So you want to be an oncologist. You want to be the physician who finally cures cancer once and for all. Let’s debunk the public perception myths and give it to you straight. This is the reality of oncology.
Welcome to our next installment in So You Want to Be. In this series, we highlight various medical specialties to help you choose the best fit for you. You can find the other So You Want to Be guides here on the Med School Insiders website as well as our YouTube playlist.
This is the specialty so many of you have been waiting for. In the past year alone, we’ve had more than 250 requests for So You Want to Be an Oncologist. We hope it was worth the wait.
What Is Oncology?
Medical oncology is the classification, treatment, and research of cancer in all its many forms.
Of all the medical specialties, oncology has a deep research component guiding much of the new treatments. Medical oncologists work closely with surgical and radiation oncologists to care for patients with all different types of cancer.
In addition, many work closely with researchers and perform basic science and benchtop research to better understand the disease and come up with new, targeted therapies.
At its core, oncologists help people in all aspects of their healthcare following the diagnosis of cancer.
Oncology vs. Hematology
First, what’s the difference between oncology and hematology?
Medical oncology training, which follows an internal medicine residency, includes both hematology and oncology. Oncology is the treatment of solid tumors and tumors of the blood and lymphatic system, whereas hematology is the treatment of benign hematologic processes.
Oncologists then have the opportunity to focus on solid organ malignancies or liquid tumors, which have different treatment options and treatment modalities.
Solid tumors can occur in any organ system. At larger practices, physicians usually focus on one organ system or one group of organs, like GI, breast, lung, and genitourinary. Others can focus on a rare specific type of tumor that occurs in various locations throughout the body, such as sarcomas.
Physicians who focus more on blood cancer, such as lymphoma or leukemia, also tend to do more benign hematology. Benign hematology primarily focuses on the diagnosis and treatment of non-cancerous blood disorders, such as anemia, bleeding and clotting disorders, and blood cell abnormalities.
Medical oncology, on the other hand, deals with the diagnosis and treatment of various types of cancer. While both fields involve the study of blood and blood-related disorders, they differ in their primary focus and approach to treatment. Benign hematology often involves managing chronic conditions that may not be immediately life-threatening, whereas medical oncology typically involves more aggressive treatments aimed at eradicating cancer cells.
Practice Setting
Oncologists have the opportunity to work in the hospital or the clinic depending on treatment types. For example, performing a bone marrow transplant versus clinical work.
The majority of oncologic practice is performed in the clinic setting. A typical day involves seeing new and returning patients in whichever specialty they follow. If oncologists are at a larger hospital or academic institution, they may do some inpatient oncology as well, which can be giving inpatient chemotherapy to patients, checking in, and following up with them once they leave the hospital.
Note that outpatient oncologists usually do long-term follow-up, but at large academic institutions, inpatient oncologists can as well.
Oncologists also see patients who have completed treatment at least every year for about 5 years—or longer, depending on the tumor type—following the completion of treatment. If the patient is on active therapy, they are seen more frequently. Oncologists check in with patients about the side effects of their treatments and see if there are any new or ongoing symptoms. They also review imaging findings and other laboratory work with patients.
Another aspect of hospital oncology is bone marrow transplants. A bone marrow transplant, or BMT, typically takes three to 18 months to complete and involves three steps: preparative regimen, transplant, and recovery.
The hospital stay for the entire BMT is typically four to six weeks, and oncologists take care of the patient throughout the whole process.
Oncologists can choose to focus on more experimental therapies and research in an academic institution, or they can focus on clinical practice, where they perform more of the treatments and follow up with patients.
Large academic institutions will have more access to clinical trials, which is where new drugs are developed and tested before they are approved. These drugs tend to be for patients who have failed first-line therapy and are looking for additional treatment options.
Oncologists working in a private practice setting tend to follow the current standards of care and perform first-line therapy for newly diagnosed cancers. That said, some private practice clinics are involved in clinical trials. Oncologists can also recruit patients for clinical trials at any point during the cancer treatment. Both academic and private practice oncologists utilize genomic testing, and more and more treatments are being guided by specific mutations within the tumor.
Misconceptions About Oncology
One common misconception about oncology is that there is little to no hope for patients with advanced cancer. However, with the advent of new therapies, as well as continued research and funding going into generating new therapies, oncology is an exciting and constantly evolving field. Patients are living longer, and there are dozens of new therapies coming out every single year that provide more options to cancer patients.
How to Become an Oncologist
For the most part, there is one specific way to get into medical oncology; however, there are multiple different ways oncologists can treat cancer patients.
