I recently heard about this burgeoning subspecialty and was wondering if anyone had a better sense of what it encompassed. Is there a chance that this field will fall under the umbrella of Radiation Oncology? That would be sweet
Interventional Oncology?
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I dont necessarily think that RadOnc folks should come at this with the mentality of "taking over" but I think there is alot of potential for group radiology practices where oncologic radiologists, radiation oncologists, interventional oncologists and nuclear medicine docs could collaborate and be productive in a privatized setting and inter-refer patients.
I am curious however as to whether it is possible to do a IntOnc fellowship following a RadOnc residency... anyone with any answers?
I am curious however as to whether it is possible to do a IntOnc fellowship following a RadOnc residency... anyone with any answers?
I thought about this myself. There would be some overlap. Radioembolization comes to mind. It seems that at least in an academic setting one could carve out a career specializing in operative rad onc stuff, such as radioimbolization, IORT, brachy, etc. I understand that there are already dedicated brachy people, so perhaps such people would absorb interventional oncology-style procedures into their practice. Thoughts?
D
deleted4401
Just start doing it.
Kick it around your local community docs, put on a presentation or two, then go radioembolize something. Sounds reasonable enough.
-S
Kick it around your local community docs, put on a presentation or two, then go radioembolize something. Sounds reasonable enough.
-S
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This is a very interesting topic. I saw a lecture about percutaneous radiofrequency ablation for lung tumors delivered to a group of rad oncs at an institution that is well known for brachy. They were not all that impressed to consider referring patients for it or to become trained in the procedure. The relatively high rates of spontaneous pneumothorax and pleural effusions (~15%) were definitely an issue in their deliberation on the topic. I got the feeling that they didn't want to manage these issues without hardcore evidence of outcome superiority in selected patients.
Any thoughts on the other procedures?
To answer your question old_boy, I am an M3 considering RadOnc who simply has fun doing procedures (especially the short and sweet ones) and loves the field of Oncology. I think it would be awesome to incorporate Interventional Oncology as part of my practice down the road (for both personal gratification and financial reasons assuming these procedures are profitable). Since it is a new field, I think this would be a great opportunity for young radiation oncologists in training to go after, to claim a piece of the pie as it were. Has there been any talk of a formal fellowship in Int Onc? I was wondering if there was any discussion on this subject from the RadOnc's POV.
With regards to turf wars, the way I see it Radiation oncologists are primed for a piece of the action here. This may be my naivete shining through, but from what I understand, the IR guys are currently not well-trained in patient care and medical oncologists lack the anatomy and imaging expertise that rad/oncs develop during their training. Clearly though, it would be hard to jump directly from radiation therapy to interventional stuff without adequate training (like a fellowship I suppose).
Please correct me if I'm way off base here..
Please correct me if I'm way off base here..
I could not agree more, who better to do these procedure than radiation oncology. To treat a cancer patient you need to have a very extensive background in tumor biology, staging, management, studies about those cancers, etc, etc. How could diagnostic rads possibly design large trials with these interventional onc therapies without thoroughly understanding the cancers, trials that have been done already, and what types of disease could really stand to benefit from these procedures, how their tumor bio would respond... Its stuff like this that our field needs to try and get involved in to ensure our survival and increase our demand, and MOST importantly make sure patients are getting the best possible care and shot at survival.
D
deleted4401
Agreed.
The ABR (or whoever is responsible for our curriculum) has erred in establishing the nuc med requirements for us, trying to get in on that piece of the pie. Thyroid ablation is mindless monkey work and pays poorly. The theraspheres for liver and Zevalin/Bexaar are of some interest, but again, not very exciting. It is very hard to get the referral for Zevalin/Bexaar, because then the med-oncs lose money for second line chemo. I see their rationale. There isn't great data out there ...
But these other procedures make a whole lot more sense for us, and go along with SRS/SBRT/brachytherapy. The field should make a push to establish our primacy in oncologic therapeutics. The targeted agents could potentially be in area we get into, but we don't want to bite the hands that feed us by prescribing Erbitux (also, we probably don't want to deal with the hospitalizations and inpatient management, either).
Our numbers are few, we are a meek bunch, and the average salaries are very high, so my prediction is we won't really do much about it and will lose out on the opportunity. It's hard not to be complacent in our current situation, but it's a bit short-sighted. Changes are going to come, and we need to get a bit aggressive.
