RADIATION ONCOLOGIST

January 2004

TABLE OF CONTENTS

• Basic information• History of oncology• Expectations of oncologists• Training outside of medical school• Personal qualities• Skill level• Code of Ethics• Earnings/benefits• Future outlook for prospecting oncologists• Other information about oncology/oncologists

BASIC INFORMATION• Oncology – the study of the causes,

properties, disease progressions and treatments of tumors & cancer

• Oncologist – physician who specializes in treating cancer

• Radiation oncologist – oncologist who specializes in using radiation to treat cancer

• Radiotherapy – use of high energy x-rays, external beams, or radioactive materials placed directly on the tumor

HISTORY OF ONCOLOGY• Surgery – oldest known way

to cure cancer (Egyptians of Middle Kingdom)

• Dr. Ephraim MacDowell, Dr. William Halstead, & Dr. Ernst Wertheim – 1st successful surgical removals of cancer on different body parts

• Myth – story of Inanna – her death & resurrection by Enki – used radiation to bring her back to life

• Röntgen – discovered x-rays in 1895

• 1st x-rays used in 1896

HISTORY CONT.• Marie & Pierre Curie, Antoine-Henri Beckquerel

– discovered natural forms of radioactivity– 1896 – uranium– 1898 – radium, polonium

• Within 10 years of discovery of radioactivity, it was tested against many diseases – some worked but had complications later on

• 30 years later – much information acquired & some superficial cancers were curable by x-ray & some accessible cancers were curable by radium therapy

• Modern physics, radiobiology, dosimetry – have made modern radiation therapy an effective method to cure cancer

HISTORY CONT.• New advances in radiation oncology –

fractionation (how dose is given in time) & high dose rate brachytherapy treatment

• Also, enhancement of effect by addition of chemotherapy

• Chemotherapy – newest way to cure cancer• Biological manipulations – future of oncology –

take killer T-cells from the tumor of a patient – clone many of the cells – enhance the cells with substances that will make them more able to kill cancer cells

EXPECTED DUTIES / PHYSICAL DEMANDS

• Confirm diagnosis suggested by other medical professionals

• Study x-rays or other images & reports• Discuss with patient & family what is going to

be done• Decide amount of radiation should be used• Treat cancer patients by treating affected body

part(s)• Monitor & care for patients after treatment• No physical abilities needed to be an oncologist

EXPECTED DUTIES CONT.

• Accurate assessment of your problem

• Realistic listing of benefits from radiation (cure, control of tumor, relief of symptoms)

• Knowledge of different treatment options available

EXPECTED DUTIES CONT.• Usually work long hours (10-12), may be on

call• Appropriate skills to explain your condition

& treatment options to you & your family• Knowledge & skills to be able to deal with

any of your symptoms• Typical day:

– 1st – see patients in the hospital– 2nd – see patients in clinic (appointments)– 3rd – lots of paperwork– 4th – visit really sick people in the hospital

TRAINING/EDUCATION• 3-4 years

undergraduate school

• 3-4 years medical school

• 5 years of training with minimum of 4 years in Radiation Oncology (residency)

TRAINING/EDUCATION CONT.

• The 4 years of Radiation Oncology training must include 36 months of clinical Radiation Oncology with Pathology & Medical Oncology

• High school classes – English, foreign languages (Latin is best), humanities, social studies, math, biology, chemistry, physics

• You use many science & math skills in oncology. You need to know English well so that you can easily communicate with your patients.

PERSONAL QUALITIES

• Excellent communication skills

• Committed to being an oncologist, doing hard work

• Tact & diplomacy

PERSONAL QUALITIES CONT.

• Self-motivated & self-disciplined• Accurate & able to work well under pressure• Excellent medical skills, technical skills,

analyzing/interpreting skills• Able to deal with many different kinds of

people• Sensitive, understanding, trustworthy• Ability to make good clinical judgments

under difficult & emotional pressure• Concerned for others

SKILL LEVEL• Licensing that is particular to the state practicing in• Certification – from American Board of Radiology• American Board of Radiology in Radiation

Oncology requirements:*must be a specialist in Radiation Oncology*recognized by peers to have high moral & ethical standards*general professional education*special training (residency)

SKILL LEVEL CONT.• The 5th year must be before the 4 years of RO

training – accredited training in Internal Medicine, Pediatrics, Surgery, Obstetrics & Gynecology, Family Practice, Transitional or Categorical Radiation Oncology, or combination of the above

