A thoracic oncologist works with various types of cancer that take place in the chest – from the diaphragm to the esophagus. One of the cancers that they will encounter is lung cancer.
It is estimated that lung cancer is the second most common cancer in men and women and is the leading cause of cancer death for both men and women. According to the American Cancer Society, “More people die of lung cancer than of colon, breast and prostate cancers combined.”
What is a Thoracic Oncologist?
An oncologist that specializes in thoracic cancers will work with patients that have cancer of the lung, chest or esophagus. The treatments that are used in these cancers involve a lot of different medical specialties and the doctors that focus on patient care work alongside other physicians – thoracic surgeons, radiation oncologists, gastroenterologists, pathologists, pulmonary physicians and more – in order to deliver complete care to the patient, treating and protecting their body while they attempt to eliminate or manage their cancer.
The thoracic oncologist is part of the entire process of care for their patients. They are involved in the diagnosis, the treatment plan and procedures, the follow-up care and may be involved in explaining procedures, prognoses and expectations to family members and care givers.
The Boston Medical Center lists the following as some of the types of cancer that a thoracic oncologist may encounter:
As a thoracic oncologist, the physician is involved in developing a treatment plan for their patients that simultaneously treats them, encourages recovery, and keeps them as comfortable as possible. Treatments can include: chemotherapy, esophageal stents, lung resection, radiation, tumor ablation and many more, depending on the type cancer, wishes of the patient and other medical factors that affect the bodies ability to handle some of the available treatments.
Educational Requirements for Becoming a Thoracic Oncologist
The minimum educational requirements for a thoracic oncologist is a doctoral degree. Training and experience in the form of internships, residencies and fellowships will ensure the physician is able to participate in this subspecialty of oncology.
Step-by-Step Educational Path to Becoming a Thoracic Oncologist
As with any doctoral degree, the student starts with undergraduate training which includes foundational studies in the sciences including biology, organic and inorganic chemistry, physiology, anatomy and other disciplines. This training prepares the students for two important milestones on their journey to becoming a doctor: the Medical College Admissions Test and the subsequent scientific training that will take place once accepted into an accredited medical school.
Many students choose to major in a science for their undergraduate degree. Though it is not required for entry into medical school, this approach ensures the student has all of the science-based courses that are pre-requisites for medical school without adding any additional time onto their undergraduate education.
Students should pay particular attention to their cumulative GPA, science GPA and extra-curricular activities from the beginning of their education. Most medical schools require a minimum 3.0 cumulative GPA with the most competitive schools requiring at least a 3.5. Particular attention is give to science classroom and laboratory work as this will make up the initial subjects of the student’s training in medical school. Extra-curricular activities are also important as they can highlight the student’s work ethic, dedication to the field, focus and determination, even applicable experience. Volunteering in a patient care setting, for example, can give students the upper hand when it comes to working in clinics as they will already be familiar with patient interaction and the methods and procedures used by all doctors to maintain sanitary conditions.
Finally, the undergraduate student will need to acquire letters of recommendation to be submitted with their medical school application and will need to be able to approach their mentors, professors or other authority figures in order to obtain letters about their professionalism, personal characteristics and focus.
Medical College Admissions Test
The Medical College Admissions Test, or MCAT, is a challenging exam that scores the student on their basic scientific knowledge, their critical thinking skills, and their problem solving abilities. The test is designed to measure the student’s readiness for medical college and is used as at admissions, therefore, the student should prepare for the exam using all the resources at their disposal in order to give themselves a competitive edge during the application process.
In most cases, the MCAT is taken during the student’s junior year of college and many medical schools will accept a person’s scores for up to three years before they begin requiring a retest.
Medical school is extremely competitive to get into. Students have to set themselves apart within just a few documents: an undergraduate transcript that shows a cumulative GPA and grades in the pre-requisite science and laboratory courses required by the medical school, letters of recommendation, and extra-curricular activities.
Once accepted into medical school the training is challenging. Students begin with two years of in-depth scientific coursework and laboratory time and an introduction to clinical practice, medical ethics and other pertinent information. After the first two years are complete, students take the United States Medical Licensing Exam, part 1. This test shows the student and their professors if they have gained adequate scientific and medical knowledge to move into a supervised clinical setting.
The next two years of medical school include rotations through several departments and practices so that students can gain experience under the direct supervision of a training physician. Some places offer a specific rotation in oncology with a thoracic oncology team which aspiring thoracic oncologists should take advantage of, if offered. Otherwise, the diversity of rotations will serve to give the aspiring physician a overview of the medical profession, how sub-specialties and specialties work together, experience with patients and experience in a clinical setting.
After completing the second two years of medical school, the students take part two of the United States Medical Licensing Examination, the score of which will indicate their ability to move on in their training to an unsupervised work with patients as they continue their education and begin to seek opportunities that will inform their sub-specialty.
After medical school, aspiring thoracic oncologists will go through a residency program. The majority of residents focus on internal medicine, but there are oncology sub-specializations in pediatrics, OB/GYN, Surgery, Urology, Pathology and Radiology. Some physicians already know they want to specialize in oncology before residency and other physicians discover their interest during this period of training.
Residency can be between one and three years and include elements of research and patient care as well as give residents exposure to the private practice setting, hospitals, government run clinics and more.