-S
The ABR (or whoever is responsible for our curriculum) has erred in establishing the nuc med requirements for us, trying to get in on that piece of the pie. Thyroid ablation is mindless monkey work and pays poorly. The theraspheres for liver and Zevalin/Bexaar are of some interest, but again, not very exciting. It is very hard to get the referral for Zevalin/Bexaar, because then the med-oncs lose money for second line chemo. I see their rationale. There isn't great data out there ...
But these other procedures make a whole lot more sense for us, and go along with SRS/SBRT/brachytherapy. The field should make a push to establish our primacy in oncologic therapeutics. The targeted agents could potentially be in area we get into, but we don't want to bite the hands that feed us by prescribing Erbitux (also, we probably don't want to deal with the hospitalizations and inpatient management, either).
Our numbers are few, we are a meek bunch, and the average salaries are very high, so my prediction is we won't really do much about it and will lose out on the opportunity. It's hard not to be complacent in our current situation, but it's a bit short-sighted. Changes are going to come, and we need to get a bit aggressive.
-S
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The data that is actually out there though is pretty compelling. It's pretty much pts that med oncs aren't interested in treating anymore (failed multiple regimens with relapsed, progressive disease), yet the still manage to get a decent response to these drugs.
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Id imagine the int radiologists would fight bitterly to hold onto this turf however, and even argue that oncologic rads have the knowledge and expertise necessary to perform these procedures. Id imagine doctors higher up the referral tree- surg oncs for example- would be better placed to absorb these techniques, especially sinve surgery has already taken on fluroscopic techniques
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hi guys,
just wanted to chime in, on this topic and it is a politically heated one. I was a rads resident hoping to do IR, (switched into gen surge) but here is the deal with interventional oncology. Currently the procedures (all are developed by interventional radiologists who are quite clinical i.e. round on patients in the morning and have their own admitting privileges see patients in outpatient clinic (if you look at most IR jobs, one of the things always mentioned is "we are setting up a new outpatient center and will hold clinic 1-2 days a week") include not only percutaneous cryoablation, RFA, but also trans-arterial chemoebolization, radioembolization with Y-90, theraspheres so on so forth, the angiographic procedures require a great deal of training, to those that don't know, IR fellowships are currently only one year, but will likely be expanding into 2-3 years (as I understand rad onc is also 3 years); but in that one year you work 6 am to 10 pm, one day off a week, may be 3 weeks off on vacation, and q2-3 call, thus there is a great deal of volume, not to mention the 6 or 7 months you do as a radiology resident. My point being is that a great deal of training goes into learning these techniques, evaluating the appropriate patients, and managing the complications; rad onc simply doesn't have the skill set for transarterial or pecrutaneous access (this is not a bash on the specialty, it's like saying general surgeons don't have the skill set to manage a pt with 3 vessel disease) and while it may look simple from afar, trust me it is not. Furthermore IR is quite capable of setting up large "complicated" trials, a la the uterine fibroid registry, which has now resulted in the ACOG stating it is a viable option for fibroid treatment. simply being a cancer doc does not mean you get to do those procedures, it is much out of the scope of rad onc, and if a rad onc did do that, then they would in effect become an interventional radiologist b/c of the number of procedures you need to do to get good at these and stay good. simply stated for rad onc to be able to do Interventional Onc, they would have to enter fellowship training, and learn not only the interventional oncology procedures (as there is no such fellowship), but also learn how to do fibroid embolization, embolization of other things, port placement, PICC placement, non-oncologic image guided procedures, which doesn't strike me as something rad oncs would like to do, of course I could be wrong.
An example are the neurosurgeons who do interventional neuroradiology, many end up doing ONLY the endovascular procedures, b/c once they go do other things their skills become extremely rusty. Just to put it in perspective. Additionally as rad onc was once a fellowship out of diagnostic radiology, and split off, there appears to be a trend in IR that it will soon also split off and form it's own 4-5 year residency by a primary certificate from the ABR, thereby negating the statement that IR lacks clinical expertise.
Again, I am not coming here to start a war of words, just to make things a little clearer. By the way, even though I switched residencies, for many personal reasons, I still get extremely protective of a wonderful field. Saying things like "this falls under our scope of practice" and "we can do this better then the people who pioneered these procedures" is akin to urologists going around placing their own radiation seeds.
