Why don’t we just start giving our own?

[Bequerel]

Dermpath didn’t ask pathology if it was ok to read skin cancers. Gastroenterologists didn’t ask surgeons if they could do colonoscopies. Neurologists didn’t ask if they could give TMZ. IR didn’t get permission to steal dozens of procedures and form their own specialty. Why don’t we just start giving radiosensitizing chemotherapy as part of our training. That could open the door to other systemic agents and then maybe we could work our way up from the bottom of the food chain and become a more sought after well rounded clinical oncologist, such as in Europe. I know I’m grasping at straws, just trying to think of outside of the box ways to stop the dumpster fire. It seems obvious that no one is chomping at the bit to contract their residency programs.

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[Gfunk6]

I think the main impediment would be the intense backlash received by our Med Onc colleagues in academic settings.

 

[RickyScott]

Dermpath didn’t ask pathology if it was ok to read skin cancers. Gastroenterologists didn’t ask surgeons if they could do colonoscopies. Neurologists didn’t ask if they could give TMZ. IR didn’t get permission to steal dozens of procedures and form their own specialty. Why don’t we just start giving radiosensitizing chemotherapy as part of our training. That could open the door to other systemic agents and then maybe we could work our way up from the bottom of the food chain and become a more sought after well rounded clinical oncologist, such as in Europe. I know I’m grasping at straws, just trying to think of outside of the box ways to stop the dumpster fire. It seems obvious that no one is chomping at the bit to contract their residency programs.

Derm gives more fractions of radiation than we do. Neurology and gynonc didn’t ask permission to give chemo either.

 

[Bequerel]

I think the main impediment would be the intense backlash received by our Med Onc colleagues in academic settings.

Obviously there would be backlash, but I’m sure there was equal backlash when the other specialties did it. I forgot to mention GYN onc who gives actual chemo. What would happen if we started to think like a shark and not a catfish. They still have to send us radiation patients. No way they could ever get radiation training. Nothing to stop us from training ourselves with some systemic therapy. There’s precedent in multiple other specialties.

 

[medgator]

Obviously there would be backlash, but I’m sure there was equal backlash when the other specialties did it. I forgot to mention GYN onc who gives actual chemo. What would happen if we started to think like a shark and not a catfish. They still have to send us radiation patients. No way they could ever get radiation training. Nothing to stop us from training ourselves with some systemic therapy. There’s precedent in multiple other specialties.

No reason to get referrals from med onc outside of lymphoma either. No reason for ent, pulm, gi etc to send to med onc first. In many cases, chemo may not be even necessary

 

[TheWallnerus]

I think the main impediment would be the intense backlash received by our Med Onc colleagues in academic settings.

Instead of hiring five clinical instructors the academic depts should hire their own rad-onc-focused med onc to integrate "The growing role of chemo and immunotherapy into rad onc" for proper rad onc resident training. Might be a tough sell but maybe the dean, and med oncs, would go for it. "Hey guys, non-threatening action here, we are all one team!" Next thing you know... COOOO-stanza, and we are doing some lite systemic therapy.


EDIT: Alternative, hire a med onc in the dept and board certify them into rad onc. Another Trojan horse-y approach.

 

[sueyom]

putting a different perspective on it, very possible medical oncology would appreciate radonc helping to support one of their faculty particularly if there were common research interests.

 

[MegaVoltagePhoton]

As long as a certain someone doesn’t give a bogus “legal” defense relying on “anti-trust”.

 

[communitydoc13]

HemOnc in the community is actually swamped with heme referrals and intensive f/u schedule. 25 pts/day type stuff with lots of farming out to mid-levels.

I truly believe that better solid tumor care would be given by an integrated solid tumor oncologist for most cases.

H&N cases: How many times do you obligatorily send to medonc colleagues hoping that they will say no to concurrent chemo and instead the give non-standard chemo in marginal pts.

GBM: The right choice can be made regarding concurrent, XRT alone or temodar alone in marginal pts. Again, in present model, everyone wants to help.

Breast: Forget that very poor toxicity calculation that 5 years AI with associated arthralgias and malaise in less toxic in an 80 year old than a little post-op XRT.

