Public/global health in rad onc??

[altruistic493]

Hey yall

My spouse is an MS3 completely struggling with specialty choice. She recently looked into radiation oncology and it looks like a sweet gig that would fit her well. The matter is we both wanna get involved in global health. It's one of the main reasons we both entered medschool as non trads. We both want to contribute to improving healthcare in underserved areas / for vulnerable populations.

Is it possible to get involved in such global health projects as a radiation oncologist? are there enough opportunities? is it possible to conduct research in this area while in rad onc?

Any comment or info would be highly appreciated, thank you

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[TheWallnerus]

Hey yall

My spouse is an MS3 completely struggling with specialty choice. She recently looked into radiation oncology and it looks like a sweet gig that would fit her well. The matter is we both wanna get involved in global health. It's one of the main reasons we both entered medschool as non trads. We both want to contribute to improving healthcare in underserved areas / for vulnerable populations.

Is it possible to get involved in such global health projects as a radiation oncologist? are there enough opportunities? is it possible to conduct research in this area while in rad onc?

Any comment or info would be highly appreciated, thank you

The lowest hanging fruit to combine global health and rad onc is to address the shortage of modern radiotherapy equipment that exists in many countries, especially in parts of Africa and Asia. There is a recent piece in Lancet Oncology on linac shortages in Brazil. In America, we are profoundly oversupplied in both linacs and rad oncs more than any other country in the world. But to address the linac shortage in some countries, I don’t think you need to do a rad onc residency; you would have more impact to try and go work for Varian (Siemens) or Elekta. To address other global health issues outside of radiotherapy access (which is a unique niche), becoming a radiation oncologist might be a dead end street?

 

[elementaryschooleconomics]

It's possible, I have a few friends who do it. Emphasis on "few" - countable on one hand and all that.

In a two physician household with an interest in global health - RadOnc is probably not the best option. Jobs are very geographically limiting. Radiation Oncologists in America are tied to the machine we use (linear accelerator or "linac"). These machines are very expensive and usually require state government approval to install (even if I had an extra few million dollars floating around right now and wanted to buy one, I'd need to go to the state government and be approved for a "Certificate of Need").

Furthermore, we literally can't do our jobs without a team of people. There's a Dosimetrist who does the treatment planning for each case, the Medical Physicist who ensures the quality/safety of the plan and maintains the machine/equipment, and the Radiation Therapist who staffs the machine and delivers the day-to-day treatment. You could be the smartest and best Radiation Oncologist on the planet but without these additional people you literally can't do anything. There's almost nothing else in medicine like it.

Now, if you're going to be a Pediatrician or something where you can get a job virtually anywhere, at anytime, and are OK with following her to whatever location she can get hired in - that's a different story. But if you ever see a future where being in a certain region is something that could be important to you or your family...I'd encourage her to look elsewhere.

 

[temujim]

The lowest hanging fruit to combine global health and rad onc is to address the shortage of modern radiotherapy equipment that exists in many countries, especially in parts of Africa and Asia. There is a recent piece in Lancet Oncology on linac shortages in Brazil. In America, we are profoundly oversupplied in both linacs and rad oncs more than any other country in the world. But to address the linac shortage in some countries, I don’t think you need to do a rad onc residency; you would have more impact to try and go work for Varian (Siemens) or Elekta. To address other global health issues outside of radiotherapy access (which is a unique niche), becoming a radiation oncologist might be a dead end street?

A stable electrical grid shortage... brush up on cobalt and brachy skills.

 

[deleted1111261]

I did a stint in Vietnam for 2 weeks through ASCO. It was an amazing experience.

I don't fathom how you could do it long term, unless you are completely okay with making what they make there. Or, you can go to a western country but I don't see how that is doing much for global health.

I think short term projects like I did, raising cash for equipment/textbooks/education are the ways we can truly help.

I think Penn and MDACC have global footprints and can see what their departments are doing. UPMC was doing some work in India and maybe Burma? Some institutions have centers in China, but they are in big cities capitalizing on treating the rich.

It's not the idea specialty for this type of work, but I think there are some limited opportunities.

 

[deleted1116990]

I did a stint in Vietnam for 2 weeks through ASCO. It was an amazing experience.

