Normal Week and Course of Treatment

[soccerusa]

Hello,

I am a med student and I had two somewhat related questions for those in practice.

1) What is your normal week like? I realize this is different for everyone, but I am particularly interested in things like: how many new patients versus continuing patients do you see each week? How many patients do you see in a day or week? How long are you able to spend with each patient? If you are in academics, how much of your time do you spend on research and/or teaching?

2) What is the "normal" course of treatment for a patient (I realize this is highly variable based on disease specifics, but I am still interested in whatever generalities of examples can be thrown out)? As in, from the time a PCP refers them to you, how long does it take to be seen? What is the first appointment like? If they end up going on chemo, how frequently do you see them while on treatment? How long between the first visit and the beginning of chemo or referal to surg/rad oncs?

Thanks for your time!

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[gutonc]

Hello,

I am a med student and I had two somewhat related questions for those in practice.

1) What is your normal week like? I realize this is different for everyone, but I am particularly interested in things like: how many new patients versus continuing patients do you see each week? How many patients do you see in a day or week? How long are you able to spend with each patient? If you are in academics, how much of your time do you spend on research and/or teaching?

Every physician and every practice will be different. I see 15-20 patients a day. 2 or 3 of them are new (they get an hour), the rest are follow-ups (they get 15 minutes on paper, but I spend whatever amount of time I need to with them...some take 5 minutes, some take 50).

2) What is the "normal" course of treatment for a patient (I realize this is highly variable based on disease specifics, but I am still interested in whatever generalities of examples can be thrown out)? As in, from the time a PCP refers them to you, how long does it take to be seen? What is the first appointment like? If they end up going on chemo, how frequently do you see them while on treatment? How long between the first visit and the beginning of chemo or referal to surg/rad oncs?

Again, this is a useless answer, but I'll give it anyway. We offer new referrals an appointment within 2 business days, so, typically same day/week or, at most, the following week. How soon they start treatment is hugely variable. Anywhere from the next day to never. And I see patients on chemo every time they get treatment. Patients getting mAbs alone may get seen every other treatment. Some people will get seen between treatments.

 

[bashwell]

Every physician and every practice will be different. I see 15-20 patients a day. 2 or 3 of them are new (they get an hour), the rest are follow-ups (they get 15 minutes on paper, but I spend whatever amount of time I need to with them...some take 5 minutes, some take 50).


Again, this is a useless answer, but I'll give it anyway. We offer new referrals an appointment within 2 business days, so, typically same day/week or, at most, the following week. How soon they start treatment is hugely variable. Anywhere from the next day to never. And I see patients on chemo every time they get treatment. Patients getting mAbs alone may get seen every other treatment. Some people will get seen between treatments.

I'm no oncologist, but I've spent some time with oncologists (and one of my mentors is an oncologist), and like gutonc said it totally varies by physician/practice, but from what I've seen a lot of it is similar to what gutonc has (broadly) described too. From what i've seen new referrals almost always seem to want to be seen yesterday.

 

[soccerusa]

Thanks for taking the time to reply so thoughtfully. I have a few more questions for you or anyone else.

What percentage of your practice involves patients in potentially curative situations versus times when this is not possible? Do you find one of these situations more or less meaningful in your interactions with patients?

I am currently interested in both rad onc and med onc. Do you feel that med onc or rad onc is able to offer more to patients or is more satisfying to practice?

 

[bashwell]

Thanks for taking the time to reply so thoughtfully. I have a few more questions for you or anyone else.

What percentage of your practice involves patients in potentially curative situations versus times when this is not possible? Do you find one of these situations more or less meaningful in your interactions with patients?

I am currently interested in both rad onc and med onc. Do you feel that med onc or rad onc is able to offer more to patients or is more satisfying to practice?

Rad onc sees plenty of patients. Although both heme/onc and rad onc have very satisfying patient interactions from a physician's perspective.

Although a generalization is heme/onc does tend to be "the" oncologist that manages the patient overall which includes all the good and bad that comes with this. Whereas rad onc pt interactions tend to be more limited if that's the right way to put it.

Also, maybe a huge generalization but rad onc doesn't tend to have as bad of a call schedule etc as heme/onc (not that heme/onc is all that bad, especially if we're comparing to cardiology or some of the surgical specialties, but rad onc is usually more "lifestyle" friendly than heme/onc -- but again these are huge generalizations and you can tailor how you pratice).

It sounds like you haven't done a rotation in either yet? (Sorry if I'm wrong and you have). If so, then at the end of the day, it'd be best to do a rotation in both to see what you'd personally enjoy most. Things may look perfect on paper for us, but when we actually experience it, everything can change.

If it were me, I'd personally say rad onc if you think you have a chance of getting in though. But I have heard it's getting more difficult to find a job in a desirable location, at least initially (though true for many other specialties too). But that's probably something to ask over on the rad onc forum.

 

[gutonc]

Thanks for taking the time to reply so thoughtfully. I have a few more questions for you or anyone else.

What percentage of your practice involves patients in potentially curative situations versus times when this is not possible? Do you find one of these situations more or less meaningful in your interactions with patients?

News flash. Life is not curable. Every single one of your patients will die, no matter what specialty you're in. Some of them will die of cancer, others will die of heart attacks, or car accidents, or falling off the roof on coumadin.

Honestly, I find the situations where I can help people live their last days well and die with dignity and without pain or suffering the most rewarding. I saw 17 patients today. Most of them were routine follow-ups with curable disease, cured patients. The one I actually remember though is the Nth line metastatic colon cancer patient with no further treatment options.

"Curing people" is great. The rest of it is even better.

I am currently interested in both rad onc and med onc. Do you feel that med onc or rad onc is able to offer more to patients or is more satisfying to practice?