just wanted to chime in, on this topic and it is a politically heated one. I was a rads resident hoping to do IR, (switched into gen surge) but here is the deal with interventional oncology. Currently the procedures (all are developed by interventional radiologists who are quite clinical i.e. round on patients in the morning and have their own admitting privileges see patients in outpatient clinic (if you look at most IR jobs, one of the things always mentioned is "we are setting up a new outpatient center and will hold clinic 1-2 days a week") include not only percutaneous cryoablation, RFA, but also trans-arterial chemoebolization, radioembolization with Y-90, theraspheres so on so forth, the angiographic procedures require a great deal of training, to those that don't know, IR fellowships are currently only one year, but will likely be expanding into 2-3 years (as I understand rad onc is also 3 years); but in that one year you work 6 am to 10 pm, one day off a week, may be 3 weeks off on vacation, and q2-3 call, thus there is a great deal of volume, not to mention the 6 or 7 months you do as a radiology resident. My point being is that a great deal of training goes into learning these techniques, evaluating the appropriate patients, and managing the complications; rad onc simply doesn't have the skill set for transarterial or pecrutaneous access (this is not a bash on the specialty, it's like saying general surgeons don't have the skill set to manage a pt with 3 vessel disease) and while it may look simple from afar, trust me it is not. Furthermore IR is quite capable of setting up large "complicated" trials, a la the uterine fibroid registry, which has now resulted in the ACOG stating it is a viable option for fibroid treatment. simply being a cancer doc does not mean you get to do those procedures, it is much out of the scope of rad onc, and if a rad onc did do that, then they would in effect become an interventional radiologist b/c of the number of procedures you need to do to get good at these and stay good. simply stated for rad onc to be able to do Interventional Onc, they would have to enter fellowship training, and learn not only the interventional oncology procedures (as there is no such fellowship), but also learn how to do fibroid embolization, embolization of other things, port placement, PICC placement, non-oncologic image guided procedures, which doesn't strike me as something rad oncs would like to do, of course I could be wrong.
An example are the neurosurgeons who do interventional neuroradiology, many end up doing ONLY the endovascular procedures, b/c once they go do other things their skills become extremely rusty. Just to put it in perspective. Additionally as rad onc was once a fellowship out of diagnostic radiology, and split off, there appears to be a trend in IR that it will soon also split off and form it's own 4-5 year residency by a primary certificate from the ABR, thereby negating the statement that IR lacks clinical expertise.
Again, I am not coming here to start a war of words, just to make things a little clearer. By the way, even though I switched residencies, for many personal reasons, I still get extremely protective of a wonderful field. Saying things like "this falls under our scope of practice" and "we can do this better then the people who pioneered these procedures" is akin to urologists going around placing their own radiation seeds.
Youngdoc
lets clear up a few issues, and dont even think you can throw up a post like that on a Rad Onc page and not create at least a friendly war of words.
First of all Rad Onc is 5 years 1 prelim and 4 Rad Onc years. Second, to say that IR fellowships are 6am to 10pm with one day off per week is laughable to say the least lets just say I have extremely good insight to the IR lifestyle and it is far from what you stated. Not to say its 9-4 Mon-Thursday, but its nothing like what you mentioned. Dont kid anyone. Third, are you really comparing the uterine fibroid registry to large, multicenter, multiarm, multi modality oncology trials? Really? I dont know where to start with that comparison. Fourth, there is obviously a technical aspect that would need to be learned when it comes to Rad Oncs doing interventional onc, hence the need to complete a fellowship, and trust me if diagnostic rad residents can learn it in 1.5 years Rad Onc residents could very likely learn it in 1. Ok, kidding with that one (but only a little).
The fact is that Diagnostic Radiologists know almost nothing about cancer. You have almost NO training in oncology. Overall the understanding of trial design, implementation, and outcomes are much more fluent/necessary to Radiation Oncologists than Diagnostic Rads. Trust me, Rad Oncers know their literature, like you would not believe.
An interesting analogy to this is looking at interventional cards. Why is that 99% cardiologists ball game? Where is IR when it comes to caths? Hiding in the reading room...thats where.. likely because the heart is super complicated, and patients do better when cardiologists do those procedures, they know the heart.
What is most important here is who has the best shot at making these profitable and exciting procedures actually achieve their purpose? A doctor that knows cancer inside and out, thats who. Inside and out includes tumor biology, detailed staging, and an extensive understanding of oncology literature.
Now...return that page, I think their is a patient with RLQ pain in the ER that needs your consult.
First of all Rad Onc is 5 years 1 prelim and 4 Rad Onc years. Second, to say that IR fellowships are 6am to 10pm with one day off per week is laughable to say the least lets just say I have extremely good insight to the IR lifestyle and it is far from what you stated. Not to say its 9-4 Mon-Thursday, but its nothing like what you mentioned. Dont kid anyone. Third, are you really comparing the uterine fibroid registry to large, multicenter, multiarm, multi modality oncology trials? Really? I dont know where to start with that comparison. Fourth, there is obviously a technical aspect that would need to be learned when it comes to Rad Oncs doing interventional onc, hence the need to complete a fellowship, and trust me if diagnostic rad residents can learn it in 1.5 years Rad Onc residents could very likely learn it in 1. Ok, kidding with that one (but only a little).
