Future of Radiation Oncology

[Veritas76]

I have done an elective in Rad Onc and have decided that I definately like the field and could see myself doing it for a living. Of course that is in regards to the current state of the field. I know this has been touched upon on this site before but I am really concerned about the future of the field.

It seems like degree of specialty of the field has left it little room for adaptability, and Rad Oncs don't seem too aggressive to claim newer treatments such as radioisotopes for throid cancer.

XRT is so non-specific and the Gamma knife hasn't turned out to be the saving grace as expected. Does anyone have some advice on where the fiueld is heading and new developments on the horizon that will allow it to compete with newer more specific treatments?

No one can predict the future, but I worry that in 30 years when I still hope to be practicing that there may no longer be a role for Rad Onc in the treatment of cancer. After 4 years of busting my butt in medical school and the prospect of training 4 more years in residency I would hate to be phased out during my career.

Any Thoughts?

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[stephew]

I smile as I read this because I just had a conversation pertaining to this today. I was noting that one can't be too critical of a patients lack of understanding of the difference between med onc and rad onc since even people in the field dont understand it.

A few misconceptions: chemo will NOT replace radiation; similarly it wont replace surgery. The modalities are complimentary and work often synergistically. And no magic bullit (not even gleevac and photodynamic therapy, the panaceas of recent news items) is on the horizen.

Rad onc is evolving like no one's business. . . mostly with respect to treatment techniques to be more conformal and to spare normal tissue, in turn allowing for boosting doses to tumor to higher levels.

There is great growth with respect to radioisotopes. Iodine for thyroid cancer is quite old news. Gliasite balloons, HDR, samarium, lots of stuff is in the offing.

I have no idea how you mean XRT is non-specific so I can't answer that. It now occurs to me that perhaps you mean its not focal and conformal enough? Well you dont want it to be in many cases, particuarly before cone-down. You want to irradiate a field (GTV/CTV/PTV-nodal drainage included). And when you want conformality, try IMRT or cyberknife. And as for gamma knife- FSR with dynamic arcing and cyberknife is superior in my view. I dont know gamma knife or any modality (see first paragraph) is supposed to be a saving grace. Again, its multimodality which is part of the appeal of oncology treatment. You have to know anatomy, radiology, chemo, medicine and surgical approaches to do it really right. You will learn about chemosensitization and cytoreduction. Playing with radiobiological properies to maximize treatment and minimize complications.


I think you have a better understanding of rad onc than most medical students, but you have a lot to learn about the technology and indeed, the interdisciplinary nature of treating cancer. Its a field that I expect to be around for a while. Remember, Nixon's war on cancer 30 years ago? Its still here. XRT doesnt take the place of surgery; chemo doesnt take the place of xrt, immunotherapy wont take the place of chemo; the role for each is constantly evolving and interdisciplinary.

If you enjoy the field as you say, I think will enjoy the highly technical and rapid fire evolution of things.

 

[sirspamalot]

If you enjoy the field as you say, I think will enjoy the highly technical and rapid fire evolution of things.

Well, 20 years later, this certainly proved true.

 

[dieABRdie]

I have done an elective in Rad Onc and have decided that I definately like the field and could see myself doing it for a living. Of course that is in regards to the current state of the field. I know this has been touched upon on this site before but I am really concerned about the future of the field.

It seems like degree of specialty of the field has left it little room for adaptability, and Rad Oncs don't seem too aggressive to claim newer treatments such as radioisotopes for throid cancer.

XRT is so non-specific and the Gamma knife hasn't turned out to be the saving grace as expected. Does anyone have some advice on where the fiueld is heading and new developments on the horizon that will allow it to compete with newer more specific treatments?

No one can predict the future, but I worry that in 30 years when I still hope to be practicing that there may no longer be a role for Rad Onc in the treatment of cancer. After 4 years of busting my butt in medical school and the prospect of training 4 more years in residency I would hate to be phased out during my career.

Any Thoughts?

My group does all the radio isotopes here because there is no one else.

Please, anyone take the thyroid patients from me.... Please.

Lutetium 177 for prostate cancer has a major chance to affect how we treat, especially if they demonstrate efficacy in the first line setting. But that means a lot more money for the hospital that gets 340b pricing... not the doctor that treats the patient. Our group will still do it.... but radio isotopes alone won't support your practice. Unless you like working for free.

