Med onc is a fellowship, rad onc is a residency. How do you propose that gets reconciled? Rad Oncs don't really learn inpatient management outside of maybe intern year. When would general inpatient management be learned? How many years are we talking about? 3 IM, 2 Med onc, 3 Rad Onc?
I missed this thread and just wrote a post about this in another thread, but:
1) Holman already permits 27 months for RadOnc
2) In current Heme/Onc fellowships, only 9-12 months are dedicated to MedOnc (the rest of the time either Heme or Research)
3) If you take the structure of a standard IM Residency and remove outpatient and elective rotations, there are probably only 18-24 months of true inpatient medicine rotations (I'm sure this varies a lot from program to program, but the minimum is 18 months of supervised inpatient training)
Doing rotations on an inpatient Oncology ward probably count for both IM and MedOnc (not sure - what I am sure is that I spent a looong time in my intern year doing inpatient Oncology ward rotations)
Bits of pieces of doing something like this already exists, but it would take:
1) an institution willing to make a residency like this (easy-ish)
2) the ABR and the ABIM to sign off (very hard)
This is frustrating to me because of my experience with my MD-PhD training. I was considering a lot of different programs, and ultimately matriculated into one which I felt like had blended the different trainings the best - and believe me, I saw a lot of different ways these programs could be run. Once in my program, I did the standard 24 month pre-clinical curriculum. This was in the late 2000s, when everything was moving towards the current trend of 18 month pre-clinical curriculums, which my school did after I was in the graduate phase. That basically told me that I had endured 6 extra months of training which was actually...not necessary? Because upon my return to the medical phase I completed the standard 24 month clinical curriculum, complete with the "4th year vacation".
The disconnect between time/skill/board exams is sad. The ABR acknowledged it again this year, by permitting people to take radbio/physics after PGY3 and clinical writtens after PGY4. What does that say? It says that ability to pass board exams is divorced from time spent in training.
So, in our specialty, depending on where you train, you could:
1) do the easiest TY program in the country, barely see patients, join a RadOnc residency, do the Holman, do 27 months clinical training, take written board exams after PGY3 and PGY4
and get the same board certification/stamp of approval as someone who
2) does a very difficult prelim Medicine intern year, goes to a RadOnc program which only allows 3-6 months of elective time, not be permitted to take boards until PGY4/5
Which person is likely to be the better clinician? I think we all assume Person #2. But, with the structure of the current system, they're "equivalent" (obviously the nature of your training will be explored come job search time, but that's a separate issue lol).
Given the inherent imbalance that already exists in RadOnc training,
why not have a combo RadOnc/MedOnc program? I mean, I agree it would throw job market stuff into chaos - but from a "possibilities" perspective, it feels like it should exist - it would just require people blatantly acknowledge inequities in training.