I don't fathom how you could do it long term, unless you are completely okay with making what they make there. Or, you can go to a western country but I don't see how that is doing much for global health.

I think short term projects like I did, raising cash for equipment/textbooks/education are the ways we can truly help.

I think Penn and MDACC have global footprints and can see what their departments are doing. UPMC was doing some work in India and maybe Burma? Some institutions have centers in China, but they are in big cities capitalizing on treating the rich.

It's not the idea specialty for this type of work, but I think there are some limited opportunities.

The majority of people I hear interested in "global health" are really interested in voluntourism for a couple of weeks a year. Getting patients from consult to EOT often takes a couple of months. Agree this is not the field for voluntourism (which is debatable if anybody should be doing it at all in any field), especially for people who are only experienced with state of the art technology.

Maybe a different story if you actually wanted to live and practice in a third world country and serve the world's extreme poor, but you would have to have some other way to fund your retirement or be independently wealthy as you would be impoverished yourself by US standards. I have not heard of this but I'm sure there are a few people out there who have done it. Also, my understanding is that these countries have very few if any radiation facilities already. As mentioned above, the limiting variable is probably the physical infrastructure, not the manpower to run it.

There are some limited opportunities to work outside of the US in other developed countries if simply getting outside of the US is your thing. I just got an email for a stint in Guam, which seemed to pay decent (which is kinda outside of the US).

 

[deleted1111261]

The majority of people I hear interested in "global health" are really interested in voluntourism for a couple of weeks a year. Getting patients from consult to EOT often takes a couple of months. Agree this is not the field for voluntourism (which is debatable if anybody should be doing it at all in any field), especially for people who are only experienced with state of the art technology.

Maybe a different story if you actually wanted to live and practice in a third world country and serve the world's extreme poor, but you would have to have some other way to fund your retirement or be independently wealthy as you would be impoverished yourself by US standards. I have not heard of this but I'm sure there are a few people out there who have done it.

There are some limited opportunities to work outside of the US in other developed countries if simply getting outside of the US is your thing. I just got an email for a stint in Guam, which seemed to pay well (which is kinda outside of the US).

Part of what is happening is that they buy the technology - high end linac that can do it all - but don't necessarily get how to utilize it. I.e. - when I visited, saw that they were treating head and neck on an Axesse with laterals and AP neck. So, went through contouring atlases, OARs, scorecards, etc. Of course, we are not going to "change the world", but in SE Asia for example, resources are so limited. The hospital nearby had a GammaKnife but no other linac! This hospital had an Axesse with IGRT and another old school linac and weren't using any of the features. No textbooks, no lectures, limited journal access. We had a team of a medonc, pharmacist and nurse, and trying to teach best practices with regards to documentation / QA, evidence-based treatment of endemic malignancies, etc. They still contact me with questions. I felt it was valuable for them and for us.

The ASCO program was supposed to be multiple groups going every few months to specific locations. Like a few months after I went, a Colorado faculty went to teach gyn. Then someone else. But, I don't know that the program lasted. It was also in other countries, but it was harder to do. Like Bhutan required you to be there 30 days b/c of their visa policy (!!). Honduras didn't seem particularly safe to people. I think Nepal had something, but it was never available.

 

[thecarbonionangle]

i must say i also do share the cynicism when I hear the word “global health” from younger traineees. They have much to learn,methinks. Yes it usually is volunteerism, go to a country and take a picture with a black kid, crack open a can of local beer, be a “saviour”.

If you are committed to underserved care and by that I mean middle of nowhere wisconsin with the maga folk, by all means go into rad onc. There are way better options to do this in other specialties. The job market is super tight and you would have trouble finding a job where your wife works. Rad onc is a penny stock. Run away while you can and save your marriage!

 

[deleted1116990]

If you are committed to underserved care and by that I mean middle of nowhere wisconsin with the maga folk, by all means go into rad onc.

It is truly the altruist who takes the rural Wisconsin job for sub MGMA pay to make locums no longer financially attractive for local hospital and delivers non-octolocums plans to the locals. God bless him/her. Hero status.

