day to day practice? Knowing what you know now, if you had to go back and redo the entire education process, how long would it take you to become as clinically proficient in the field of radiation oncology as you are now, if you were only concerned with learning stuff that will directly come into play in your day to day practice? So for example, if your clinical decisions never involve pondering the Oxygen-Hemoglobin dissociation curve, you don't learn it, etc.

This is a general question I have for the practice of medicine, not just rad onc. I definitely won't use 80%+ of the stuff I learned (and promptly forgot) in undergrad if I become a physician yet technically undergrad is a part of medical education. I'm wondering if that still holds true to medical school and the more theoretical components of residency.

 

[Dare2Dream]

To go along with the above, do you believe a five year residency overall is needed or could it be reduced to 4 years at some point?

 

[oncologydude2]

So you've spent 9 years of your life absorbing information, first in medical school and then in residency. What fraction of this knowledge do you actually apply in your day to day practice? Knowing what you know now, if you had to go back and redo the entire education process, how long would it take you to become as clinically proficient in the field of radiation oncology as you are now, if you were only concerned with learning stuff that will directly come into play in your day to day practice? So for example, if your clinical decisions never involve pondering the Oxygen-Hemoglobin dissociation curve, you don't learn it, etc.

This is a general question I have for the practice of medicine, not just rad onc. I definitely won't use 80%+ of the stuff I learned (and promptly forgot) in undergrad if I become a physician yet technically undergrad is a part of medical education. I'm wondering if that still holds true to medical school and the more theoretical components of residency.

Forgive my saying, but this is a bit of a nonsensical question. The primary distinction between physicians and physician extenders (e.g. NPs, PAs) is (a) the depth and breath of a physician's education and (b) long and rigorous period of practical training (e.g. residency/fellowship). This gives physicians an excellent foundation to understand WHY things are going wrong and not simply HOW to treat/manage them. Furthermore, it gives all doctors a common "currency" to discuss complex medical matters amongst one another. You cannot build this vast foundation of knowledge without a strong base.

Although I don't know/care (off the top of my head) where the adductor magnus is or about the oxygen/hemoglobin dissociation curve - I can quickly "refresh" this information in my mind with a cursory study.

 

[oncologydude2]

To go along with the above, do you believe a five year residency overall is needed or could it be reduced to 4 years at some point?

Certainly not. In fact, it has consistently lengthened over time from three years (back when Radiation Oncology and Diagnostic Radiology were not separate), to four years, to five years. If you were bright, you could PROBABLY get away with learning everything in four years instead of five but academic institutions are loathe to admit this and give up their cost-effective indentured servitude.

 

[Petrichor1]

So you've spent 9 years of your life absorbing information, first in medical school and then in residency. What fraction of this knowledge do you actually apply in your day to day practice? Knowing what you know now, if you had to go back and redo the entire education process, how long would it take you to become as clinically proficient in the field of radiation oncology as you are now, if you were only concerned with learning stuff that will directly come into play in your day to day practice? So for example, if your clinical decisions never involve pondering the Oxygen-Hemoglobin dissociation curve, you don't learn it, etc.

This is a general question I have for the practice of medicine, not just rad onc. I definitely won't use 80%+ of the stuff I learned (and promptly forgot) in undergrad if I become a physician yet technically undergrad is a part of medical education. I'm wondering if that still holds true to medical school and the more theoretical components of residency.

a math professor once told me that memorizing formulas is plain useless. It's the conceptual background that you have and the understanding that deciphers you from students that are just fulfilling math requirements. If you have the base cleared, it is quite possible and expected that instead of becoming a memorizer, you can just derive things on the spot.

 

[ScubaManD]

"Cost effective indentured servitude" - oncologydude2

Quote of the day.

 

[barsoum.michael]

Thanks so much

Surgical Oncology is a bit of a heterogeneous field. The "classic" surgical oncologist completes a fellowship after the end of a General Surgery residency. Usually this is done in a high volume cancer center like MD Anderson or Memorial Sloan Kettering. These types of surgical oncologists generally focus their practice on GI cancers (e.g. rectum, colon, stomach, pancreas, etc.).

Other routes to perform surgery on cancer patients include . . .

1. Gynecologic Oncologists - fellowship after OB/GYN residency
2. Pediatric Oncologists - fellowship after General Surgery
3. Neurosurgeons - if you train at a center which is high-volume for brain cancers you can practice straight out of residency without need for fellowship
4. Head and Neck surgeons - same as Neurosurgeons. If you train at a high volume center you will feel comfortable performing surgeries of the oral cavity, oropharynx, larynx, lymph nodes of neck, etc.

 

[Lawgiver]

If you need a job and location is removed from the equation, then you will have no problems whatsoever. Jobs in the Midwest are actually quite plentiful (especially in the cities you cited). The hardest places to find jobs are in the NYC metro (NY-NJ-PA), West Coast (SF, LA, SD in CA and Portland/Seattle).

Yes, stay away from Oregon. 🙂

 

[sunflower18]

Yes, stay away from Oregon. 🙂

🙁

 

[Undecidedgirl03]

In the spirit of similar threads, I thought I would provide a useful service to SDN pre-meds.

Background:
Age: Early 40s
Practicing Oncologist in a Physician owned and operated group
20% Administrative + 80% Clinical

Would be happy to answer questions.

I am aware you are an oncologist, however I had a question about radiation therapists as I assume you work closely together. Would it be worth it to seek out a bachelors in Radiation/radiation therapy, which are hard to find programs, or a bachelors in biology and then into radiation therapy, or would pay/job opportunities be very similar with just a two year associates in radiation therapy? I really do want to get a bachelors degree and spend the 4 years in college but I want to make sure it's fully worth the time and money in the end. If your not sure about my question could you please direct me to someone who could help me? Thanks!

 

[jeromewilkins]

Hello,

I'm an interested upcoming applicant and I had a specific medical question regarding the field of radiation oncology if the program director or someone knowledgeable about the field could please shed some light on this.

My question is: do radiation oncologists have discussions, document and/or put in orders for DNR/DNI for patients? My impression was this topic was left mostly for internal medicine physicians and medical oncologists. I only ask because this may conflict with a personal religious topic and I'd like to clarify it before applying.

I appreciate your time and answer.

Sincerely,

JW

 

[DavidPartin]

I am cancer caregiver to a family member. what are the basic things to be taken car off and the precautions for the patients to recover fast.

 

[de Ribas]

I am cancer caregiver to a family member. what are the basic things to be taken car off and the precautions for the patients to recover fast.

make sure you keep your self anonymous on the forum and don't bump old threads.