Modern stereo tactic XRT is virtually the definition of "specific" cancer therapy. I can pretty much destroy anything inside of the body that I can see leaving most of the tissue near it without major toxicity.

RT will remain an incredibly useful modality; but you are right there just isn't much room for advancement. I wouldn't do it if I was in your position, unless you really don't care where you live and what environment you have to practice in.

 

[Mandelin Rain]

Hopefully the OP finished Rad Onc residency in 2007 and got a year or two of $$$$

 

[Neuronix]

The op last logged into SDN on Jan 21, 2003

 

[Doctorer]

Man I hope Veritas76 went in to radonc in 2002.

Hopefully the OP finished Rad Onc residency in 2007 and got a year or two of $$$$

Yeah I was gonna say, hopefully Veritas76 became a radonc and got a few of the glory years in.

 

[pikachu]

The op last logged into SDN on Jan 21, 2003

Clearly the future is now

 

[IonsAreOurFuture]

I have done an elective in Rad Onc and have decided that I definately like the field and could see myself doing it for a living. Of course that is in regards to the current state of the field. I know this has been touched upon on this site before but I am really concerned about the future of the field.

It seems like degree of specialty of the field has left it little room for adaptability, and Rad Oncs don't seem too aggressive to claim newer treatments such as radioisotopes for throid cancer.

XRT is so non-specific and the Gamma knife hasn't turned out to be the saving grace as expected. Does anyone have some advice on where the fiueld is heading and new developments on the horizon that will allow it to compete with newer more specific treatments?

No one can predict the future, but I worry that in 30 years when I still hope to be practicing that there may no longer be a role for Rad Onc in the treatment of cancer. After 4 years of busting my butt in medical school and the prospect of training 4 more years in residency I would hate to be phased out during my career.

Any Thoughts?

This can happen in any field of medicine and any line of work. There's no guarantee of employment for anyone anymore. Job security is an illusion.

When was the last time you booked your airline ticket with a human being?

 

[Mandelin Rain]

This can happen in any field of medicine and any line of work. There's no guarantee of employment for anyone anymore. Job security is an illusion.

When was the last time you booked your airline ticket with a human being?

You have to own the body part.

Bones always break. Ortho is fine.

Babies are always born. OB-GYN is fine.

Eyes always cloud. Ophtho is fine.

Prostates are always big, and wieners soft. Urology is fine.

Arteries always clog. Cardiac surgery is, er.... strike this example.

 

[Neuronix]

You have to own the body part.

Bones always break. Ortho is fine.

Babies are always born. OB-GYN is fine.

Eyes always cloud. Ophtho is fine.

Prostates are always big, and wieners soft. Urology is fine.

Arteries always clog. Cardiology is fine

Fixed it for you.

It still makes your point just fine.

If you want job security in medicine, don't tie yourself to a single modality (i.e. RADIATION oncology, cardiac SURGERY).

 

[Mandelin Rain]

Fixed it for you.

It still makes your point just fine.

If you want job security in medicine, don't tie yourself to a single modality (i.e. RADIATION oncology, cardiac SURGERY).

Even the med oncs.

Say whole body FLASH somehow starts curing all cancers without liquifying organs. What they going to do?

 

[communitydoc13]

Even the med oncs.

Say whole body FLASH somehow starts curing all cancers without liquifying organs. What they going to do?

The med oncs are the medical doctors in charge of cancer patients and those with blood disorders. They'll be fine forever. Therapeutic medicine is just the administration of molecular tech to disease processes.

It's the interventionalists that will be at risk going forward (although I expect AI to impact the decision makers in a much more timely fashion).

Maybe docs will be gone entirely except for the elite few leading large institutions.

Just mid levels and medicine consumers.

Wondering about the future of Bariatric Surgery at this point. Looks like they really have come up with a good weight loss drug.

 

[RickyScott]

Fixed it for you.

It still makes your point just fine.

Don't tie yourself to a single modality (i.e. RADIATION oncology, cardiac SURGERY) if you want job security.

cardiac surgeons at my hospital switched to thoracic. Probably have a lot of options with minimal retraining. Radonc will be left high and dry.

 

[Fpg1245]

There will be the top 1% of people in medicine basically doing research and making decisions. The rest will be underemployed or unemployed.