The fact is that Diagnostic Radiologists know almost nothing about cancer. You have almost NO training in oncology. Overall the understanding of trial design, implementation, and outcomes are much more fluent/necessary to Radiation Oncologists than Diagnostic Rads. Trust me, Rad Oncers know their literature, like you would not believe.
An interesting analogy to this is looking at interventional cards. Why is that 99% cardiologists ball game? Where is IR when it comes to caths? Hiding in the reading room...thats where.. likely because the heart is super complicated, and patients do better when cardiologists do those procedures, they know the heart.
What is most important here is who has the best shot at making these profitable and exciting procedures actually achieve their purpose? A doctor that knows cancer inside and out, thats who. Inside and out includes tumor biology, detailed staging, and an extensive understanding of oncology literature.
Now...return that page, I think their is a patient with RLQ pain in the ER that needs your consult.
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ok, friendly war of words it is 🙂 also sorry, I didn't know rad onc was 5 years todal,
your description of IR being monday-thursday and being a "lifestyle specialty" are true to a degree, unfortunately the people that practice it this way are destroyoing the field, and are in fact the reason why cards and vascular have taken over a lot of PAD/cards stuff. Additionally, the fact that you dont know that IR now rounds, has clinic and admission services is not suprising, this is a new paradigm shift in practice that will likely lead to a new training paradigm
As an aside, the cards stuff, I actually looked into it a bit more, granted it was in a cardiac cath book, but it looks like the history is distorted, Dotter (a radiologist), did in fact pioneer stenting/catheterization, and Seldinger (another radiologist created the ubiquitous technique), however the cards guys did have some hand in creating these procedures, one went as far as cathing himself (5 times), then went into urology, go figure.
If you look at practices like Riverside in Ohio, CIRA in Illinois or Miami Vascular (an entire hospital, run exceptionally well by Interventional Radiologists), and look at fellowships worth training in, UPenn, UCSD, Hopkins (MGH is not one of these), Miami these are as intense as described in my previous post (furthermore would not consider a rad onc), and again if a rad onc would want to do an IO type of practice, they would have to learn ALL interventional procedures, including peripheral vascular work, which is still practiced extensively in private practice, that means ileal stents, etc, you cannot do a fellowship and pick which procedures you will and will not learn.
Futhermore, again agree that DR does not get the training in cancer bio, but if you look at the Upenn/hopkins programs they do get quite a bit of knowlege, do they need to know about all cancer bio? no, b/c the procedures are limited to HCC ,lung, kidneys and prostate so far. And I agree that DR is not the greatest pool to field IR candidates from, this is for better or worse a surgical specialty which requires knowlege of disease processes, complications and pt management, therefore rad onc not also the best pool. not only for that reason, but also for the reason that you do require 4 years of IMAGING training to these, that is the other reason IR evolved from DR, and if you say rad onc is as good as diagnostic rads at imaging or cancer imaging you will be sorely mistaken, rad onc may be better then internal med or surgery for reading (which I doubt) but certainly not the people who trained for 4 years. For my money I'd rather have IR turn into either 1)a separate residency recruiting students who would otherwise go into surgery
or 2)be a surgical fellowship
now, if you want to zing me about being a surgeon, i will have to zing you about being a rad onc
by the way IR has had no problem making these procedures profitable or widely available despite surgical resistance, that is why their average salary is 450K
the medical physicit is paging you to sign the order so that he may continue treating the patient while you are posting on SDN and working on your post-doc research
your description of IR being monday-thursday and being a "lifestyle specialty" are true to a degree, unfortunately the people that practice it this way are destroyoing the field, and are in fact the reason why cards and vascular have taken over a lot of PAD/cards stuff. Additionally, the fact that you dont know that IR now rounds, has clinic and admission services is not suprising, this is a new paradigm shift in practice that will likely lead to a new training paradigm
As an aside, the cards stuff, I actually looked into it a bit more, granted it was in a cardiac cath book, but it looks like the history is distorted, Dotter (a radiologist), did in fact pioneer stenting/catheterization, and Seldinger (another radiologist created the ubiquitous technique), however the cards guys did have some hand in creating these procedures, one went as far as cathing himself (5 times), then went into urology, go figure.
