By Rehema Thomas, MD candidate, Class of 2022
Going into medical school, I knew that treating cancer was what I was called to do. With my eyes set on oncology, I was aware that there were still options when it came to choosing a specialty. There was surgical oncology, medical oncology and radiation oncology. What road would I choose in the end? As my first year of medical school went along, our preclinical curriculum covered aspects of medical oncology, chemotherapies and surgical techniques. However, I realized I was not getting much exposure to radiation oncology, and I wanted to know more. With that and a growing love for imaging, I knew I wanted more experience in “rad onc” and decided to find out how I could secure it. With a simple internet search for summer research opportunities in radiation oncology, the ASTRO Minority Summer Fellowship (MSF) was the first result I saw. It was perfect! I reached out to my mentor, Curtiland Deville, MD, via email, scheduled a meeting with him, completed the application and ― the rest is history.
Being a recipient of the ASTRO MSF Award provided me with one of the most rewarding experiences in my medical training that I have had to date. My summer experience truly cemented my choice to pursue radiation oncology as a specialty. Throughout my summer working at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center with Dr. Deville, I was exposed to many different facets of radiation oncology. I was able to witness firsthand what goes into a complete course of treatment ― from the consultation to treatment planning, to treatment delivery. I had the opportunity to spend time with nurses, dosimetrists, physicists, therapists and physicians and see just how much each member of the team contributes to patient care. I sat in on several consultations with Dr. Deville for his prostate and sarcoma patients. I really appreciated how much patient education goes into consultations and how there is a visible alleviation in the uncertainty patients feel after having a conversation with the physician and getting a better understanding of their options.
Not only did I get to observe prostate and sarcoma consultations, but I was able to sit in on breast, lung and gynecologic consultations with other radiation oncologists in clinic. In my observation of on-treatment visits, I was able to gain more insight into the radiation-associated side effects that patients experience throughout treatment and how they are managed. Patient simulations, treatment set-up and treatment delivery were also exciting elements of my clinical exposure. Although the majority of my experience was in Washington, D.C., I did get the chance to travel to Baltimore and participate in Johns Hopkins’ Prostate Cancer Multidisciplinary Clinic. I thoroughly enjoyed that experience, as I value the shift medicine is taking toward multidisciplinary individualized care. Outside of the clinical visits and research, I had the opportunity to contour volumes for patient organs at risk and through that, gain familiarity with treatment planning systems used by the team.
Most importantly, I was able to foster a meaningful mentorship and complete significant research throughout the eight weeks of the fellowship. Dr. Deville was and continues to be an excellent mentor. I am very proud of how much I was able to learn and what we produced in the eight weeks. My poster, “Comparative in Silico Analysis of Pre-operative Scanning Beam Proton Therapy, Intensity-Modulated Photon Radiation Therapy, and 3-D Conformal Photon Radiation Therapy in Adult Soft Tissue Sarcoma,” was presented at the 2020 ASTRO Annual Meeting.
I enjoyed all aspects of the fellowship, and it confirmed my choice to pursue radiation oncology as a specialty. I extend my sincerest thanks to the ASTRO Committee on Health Equity, Diversity and Inclusion for the invaluable opportunity.
Share this opportunity with medical students and colleagues. See the eligibility requirements and access the application for the ASTRO 2021 Minority Summer Fellowship.
Rehema Thomas is an MD candidate in the Class of 2022 at the George Washington University School of Medicine and Health Sciences. She is a METEOR Research Fellow and president of the GW SMHS Women in Radiology.
By Thomas Eichler, MD, FASTRO, ASTRO Chair
After more than a decade of enjoying the prestige of being one of the most highly sought-after specialties in the medical student match process, there have been troubling signs in the past few years that something was amiss. In 2019, the number of medical students who initially matched into radiation oncology declined with multiple slots unfilled. At the time, there was speculation about whether this was an anomaly or the beginning of a trend that had been forecast years before. In 2020, the field saw a larger decline in the number of medical students who matched, coupled with an increase in the number of people who then entered the field through the Supplemental Offer and Acceptance Program (SOAP) process. In fact, radiation oncology had the highest percentage of spots filled through the SOAP of any medical specialty.