 

[RSAOaky]

My wife and I are passionate travelers. I was born in a third world country and my wife has spent a significant amount of time volunteering in one. I remember seeing the Botswana job that Surbhi Grover ultimately took pop up and thinking wow this is my dream! I had a friend who rotated with her down there and had an amazing experience but by that time I had come to the realization that it wasn't for me. We sometimes idealize global health work but for the people that do it full time it is never glamorous, you will not get paid for it, and unless you feel so deeply and strongly within your bones that this is your calling in life that you would be unhappy doing anything else, your time is better spent volunteering in some other way.

 

[Chartreuse Wombat]

Hey yall

My spouse is an MS3 completely struggling with specialty choice. She recently looked into radiation oncology and it looks like a sweet gig that would fit her well. The matter is we both wanna get involved in global health. It's one of the main reasons we both entered medschool as non trads. We both want to contribute to improving healthcare in underserved areas / for vulnerable populations.

Is it possible to get involved in such global health projects as a radiation oncologist? are there enough opportunities? is it possible to conduct research in this area while in rad onc?

Any comment or info would be highly appreciated, thank you

At the risk of being labeled a nativist (or worse), there are plenty of underserved/vulnerable populations in the US. The nature of RadOnc (reliance on sophisticated machines that require a stable electrical grid) make it very difficult to make a difference. I know some who have tried but few who have succeeded. Your altruism is to be lauded. I trust that you can meet this need to care for the underserved right here in the US.

 

[TheWallnerus]

Followup

Advancing Cancer Care Globally

100% volunteer-run, mountain climbing, cancer-cure focused nonprofit. Improving cancer care, specifically radiation oncology care, around the globe.

www.radiatinghope.org

 

[IonsAreOurFuture]

Cancer kills more people in Africa than AIDS, TB, and malaria combined.

Nigeria, a rapidly modernizing country of over 100 million people had only 6 Linacs at one point and most of them were broken. It wasn't a lack of machines, it was lack of stable expertise in-country that kept those machines mothballed.

With SBRT and hypofractionation (one course in one to 5 days), there has never been a better time in Rad Onc to serve people with limited access to housing or transportation who can't stay at a cancer center for weeks on end.

Half the cost of running a center is hardware related, but the harder half to sustain is the qualified staff and salaries. Fortunately, dosimetry and physicists can do a lot of the day to day stuff remotely (even overseas) and physicians can too. There's a center in Canada where the physicians simply didn't go during the pandemic, and others in the rural US where the MD goes only 1 or 2 days a week. I'd say go for it.

 

[jondunn]

Def some good points that has applications for rural rad onc as well.

One day the people that hated the hypofrac trials will look REALLY silly.

 

[altruistic493]

Wow thank you so much to everyone who took the time to answer, I was not expecting that many answers. It really helps and it allowed very interesting discussions with my spouse today.

I am a family doctor so mobility is not an issue and we don't mind moving to remote areas. We are looking for a long term commitment part-time (abroad or in remote areas of US as some of you mentioned; I think that both could be done). We are very sensitive to voluntourism since we both come from foreign countries and have work experience in global health prior to medical school. We would ideally like to have patients of our own that we follow from abroad (don't know if this is idealistic or futuristic).
She was originally very inclined to a surgical specialty but rapidly realized that the schedule was just not for her and that she couldn't keep up with the demands of a surgical residency. She is very interested in technical, procedural work. Money is also something important because she might need to take her parents in charge in the future. She's interested in research, innovation, leadership/business, and multidisciplinary work. She also values lifestyle.
Radiation oncology checks pretty much all the boxes and she is genuinely interested in the field (she considered the ROADs but they're not her cup of tea).

Some of you mentioned that other fields such as primary care might be a better fit for global health. There might be more opportunities but I observe that these fields typically are the ones with lots of voluntourism and less 'true impact' within a community. Although global health implication may be more difficult to find in rad onc, it is very concrete and nobody could doubt the immense impact it would have on people's lives and health. I understand that there are huge challenges though.

Some of you mentioned programs; would you mind sharing their name? What about global health research in the field?

 

[elementaryschooleconomics]

Some of you mentioned programs; would you mind sharing their name? What about global health research in the field?