Medical oncology focuses on chemotherapy, research, and coordinating between surgical and radiation oncology. Medical oncologists also tend to see their patients more frequently and have the longest follow-up period.
To get into medical oncology, you first need to complete an internal medicine residency, which is 3 years followed by a 3-year hematology/oncology fellowship. While there are some 2-year oncology-only programs, these are uncommon. If you are particularly research-focused, you can also participate in a combined internal medicine oncology program, which provides additional research time, but there are only a handful of these throughout the country.
There is also pediatric oncology, which requires a 3-year pediatric residency followed by a 3-year pediatric oncology fellowship. Neuro-oncology is another option, and it requires a 4-year neurology residency and a 2-year neuro-oncology fellowship. Radiation oncology is a 5-year program.
Surgical oncology first requires a general surgery residency, which is 5 years, followed by a surgical oncology fellowship, which is 2 years. Alternatively, after general surgery residency you could complete a breast or colorectal fellowship, which last 1 to 2 years, and largely focus on oncology within their organ system.
Following an oncology fellowship, physicians typically begin practicing. During internal medicine residency or within fellowship training, many oncologists will start to develop a particular field of interest. They do not typically complete additional training outside of the fellowship.
Medical oncologists tend to be caring, compassionate physicians who enjoy this complicated disease process. They tend to have more of a research focus than other medical specialties due to the extremely complex genetic and molecular biology components associated with the disease itself. They are typically resilient, as patients are often quite ill and require a great deal of attention, and despite advances, metastatic disease still has a high mortality rate.
The Fellowship Competitiveness Index ranks hematology/oncology second among internal medicine subspecialties, with cardiology at number one and gastroenterology at number three. While the average match rate for oncology is on the rise, going from 57.5% in 2008 to 73.5% in 2022, hematology/oncology is still highly competitive.
What You’ll Love About Oncology
There’s a lot to love about oncology.
Oncologists are able to take care of an incredibly diverse and thankful patient population and build long-term, collaborative relationships, as well as participate and learn in a rapidly evolving and expanding field that sees new treatment and therapeutic options every year. They get to work on complex problems and have flexibility to treat patients with different therapies.
There are also many different options within the field itself to treat different types of cancer. The field is constantly expanding, changing, and requires a heavy research focus to better understand the complicated nature of cancer itself.
The general specialty of internal medicine ranks third for the most NIH funding, based on average dollars of funding per physician per year. Many of the most heavily-funded diseases are various types of cancer.
Oncologists have a great work-life balance with minimal calls and few emergencies. Their working hours will be spent mostly in the clinic with limited hospital call. There are also many opportunities to participate in research and clinical trials.
The compensation is also excellent. It ranks third among internal medicine subspecialties, averaging $463,000 per year.
What You Won’t Love About Oncology
Of course, oncology is not for everyone.
Oncologists treat very ill patients who may have a rapidly progressing disease with few treatment options. In other words, they deal with lots of end-of-life and palliative care and often must have difficult discussions with patients and their family members when diseases progress on multiple lines of therapy. This is undeniably tough emotionally, as in many cases, you will have been treating the patient for some time and developed a strong bond. Over the years, the weight of these losses can compound, potentially leading to burnout.
Oncologists often become the patient’s de facto primary care physician, taking care of many of their medical needs outside of their specialty.
As the treatments and new therapies are rapidly progressing for each area of the body, it’s becoming more difficult to be a general oncologist. It’s more likely that patients will see an oncologist who specializes in a specific area of the body. This means oncologists are beginning to lack flexibility in the type of cancers they treat.
Should You Become an Oncologist?
So, should you become an oncologist?
If you are motivated, love research, enjoy complicated disease processes, and want a specialty where you can spend ample time with patients, oncology might be for you.
You should have a curious mind and find a great deal of pleasure in sorting through minute details, solving puzzles, and building long-term relationships with patients as well as their families.
You should also enjoy being on the cutting edge of medicine and be willing to put in the time and effort to keep up with the latest medical literature.
And if you prioritize work-life balance, oncology won’t make you choose between your family or work.
To become an oncologist, you’ll need to do well in medical school, thrive at standardized tests, stand out in your clerkship training, and craft a stellar residency application. And before all of that, you’ll need to get into medical school, which is a long, complex, and arduous process.
Med School Insiders has helped thousands of premeds and medical students succeed in pursuing their ideal career paths. Our team of physicians were top of their class, attended their dream medical schools, and matched into the nation’s top residency programs. And they can show you exactly how to do the same, every step of the way.
Now that we’ve covered oncology, what specialty should we tackle next? Leave a comment to add your vote.
