Outlandish thought experiment

[deleted950463]

So thought experiment: what if all radonc residencies shutdown and become a 2-3 year therapeutic radiology fellowship after diagnostic radiology residency? This way only truly motivated people will go to radonc and the number of applicants (and elligible applicants) will drop. Only the truly motivated students will go from DR to RO.

more over, programs won’t be able to just scramble random FMGs because now those people needs to beACGME radiology grads. Right now many less competitive DR fellowships just sit empty, regulating the market.

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[deleted941485]

So thought experiment: what if all radonc residencies shutdown and become a 2-3 year therapeutic radiology fellowship after diagnostic radiology residency? This way only truly motivated people will go to radonc and the number of applicants (and elligible applicants) will drop. Only the truly motivated students will go from DR to RO.

more over, programs won’t be able to just scramble random FMGs because now those people needs to beACGME radiology grads. Right now many less competitive DR fellowships just sit empty, regulating the market.

This isn’t outlandish. It’s not even new. Folding radiation oncology into radiology again has been discussed on this forum. It’s a question of what kind of identity we want. Are we oncologists or are we radiologists that treat cancer?

 

[deleted950463]

This isn’t outlandish. It’s not even new. Folding radiation oncology into radiology again has been discussed on this forum. It’s a question of what kind of identity we want. Are we oncologists or are we radiologists that treat cancer?

are surg oncs surgeons or oncologists that wield a knife?

 

[BobbyHeenan]

This isn’t outlandish. It’s not even new. Folding radiation oncology into radiology again has been discussed on this forum. It’s a question of what kind of identity we want. Are we oncologists or are we radiologists that treat cancer?

I have a very good team of IR docs I think. They are absolutely a valuable member of our multi-D team.

However, they have a "clinic" which doesn't really manage symptoms, doesn't work people up, and they have minimal to any knowledge of overall survival ranges, typical management paradigms. They see a spot in the liver and want to talk to the patient about local therapy and local therapy only. NOthing about survival, end of life, palliative versus curative, etc.

I'd rather be an oncologist than a technician.

The surg oncs are oncologists IMO - they understand sequencing of therapy, local versus distant risk of recurrence patterns, etc at a much higher level than the IR's. They work people up and order labs/markers, scans, manage symptoms, round on patients, know survival curves, etc.

 

[fiji128]

As the imaging modalities we use get more and more complex and our treatments get more and more conformal having formal training in diagnostic imaging becomes increasingly useful.

 

[deleted950463]

I have a very good team of IR docs I think. They are absolutely a valuable member of our multi-D team.

However, they have a "clinic" which doesn't really manage symptoms, doesn't work people up, and they have minimal to any knowledge of overall survival ranges, typical management paradigms. They see a spot in the liver and want to talk to the patient about local therapy and local therapy only. NOthing about survival, end of life, palliative versus curative, etc.

I'd rather be an oncologist than a technician.

The surg oncs are oncologists IMO - they understand sequencing of therapy, local versus distant risk of recurrence patterns, etc at a much higher level than the IR's. They work people up and order labs/markers, scans, manage symptoms, round on patients, know survival curves, etc.

That’s the issue with DR training. It’s really light on the clinical aspect of patient care.

but then the beauty of being a DR subspecialty is that one can always fall back into practicing DR so as long as the overall rad job market is ok, even if certain subspeciality overexpand it will correct itself as grad begin to work in environment with less subspecialty focus (say,75% subspecialty, 25% general)

 

[evilbooyaa]

This is how it was done in the 70s. It was split off to become its own residency because of the largely increasing complexity of radiation treatments, as well as a re-shift in the '90s (when a bunch of programs closed) to become more focused on oncology management, not just focused on radiation (which is where most IR docs are currently).

There are much easier solutions to the job market than this.

Surg oncs, med oncs, are all oncologists. It is rare to have an IR doc that I would actually call an 'interventional oncologist' - certainly the minority of that specialty.

 

[scarbrtj]

I have a very good team of IR docs I think. They are absolutely a valuable member of our multi-D team.