The primary two I can think of are Penn and Harvard. I think Hopkins has something going on, or maybe that was a fever dream on my part?

 

[RO28]

I would second Penn. They have a program called Power Up Gambia that works towards providing reliable electricity to clinics through solar power. With programs like that already in existence they are looking towards building sustainable solutions to improve healthcare abroad.

 

[ivybme]

UCSD has a volunteer rad onc program as well.

Advancing Cancer Care Globally

100% volunteer-run, mountain climbing, cancer-cure focused nonprofit. Improving cancer care, specifically radiation oncology care, around the globe.

www.radiatinghope.org

 

[medgator]

Hey yall

My spouse is an MS3 completely struggling with specialty choice. She recently looked into radiation oncology and it looks like a sweet gig that would fit her well. The matter is we both wanna get involved in global health. It's one of the main reasons we both entered medschool as non trads. We both want to contribute to improving healthcare in underserved areas / for vulnerable populations.

Is it possible to get involved in such global health projects as a radiation oncologist? are there enough opportunities? is it possible to conduct research in this area while in rad onc?

Any comment or info would be highly appreciated, thank you

Perfect timing...

This was just posted. Can't say I've ever seen a job like this posted before

https://careers.astro.org/job/assistant-professor-radiation-oncologist-global-oncologyhealth-equity/62831230/

 

[seper]

I know a company that launches cervical brachytherapy programs in Sub-Saharan Africa and Asia. A few of my colleagues joined those efforts prior to Covid, and it was massively satisfying

 

[TheWallnerus]

Cancer treatment: How Nigeria loses N21 billion to Ghana annually​

 

[deleted1116990]

Perfect timing...

This was just posted. Can't say I've ever seen a job like this posted before

https://careers.astro.org/job/assistant-professor-radiation-oncologist-global-oncologyhealth-equity/62831230/

That is a lot of woke b.s. for a job ad, even for academia.
I don't think I've ever seen a mandatory covid vaccination policy without ANY exception consideration whatsoever. That's next level. Is covid really still that big of a threat? Stupid.

I swear signing up to work for these universities is seeming more and more like joining a cult. At least there is no pledge of allegiance to equity and diversity essay required. I feel at some point there will be an official ceremony with a verbal oath taken before the elders with some sort of burnt offering. Oh, and don't forget the tithing of RVUs back to the system.

So glad I got out of training before these places went full on Looney toons.

Edit: Nevermind, they do require a diversity essay. Of course they do.

 

[fiji128]

"I swear signing up to work for these universities is seeming more and more like joining a cult." on point!

 

[communitydoc13]

hat is a lot of woke b.s. for a job ad, even for academia.

I don't think so. The job description is "Physician Lead of the Global Oncology/Health Equity Program for Radiation Oncology". It's a woke job, not a carbon ion job.

This is a state university with state mandate regarding covid vaccination. They do include language for exceptions.

I am concerned with the one year, non-tenured contract and I suspect pay is low. I am not sure that it is a great opportunity or one that would be offered with the same terms in a better job market.

Should be offered as a tenure track, long term position with good pay if they are serious.

 

[Gfunk6]

Edit: Nevermind, they do require a diversity essay. Of course they do.

My essay would be: "My skin is brown so I'm diverse by default, right?"

 

[deleted1116990]

I don't think so. The job description is "Physician Lead of the Global Oncology/Health Equity Program for Radiation Oncology". It's a woke job, not a carbon ion job.

This is a state university with state mandate regarding covid vaccination. They do include language for exceptions.

I am concerned with the one year, non-tenured contract and I suspect pay is low. I am not sure that it is a great opportunity or one that would be offered with the same terms in a better job market.

Should be offered as a tenure track, long term position with good pay if they are serious.

That's a good point about it being a woke job. On one hand it's frustrating that jobs with such terms are being offered. On the other hand, the job sounds like a lot of fluff, and it would be more annoying if, in the name of equity, the job were on the same playing field in terms of pay and career prospects as other academic staff including 100% clinical satellite docs and 80/20 physician scientists jobs or something. I'm sure high producing faculty would be thrilled to donate RVUs to a pool that is split with woke jobs.