Residency is still a very challenging time for doctors-in-training. It is the last step before someone is considered a physician and is the final training before taking the third part of the United States Medical Licensing Examination which effectively licenses the doctor to work in the United States and is required by all states before practice begins.
Once the doctor decides that they are going to subspecialize in oncology additional training years begin in the form of a fellowship. The fellowship phase of training can begin with general medical oncology and be followed up by thoracic focused oncology training, or in some instances, students can begin their training with thoracic oncology immediately after residency.
In order to be accepted into a fellowship program, doctors need to be prepared to submit their application, including letters of recommendation, medical school diplomas and transcripts and board scores. Some programs also require specific written essays or explanations that show the students thoughtfulness and dedication to the field.
Fellowship training can last between two and five years, depending on the focus and the facility where the doctor is in training. This time can be split between clinical care, research, and/or surgery depending on what is offered within the program selected by the physician and the career goals.
Some fellowships are extremely competitive, with only one or two positions open each year. It is recommended that those wishing to specialize in thoracic oncology seek out a fellowship program and research the requirements of the program as early in their education as possible. This will allow them to make decisions about their education and experience as required or recommended by the program including choosing the type of residency program that is required, finding appropriate mentors, and having the experience necessary to fully engage in the program.
Licensing and Certifications
Before sub-specializing in thoracic oncology, the American Board of Internal Medicine will certify the physician in Medical Oncology. This certification requires the following:
There are very specific requirements and limitations to the training and experience that will count towards certification in medical oncology including minimum months of training and clinical months required.
Some oncologists with a focus on thoracic oncology will choose to gain special training and certification in thoracic surgery. This will involve a completed residency in general surgery or similar surgical training as described by the American Board of Thoracic Surgeons. In addition, the physician my have “an ethical standing in the profession and a moral status in the community that is acceptable to the Board,” as well as pass the American Board of Thoracic Surgery examination.
Most licensures and board certifications have required continuing education programs. These programs help ensure that all certified and licensed physicians are up-to-date on their specialty and practice medicine according to the rules and ethics established by the state and by the boards that hold the authority of their certification. Continuing education can very by state. It is recommended that every physician, regardless of specialty and in line with their specialty, research the states requirements where they practice medicine to ensure they are taking the correct number of credit hours and general requirements necessary to maintain their licensure and certification.
Understanding the Career Path
The following information is applicable to all oncologists. Thoracic oncologists will find that their work environments and salaries are similar to the general specialty. Those specializing in thoracic surgery should consult recorded surgical salaries and work information.
Oncologists spend a lot of time with their patients. Both in seeing them one-on-one and in the overall amount of time each week that is spent on patient care. Oncologists work alongside a team of people dedicated to the patient’s needs like nurses, other physicians, surgeons and more, but remain highly involved in care themselves. On average, oncologists report spending more than 30 hours per week seeing patients with over 60% reporting that they spend over 40 hours per week with patients. Due to the varying needs of patients, oncologists spend between 13 and 20 minutes with each person. This ads up to between 25 and 75 patients a week depending on the patient’s diagnosis and needs and the team of people that are dedicated to their care as well as the specific treatment they are receiving.
It is important for aspiring oncologists to be aware of the vast number of other medical professionals that will be involved in the care of their patients. The patients who are undergoing cancer treatment need physical care, psychological care and spiritual care, which extends their base of support throughout the medical professions. There may be pathologists, radiologists, nurses, social workers, caregivers, a team of doctors based on the type and location of the cancer and more.
In the most complex cancer cases there may be the need of an entire tumor board to help with deciding the right coarse of action for the patient. These medical experts will review a particular patient’s case and provide their own expertise and feedback in order to clarify how treatment should progress as well as what should be provided for family support.
There are several factors that affect the salary of an oncologist: their geographic locations, the type of practice that they work in, how they are employed, their years of experience and level of training, and many more things affect the base salary and bonuses that can be expected by the physician.
On average, male oncologists make $303,000 per year and female oncologists make $254,000 a year. Geographically, the Southwestern states (NV, UT, CO, NM, AZ) have the highest salary with a median of $331,000 while Northeastern states have a median of $255,000.
The type of work environment also plays a role in the annual compensation for the doctor. The following median incomes represent the variety of workplaces and the doctor’s median earnings for each environment:
There have been many advances in the field of oncology that have changed the way patients receive care, plans for treatment, and the invasiveness of procedures. One of the advances is the CyberKnife, which is used at The Center for Thoracic Oncology in Boston.
The CyberKnife limits the amount of healthy tissue that would come in contact with radiation during treatment. The surgeons involved in the procedure use a computer controlled robotic arm that directs multiple laser beams into the tumor very precisely. This lessens the potential for side effects as the patient’s normal tissues are not targets.
According to Dr. Michael Ebright, assistant professor of cardiothoracic surgery at Boston University School of Medicine, the CyberKnife, “Typically requires only three to five treatments, has fewer side effects than conventional radiation therapy and is painless.”
This technology –geared toward patients with early stage lung cancer or pulmonary metastases – is one of the many advances that oncologists get to experience. Continuing advances should inspire aspiring students to enter this ever-evolving and fulfilling field.