Rad onc/med onc hybrid = happier?

[scarbrtj]

I believe we have covered this before and if so apologies in advance but I today had a mini-epiphany that there are no radiation oncologists in the UK. There are only medical oncologists (those who do non-surgical, non-RT cancer care) and clinical oncologists (those who do non-surgical cancer care). How interesting the huge difference in radiation medicine training in the US vs the UK. (Am pretty sure that there are radiation oncologists in Australia FWIW as a contradistinction.) That there would be a systemic-therapy and radiation-therapy-trained human makes more sense to me than sidling up to radiology, although either one sort of hints at the fact that a pure rad onc may be too one-trick-ponyish at least as we hurtle into the future. The revelation occurred to me because someone in the UK looked at physician job satisfaction and 1) reports that clinical oncologists ("medical oncologists who do radiation," in American parlance) are happier than medical oncologists, and 2) unsurprisingly, clinical oncologists have bigger workloads. If one truly wants to be an oncological polymath, UK clinical oncology training might be the way to go.

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[Fpg1245]

I believe we have covered this before and if so apologies in advance but I today had a mini-epiphany that there are no radiation oncologists in the UK. There are only medical oncologists (those who do non-surgical, non-RT cancer care) and clinical oncologists (those who do non-surgical cancer care). How interesting the huge difference in radiation medicine training in the US vs the UK. (Am pretty sure that there are radiation oncologists in Australia FWIW as a contradistinction.) That there would be a systemic-therapy and radiation-therapy-trained human makes more sense to me than sidling up to radiology, although either one sort of hints at the fact that a pure rad onc may be too one-trick-ponyish at least as we hurtle into the future. The revelation occurred to me because someone in the UK looked at physician job satisfaction and 1) reports that clinical oncologists ("medical oncologists who do radiation," in American parlance) are happier than medical oncologists, and 2) unsurprisingly, clinical oncologists have bigger workloads. If one truly wants to be an oncological polymath, UK clinical oncology training might be the way to go.

Will only happen once the field has completely collapsed and the radiology community effectively laughs us out of their camp. “Sure! We will offer the desperate rad oncs multi-year fellowship in imaging. Just don’t expect anyone this side of western medicine to hire you or take you seriously”. This will take the better part of most ROs careers to happen. Then they’ll go
For the clinical oncology title but med oncs so obviously dominate the non surgical aspect of oncology that they’ll likely have paired up with their own RO depts and turned it into a fellowship of med Onc. Meanwhile those the went the straight RO route won’t have the option to do a Med Onc fellowship withit first completing 2-3 years of IM. Just keep tacking on those years upon years of training till the whole enterprise looks like a giant farce.

Maybe you can cite the immense career satisfaction clinical oncologists in the UK have as evidence to combine specialties. I’m sure it will be very well received by hand wringing US med oncs who will use it to turn the whole ordeal into a decade of indentured servitude.

 

[Palex80]

Centralization & site/disease specialization is an issue here.
In the UK the NHS is dominant and you will find big departments with multiple physicians, most of them treating one site/disease each.
The „prostate guy“, the „lung lady“ of the clinic and so on. They are clinical oncologists and prescribe chemo/antobodies/small molecules, but they focus on one disease.
You can do that if you have 10 physicians (+ X residents) and 5 linacs per site.
You wont find many private practices or small radiation oncology centers with 2–3 physicians and one linac treating everything in the UK. It would indeed be very troublesome to take care of so many patients/issues and stay uptodate in both specialities for all disease sites.

 

[nkmiami]

Centralization & site/disease specialization is an issue here.
In the UK the NHS is dominant and you will find big departments with multiple physicians, most of them treating one site/disease each.
The „prostate guy“, the „lung lady“ of the clinic and so on. They are clinical oncologists and prescribe chemo/antobodies/small molecules, but they focus on one disease.
You can do that if you have 10 physicians (+ X residents) and 5 linacs per site.
You wont find many private practices or small radiation oncology centers with 2–3 physicians and one linac treating everything in the UK. It would indeed be very troublesome to take care of so many patients/issues and stay uptodate in both specialities for all disease sites.

Thoughts
At least in radiation, macroscopically, how much practice changing new info is there really to keep with us vs medonc?
Gynonc delivers chemo with mostly surgical training in fellowsh

 

[Fpg1245]

Centralization & site/disease specialization is an issue here.
In the UK the NHS is dominant and you will find big departments with multiple physicians, most of them treating one site/disease each.
The „prostate guy“, the „lung lady“ of the clinic and so on. They are clinical oncologists and prescribe chemo/antobodies/small molecules, but they focus on one disease.
You can do that if you have 10 physicians (+ X residents) and 5 linacs per site.
You wont find many private practices or small radiation oncology centers with 2–3 physicians and one linac treating everything in the UK. It would indeed be very troublesome to take care of so many patients/issues and stay uptodate in both specialities for all disease sites.

So I guess the best ways to minimize cognitive load associated with wearing both hats so to speak is to reduce the RT component down to a very formulaic approach with little deviation, specialize in one disease site, or try to eliminate it all together (out of site out of mind) focus solely on systemic agents.