The number of people who can legitimately answer this question with personal experience is vanishingly small. I happen to know one of them. He practices Rad Onc. Take that for what it's worth.

 

[bashwell]

News flash. Life is not curable. Every single one of your patients will die, no matter what specialty you're in. Some of them will die of cancer, others will die of heart attacks, or car accidents, or falling off the roof on coumadin.

Honestly, I find the situations where I can help people live their last days well and die with dignity and without pain or suffering the most rewarding. I saw 17 patients today. Most of them were routine follow-ups with curable/cured patients. The one I actually remember though is the Nth line metastatic colon cancer patient with no further treatment options.

"Curing people" is great. The rest of it is even better.


The number of people who can legitimately answer this question with personal experience is vanishingly small. I happen to know one of them. He practices Rad Onc. Take that for what it's worth.

Great points by @gutonc.

I'd add for the last bit that OP you could try asking UK oncologists because they're often (always?) trained in both rad onc and onc (but not haem, which is separate). But obviously the UK practice environment for oncology is very different than the US practice environment. Still, you could learn about the fields themselves as medical scientific disciplines.

 

[soccerusa]

News flash. Life is not curable. Every single one of your patients will die, no matter what specialty you're in. Some of them will die of cancer, others will die of heart attacks, or car accidents, or falling off the roof on coumadin.

Honestly, I find the situations where I can help people live their last days well and die with dignity and without pain or suffering the most rewarding. I saw 17 patients today. Most of them were routine follow-ups with curable disease, cured patients. The one I actually remember though is the Nth line metastatic colon cancer patient with no further treatment options.

"Curing people" is great. The rest of it is even better.


The number of people who can legitimately answer this question with personal experience is vanishingly small. I happen to know one of them. He practices Rad Onc. Take that for what it's worth.

Again, thank you for your thought. I'm really interested in oncology in part because of its potential for long term patient relationships in the face of serious illness.

If you have any more time, how satisfied are you with your choice of oncology? Is there anything you see as a major detriment to the field that most medical students overlook?

Again, I really appreciate your insight.

 

[gutonc]

If you have any more time, how satisfied are you with your choice of oncology? Is there anything you see as a major detriment to the field that most medical students overlook?

I'm very satisfied with my choice. I love my job and can't imagine doing anything else.

The major detriment I see has nothing to do with the job itself but with the economics of it. Crazy expensive drugs with minimal improvement in survival.

 

[visari]

I think radiation oncology is a great field if you can get a spot. It's a relatively easy residency with good lifestyle and good money. You don't usually have to break in bad news or have end of life discussions as a radiation oncologist. I personally enjoy that part of oncology and I truly believe that I am being most helpful when I help a patient make an informed decision (especially when avoiding more therapy rather than convincing them that more chemo might work).

Another observation that I often find interesting: Patients remember their oncologist's name and refer to him/her as their "doctor" but it's common for them not to remember their radiation oncologist or refer to him as the "radiation guy". not that it's a big deal but it probably means something.

 

[RustBeltOnc]

I think radiation oncology is a great field if you can get a spot. It's a relatively easy residency with good lifestyle and good money. You don't usually have to break in bad news or have end of life discussions as a radiation oncologist. I personally enjoy that part of oncology and I truly believe that I am being most helpful when I help a patient make an informed decision (especially when avoiding more therapy rather than convincing them that more chemo might work).

Another observation that I often find interesting: Patients remember their oncologist's name and refer to him/her as their "doctor" but it's common for them not to remember their radiation oncologist or refer to him as the "radiation guy". not that it's a big deal but it probably means something.

I prefer the content of med onc to rad onc, and prefer explaining the content of med onc to patients.
Pembrolizumab, fascinating. IMRT, not so much.

The training and practice is physically / emotionally more demanding, but the visual / physics aspect
of rad onc is more difficult for some, and simply is too abstract / dry to engage many of us.

The oncologist is "my doctor" aspect is a double-edged sword. On one hand, there is great satisfaction
with this, but also mission creep --- often times referring doctors (and patients) passively-aggressively
expect you to assume the role of PCP and you and your office may not be equipped for this. All other
things being equal, try to work in a practice and community that limits this.

 

[gutonc]

The oncologist is "my doctor" aspect is a double-edged sword. On one hand, there is great satisfaction
with this, but also mission creep --- often times referring doctors (and patients) passively-aggressively
expect you to assume the role of PCP and you and your office may not be equipped for this. All other
things being equal, try to work in a practice and community that limits this.

I actually refuse to do this. I deal with cancer and cancer/treatment related issues. That's it.

I don't do hypertension. I don't do statins and I don't care what your A1C is.

And it's taken me a few years to convince my triage nurses that we are not an urgent care clinic.

 

[visari]

I agree and I didn't mean by the "my doctor" thing that I usually take responsibility for their A1c or titrating their insulin or BP meds (unless it's something ridiculously simple)... what I meant was that the physician-patient relationship in the case of a radiation oncologist if often brief and superficial compared to the medical oncologist ...

 

[RustBeltOnc]

I actually refuse to do this. I deal with cancer and cancer/treatment related issues. That's it.

I don't do hypertension. I don't do statins and I don't care what your A1C is.

And it's taken me a few years to convince my triage nurses that we are not an urgent care clinic.

gutonc, nothing but props to you. I am impressed you succeeded.

I am able to avoid much of the PCP work, but there are still scenarios where I must do it.

One is, patients are close to destitute and just cannot get to another MD appointment

Another is, PCP is overwhelmed etc, and doesn't really want patient back in part because
they don't want the appointments to involve prognosis, treatment of malignancy X.
They will never tell you explicitly this is the deal, but after 6-12 mos, you figure it out.