How to Become a Radiation Oncologist and What It’s Like

Session 164

Dr. Malika Siker joins her to discuss her career as a radiation oncologist. they discuss her typical day, what residency is like, how competitive it is, and more!

For more podcast resources to help you along your journey to medical school and beyond, check out Meded Media.

Find out more about this specialty and check out the American Society for Radiation Oncology (ASTRO)

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[00:58] Interest in Radiation Oncology

Marika became interested in oncology in general, during her second year of medical school when her dad was diagnosed with blood cancer. Marika didn’t understand the big picture. Her dad had a number of incredible oncologists that were part of his clinical care. And that’s what inspired her to go into oncology.

And then through third year, Marika knew that she wanted to be an oncologist. Although she didn’t know what type of oncologist and so it was a fun way to go through third year focusing on oncology.

“Oncology touches every single specialty.”Click To Tweet

Marika was able to focus on the oncologic angle of every single specialty in medicine. And she found she liked a little bit of everything. But it was a peer mentor who put her in the direction of radiation oncology. Had it not been for her peer mentor. Marika doesn’t think she would have even known radiation oncology even existed.

Initially, Marika had safety concerns, whether it was going to be safe for her to be around radiation for cancer patients. And so learning about that it was just as safe as any other field and that we’re not directly exposed to ionizing radiation. This was something that reassured her. That being said, Marika just felt it seemed like the perfect fit. To her, it seemed like the perfect combination of all the other fields.

She also liked the creative aspect to it as well. It was like where the art of medicine meets the science of medicine.

Radiation is right in the middle of it being diagnostic and surgical. As a radiation oncologist, they use radiation therapy to cure cancer. What’s more glorious than that is being able to cure somebody’s cancer. Although oftentimes, they end up diagnosing things on their treatment planning scans, or during their workups. So they wear a lot of different hats.

[04:26] The Biggest Myths or Misconceptions Around Radiation Oncology

One of the misconceptions around radiation oncologists is that they’re just physicists and you have to be good at math. Most of the people that got into medical school had a basic knowledge of physics, math, and science as a prerequisite. And that’s more than enough to get you through your boards and everything.

Another misnomer is the safety concerns people have. And that their field doesn’t attract a lot of individuals who are women, or who are underrepresented in medicine and science.

“People don't realize that this is a fantastic field that's very welcoming, where anybody can belong and thrive.” Click To Tweet

[05:58] Personal Traits or Qualities That Lead to Being a Good Radiation Oncologist

The number one quality would be to have a firm commitment to caring for cancer patients in a holistic way. So practicing empathy, taking care of the patient is a very important part. Oncology is a different field than orthopedic surgery.

You’re dealing with patients who sometimes have life-threatening, or potentially life-ending diagnoses. And so one has to be completely committed to being there for the patient. physically and emotionally.

[07:12] Types of Cancer Patients

Radiation oncologists see any and all types of cancers, whether it’s curative or palliative. They see almost every single type of cancer. Sometimes they are able to cure cancers on their own with radiation therapy alone. But oftentimes, it’s in combination with surgery, or with chemotherapy or systemic agents. They work in a very dynamic, highly collaborative, multidisciplinary team to provide patient centered, compassionate care

[07:51] Typical Day

Malika’s typical day usually starts around 7-730. Many days will be a tumor board. Tumor boards are where multidisciplinary groups of physicians get together to talk about cancer patients.

So there might be a breast tumor board where there’s a breast surgeon, a radiation oncologist, a medical oncologist, radiologists, and pathologists. And we’ll go through and talk about any newer, challenging patients.

In the outpatient clinic, they see three different types of patients. First are the new patients who are being considered for radiation therapy. The second type are the follow-up patients. They are patients who are treated with radiation therapy and they’re looking at potentially long term side effects or complications or whether or not the cancer is returned. And the third type of patients they see are patients that are currently under treatment.

[09:02] Taking Calls

They take one week at home pager calls. And so when she’s on call, she’s holding the pager for about a week at a time. And together with the resident, she answers any types of patient phone calls that come up.

It’s pretty rare that they have to go in to treat a patient. Sometimes, they will have to go in to talk to a patient after hours, or over the weekend. But it’s pretty rare that they get called in and actually have to start a treatment on the fly at night or on the weekend without their support team around.

Radiation emergencies would typically be spinal cord compression in a patient who’s lost the ability to walk or feel their legs. Sometimes, they deal with difficulties in breathing, coughing up blood, brain metastases or a brain tumor. So they evaluate each patient on call to see if there’s a reason for emergency treatment. But that’s pretty rare. She only gets in maybe once or twice every couple of years.

[10:18] Choosing an Academic Setting

For radiation oncology, it’s pretty 50-50 private practice and academic centers. Half of the residents at her program go into private practice, the other half go into academics. There are certain institutions where they might have more private practice or more acquisitions. But at her center, it was pretty 50-50.

For her, the decision to go into academics was her interest in health disparity research and teaching. So academic seemed to her like a natural place.

But Marika did look at some private practice institutions. And she also knows of some private practices that are just as academic as any academic medical center, and vice versa. So you don’t have to get so hung up on some of these old school definitions. There are ways to be academic if you’re in private practice, and vice versa.

“Some academic medical centers are pretty much run like a private practice.”Click To Tweet

[11:28] Life Outside of the Hospital

Malika recently took on a new administrative role as the Associate Dean for Student Inclusion and Diversity and so her admin work now takes up 50% of her time, and her clinical work is the other 50%. She’s certainly working from home 50% of the time because of COVID-19. So it can get kind of complicated in terms of when does the workday start and stop. So one has to set pretty clear boundaries about when to make that transition.

