Oncologist
An oncologist is a specialized physician focused on the study, management, and treatment of cancers, also known as neoplastic diseases. They may further train in distinct areas of oncology such as surgical oncology, medical oncology (chemotherapy), or radiation oncology, and some may focus on specific cancer types, such as pediatric oncology or hematology for blood cancers. The path to becoming an oncologist involves extensive education, beginning with a bachelor's degree, followed by medical school, residency in internal medicine, and specialized fellowship training in oncology. Oncologists play a critical role in cancer diagnosis, treatment planning, and coordinating care with a multidisciplinary team, which may include surgeons, radiation therapists, and oncology nurses.
The outlook for oncologists is positive, with a steady demand expected due to an aging population and increasing cancer incidence. Their median annual earnings are approximately $239,000, reflecting the specialized nature of this field. Advances in molecular biology and genetics are shaping the future of oncology, leading to personalized medicine approaches that target specific cellular pathways in cancer treatment, enhancing efficacy while minimizing harm to healthy tissues. This evolving landscape emphasizes the importance of ongoing research, collaboration, and education within the oncology community.
Oncologist
Earnings (Yearly Median): $239,000 (Bureau of Labor Statistics, 2023)
Employment and Outlook: 4% (As fast as average) (Bureau of Labor Statistics, 2023)
O*NET-SOC Code: 29-1229.00
Related Career Cluster(s): Education & Training; Health Science; Human Services
Scope of Work
An oncologist is a physician trained in the study, management, or treatment of neoplastic diseases (cancers). Most oncologists are further trained in subspecialties of the profession of oncology, which can include surgical oncologists, trained in the removal of solid tumors; radiation oncologists, trained in the use of radiotherapy for the treatment of cancers; and oncologists who specialize in the treatment of cancers with chemotherapeutic agents. Not all neoplastic disease involves solid tumors, and some oncologists often specialize in certain types of cancers. For example, leukemia and lymphomas represent cancers of blood-forming cells; oncologists specializing in these areas are generally trained as hematologists. Some oncologists may specialize in brain tumors, referring patients with other forms of cancers to a different oncologist.
Oncologists may also specialize in the type of patient with which they deal, such as pediatric oncologists, who treat cancer in children or young adults.
Education and Coursework
Since an oncologist is trained as a physician, education in the medical field is a requirement. Students begin by earning a bachelor's degree. The undergraduate program should include courses in general biology as well as in both inorganic and organic chemistry, mathematics, and physics. Courses in biochemistry, microbiology, and immunology (while not required) will prove particularly helpful in any future medical school program.
Grades are important for admittance to any professional school but are not the only determining factor for acceptance. Work experience in the field, as well as faculty or instructor recommendations, play significant roles in acceptance to a medical school. Students should develop as much work experience as possible, including serving as a volunteer or carrying out an internship while working with physicians or in medical facilities, such as hospitals. As undergraduates, students should also take advantage of any opportunity to work directly with science faculty, including carrying out undergraduate research where available.
A master's degree is unnecessary for acceptance to medical school. Some schools have an MD/Ph.D. program for students who wish to emphasize research rather than a general medical practice, but for the student interested primarily in the diagnosis or treatment of cancer—an oncologist—the standard medical program is sufficient. Medical school training usually involves a four-year program, culminating with an internship and residency, preferably providing experience in dealing with cancer patients.
The specialty in oncology requires several years of further training beyond medical school, providing practical experience in the field of oncology. To be certified as an oncologist by the American Board of Internal Medicine—one of several such boards that oversee the practice of medicine—the physician must pass both written and oral examinations on the subject.
Most oncologists will train in specific areas of oncology, with emphasis on surgery being among the most rigorous of such programs. Surgical oncology requires up to five years of a residency program followed by several years of a fellowship. The field of surgical oncology is overseen by the Society of Surgical Oncology. Other programs include medical oncology, with an emphasis on chemotherapeutic treatments, and radiation oncology.
Career Enhancement and Training
A physician planning on specializing in oncology must first become certified in internal medicine, a process overseen by the American Board of Internal Medicine (ABIM). ABIM certification requires a three-year residency program terminating with an examination. Once the physician is certified in internal medicine, an additional fellowship program is required: a two-year training program in oncology followed by an examination. Periodic reexamination is required to maintain certification.
If the physician wishes to specialize in specific areas of oncology—such as radiation or pediatric oncology—additional certification is necessary. Specialization in radiation oncology requires a four-year residency following an internship in internal medicine. Certification is contingent upon passing an examination administered through the American Board of Radiology.
Several professional societies exist, the largest being the American College of Physicians, an umbrella organization that oversees most major medical specialties. The American Society of Clinical Oncology (ASCO) provides updates on relevant information as well as access to clinical tools. ASCO places a particular emphasis on the physician-patient dynamic, and many of its publications address this area. The American Association for Cancer Research provides access to those interested in the research area rather than that of clinical practice. The society publishes numerous professional journals as well as supporting professional conferences with an emphasis on the latest findings on the subject.