If you look at practices like Riverside in Ohio, CIRA in Illinois or Miami Vascular (an entire hospital, run exceptionally well by Interventional Radiologists), and look at fellowships worth training in, UPenn, UCSD, Hopkins (MGH is not one of these), Miami these are as intense as described in my previous post (furthermore would not consider a rad onc), and again if a rad onc would want to do an IO type of practice, they would have to learn ALL interventional procedures, including peripheral vascular work, which is still practiced extensively in private practice, that means ileal stents, etc, you cannot do a fellowship and pick which procedures you will and will not learn.
Futhermore, again agree that DR does not get the training in cancer bio, but if you look at the Upenn/hopkins programs they do get quite a bit of knowlege, do they need to know about all cancer bio? no, b/c the procedures are limited to HCC ,lung, kidneys and prostate so far. And I agree that DR is not the greatest pool to field IR candidates from, this is for better or worse a surgical specialty which requires knowlege of disease processes, complications and pt management, therefore rad onc not also the best pool. not only for that reason, but also for the reason that you do require 4 years of IMAGING training to these, that is the other reason IR evolved from DR, and if you say rad onc is as good as diagnostic rads at imaging or cancer imaging you will be sorely mistaken, rad onc may be better then internal med or surgery for reading (which I doubt) but certainly not the people who trained for 4 years. For my money I'd rather have IR turn into either 1)a separate residency recruiting students who would otherwise go into surgery
or 2)be a surgical fellowship
now, if you want to zing me about being a surgeon, i will have to zing you about being a rad onc
by the way IR has had no problem making these procedures profitable or widely available despite surgical resistance, that is why their average salary is 450K
the medical physicit is paging you to sign the order so that he may continue treating the patient while you are posting on SDN and working on your post-doc research
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Alright, both of you had the chance to get your shots in. From this point let's please keep it civil. This is an excellent thread so please don't force me to close it by escalating things. Thanks.
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this is not meant to be insulting, I was under the impression that bragmt and I were just "joshing", and I don't mean to insult a very prestigious specialty as rad onc, after re-reading what I wrote, without knowing the tone, it would be hard to interpret it as "non-inflammatory" which was my intent, merely to shine more light on the subject. I agree, and many IRs do as well, that doing IR from a DR residency is a bit of a bad move, while the imaging is quite imortant, most IR that have been practicing for >5 years do not have the same skill set as a diagnostic radiologist, the same could be said for rad onc who would find their way into an IR fellowship, they would certainly lose a lot of the bread and butter of Rad Onc, kind of like an interventional cardiologist can't find his/her way around a CHF exacerbation with a delicate pt (true story). Perhaps the ABR should re-evaluate having IR be a CAQ, and make it a primary certificate with rad onc, surgical, medical, DR rotations, but primarily focusing on treatment/management of pts requiring interventional procedures. So sorry to have offended anyone, not my intent at all. I echo the sentiment that this is a great topic that needs to be explored.
Just wanted to share a couple of my thoughts on this issue. It sounds like each specialty discussed (IR, SurgOnc, RadOnc) has a valuable skill set that it can contribute to IntOnc. As it stands, all could benefit from expanding their practices to involve this growing field. In all honesty, I feel like the most aggressive of the bunch will end up claiming this territory. This is why I think it is critical for RadOncs to get involved now.
With specific consideration of IntOnc training, I think it would be totally reasonable for a RadOnc to be trained in these procedures in a span of no more than 1-2 years in the same way a Neurologist or Neurosurgeon learns NIR in that same time frame. Neurologists/-surgeons who are interested in Neurointerventional rads do not have to learn "every IR procedure". In fact, they learn only what they intend to practice (namely, endovascular coiling/stenting etc). Also, I personally know 2 endovascularly trained neurosurgeons who are absolute superstars in open vascular and neuroonc, respectively. By no means are they limited to just IR procedures just because they are trained in them.
If a Neurologist can be trained in this stuff, a RadOnc can do it to (not that every radiation oncologist would want to, but the option should absolutely exist). The truth is, the IR guys are scared to death about losing IntOnc like they lost Int Cardiology so they will fight to the bitter end to claim it as their own.
Anyways, I understand there is an experimental "fellowship" from RadOnc into IntOnc at the Harvard program (which I gleaned from a simple search). However, it doesn't sound like there has been much growth from that starting point...As a future RadOnc resident, I think it is imperative that we keep our collective eye on the ball, be vocal, and be aggressive about claiming this potential practice space in the coming years.