From a treatment perspective, many factors, including the decreased use of radiation for some disease sites and an increased use of hypofractionation, bring into question the long-term viability of our specialty. Despite the many positive aspects of radiation oncology, there are growing concerns about the future of the workforce. There has been an increase in the number of available trainee positions despite the apparent decline in medical student interest and concern regarding patient volume projections. These issues contribute to forecasts of declining income streams and anxieties about the future given the recently proposed ― and now delayed ― radiation oncology alternative payment model. The worrisome trend in the SOAP percentages for radiation oncology underscores some of these negative perceptions about the field among students and residency applicants, which are in turn amplified on social media platforms. Not surprisingly, many students are confused about what career path to choose and may be discouraged to pursue radiation oncology before they even truly explore it.
ASTRO leaders have sought to be forthright with our members about challenges in the field (see previous blog posts below) and ASTRO’s role in addressing them. While there are strict anti-trust principles ASTRO must abide by, the Board of Directors felt compelled to issue a definitive statement so that there is no ambiguity about our position.
ASTRO Position Statement on the U.S. Radiation Oncology Workforce
- Radiation oncology has long been a critical component of multidisciplinary cancer management, driven by clinical and scientific innovation. Recent advances in technology and our understanding of cancer biology have allowed radiation oncologists to offer more accurate and effective therapies, often in fewer total treatments than before, resulting in improved patient care. ASTRO has observed growth in residency training positions over the past two decades. With more efficient treatment delivery, fewer radiation oncologists may be needed in the coming years. Residency training positions should be reserved for those who are enthusiastic about the field and should reflect the anticipated societal need for radiation therapy services. As we prepare the next generation of radiation oncologists for independent practice, we encourage stakeholders to carefully consider these aspects affecting our specialty as they review the size and scope of their training programs.
Additionally, ASTRO acknowledges the continued need to grow and nurture diversity within the next generation of our workforce. We serve diverse peoples, and our trainees and faculty should reflect that diversity. We are committed to addressing all aspects of bias as we seek to ensure equity and inclusion within our specialty and to improve health outcomes for all our patients.
While we acknowledge that this statement will not magically solve the issues impacting the field, we do want to be clear with our current and future members about ASTRO’s stance on this critical issue. We also strive to keep the lines of communication open with all members, including our residents. We listen to and appreciate the insights and perspectives from Association of Residents in Radiation Oncology (ARRO) to better understand their perceptions and experiences. Results from a survey of the class of 2020 found that residents had an average of five job interviews, received at least two job offers and, perhaps most significantly, 89% of residents were satisfied with the offers they received. While there are some vocal naysayers on social media, the direct response from residents gives us confidence and hope about the current realities in the field.
Radiation oncology has always sought the best and the brightest minds for our field because we know it is a truly rewarding area of cancer treatment. That will not change. We have deeply meaningful interactions with our patients, curing many of their cancers, alleviating suffering and extending life. Technology continues to play a large role in the field with novel and groundbreaking synergies between radiation and systemic agents, including immunotherapeutics, and many contemporary research questions are emerging, ripe for exploration and clinical trials. The field is also expanding due to innovations in radiopharmaceuticals and theranostics, offering radiation oncologists exciting new ways in which to help patients. While the future is unpredictable, we unequivocally believe in the continued impact and relevance of our specialty going forward, and perhaps more importantly, have unshakeable faith in the dedicated professionals who have made radiation oncology fundamental in the fight against cancer.