Daily Tasks and Technology
The first interaction between the cancer patient and a physician may involve either the routine examination consisting of the general physical or results of preliminary tests or concerns about physical changes such as the presence of a lump, physical symptoms, or unusual bruising or bleeding. At this stage, the physician is likely a general practitioner rather than a specialist. The physician will likely recommend a biopsy or other further testing, which can include computed tomography (CT) scans or magnetic resonance imaging (MRI) if the tumor is internal.
If tests for cancer are positive, the patient will be referred to a specialist or an oncologist trained in that particular specialty—breast, lung, or colon cancers, for example. The oncologist is likely associated with either a private or a university hospital. Once the examination is completed and the type and extent of the cancer are confirmed, the oncologist will determine the best procedures to be followed.
In most situations, a team, rather than any single individual, is involved in treating the disease. If the tumor is solid and localized, a surgeon or surgical oncologist will determine the optimal means of removing the tumor.
Following the removal of the tumor, the surgical team—which now may include a medical oncologist if chemotherapy is necessary or a radiation oncologist if that is the course to follow—will make further recommendations for additional treatment. Depending upon the site of the tumor and the likelihood that it has metastasized (spread), the team will recommend either radiation treatment or a course of chemotherapy. Radiation therapy, carried out by a technician trained in the process, will take place in the hospital. The program of chemotherapy, the length of which is dependent upon the type and extent of cancer, may take place in the form of an outpatient. Follow-up examinations and monitoring of patient health will continue until the disease has been resolved; the prognosis is dependent on numerous factors, including the type of cancer, metastasis, and the response of the disease to treatment.
Earnings and Employment Outlook
Despite perceptions of the increasing incidence of cancer, most cancers—with the exception of those cancers that are smoking-related—are chronic diseases of older persons. As the population ages, the incidence of certain cancers will also increase. Consequently, oncology as a field and the employment outlook for trained oncologists will continue to be highly positive.
Salary levels will likely increase as well, subject to several interrelated factors. The issue of health and medical care in the US will likely continue to generate controversy, with possible implications related to salaries affected by Medicare and Medicaid programs being part of that equation. Other factors will also have an impact on average salaries. Oncologists working in the private sector—private practice or employment in hospitals associated with universities—will likely continue to earn more than those in the public domain. The location of the practice will also affect salary levels. Oncologists working in larger cities or states located on the coasts will encounter higher costs of living, with increased salary compensation as a result. Improved technology, however, continues to provide access to medical information even for physicians living in smaller cities or towns, often locations for newer medical facilities. Average salaries in these areas, including the Midwest, where the cost of living is lower, will also be lower.
Related Occupations
• Hematologist: Hematologists are specialists in diseases of the blood, which can include leukemia and lymphomas.
• Pathologist: Pathologists are physicians trained in the diagnosis of diseases with emphasis on characteristics of cells and tissues.
• Radiation Therapist:Radiation therapists, while not necessarily physicians, may specialize in radiation therapy of tumors, working as part of a team in the treatment of some forms of cancer.
• Oncology Nurse: Trained in a nursing program, oncology nurses address the day-to-day treatment and monitoring of cancer patients.
• Geneticist:Geneticists are trained in the study of the underlying genetics of diseases such as cancer and may provide counseling or advice concerning genetic predisposition to the disease.
• Radiochemist:Radiochemists specialize in the use of radiotherapy in diagnosis (cancer imaging) or treatment of disease.
• Molecular Biologist: Usually, a Ph.D. rather than a physician, a molecular biologist may choose to study the underlying causes of cell abnormalities.
Future Applications
Among the most significant advances in the field of oncology is the understanding that, while cancer does not represent a single disease, the underlying causes of most forms of cancer have their origins in the molecular disruption of cell regulation. These discoveries have had two immediate impacts on the field—first, the possibility of genetic screening to identify persons at greatest risk for the development of the disease, and second, the application of personalized medicine aimed at the specific sites or cellular pathways disrupted in the patient.
For these reasons, the fields of molecular biology (the study of changes within the cell at the molecular level) and genetics (the study and application of genetic factors that may place the person at increased risk for cancer), as well as improved counseling on the subject, will become increasingly important.
In the past, an oncologist had few options in dealing with the disease: surgery to remove a solid tumor, directed radiation against the cancer, or chemotherapy and its attendant side effects. During the 1990s, the first of the anticancer drugs directed at specific pathways became available. In the future, it is likely the team that treats the patient will include, in addition to the oncologist, other members who can provide recommendations for specific treatments directed solely against the tumor while leaving normal cells and tissues unharmed.
Bibliography
"Physicians and Surgeons." Occupational Outlook Handbook. Bureau of Labor Statistics, US Department of Labor, 17 Apr. 2024, www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm. Accessed 28 Aug. 2024.
"Occupational Employment and Wages, May 2020; 29-1228 Physicians, All Other; and Ophthalmologists, Except Pediatric." Occupational Employment Statistics. Bureau of Labor Statistics, US Department of Labor, 31 Mar. 2021, www.bls.gov/oes/2020/may/oes291228.htm. Accessed 28 Aug. 2024.
"Summary Report for: 29-1229.00 – Physicians and Surgeons, All Other." O*NET Online, 9 Aug. 2024, www.onetonline.org/link/summary/29-1229.00. Accessed 28 Aug. 2024.