However, they have a "clinic" which doesn't really manage symptoms, doesn't work people up, and they have minimal to any knowledge of overall survival ranges, typical management paradigms. They see a spot in the liver and want to talk to the patient about local therapy and local therapy only. NOthing about survival, end of life, palliative versus curative, etc.

I'd rather be an oncologist than a technician.

The surg oncs are oncologists IMO - they understand sequencing of therapy, local versus distant risk of recurrence patterns, etc at a much higher level than the IR's. They work people up and order labs/markers, scans, manage symptoms, round on patients, know survival curves, etc.

I do not claim to have the right answers on what we should call ourselves or what others should call us. Personally, I do think it's always important to keep an open mind and not take offense; e.g., if I were an otolaryngologist I wouldn't mind being called an ear doctor. Ultimately it's what we do that counts as it's this, more than a name, that governs the perception of others. "What's in a name? That which we call a rose by any other name would smell as sweet." And in the presence of a perceived or real B.O., it matters not whether one calls oneself oncologist, therapeutic radiologist, dog-catcher, or healer.

I believe there's a paper somewhere that shows there are more people treated in radiation clinics in Germany that don't have cancer than people that do. In every single textbook of radiation oncology I've ever read there's a whole clinical chapter devoted to conditions which have no relationship to oncology whatsoever. Not sure such a clinical chapter exists in DeVita's Oncology, not to mention that textbook feels like a cancer ocean and our "oncology textbook" feels in relation like a cancer pond. Harvey Cushing, according to William Osler, didn't like being called a neurosurgeon at all. He preferred "neurological surgeon" but especially preferred "a neurologist who operates." That last one really never caught on despite someone of Cushing's stature advocating for it. The average derm might treat ten times more "cancer patients" in a year than the average rad onc, and I'm sure there are derms that deal almost exclusively in skin cancers. Are all those people oncologists? Do they wanna be? If radiation oncologists exclusively focus on treatments like this, will they still be "oncologists"?

And who needs to know survival curves, and quote them to patients, nowadays anyways thanks to the web?

 

[deleted941485]

I do not claim to have the right answers on what we should call ourselves or what others should call us. Personally, I do think it's always important to keep an open mind and not take offense; e.g., if I were an otolaryngologist I wouldn't mind being called an ear doctor. Ultimately it's what we do that counts as it's this, more than a name, that governs the perception of others. "What's in a name? That which we call a rose by any other name would smell as sweet." And in the presence of a perceived or real B.O., it matters not whether one calls oneself oncologist, therapeutic radiologist, dog-catcher, or healer.

I believe there's a paper somewhere that shows there are more people treated in radiation clinics in Germany that don't have cancer than people that do. In every single textbook of radiation oncology I've ever read there's a whole clinical chapter devoted to conditions which have no relationship to oncology whatsoever. Not sure such a clinical chapter exists in DeVita's Oncology, not to mention that textbook feels like a cancer ocean and our "oncology textbook" feels in relation like a cancer pond. Harvey Cushing, according to William Osler, didn't like being called a neurosurgeon at all. He preferred "neurological surgeon" but especially preferred "a neurologist who operates." That last one really never caught on despite someone of Cushing's stature advocating for it. The average derm might treat ten times more "cancer patients" in a year than the average rad onc, and I'm sure there are derms that deal almost exclusively in skin cancers. Are all those people oncologists? Do they wanna be? If radiation oncologists exclusively focus on treatments like this, will they still be "oncologists"?

And who needs to know survival curves, and quote them to patients, nowadays anyways thanks to the web?

Illustrating the current identity crisis.

 

[deleted941485]

Here’s an outlandish idea! How about a new entrance exam designed specifically for people interested in radiation oncology! Academicians love tests and love quantitative data! This should be a hit with any budding faculty member who needs pubs.

 

[scarbrtj]

Here’s an outlandish idea! How about a new entrance exam designed specifically for people interested in radiation oncology! Academicians love tests and love quantitative data! This should be a hit with any budding faculty member who needs pubs.

We could try making getting into rad onc as hard as getting into Google.

 

[deleted941485]

We could try making getting into rad onc as hard as getting into Google.

That actually is exactly what we should do no joke.