• Written examination after residency is complete• Oral examination after written exam is complete• Practice examination after oral exam is complete

SKILL LEVEL CONT.• Contents of examinations:

– Oral – 8 anatomical categories – anatomy, epidemiology, pathology, clinical evaluation, selection of treatment form, radiation therapy planning & technique, results of treatment, complications of treatment

– Written – physics of radiation therapy, cancer & radiation biology, clinical oncology

CODE OF ETHICS• Intended to aid

radiation oncologists in maintaining a high level of ethical conduct

CODE OF ETHICS CONT.• Section 1 – Principles of Ethics:

1. The main objective of oncologists is the give service with full respect for human dignity & in the best interest of the patient.

2. Always strive to improve their medical knowledge & skill and make the improvements available to their patients.

3. At all times be aware of their limitations & be willing to seek help if needed.

4. Oncologists should follow all laws, keep the dignity & honor in the profession.

CODE OF ETHICS CONT.5. Responsibilities of oncologists extend to society

also (not just the patient). These responsibilities include the participation in activities which improve the health & well-being of the individual & the community.

6. Oncologists may not reveal things told to them during a meeting with the patient, unless they are required to by law to protect the welfare of the patient or the community.

7. The decision to get service from an oncologist is decided by the patient & their physician in the best interest of the patient.

8. The bond between oncologists & their patients should not be used for personal advantage.

CODE OF ETHICS CONT.

• Section 2 – Rules of Ethics:1. Oncologists should provide x-rays and other

images to the patient.2. Oncologists should provide a consultative opinion

in the management of cancer & other disorders treated with radiation.

3. Before practicing in a hospital or other facility, the oncologist should apply & be accepted as a member of that facility’s health care staff, and follow that facility’s staff bylaws in the same way as the other physicians.

CODE OF ETHICS CONT.

4. Oncologists should make sure that the patient is not referred to a health care facility that has a financial interest that is not in the best interest of the patient.

5. Oncologists should relate to other members of the health care team with mutual respect, and they should stay away from harassment or unfair discriminatory behavior.

6. Oncologists should have the right to enter into whatever contract arrangements with health care systems they want to.

7. Oncologists should not enter into an agreement that prohibits the supplying of necessary care or that gives care below acceptable standards.

CODE OF ETHICS CONT.

8. Oncologists should clearly respond to questions from patients regarding costs. An oncologist should not participate in a billing arrangement which misleads the patient.

9. Oncologists should use extreme caution to make sure that a testimony (if needed) provided is correct and accurate.

10. Radiologic research must be performed with integrity and be honestly reported

11. Oncologists should not claim written/oral (plagiarism) material that is not theirs.

CODE OF ETHICS CONT.

12. Oncologists should not publicize themselves through any form of public communication in an untruthful, misleading, or deceptive manner.

• Section 3 – Disciplinary Procedures for Violation of Rules of Ethics:

– States the punishments for violating the rules of ethics.

EARNINGS/BENEFITS• Salary varies• Starting salary

about $100,000/year

• Starting private practice – $140,000-$160,000/year

• Cons about oncology – give bad news to people

EARNINGS/BENEFITS CONT.

• Experienced oncologists – $200,000-$300,000/year

• Experienced private practice – $350,000-$375,000/year

• Average net income for 1998 - $230,000• Benefits:

– Satisfaction – cure people, patients have good deaths

– Feel respected

EARNINGS CONT.Average Net Income of M.D.s

$0$50,000

$100,000$150,000$200,000$250,000$300,000

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FUTURE OUTLOOK• Faster than average outlook through 2008• Number of oncologists expected to increase

moderately over next 4-5 years• Number of patients treated every year is going

up, leading to higher demand for oncologists• Growth of oncologists due to expansion of

health care industry• Continuing Medical Education requirements:

– Minimum of 40 credits every 2 years (North Dakota)

FUTURE OUTLOOK CONT.

• Options for specializing in oncology – gynecological, neurological, radiation, medical, surgical, pediatric, chemotherapy

OTHER INFORMATION• Usually work in hospitals, clinics, private

practices• Equipment used:

*medical equipment/instruments*computer*complicated electronic equipment*radioactive materials

• Dosimetry – science of measuring, computing, calculating, & optimizing the dose of radiation

OTHER INFO CONT.• About 0.5% (3,500)

of all physicians in the US in 1999 were radiation oncologists

• No specific dress code – dress nicely

• No potential hazards, but a lot of mental burn out