Problem is you need medonc to handle neutropenic fever admissions. But, every IR doc ever needs surgical back-up.

 

[medgator]

HemOnc in the community is actually swamped with heme referrals and intensive f/u schedule. 25 pts/day type stuff with lots of farming out to mid-levels.

I truly believe that better solid tumor care would be given by an integrated solid tumor oncologist for most cases.

H&N cases: How many times do you obligatorily send to medonc colleagues hoping that they will say no to concurrent chemo and instead the give non-standard chemo in marginal pts.

GBM: The right choice can be made regarding concurrent, XRT alone or temodar alone in marginal pts. Again, in present model, everyone wants to help.

Breast: Forget that very poor toxicity calculation that 5 years AI with associated arthralgias and malaise in less toxic in an 80 year old than a little post-op XRT.

Problem is you need medonc to handle neutropenic fever admissions. But, every IR doc ever needs surgical back-up.

Accurate. How many of them could stage a lung or head neck cancer accurately unless they were specialized? Out in the community it's way too much for them to be good onc generalists while still focusing on heme and inpatient

 

[StIGMA]

We need more concurrent molecular therapy indications based on biomarkers… and trials aimed to address this. I dont know why we couldnt manage a PARP inhibitor before/during/after radiation for instance, when the goal of the drug is to enhance the radiation.
Once this is established the door is open to Rx agents independently of radiation.

 

[madchemist89]

Becoming clinical oncologists is the only way forward. IR and DR cannot save us.

 

[theradiator]

How about the bloated training programs mandating elective rotations Clinical Oncology in the UK like the old Pediatric rotations at St. Jude’s?

 

[medgator]

How about the bloated training programs mandating elective rotations Clinical Oncology in the UK like the old Pediatric rotations at St. Jude’s?

One way to reduce programs and slots, which will also help to save the specialty by attracting the best and brightest again

 

[cardsperson]

Agreed, why don't doctors with very little internal medicine or inpatient training give chemo/immunotherapy? What could possibly go wrong? It's not like these drugs are known for their toxicities /s

At any given day on an inpatient onc service, maybe about 10% of the patients are getting radiation. If you're not seeing 90% of cancer care, it's easy to assume that it's all formulaic and easy.

 

[Gfunk6]

Agreed, why don't doctors with very little internal medicine or inpatient training give chemo/immunotherapy? What could possibly go wrong? It's not like these drugs are known for their toxicities /s

At any given day on an inpatient onc service, maybe about 10% of the patients are getting radiation. If you're not seeing 90% of cancer care, it's easy to assume that it's all formulaic and easy.

Agree 100%.

 

[TheWallnerus]

Agreed, why don't doctors with very little internal medicine or inpatient training give chemo/immunotherapy? What could possibly go wrong? It's not like these drugs are known for their toxicities /s

At any given day on an inpatient onc service, maybe about 10% of the patients are getting radiation. If you're not seeing 90% of cancer care, it's easy to assume that it's all formulaic and easy.

I just spent the entire day with our new EMR people, and a bunch of med oncs, listening how they were making all their chemo Rx's (hundreds? thousand?) exceedingly and unyieldingly formulaic... the anti-emetics, the labs, the EKGs, the tumor markers, etc. So that part is a given. It is formulaic... to a large extent. Managing side effects is not nearly as formulaic. Thus why rad oncs would need inpatient exposure and internal medicine (re)training. Jack Kevorkian said he was medically able to psychologically analyze his patients because he did psychiatry rotations in medical school. We aren't talking about going that far!

 

[RickyScott]

I just spent the entire day with our new EMR people, and a bunch of med oncs, listening how they were making all their chemo Rx's (hundreds? thousand?) exceedingly and unyieldingly formulaic... the anti-emetics, the labs, the EKGs, the tumor markers, etc. So that part is a given. It is formulaic... to a large extent. Managing side effects is not nearly as formulaic. Thus why rad oncs would need inpatient exposure and internal medicine (re)training. Jack Kevorkian said he was medically able to psychologically analyze his patients because he did psychiatry rotations in medical school. We aren't talking about going that far!