With specific consideration of IntOnc training, I think it would be totally reasonable for a RadOnc to be trained in these procedures in a span of no more than 1-2 years in the same way a Neurologist or Neurosurgeon learns NIR in that same time frame. Neurologists/-surgeons who are interested in Neurointerventional rads do not have to learn "every IR procedure". In fact, they learn only what they intend to practice (namely, endovascular coiling/stenting etc). Also, I personally know 2 endovascularly trained neurosurgeons who are absolute superstars in open vascular and neuroonc, respectively. By no means are they limited to just IR procedures just because they are trained in them.
If a Neurologist can be trained in this stuff, a RadOnc can do it to (not that every radiation oncologist would want to, but the option should absolutely exist). The truth is, the IR guys are scared to death about losing IntOnc like they lost Int Cardiology so they will fight to the bitter end to claim it as their own.
Anyways, I understand there is an experimental "fellowship" from RadOnc into IntOnc at the Harvard program (which I gleaned from a simple search). However, it doesn't sound like there has been much growth from that starting point...As a future RadOnc resident, I think it is imperative that we keep our collective eye on the ball, be vocal, and be aggressive about claiming this potential practice space in the coming years.
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But I imagine radoncs would have a far harder time both conceptually convincing their int rads colleagues and practically taking on this practice than neurologists did. The latter since rad oncs are at the bottom of the referral chain. And the former because neurologists who are specialists in stroke can justify the NIR procedures are very much in the scope of their practice- treating stroke-risk patients with aneurysms etc.
However, the job title of a radiation oncologist is a cancer doctor that utilises radiation- internal, external, but radiation nonetheless. This limits the conceptual scope of rad onc, and probably excludes a lot of what interventional oncology entails. Radioembolic agents are a very small niche in interventional oncology, and the same techniques are used for chemoembolic agents, RFAs etc where the only radiation used is from the image intensifier in theatre. So it would require completely redefining the scope of the field to start practicing these techniques.
That's why I think surgical oncologists are in a much better position to absorb these techniques, as they could truly argue they are 'interventional oncologists'- as surgery isn't anything but an intervention anyway and plenty of vascular and neurosurgeons use fluoroscopic techniques these days- sometimes exclusively. As far as I know rad oncs partner with surgeons- e.g. urologists, ENTs - when putting in brachytherapy devices interstitially these days- at least at my cancer hospital where the only brachytherapists that 'operate' solo are the gyne ones.
I'm not saying rad oncs wouldn't be good at the techniques and don't have the know-how to learn them. I'm just saying that I think surgical oncologists are better positioned to take them into their practice.
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I'll just add a small, pedantic physics point here (for fun). The RF in RFA is certainly radiation. Not ionizing radiation, but radiation. Same with ultrasound, or any other "radiant energy".
Turf wars - often historical and arbitrary, but somehow almost everyone gets sucked in.
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on a philosophical note, if all doctors got paid the same salary regardless of specialty: let's say between 250,000 and 350,000, I think everyone would be much happier, choosing fields based on interests and patient populations rather than money (lifestyle would likely still be a factor). Wouldn't change much in the distribution of applicants I think, but would certainly affect the scope of practice of each field.
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you really believe that?
I've heard anecdotal reports of CT surgery spots going unfilled because of their relatively low compensation when they finally make it out after 8+ years of training.
An interesting point, I guess reality is why does anyone make more than anyone else in health care? After all we all have the same goal...right? Why should RN's make more than LPN's? Why do MD's make more than RN's? Why should a Neurosurgeon make more than a Family Medicine doctor? Why can't we all just be the same!
Of course people would still go through 5 or 7 year residency programs if they were going to come out and make the same amount as a Family Medicine doctor that went through 3 years of residency.
I am also sure people would still be publishing like crazy and scoring 260's on step one to get top residencies so they could make the same amount as someone that tanked the MCAT and barely made it through med school in the Caribbean.
The fact is if you want to really make some progress on incredibly complicated diseases you need the best of the best. Sadly human nature is such that most great accomplishments and progressions in our society have taken place for direct financial gain. I know we never say it but the 400-500 k salaries in Rad Onc have SOMETHING to do with its high quality applicants. Probably not everything, but something. There is a fortune to be made in curing cancer, and it may sound cold, but ask any GBM patient, they don't care how we discover a cure, or what the motivation of the person that finds it was; they just want to make it to their next birthday.
But don't worry, with the shifts that this administration is taking in our countries policies we will be dancing in the streets of socialism soon, and all those dreams you have about everyone just making the same amount will likely come true. After all its only fair that we pay 55% taxes, how dare we make more than 250k a year...shame on us.