 

[RickyScott]

best ways to minimize cognitive load..... is to reduce the RT component down to a very formulaic approach with little deviation, specialize in one site

MDACC ? Yes, that is how our field is practiced at some centers, kind of obviates the need to really stay uptodate or even worse...

Large areas of radiation like breast /prostate- what is there really to think about? treat nodes/dont treat nodes/ everything dictated by standardization

 

[Fpg1245]

MDACC ? Yes, that is how our field is practiced at some centers, kind of obviates the need to really stay uptodate or even worse...

Large areas of radiation like breast /prostate- what is there really to think about? treat nodes/dont treat nodes/ everything dictated by standardization

Technicians through and through.

 

[scarbrtj]

treat nodes/dont treat nodes

Haha, once you have this down, you've learned 50% of all you need to know in radiation oncology

 

[Palex80]

I think the Norwegians also have a similar model. A few years ago I was talking to a clinical oncologist on a consensus meeting of a European society and we were discussing about prostate cancer. And then another colleague joined the discussion and asked the clinical oncologist what his thoughts were on the (back then) newly published MA20 trial. And the clinical oncologist just said "Oh, I am sorry, I treated my last breast cancer more than 10 years ago, haven't been following up on that".

I was kind of shocked.
I wouldn't want to become that. I understand that a certain degree of specialization is there in order to master a disease, but I'd still like to be at least of aware of what's going on in other fields of my speciality and be able to treat according to what's considered more or less standard of care the major bulk of patients presenting for treatment.

 

[Radiator20]

I think the Norwegians also have a similar model. A few years ago I was talking to a clinical oncologist on a consensus meeting of a European society and we were discussing about prostate cancer. And then another colleague joined the discussion and asked the clinical oncologist what his thoughts were on the (back then) newly published MA20 trial. And the clinical oncologist just said "Oh, I am sorry, I treated my last breast cancer more than 10 years ago, haven't been following up on that".

I was kind of shocked.
I wouldn't want to become that. I understand that a certain degree of specialization is there in order to master a disease, but I'd still like to be at least of aware of what's going on in other fields of my speciality and be able to treat according to what's considered more or less standard of care the major bulk of patients presenting for treatment.

Hmm. I don’t disagree with your point, but I think most US academic radiation oncologists, unless they specifically treated breast, would have given a similar response... no?

 

[scarbrtj]

I think the Norwegians also have a similar model. A few years ago I was talking to a clinical oncologist on a consensus meeting of a European society and we were discussing about prostate cancer. And then another colleague joined the discussion and asked the clinical oncologist what his thoughts were on the (back then) newly published MA20 trial. And the clinical oncologist just said "Oh, I am sorry, I treated my last breast cancer more than 10 years ago, haven't been following up on that".

I was kind of shocked.
I wouldn't want to become that. I understand that a certain degree of specialization is there in order to master a disease, but I'd still like to be at least of aware of what's going on in other fields of my speciality and be able to treat according to what's considered more or less standard of care the major bulk of patients presenting for treatment.

So this is what you're saying...

 

[RickyScott]

I honestly also havent treated a breast case in many years, but i did read the MA20 abstract conclusion once (while sitting on the toilet). I honestly feel I can contour the axilla/scv/and IMN as well as anyone. If I had an institutional policy of when to treat the nodes, what clinical knowledge do I need, what do I need to stay on top of? If breast was all I did, wouldnt I be so much useful if I could stay on top of and deliver systemic treatments?

 

[Palex80]

I think this is not a radiation-oncology-specific problem, it probably happens within other specialities as well. Even in other professions.
Just like a small-townb law office with two attorneys. They will pretty much deal with any case they get their hands on. They cannot be considered experts in all fields of law, but they won't probably screw up.
If you go the city and look into the offices of a big law firm with 30 attorneys, you will probably find a couple of them that only deal with divorces or any other specific scenario. They don't need to decline other cases, since there are enough other lawyers in the firm that will deal with those. Will they become experts when it comes to divorces? You bet.

It's not necessarily an academic vs. non-academic issue. Size is what matters here. The bigger the company / the hospital, the more specialized the professionals are.
In radiation oncology it is linked to academic vs. not-academic, simply because most of the big US clinics are also academic clinics. It doesn't have to be that way however everywhere and it has a lot to do on how your clinic works.
I've seen departments were indeed the rest of the team has no idea how the "breast team" or the "lung team", which generally consists of a few physicians treats patients. The "breast team" does all the talking with the patient, thinks of what and how to irradiate, contours, follows up the patient. Noone outside the breast team (on the physician side) even knows that the patients the breast team treats actually exist... . That's quite a boring way to work, if you ask me. But that's just me. I enjoy reviewing cases my colleagues see, debate on how to treat and learn a thing or two, just like they hopefully learn from me to.

 

[Radiator20]

So this is what you're saying...

To be fair to academic subspecialists, your 2D diagram of breadth does leave out the question of depth.

Agree with Palex that the fundamental issue is subspecialization, not academic vs non-academic, and that the phenomenon is not specific to rad onc.