Gyn onc does just fine despite lack of IM and a fellowship that is surgically focused. Program director from Columbia was boasting about how his residents used a year of training for a masters in bioethics or to complete some trash research. Much better if they learned some oncology.

 

[TheWallnerus]

Gyn onc is fine.

Maybe Steve Hahn, board certified in internal medicine, hem/onc, and rad onc, could show us the way.

But in seriousness... Charles Thomas is... Andrew Turrisi is too...

 

[medgator]

Agreed, why don't doctors with very little internal medicine or inpatient training give chemo/immunotherapy? What could possibly go wrong? It's not like these drugs are known for their toxicities /s

At any given day on an inpatient onc service, maybe about 10% of the patients are getting radiation. If you're not seeing 90% of cancer care, it's easy to assume that it's all formulaic and easy.

Not sure why we could just do it as combo med/rad onc program for 4 years after 2 years of medicine. Or 3+3. Keep it as an option, won't work in every setting, but may for some coming out now

 

[cardsperson]

Gyn onc does just fine despite lack of IM and a fellowship that is surgically focused. Program director from Columbia was boasting about how his residents used a year of training for a masters in bioethics or to complete some trash research. Much better if they learned some oncology.

Gyn onc is hardly a good example. Their brutal surgeries and primitive chemo are basically where the rest of oncology was in the 1960s.

 

[jondunn]

Maybe Steve Hahn, board certified in internal medicine, hem/onc, and rad onc, could show us the way.

But in seriousness... Charles Thomas is... Andrew Turrisi is too...

and the pope ****s

 

[CaesarRO]

Gyn onc is hardly a good example. Their brutal surgeries and primitive chemo are basically where the rest of oncology was in the 1960s.

I think that the chemos proposed here are similarly "simple".

Cisplatin, xeloda, carbo/taxol would cover vast majority of concurrent chemorads cases and wouldn't be much different from what Gyn Onc does

5FU/MMC for anal is the riskiest of the concurrent chemos with respect to neutropenic fever

 

[elementaryschooleconomics]

At a minimum, I don't understand why we're routinely punting the early-stage breast patients to MedOnc for endocrine therapy. Many of us are already managing ADT for the prostate guys, would this really be much different? I feel like that simple change would go a long way towards removing the negative "technician" stereotype hanging over our heads.

I mean obviously, at least in academic centers, people get very territorial about breast, but we all know how swamped the MedOncs can get. I don't think much reimbursement would be lost by them, or gained by us, but I feel like this would help other docs see us as "Oncologists first, Radiation Oncologists" second, like so many people like to spout on about.

 

[medgator]

At a minimum, I don't understand why we're routinely punting the early-stage breast patients to MedOnc for endocrine therapy. Many of us are already managing ADT for the prostate guys, would this really be much different? I feel like that simple change would go a long way towards removing the negative "technician" stereotype hanging over our heads.

I mean obviously, at least in academic centers, people get very territorial about breast, but we all know how swamped the MedOncs can get. I don't think much reimbursement would be lost by them, or gained by us, but I feel like this would help other docs see us as "Oncologists first, Radiation Oncologists" second, like so many people like to spout on about.

No reason you couldn't... What happens when they met out and need ibrance in combination? It all depends on your current practice/referral patterns. The last thing i want to be doing with my precious time is managing the AI and checking a dexa scan on a pt i treated years ago with RT

 

[elementaryschooleconomics]

The last thing i want to be doing with my precious time is managing the AI and checking a dexa scan on a pt i treated years ago with RT

Totally agree it would be a time suck with a low financial reward, but the reward would potentially be "reputation equity" and how you're viewed in your community.

 

[RadOncDoc21]

I rather work part time and get paid less then do more work. Make what you can and get off this sinking ship!

 

[RickyScott]

Gyn onc is hardly a good example. Their brutal surgeries and primitive chemo are basically where the rest of oncology was in the 1960s.