Of course people would still go through 5 or 7 year residency programs if they were going to come out and make the same amount as a Family Medicine doctor that went through 3 years of residency.
I am also sure people would still be publishing like crazy and scoring 260's on step one to get top residencies so they could make the same amount as someone that tanked the MCAT and barely made it through med school in the Caribbean.
The fact is if you want to really make some progress on incredibly complicated diseases you need the best of the best. Sadly human nature is such that most great accomplishments and progressions in our society have taken place for direct financial gain. I know we never say it but the 400-500 k salaries in Rad Onc have SOMETHING to do with its high quality applicants. Probably not everything, but something. There is a fortune to be made in curing cancer, and it may sound cold, but ask any GBM patient, they don't care how we discover a cure, or what the motivation of the person that finds it was; they just want to make it to their next birthday.
But don't worry, with the shifts that this administration is taking in our countries policies we will be dancing in the streets of socialism soon, and all those dreams you have about everyone just making the same amount will likely come true. After all its only fair that we pay 55% taxes, how dare we make more than 250k a year...shame on us.
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Knowing someone that is in IR fellowship is different than being a Diagnostic Radiology Resident and doing IR as a resident.
Let me just remind everyone that to be board certified in Diagnostic Radiology one must pass the written and oral board exam in Diagnostic Radiology and one of the subsections in the Diagnostic Radiology is Interventional Radiology. In fact, all radiology residents MUST do multiple IR rotations as a diagnostic radiology resident. Furthermore, there are many procedure heavy rotations such as Abdominal Radiology and Cardiothoracic Radiology during radiology residency in which radiology residents use IR skills to drain abscesses, get biopsies etc.
The bottomline is this. Diagnostic Radiology Residency requires procedure skills, IR rotations, and being board tested in IR. Radiation Oncology training does not test you on IR skills on their board exam.
This is the reason IR is a subspecialty of Diagnostic Radiology. To say, a Radiation Oncologist can step in and do a 1 year IR fellowship is completely and utterly ludicrous because they don't have the same procedural skills gained from doing rotations in IR and being tested on board exams.
Furthermore, IR fellowships are very brutal these days. Anyone that tells you otherwise is clueless. The hours are very close to a surgery intern's hours. Sure, there were days when IR had cush hours. But these days thanks to SIRweb.org recommendation. All IR fellowships follow a clinical model of admitting patients, rounding on patients, getting consults, and following up on patients after D/C in clinic. This on top of a full IR schedule.
Bragmt, nice try. Let's not talk about something we don't know about. Ask any senior radiology resident before you make such foolish comments.
Let me just remind everyone that to be board certified in Diagnostic Radiology one must pass the written and oral board exam in Diagnostic Radiology and one of the subsections in the Diagnostic Radiology is Interventional Radiology. In fact, all radiology residents MUST do multiple IR rotations as a diagnostic radiology resident. Furthermore, there are many procedure heavy rotations such as Abdominal Radiology and Cardiothoracic Radiology during radiology residency in which radiology residents use IR skills to drain abscesses, get biopsies etc.
The bottomline is this. Diagnostic Radiology Residency requires procedure skills, IR rotations, and being board tested in IR. Radiation Oncology training does not test you on IR skills on their board exam.
This is the reason IR is a subspecialty of Diagnostic Radiology. To say, a Radiation Oncologist can step in and do a 1 year IR fellowship is completely and utterly ludicrous because they don't have the same procedural skills gained from doing rotations in IR and being tested on board exams.
Furthermore, IR fellowships are very brutal these days. Anyone that tells you otherwise is clueless. The hours are very close to a surgery intern's hours. Sure, there were days when IR had cush hours. But these days thanks to SIRweb.org recommendation. All IR fellowships follow a clinical model of admitting patients, rounding on patients, getting consults, and following up on patients after D/C in clinic. This on top of a full IR schedule.
Bragmt, nice try. Let's not talk about something we don't know about. Ask any senior radiology resident before you make such foolish comments.
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I'm having a difficult time understanding how your post addresses bragmt's quote...
However, I would like to chime in and say that before I matched in radonc, I spent a year working with one of the pioneers of IO. He is in the process of starting an IO fellowship and has made reference to the fact that he would accept radonc applicants for the position. In addition, I know of an existing IO fellowship that has already accepted a radonc for the position. She, however, took a PP position instead. Nonetheless, program directors obviously feel different than you do about the skills that radonc brings to the table.
D
deleted4401
Ha.
