Specialty Profile

Radiation Oncology GENERAL INFORMATION (Source: RCPSC and Pathway Evaluation Program) Radiation oncologists are medical specialists with unique knowledge, understanding and expertise in the diagnosis and care of patients with malignant disease. They are integrally involved in the formulation and execution of the management plan of cancer patients and therefore require specific knowledge and skills in the application of ionizing radiations to cancer treatment. Using an evidence-based approach, they are responsible for the appropriate recommendation, prescription and supervision of therapeutic ionizing radiation. The competent and ethical discharge of these responsibilities results in improved quality of life and/or survival for cancer patients, which in turn benefits families, society and future care. Typically, a radiation oncologist practices in a multidisciplinary fashion in close collaboration with general and subspecialty surgeons, medical and gynecological oncologists. Ambulatory patient care is the norm. Cancer centres are generally located in large cities within academic health science centres, thus most radiation oncologists should expect to have an academic career. Upon completion of medical school, to become certified in radiation oncology requires an additional 5 years of RCPSC-approved residency training. This training includes:

• 1 year of approved basic clinical training to introduce and expose the trainee to independent responsibility for decisions involving clinical judgment skills, the further development of an effective, and mature physician-patient relationship, and the achievement of competence in primary technical skills across a broad range of medical practice. The first year of an approved family medicine program is acceptable in fulfillment of this requirement.

• 3 years of approved residency training in radiation oncology, 1 year of which must include: 6 months of approved residency training in internal medicine, which may include up to three months of hematology/oncology; and 6 months of approved training in clinical training, basic science, or research training.

For further training requirements go to: http://rcpsc.medical.org/residency/certification/training/rad-oncology_e.pdf There are currently 370 radiation oncologists practicing in Canada. Of these, 7% are under the age of 35, 64% are 35-54, and 25% are 55 and older. Most practicing radiation oncologists are male (69%) and 31% are female. (Source: 2008 CMA Masterfile).

DETAILED INFORMATION The remainder of the data contained in this specialty profile has been extracted from the 2007 National Physician Survey (NPS), unless otherwise stated. All percentages are for respondents only. A total of 84 radiation oncologists responded (for a response rate of 26%). Complete data tables for radiation oncology from the 2007 NPS are available at: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/Results/physician3.1_sp-e.asp For an index to all specialties, go to: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/2007results-e.asp Choosing radiation oncology (2004 NPS Data) In 2004, almost a third (30%) of radiation oncologists decided on this specialty as a career choice during their residency, while 24% decided during their clerkship year (i.e., the last year of medical school) and 18% decided during medical school but prior to their clerkship. The most frequently cited reason for becoming a radiation oncologist was for the intellectual stimulation/challenge this specialty provides (81%). Also cited as factors were the quality of the doctor-patient relationship that is established (74%) and for the research opportunities that were available (40%). From these factors, intellectual stimulation/challenge of the specialty was cited as the single most important career decision-making factor (39%). Practice Setting Nearly all radiation oncologists (86%) work in an academic health sciences centre, while 27% work in a university/faculty of medicine and 20% are in a community hospital. Given the primary location of their practice, the academic health sciences centre is also the main patient care setting for 71% of radiation oncologists. The availability of a practice opportunity was the major influence (73%) on a radiation oncologists’ selection of their current practice location, but liking the area (66%) and the opportunity for affiliation with a university (52%) were also cited as important influences. Practice Profile More than half of radiation oncologists (54%) work in a group practice where on-call duties, equipment, office space and/or staff are shared amongst the physicians, while just under half (45%) are in an interprofessional practice setting where physicians and other health professionals have their own caseloads. In their main patient care setting, 80% of radiation oncologists share patient care with other types of health care providers, including:

• social workers (84%) • dieticians/nutritionists (82%) • family physicians (81%) • pharmacists (72%) • nurses (63%)

All radiation oncologists feel that this collaboration improves the care that their patients receive and also enhances the care that they can deliver. During a typical week, radiation oncologists see an average of 49 patients. The majority of radiation oncologists (62%) serve mainly an urban/suburban population. Radiation oncologists work an average of 55 hours per week on professional activities (excluding on-call). The majority of this time (28 hours per week) is devoted to direct patient care, with or without a teaching component. An additional 8 hours per week is spent on indirect patient care, such as making appointments with specialists, charting, meeting a patient’s family, etc. and 5 hours per week is spent doing research. The remainder of the time is spent on CME/CPD, teaching and administration. Most radiation oncologists (83%) make themselves available to their patients (i.e., on-call) outside of their regularly scheduled hours. Of those who do on-call, the majority (89%) spend up to 120 hours per month on-call, while 5% put in more than 120 hours per month. On average, a radiation oncologist is on-call 56 hours each month. During the time they are on-call each month, they spend an average of 12 hours on direct patient care and see an average of 6 patients. Income More than half of radiation oncologists (52%) receive 90+% of their income from a blended source (i.e., made up of a combination of 2 or more payment methods like fee-for-service, salary, capitation, sessional, contract, benefits/pensions, on-call remuneration or some other form), while 18% receive 90+% from a salary and 18% receive their income from a service contract. When asked their preferred method of remuneration, 61% of radiation oncologists prefer some form of blended remuneration, 12% prefer a salary only and 11% would prefer to be on a service contract. To protect their income, physicians take out medical liability coverage in the event that a patient is harmed in a medical misadventure. According to The Canadian Medical Protective Association’s Fee Schedule for 2009, the annual cost for insurance for a radiation oncologist is:

Quebec Ontario Rest of Canada $ 2,564 $ 2,856 $ 1,260

Satisfaction Three-quarters of radiation oncologists (75%) report that they are very or somewhat satisfied with their current professional life.

Nearly all (93%) are very or somewhat satisfied with their relationship with their patients, with their relationship with specialist physicians (89%) and with their relationship with family physicians (74%). Radiation oncologists are less likely to be very or somewhat satisfied with finding a balance between personal and professional commitments (52%). They are also less likely to be very or somewhat satisfied with their net revenue per hour compared to other radiation oncologists (47%) and with their net revenue per hour compared to other specialties (35%) ADDITIONAL INFORMATION Additional information on this specialty can be found from the: Canadian Association of Radiation Oncology: http://www.caro-acro.ca