If the chemo is primitive and toxic and the surgeries are brutal, yet gync onc with minimal chemo training can still handle the patients just fine, aren’t you making the same point. ( at one point they were giving chemo ip) Btw, gync oncs give plenty of IO and targeted therapy live avastin and parp inhibitors.

 

[Ray D. Ayshun]

At a minimum, I don't understand why we're routinely punting the early-stage breast patients to MedOnc for endocrine therapy. Many of us are already managing ADT for the prostate guys, would this really be much different? I feel like that simple change would go a long way towards removing the negative "technician" stereotype hanging over our heads.

I mean obviously, at least in academic centers, people get very territorial about breast, but we all know how swamped the MedOncs can get. I don't think much reimbursement would be lost by them, or gained by us, but I feel like this would help other docs see us as "Oncologists first, Radiation Oncologists" second, like so many people like to spout on about.

The problem is getting into a follow-up war of attrition where the only loser is the patient getting seen monthly for 5 years to follow a stage I breast cancer.

 

[medgator]

The problem is getting into a follow-up war of attrition where the only loser is the patient getting seen monthly for 5 years to follow a stage I breast cancer.

$35-150 co-pays/visit. I was shocked when I saw a $150 co-pay but it exists.

 

[TheWallnerus]

At a minimum, I don't understand why we're routinely punting the early-stage breast patients to MedOnc for endocrine therapy. Many of us are already managing ADT for the prostate guys, would this really be much different? I feel like that simple change would go a long way towards removing the negative "technician" stereotype hanging over our heads.

I mean obviously, at least in academic centers, people get very territorial about breast, but we all know how swamped the MedOncs can get. I don't think much reimbursement would be lost by them, or gained by us, but I feel like this would help other docs see us as "Oncologists first, Radiation Oncologists" second, like so many people like to spout on about.

The way this is going to work, and work for rad oncs in practice, is for the ACADEMIC RAD ONCS to take on some of these additional responsibilities and to reshape our specialty.

Residency training is cultural training. If residents in other specialties are not "trained" during their residency years that rad oncs do other things besides just radiation, rad oncs will never get additional referrals. Radiation doesn't have a scope of practice problem, really... we have a get-referrals problem (and sure that is to large extent due to our reputation as more technical than physician-y). You have to train 'em young. We would need to train rad onc residents coming in, and the med onc, urology, etc., residents would have to see "Oh ,gee, I can hand some of this stuff off to rad onc, they do a good job with durva/hormones/what have you." Then when those med oncs and urologists get out in practice they will be more willing to yield some work because they were trained and saw it back in residency and it seemed normal.

The moment we have some weird side effect from Arimidex, we will need to refer , probably, to med onc. The only way that spoonful of medicine is going to go down is if it happened a few times during the med onc's fellowship training and he saw such instances as a normal fact of life versus the rad onc being stupid at oncology.

We will never make more money or get more relevance or more "reputation equity", I am afraid, if we all just started, today, in our practices, giving Temodar and Lupron and checking dexa scans etc. No one makes money from that "crap" first of all. (They make some money from infusions, true, and having their own pharmacy.) They make money from the constant spigot of referrals coming into their clinic IMHO. (And med onc has neat tricks whereby they're treating patients over much longer periods of time than rad onc; another story.)

So we all need to think this through and see what it is we are really asking and what we really want. We shouldn't care if we are relevant or not, or what our rep is. We should just care about getting more referrals and how to do more with the referrals we get. Of course, it is all connected: relevance, reputation, and referrals. To that end, academic rad onc will have to lead the way because it is academic RO who defines and shapes the culture of rad onc. This last sentence, though, sucks hope from my soul.

 

[DebtRising]

If we give chemo we should be trained. Creating a 3 year IM/onc fellowship on top of rad onc residency would be a worthwhile endeavor. Respect that said person would be a clinical oncologist not covering heme and never running an IM clinic. That would be 8 years of training, but create an individual who has the knowledge and training to be a true Oncologist. I would have and still may consider something like that if it ever existed.

Outside training, it’s not the right thing to do in my opinion. And a great idea but the wrong approach to fix our oversupply. The easiest, and most just, fix is to contract residency spots drastically now and allow those of us well trained, practicing, passionate, and delivering radiation within our scope of practice to continue to provide value to patients and the medical system we work in without being parasitized by our elders.

