Radiation Oncologist

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					 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.
 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

				
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