Read previous posts:
A Commitment to the Field - Dr. Theodore DeWeese, March 10, 2020
The Residency Training Landscape, Continued - Dr. Paul Harari, May 28, 2019
The Residency Training Landscape - Dr. Paul Harari, March 20, 2019
By Colin Whitney, ASTRO Government Relations Specialist
2020 has been a year of unavoidable changes and challenges. ASTRO’s annual Advocacy Day was no exception, as the original April event dates were canceled in early March. But with the release of the RO Model, steep cuts in the 2021 Medicare Physician Fee Schedule (MPFS) and increased prior authorization delays, ASTRO’s Advocacy team knew that the event was now more critical than ever.
Following ASTRO’s successful virtual Annual Meeting, the team decided to move forward with a new, virtual Advocacy Day experience on November 19-20. Virtual Advocacy Day 2020 ultimately consisted of more than 50 ASTRO members and 14 ASTRO staff meeting with 94 congressional offices. In the meetings, ASTRO members were able to share the key issues facing the radiation oncology community going into 2021 and inform Congress on action they can take to protect patients and providers. To gauge the success of this new look for Advocacy Day, we posed some questions to our participants:
Q: What were your key takeaways from this year’s Advocacy Day?
Casey Chollet, MD, chair of ASTRO’s Government Relations Committee, Tennessee Oncology, PLLC, Nashville: I have been attending ASTRO Advocacy Day since 2009 and really appreciate the extraordinary effort ASTRO staff put into making our first virtual Advocacy event a success. One of my big takeaways was that the virtual format allowed for more dedicated discussion time with the congressional staff members. It was a pleasant surprise to have a full 30 minutes to really go into the details of the critical issues facing our specialty and the accompanying congressional asks; plus, there were none of the usual interruptions that come with being in D.C. Given the unique circumstances created by the COVID-19 public health emergency, this was a welcome change from the sometimes rushed in-person meetings.
Krisha Howell, MD, Fox Chase Cancer Center, Philadelphia: My key takeaways were that ASTRO continues to work with our government officials of both parties to further the issues important to our field. It is evident from this event that the ASTRO staff has made alliances and is working hard throughout the calendar year on these concerns.
Q: Why is it important to advocate for the profession?
Anish Butala, MD, resident, University of Pennsylvania, Philadelphia: As physicians, we are not only leaders of our health care teams but are also responsible for promoting the interests of our patients and society. We are privileged to care for cancer patients, which arms us with unique insights surrounding the impact of broad legislative measures on health care policy and daily clinical practice. As such, when negatively impactful legislation is identified, it is our duty to reach out to our congressional leaders to inform them of the issues at hand and advocate for meaningful change. Doing so may not only improve the administrative and financial burdens facing our field but ultimately influence the care received by each of our patients.
Q: What advice would you give to someone who wants to get engaged in advocacy?
Dr. Butala: It can be challenging to know where to begin within this complex landscape. With this in mind, initial steps might include reaching out to a peer or colleague who has engaged in prior advocacy work to obtain their guidance. Participating in the annual Advocacy Day is an additional avenue to broaden your exposure to public policy and expand your professional network. Finally, becoming involved with ASTRO Subcommittees is another important way to gain valuable experience and advocate on our profession’s behalf.
Thomas Eichler, MD, FASTRO, chair of ASTRO, VCU Health Massey Cancer Center, Richmond, Virginia: Advocacy for our patients and our specialty can take many forms, ranging from the face-to-face interactions that occur during Advocacy Day, to sending letters and contacting your state congressional delegation via ASTRO’s Advocacy Action Center. Writing to your senators and representative is a critical and meaningful way to make your voice heard in Washington. The ASTRO Advocacy team is continually updating the center to include new campaigns focused on actions that Congress can take to address the issues of greatest urgency for our community. Participating in these advocacy campaigns takes less than a minute and lets Congress know exactly how they can help to solve the pressing challenges we face.
Social media provides another easy route to jumpstart or amplify your advocacy efforts. Retweeting #ASTROAdvocacy posts and posting directly to your representative and senators is not only easy but is an effective means of keeping our issues on their radar screen.
Thank you to all our members who participated in Advocacy Day! Learn more about the key issues addressed during the congressional visits at www.astro.org/advocacy.