 

[RickyScott]

If we give chemo we should be trained. Creating a 3 year IM/onc fellowship on top of rad onc residency would be a worthwhile endeavor. Respect that said person would be a clinical oncologist not covering heme and never running an IM clinic. That would be 8 years of training, but create an individual who has the knowledge and training to be a true Oncologist. I would have and still may consider something like that if it ever existed.

Outside training, it’s not the right thing to do in my opinion. And a great idea but the wrong approach to fix our oversupply. The easiest, and most just, fix is to contract residency spots drastically now and allow those of us well trained, practicing, passionate, and delivering radiation within our scope of practice to continue to provide value to patients and the medical system we work in without being parasitized by our elders.

I agree with you about the extra 2-3 years, but disagree that contracting residencies will meaningfully fix the oversupply over the next 15-20 years. Even if we eliminated every residency and allowed current trainees to graduate , we would still enter the 2030s with an oversupply problem.

 

[communitydoc13]

Agreed, why don't doctors with very little internal medicine or inpatient training give chemo/immunotherapy? What could possibly go wrong? It's not like these drugs are known for their toxicities /s

At any given day on an inpatient onc service, maybe about 10% of the patients are getting radiation. If you're not seeing 90% of cancer care, it's easy to assume that it's all formulaic and easy.

A designated inpatient onc service may not even exist in many community hospitals and inpatient oncology is hardly reflective of the majority of solid tumor cancer care. An academic or large hospital inpatient floor is going to massively skew away from outpatient solid tumor oncology.

Population-Based Assessment of Hospitalizations for Toxicity From Chemotherapy in Older Women With Breast Cancer

There are no population-based data on hospitalization rate for toxicity from breast cancer chemotherapy, and even large clinical trials often do not report this information. Medicare data, linked to the Surveillance, Epidemiology, and End-Results (SEER) ...

www.ncbi.nlm.nih.gov

Chemotherapy-Related Hospitalization Among Community Cancer Center Patients

The frequency, nature, trends, predictors, and outcomes of chemotherapy-related hospitalizations among a nonselected population of cancer patients treated at a community cancer center are described. The feasibility of implementing continuous quality improvement ...

www.ncbi.nlm.nih.gov

Above links reference solid tumor populations (even vulnerable populations) getting multiagent, very toxic outpatient chemo regimens (not what people on this board are talking about giving) and hospitalization rate~9%

I rather work part time and get paid less then do more work. Make what you can and get off this sinking ship!

This is a fine attitude and per person for those already established in reasonable community (or even academic) practices is relatively standard. It is almost certainly how the remainder of my career will go. No way forward for the field however with this approach.

I am afraid, if we all just started, today, in our practices, giving Temodar and Lupron and checking dexa scans etc. No one makes money from that "crap" first of all.

I think the attitude that "we generate all this income for hospitals so we should be paid commensurately" is bogus. Now, this does not apply to those who are truly in private practice (rare nowadays and some of the money I have heard about is frankly unfathomable to me). Most of us are beholden to employers who's basic measure of value of a physician is how little they can pay them and still keep them around. I suspect those remote job postings would quickly tick upwards in terms of salary if their new radonc hire had an expanded scope of practice and it kept another mid-level off of the medonc books.

Plus, for academic radonc, think of the expanded intellectual space in terms of clinical research?

"reputation equity"

We're never getting this without additional training or even a medonc residency. I remember a few years back when radonc chairs were lamenting their career ceiling in academic medicine.

DEFINE_ME

Ridiculous. I mean why would radonc chairs become deans. We never put in the hard work. Radonc is not foundational, medicine and surgery are. We knew when we took a residency without overnight call and weekends off that we were never going to be respected outside of the begrudging respect given to specialties like derm when we were very competitive. There is a reason that the relatively few double boarded radoncs are disproportionately ascendant in terms of upper level careers.

 

[deleted1111261]

No way 2-3 years. Not necessary.