Also Med onc isn’t immune either. They’ll have patients but honestly you could protocolize the process and fill it with MLPs and have just a handful of them.

The future is basically the tippy top get to have all the opportunities and everyone else will get on UBI.

 

[sirspamalot]

The future is basically the tippy top get to have all the opportunities and everyone else will get on UBI.

And then the revolution happened. The underlings rose up against the AI wielding overlords.. Elysium wasn't just a movie they said..

 

[Fpg1245]

And then the revolution happened. The underlings rose up against the AI wielding overlords.. Elysium wasn't just a movie they said..

The RO chairs think they’ll be dead or in Elysium so no action need be taken

 

[HemeOncHopeful19]

You have to own the body part.

Bones always break. Ortho is fine.

Babies are always born. OB-GYN is fine.

Eyes always cloud. Ophtho is fine.

Prostates are always big, and wieners soft. Urology is fine.

Arteries always clog. Cardiac surgery is, er.... strike this example.

Seems a little cherry-picked.

Nephrology is fine? They own the kidneys
Peds is fine? They own the children

I would not call OB-Gyn a stellar/desirable field either

 

[deleted1111261]

Not necessarily a helpful breakdown of why certain specialities fare better economically. And it’s clearly self selecting bc pediatricians make pittance but are remarkably happy (as a group, I’m sure you know some miserable person working for $17/hr in chicago or something).

If our workforce was just all of a sudden 20% smaller than it is now, what are we all gonna argue about? It’s a great treatment modality, it is cost effective, it’s getting safer and safer, it’s interesting.. it would be like … RadOnc in 2012!! The best of the best …

 

[sirspamalot]

Radonc 2005! C'mon bro!

The golden years were amazing. The show is over. Unless you already won (ie secure at major system near the top), are in academia in same situation, or are leading a private practice group with market dominance (and working like a dog) you are just chattel.

Of course, the few, the proud, the 1099 geographic arbitrage one-offs.. we find a way to survive. I think there will always be a need for this.. I can back off to part-time maybe in 5 years or so.. not a bad ride into the sunset.

 

[deleted1111261]

Radonc 2005! C'mon bro!

The golden years were amazing. The show is over. Unless you already won (ie secure at major system near the top), are in academia in same situation, or are leading a private practice group with market dominance (and working like a dog) you are just chattel.

Of course, the few, the proud, the 1099 geographic arbitrage one-offs.. we find a way to survive. I think there will always be a need for this.. I can back off to part-time maybe in 5 years or so.. not a bad ride into the sunset.

Ah, I meant the "caliber" of the applicants. Yes, practicing in 1999-2009 or so must have been like having an accurate counterfeit machine in the 1920s

 

[sirspamalot]

It was so so good. 2M/year is just a pipe dream now. Hell, for many, W2 500k is a pipe dream if they want to be in a desirable area and are showing up just now.

Very sad indeed.

 

[Fpg1245]

It was so so good. 2M/year is just a pipe dream now. Hell, for many, W2 500k is a pipe dream if they want to be in a desirable area and are showing up just now.

Very sad indeed.

Disgusting what’s happened really. Except of course you sold out or run a program.

 

[TheWallnerus]

Arteries always clog. Cardiac surgery is, er.... strike this example.

If you want job security in medicine, don't tie yourself to a single modality (i.e. RADIATION oncology, cardiac SURGERY).

Cardiology hit the most of any specialty over time, up until 2018 that is.

 

[sirspamalot]

Do what you love, and love what you do. Oh, and also, pick a specialty with some sensible leadership.

OTOH, buying "low" in 1998 for Radiation Oncology was nothing short of epic.

 

[IonsAreOurFuture]

Fixed it for you.

It still makes your point just fine.

If you want job security in medicine, don't tie yourself to a single modality (i.e. RADIATION oncology, cardiac SURGERY).

Xrays are a single modality.

Protons are a single modality.

Carbon is a single modality.

Better get all 3!

 

[goodkerma]

Cancer, always finds a way. RadOnc is fine.

 

[sirspamalot]

Cancer, always finds a way. RadOnc is fine.

Photon Hears a You (not a Dr Seuss story)

A story about a lonely radonc stationed in Nowheresville (OH, NM, etc etc) who wonders what living in a real city must be like...

 

[sloh]

Cardiology hit the most of any specialty over time, up until 2018 that is.

Where did you get this graph from?