RADIATION ONCOLOGIST

1. RADIATION ONCOLOGIST January 2004

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

11. 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.

12. PERSONAL QUALITIES • Excellent communication skills • Committed to being an oncologist, doing hard work • Tact & diplomacy

13. 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

14. SKILL LEVEL • Licensing that is particular to the statepracticing 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)

15. 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

16. 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

17. CODE OF ETHICS • Intended to aid radiation oncologists in maintaining a high level of ethical conduct

18. CODE OF ETHICS CONT. • Section 1 – Principles of Ethics: • The main objective of oncologists is the give service with full respect for human dignity & in the best interest of the patient. • Always strive to improve their medical knowledge & skill and make the improvements available to their patients. • At all times be aware of their limitations & be willing to seek help if needed. • Oncologists should follow all laws, keep the dignity & honor in the profession.

19. CODE OF ETHICS CONT. • 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. • 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. • The decision to get service from an oncologist is decided by the patient & their physician in the best interest of the patient. • The bond between oncologists & their patients should not be used for personal advantage.

20. 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.

21. CODE OF ETHICS CONT. • 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. • 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. • Oncologists should have the right to enter into whatever contract arrangements with health care systems they want to. • Oncologists should not enter into an agreement that prohibits the supplying of necessary care or that gives care below acceptable standards.

22. CODE OF ETHICS CONT. • Oncologists should clearly respond to questions from patients regarding costs. An oncologist should not participate in a billing arrangement which misleads the patient. • Oncologists should use extreme caution to make sure that a testimony (if needed) provided is correct and accurate. • Radiologic research must be performed with integrity and be honestly reported • Oncologists should not claim written/oral (plagiarism) material that is not theirs.

23. CODE OF ETHICS CONT. • 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.

24. 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

25. 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

26. EARNINGS CONT.

27. FUTUREOUTLOOK • 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)

28. FUTURE OUTLOOK CONT. • Options for specializing in oncology – gynecological, neurological, radiation, medical, surgical, pediatric, chemotherapy

29. 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

30. 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