1 year for solid tumors. Skip research year if you want to do it. Maximum 2.

Endocrine therapy, TMZ, Xeloda, cisplatin and cis doublets, carbo +/- taxol, ADT and other prostate therapies.

I think you’re overrating how much time you need to do this stuff. Just my opinion- may be wrong. I think the people that graduated “peak Rad onc” confuse the specialty with being hard vs being hard to get into. This is not brain surgery, even if you are a proficient radio surgeon, like Randy Waggoner.

That being said, I wouldn’t like that job one bit.

 

[jondunn]

I agree with you about the extra 2-3 years, but disagree that contracting residencies will meaningfully fix the oversupply over the next 15-20 years. Even if we eliminated every residency and allowed current trainees to graduate , we would still enter the 2030s with an oversupply problem.

this sounds like 'why do anything because global warming will happen anyway' energy

no, sir, we do need to contract, and it CAN help.

also the idea that 20 x 180 people a year = 3600 docs, not being in the picture wouldnt matter is asinine.

 

[medgator]

People forget that rad onc residency used to be 3 years until the 90s... Part of the reason to extend training year was to fix a bad job market....

 

[RickyScott]

this sounds like 'why do anything because global warming will happen anyway' energy

no, sir, we do need to contract, and it CAN help.

also the idea that 20 x 180 people a year = 3600 docs, not being in the picture wouldnt matter is asinine.

Optically, whether 20% of graduating residency class or 60% in 2030 is unemployed is not that meaningful to me and we will be the most unhinged field in medicine either way.
Allowing the 1000 or so residents in the pipeline to graduate and eliminating every single residency means we go to into 2030 with 7000+ radoncs as baby boomers die off, smoking related and hpv cancer declines etc

 

[jondunn]

Optically, whether 20% of graduating residency class or 60% in 2030 is unemployed is not that meaningful to me and we will be the most unhinged field in medicine either way.
Allowing the 1000 or so residents in the pipeline to graduate and eliminating every single residency means we go to into 2030 with 7000+ radoncs as baby boomers die off, smoking related and hpv cancer declines etc

you said 20 years so let's go with the year 2040.

how do you get to 7000 in 2040 after the next 20 years of retirements?

 

[TheWallnerus]

That being said, I wouldn’t like that job one bit.

I am with you. We chose the job we chose. We will get to ride this job into the sunset I reckon. However I do not think someone being born today will be functioning in our job 35 years from now. It will have to change. The leaders of what is our job nowadays need to heed (highly doubt but I can dream) the words of the poet:

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you is worth savin’
Then you better start swimmin’ or you’ll sink like a stone
For the times they are a-changin’

 

[Chartreuse Wombat]

I am with you. We chose the job we chose. We will get to ride this job into the sunset I reckon. However I do not think someone being born today will be functioning in our job 35 years from now. It will have to change. The leaders of what is our job nowadays need to heed (highly doubt but I can dream) the words of the poet:

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you is worth savin’
Then you better start swimmin’ or you’ll sink like a stone
For the times they are a-changin’

Nobel laureate

 

[RickyScott]

you said 20 years so let's go with the year 2040.

how do you get to 7000 in 2040 after the next 20 years of retirements?

Yes, in that timeframe we would be ok assuming nothing disruptive like eliminating most adjuvant radiation based on biomarker or ct dna etc

 

[DebtRising]

No way 2-3 years. Not necessary

May or may not be. But would need to be enough training to have IM and onc background because that is the stage currently setup.

That being said, I wouldn’t like that job one bit.

That may be true and respect your and Wallnerus’ stance, but that is certainly going to vary person to person, and frankly based on their motivations to join rad onc, years in practice, and stability of current / projected financial situation.

I may like that job. Without necessity it wouldn’t be where I would be looking, but I don’t see a long term future in this field. There may be other highly motivated people like myself who would consider such a pathway, and we may have good academic scores, a good track record in practice, and a mix of experience without reticence to change where we could be benefactors to the system.