[12:08] The Training Path

The training path to become a radiation oncologist is one plus four. So you do an intern year. The majority of individuals do internal medicine or transitional year. A few people will do a prelim surgery year, and then it’s four years of radiation oncology.

What appealed to her about the training path was that it was the straightest shot right into oncology, after graduating from medical school. Whereas if you want to be a surgical oncologist or a medical oncologist, typically you would complete a general internal medicine residency first or a general surgery residency first.

Radiation oncology used to be extremely competitive, in fact, as competitive as plastic surgery and neurosurgery. But the tide has changed in the past couple of years. And over the past few years, they’ve had approximately 30 unmatched slots in the residency match cycle.

Additionally, there were concerns in last year’s match in that the number of US seniors in medical schools in the US were actually less than the number of positions available.

[13:44] Message to Osteopathic Students

There are a lot of prominent osteopathic radiation oncologists in the field. Marika stresses that they’re a small field where relationships matter. So, Marika would recommend that you do away rotations so you can cultivate relationships with radiation oncologists that can vouch for you.

[14:51] The Need for Radiation Oncology in the Future

As systemic therapies become better, local control becomes more important. And so one would argue that there could potentially be an even more expanded role if the systemic agents are successful as they hope.

“One of the main reasons that individuals aren't as attracted to radiation oncology is that the field is very small.”Click To Tweet

Radiation oncology is a small field. Another good trend is the hypofractionation, meaning a prostate cancer treatment that used to take nine weeks now takes seven weeks. So their treatments are becoming shorter. That being said, their workforce might need to become smaller. Plus, they have a new payment model, the Radiation Oncology Alternative Payment Model coming down from Medicare. All those are part of the reasons why students are not as interested in radiation oncology.

Marika thinks it’s really important for them in the field to have honest discussions about what that looks like for students who may be interested in the field.

In radiation oncology, their representation for women and underrepresented individuals in medicine is lacking compared to other fields. So mentorship is key. Marika encourages those from schools that don’t have radiation oncology departments to figure out ways to get exposure, get a mentor, and to learn more about it.

[17:33] Message to the Future Primary Care Physician

Radiation oncologists work very closely with primary care doctors at all ends of the spectrum from diagnosis to care during treatment to care after treatment. From a screening or diagnosis point of view, they work closely with primary care doctors to ensure that patients are getting adequate treatment. They make sure they’re being referred adequately once they’re diagnosed.

During treatment, sometimes they have patients that develop complications. Or sometimes there are things that pop up that people think are a “radiation side effect” that isn’t a radiation side effect.

“If somebody is getting radiation to their prostate and then develops a rash on their face, it's not from radiation therapies.” Click To Tweet

So they work closely with primary care doctors to elucidate what’s the true radiation side effect and what’s not and how to best care for patients. It’s important to work with primary care providers to determine what truly is a radiation oncology-related long-term toxicity, versus something that just happens unrelated to radiation therapy. So they keep in touch with the primary care providers very frequently,

[19:09] Other Specialists They Work the Closest With

Their closest collaborators are surgeons and medical oncologists, but also radiologists and pathologists. In addition, they work with a huge multidisciplinary team including nurses, radiation therapists, physicists, and dosimetrists.

For someone who wants to work with their hands and they love that aspect of doing procedures, that depends on what your specialty is. There’s a specialty within radiation therapy called brachytherapy. And that’s where they place radioactive sources directly in a patient’s body.

There are opportunities for brachytherapy in prostate cancer as well as in gynecologic cancers. Brachytherapy also plays an extremely critical component of curative care for cervical cervical cancer.

“If somebody is interested in working with their hands, there's definitely an opportunity with brachytherapy.”Click To Tweet

[20:23] The Most and Least Liked Things

Marika emphasizes that she takes time in knowing all of her patients. She finds out what’s important to them, what scares them, and what brings meaning to their life. That’s what patients want most of all is the connection, knowing they’re doing everything they can to provide them with the best care.

Malika likes everything about being a radiation oncologist. She loves blending the art and the science and having the opportunity to be creative and being able to teach a little bit on the side.

“Curing somebody’s cancer is a pretty awesome way to make a difference in somebody's life.”Click To Tweet

And even just being able to make somebody’s life more comfortable, in their final days, weeks, months or years, is something that’s extremely important.

Marika says that the best part of her job is bringing value to our patients’ lives, whether that’s in the form of a cure, or even just quality of life.

On the flip side, what she likes the least is the administrative and bureaucratic tasks they’re asked to do, regardless of any specialty.

[23:27] Major Changes Coming to the Field

Hypofractionation is here to stay. And that’s a good thing if they can cure patients in a shorter amount of time, without any detriment or perhaps even better, and improvement of quality of life.

“There may be a day that we'll be able to cure some of these cancers that took nine weeks before to a week or less.”Click To Tweet

As these systemic therapies become more and more successful, local control becomes more and more important. So there might be a way for them to have more of a role in metastatic disease. “Metastatic” being cancers that have spread to other places.

Other new and upcoming technologies include the proton therapy image-guided or MRI-guided radiation therapy. This uses different types of radiation or combining radiation with different imaging modalities, so they could become more precise and conformal on their treatments. So it’s exciting that the technology is going to continue to improve and they’ll have more ways to cure patients or treat patients with fewer side effects.

[25:05] Final Words of Wisdom

If she had to do it all over again, Marika would still have chosen the same specialty. She loves being a radiation oncologist although Marika wears a lot of hats. Marika is very proud to be a cancer doctor.

Finally, Marika wishes to tell students that being a very small field, they’re also a very passionate and friendly field. And if this is something you’re interested in, reach out to anybody that’s a radiation oncologist. They love having students come and shadow so they can share their hidden gem of a field.