I read his post twice, just to make sure I wasn't just losing my mind. I'm glad someone else noticed that bragmt's post had nothing to do with the passionate response by p53. Not mentioning that IR is an easy fellowship? Check. Not mentioning that the skillset obtained in DR is exactly the same as the skillset acquired in radonc? Check. Not mentioning that DR is a particularly easy residency with no board examinations and very few IR rotations? Check. In fact, I don't think one thing addressed by p53 was even mentioned by bragmt. This is akin to bragmt asking "What time are you going to see 'Hot Tub Time Machine' tonight?" and p53 answering "Ice cream."
I think it's a bit over the top to say that one couldn't learn it in 12 months. A rad onc (or surg onc or whoever) wouldn't need to learn how to drain an abscess, or coil a vessel in the brain, or biopsy a tumor, or stent a blocked vessel, or any of that. They would need to learn a few specific procedures, and learn them well - Theraspheres, Zevalin, Bexaar, some intra-op brachy.
The surgeons I respect the most would say that hardest thing about surgery isn't the surgery, it's knowing when and when not to operate. Extrapolating from that, knowing the oncology has its importance. If its a limited number of oncologic procedures, I think 12-24 months would suffice, and some board (perhaps the radiologists?) could decide how many #s of each procedure are necessary prior to being boarded.
At the end of the day, I don't understand why any radiation oncologist (who has actually completed training, not just shooting from the hip) would want to invest time and energy into that aspect, when we have more than enough to master.
-S
I read his post twice, just to make sure I wasn't just losing my mind. I'm glad someone else noticed that bragmt's post had nothing to do with the passionate response by p53. Not mentioning that IR is an easy fellowship? Check. Not mentioning that the skillset obtained in DR is exactly the same as the skillset acquired in radonc? Check. Not mentioning that DR is a particularly easy residency with no board examinations and very few IR rotations? Check. In fact, I don't think one thing addressed by p53 was even mentioned by bragmt. This is akin to bragmt asking "What time are you going to see 'Hot Tub Time Machine' tonight?" and p53 answering "Ice cream."
I think it's a bit over the top to say that one couldn't learn it in 12 months. A rad onc (or surg onc or whoever) wouldn't need to learn how to drain an abscess, or coil a vessel in the brain, or biopsy a tumor, or stent a blocked vessel, or any of that. They would need to learn a few specific procedures, and learn them well - Theraspheres, Zevalin, Bexaar, some intra-op brachy.
The surgeons I respect the most would say that hardest thing about surgery isn't the surgery, it's knowing when and when not to operate. Extrapolating from that, knowing the oncology has its importance. If its a limited number of oncologic procedures, I think 12-24 months would suffice, and some board (perhaps the radiologists?) could decide how many #s of each procedure are necessary prior to being boarded.
At the end of the day, I don't understand why any radiation oncologist (who has actually completed training, not just shooting from the hip) would want to invest time and energy into that aspect, when we have more than enough to master.
-S
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was actually in response to a comment by bragmt further up the thread. Reading that earlier comment from bragmt helps p53's reply make more sense, but obviously, not any more accurate...
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deleted4401
Well I feel a bit sheepish. But the misquote really threw me off. My bad p53.
I've heard those IR fellowships are insane in terms of hours.
-S
I've heard those IR fellowships are insane in terms of hours.
-S
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I've heard it described as "image-guided" general surgery.
Sorry to resurrect an old thread, but I was wondering if anyone has heard any updated information about this topic. I've heard of interventional oncology becoming the "4th arm" of cancer treatment sometime in the near future, but it's been unclear whether it'll exist as a separate specialty or be incorporated into the practice of one of the existing arms of cancer treatment (i.e. surg onc, med onc, or rad onc). FYI I'm a 3rd year med student contemplating a career in oncology. The ability to do an interventional fellowship 6-7 years from now after a rad onc residency wouldn't be a dealbreaker for rad onc per se, but it would definitely make the specialty more appealing for a procedural minded med student.
My general advice would be don't pursue radiation oncology in the hope that it will be something different than it is today. Right now what would fall under "interventional oncology" is not used enough to be it's own field (from what I've seen and perceive to be interventional oncology). If you include CT guided biopsies then maybe it could be but it is pretty clear that is part of IR and I suspect (but obviously don't know) that most of the procedure type treatment will remain in IR. I suspect that IO will be divided up where it seems to fit best with some institutional variation rather than a distinct field.
I personally don't see IO being a separate field in the near future and certainly wouldn't plan my training based on some hope of doing IO exclusively in the future.
Radiation oncology does have brachy if you like procedures but you are going to be doing a lot of external beam during training as well.