 

[deleted1111261]

I am with you. We chose the job we chose. We will get to ride this job into the sunset I reckon. However I do not think someone being born today will be functioning in our job 35 years from now. It will have to change. The leaders of what is our job nowadays need to heed (highly doubt but I can dream) the words of the poet:

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you is worth savin’
Then you better start swimmin’ or you’ll sink like a stone
For the times they are a-changin’

During peak pandemic in Arizona in the late spring / summer or 2020, Banner Health had ads with this song, and I really liked them. Made me soft for my employer (who actually did a heckuva job during the pandemic, after some obnoxious missteps).

 

[DrAdonis]

Radiation and clinical oncology training takes 5 years in the UK and many other countries. They treat solid tumors with radiation, chemo, hormonal and other targeted agents and are known to do it well.
In oncology trainings, we learn the same/similar things about malignancies and ideally should all know when to treat with meds, surgery or radiation. The major difference is in executing different treatment modalities. Radiation therapy and surgery need specific skill sets that may take time to acquire, med onc on the other hand thrives on knowledge of medications and their side effects.
Med oncologists prescribe chemo while nurses administer them and new drugs are frequently introduced to them by Pharma reps with emphasis on common medication adverse effects.

Adding an additional residency year and reducing dedicated research time from a year to 6 months should be more than enough to get adequate training as radiation and clinical oncologist in the US.

I believe that this option should be made available to interested residents, and programs that have accreditation for both medical and radiation oncology training can work out a curriculum for this.

Although I may be wrong, the only current obstacle in the way of this double certification is the requirement for internal medicine residency before med onc training and this should not be difficult to do away with. We also did a year of IM/TY and IM residency has been waived for specialties like neurology.

 

[CurbYourExpectations]

1 year inpatient internal medicine
2 years medical oncology
2 years radiation oncology
1 year elective depending on how you want to spend your career (research, more inpatient, clinic)
?????
=
Instant job market improvement

 

[medgator]

1 year inpatient internal medicine
2 years medical oncology
2 years radiation oncology
1 year elective depending on how you want to spend your career (research, more inpatient, clinic)
?????
=
Instant job market improvement

1+2.5+2.5. keep it clinical and onc focused

 

[Bequerel]

1+2.5+2.5. keep it clinical and onc focused

2.5 years of oncology is longer then a medical oncology only fellowship. We need to become the preferred and more relevant oncologist to referring physicians. We need to be a complete clinical oncologist that can curatively treat head and neck, lung, GYN, prostate, etc. patients on our own with both radiation AND systemic therapy. Why can’t we just teach ourselves to administer it in our own without requiring years of training from medical oncologists. Medical oncologists would never agree to this. We all know what needs to be given. Only an NP has to be in the building to deliver it. Any Med onc over the age of 50 never trained with immunotherapies and have learned from the drug reps or meetings what to give. There’s precedent for multiple other specialties giving such therapies. I went to a dermatology convention with a medical school buddy of mine from medical school when he was in town during my residency. I posted about it 10 years ago in here because I was floored at the couple hours of primitive lectures in rad bio and physics that was given to “teach” the dermatologists about giving radiation. Again, I say a lot of this tongue in cheek. Residency closure/contraction is a simpler fix, but doesn’t seem to be happening. Also, I really have no real interest in doing anything that I’m saying. I’m hoping to bank as much as I can in my current gig and have enough to retire before this gig is up. I just firmly believe that a big change is needed to restore us back to the “glory days”. We need a complete different mindset and, obviously, different leadership. If our leadership, embraced an aggressive private practice type mentality, instead of acting like they were above it, we wouldn’t have gone from a top 3 competitive field to the least competitive field in less than 5 years. I could keep babbling, but it’s too depressing.

 

[deleted1111261]

I brought this up and tagged ASTRO and ARRO. Pretty soon, they will claim it as their own idea.

A line from a show that takes place in LA says something like “hipster stuff is just latino stuff from five years ago”

Big RadOnc/Astro’s ideas are just SDN’s ideas from 5 years ago…

 

[radoncopotamus]

Most rad oncs would have no interest in having an inpatient service which is what this pathway would require. You can't expect to admit to med onc service if you've cut them out of the picture.