Do oncologists only follow NCCN guidelines, is that all they do?

[sallyhasanidea]

Not to sound like a dick, I'm a third year medical student strongly considering IM --> heme/onc, but I'm wondering about midlevel creep into oncology and what that would mean for a future career. I talked to a surgical oncologist about heme onc jobs and he told me they're saturated and all oncologists do is follow NCCN guidelines, is this true?

I understand that some parts of the field change very fast, so the NCCN guidelines change as well; so if an oncologist just follows NCCN guidelines why can't an NP just do that as well?

Do you really need 4 years of med school, 3 years of IM, 3 years of heme/onc to basically follow NCCN guidelines?

What am I missing in this broader picture of what it means to be an oncologist, what service does an oncologist provide that an NP couldn't?

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[gutonc]

Not to sound like a dick, I'm a third year medical student strongly considering IM --> heme/onc, but I'm wondering about midlevel creep into oncology and what that would mean for a future career. I talked to a surgical oncologist about heme onc jobs and he told me they're saturated and all oncologists do is follow NCCN guidelines, is this true?

I understand that some parts of the field change very fast, so the NCCN guidelines change as well; so if an oncologist just follows NCCN guidelines why can't an NP just do that as well?

Do you really need 4 years of med school, 3 years of IM, 3 years of heme/onc to basically follow NCCN guidelines?

What am I missing in this broader picture of what it means to be an oncologist, what service does an oncologist provide that an NP couldn't?

You're missing that the surgeon was being a dick.

Guidelines are just that, guidelines. They're a great place to start. Following guidelines is easy and if that's all it took to be an oncologist then, yes, a decently trained NP could do it. But the real practice of oncology is determining when NOT to follow the guidelines, or when the guidelines don't apply, or have a dozen options to choose from and you need to know that only one of them will be safe/effective for your patient, or what to do when guidelines don't exist, or...or...or....

To speak to the surgeon's attitude, if all it took to be a surgeon was learning to cut when the book tells you to cut, you could teach an NP to do that too. The real art of being a surgeon is knowing when not to cut, or when to cut differently.

 

[sallyhasanidea]

You're missing that the surgeon was being a dick.

Guidelines are just that, guidelines. They're a great place to start. Following guidelines is easy and if that's all it took to be an oncologist then, yes, a decently trained NP could do it. But the real practice of oncology is determining when NOT to follow the guidelines, or when the guidelines don't apply, or have a dozen options to choose from and you need to know that only one of them will be safe/effective for your patient, or what to do when guidelines don't exist, or...or...or....

To speak to the surgeon's attitude, if all it took to be a surgeon was learning to cut when the book tells you to cut, you could teach an NP to do that too. The real art of being a surgeon is knowing when not to cut, or when to cut differently.

Thanks for the reply. This makes sense.

I think you underestimate the importance and difficulty of Primary Care and overestimate the importance and difficulty of Oncology.

Manage the symptoms (of the disease or the treatment), review the labs and imaging, sign the chemo orders that your nurse coordinator wrote for you, lather, rinse, repeat.

Onc is pretty cookbook once you get the diagnosis. You need NCCN.org and chemoregimen.com and you're in business. Once things get too dicey, a referral to the closest academic medical center and you're on to your 10:15.

10 years ago you posted this comment, do you disagree with what you said previously?

 

[gutonc]

Thanks for the reply. This makes sense.



10 years ago you posted this comment, do you disagree with what you said previously?

Yes and no. It's kind of amazing what a little maturity and actual experience will do for you. I posted that during my 5th month of fellowship. I'm currently in my 8th year as an attending. Feel free, as an MS3 know it all, to judge as you will.

I think this post is more on point though.

Something else to understand is that there are 2 different kinds of people with cancer. Oncology patients and cancer victims. They may have exactly the same disease(s) and respond to therapy in exactly the same way but are completely different in every other way.

The oncology patients get their diagnoses, get their treatment and go on with their lives. The cancer victims get their diagnoses, get their treatment and then let their diagnosis and therapy completely rule their lives.

The first group of patients can be seen in a 5 minute visit every 2-6 weeks (whenever they need to be seen), the second group is what will keep you in clinic until 8p.

 

[IM_applicant]

"Midlevels" and guidelines are not unique to oncology. The question of needing so much medical education to eventually subspecialize is also not unique to oncology.

For every heart failure patient, you literally have to discuss GDMT (Guideline directed medical treatment). There are guidelines for asthma, COPD, IBD etc. There are guidelines for most well studied or common diseases, including surgical diseases. There are also "midlevels" pretty much everywhere.

Is your dilemma surg-onc vs med-onc? You need to decide if you want to go into a surgical profession or not. And you need to think if you want to take of cancer patients. And then consider the practicalities and what lifestyle you would like.

Oncology is taking care of cancer patients from their first to last day. When the treatment works and when it doesn't. When they have complex conditions that challenge you and are not addressed in the guidelines, or when they have textbook disease that is "easy" to manage.

Hope this helps. Good luck with med school and making these decisions!