Radiation oncologist calls on field to ‘advocate and educate’ as numbers fall
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Key takeaways:
- Radiation oncology residency applications have declined for the past 5 years.
- Advocacy and education are key to bringing interest back to the field.
Arya Amini, MD, still remembers sitting on the steps outside of his dean’s office at University of California, Irvine, more than a decade ago, prepared to race inside in case he did not get matched with a radiation oncology residency.
Candidates far outnumbered residencies, and those who did not receive a match letter had to frantically search for a program with an open spot.
“This process is called SOAP [Supplemental Offer and Acceptance Program]. It used to be called ‘scramble,’ which is exactly what it sounds like,” he said. “If I didn’t match, my dean would help me look for any open programs in radiation oncology. You would be interviewing last minute to try to get into that program and you’re doing that with other people who did not match. It’s really stressful.”
Amini did find a match, with University of Colorado, and he’s now a radiation oncologist at City of Hope.
However, there are concerns about the future of his field, as the interest in radiation oncology has waned substantially. Residency applications have declined 5 straight years since 2017, according to a report he co-authored in Journal of the American College of Radiology.
In 2023, 37 residency positions went unfilled. Lately, SOAP has less frequently been used by students to find a radiation oncology opening. Rather, radiation oncology programs use it to find candidates from other specialties that did not get accepted to their first choice.
“If we’re not competitive — if a field lets go of that gas pedal and gets complacent — then you’ll see this drop, and then, unfortunately, that will lead to a decrease in radiation oncologists. Then you’re scrambling, because now there’s not enough radiation oncologists to take care of all these patients,” Amini said.
“We saw that unfold during COVID,” he added. “Afterwards, certain areas of the workforce got really low and you couldn’t get the services that we once could. That, in medicine, leads to people dying. We can’t ignore it.”
Getting out of the basement
Amini and colleagues cited multiple factors that have influenced the reduction in radiation oncology applicants.
The first stems from an online post from 2018 — the beginning of the decline — in which someone wrote about the current and future state of radiation oncology.
“Sometimes information is great and sometimes it’s false,” Amini said. “There’s a website called Student Doctor. There was literally one post that said there’s no jobs out there. The future of radiation oncology is poor. The field is not going to be around anymore in 10 to 15 years. Unfortunately, people listen to that.”
Also in 2018, pass rates for biology and physics board exams fell from 90% to 70% and 75%, respectively. Amini attributed that to modernization of the field not being taught. As new testing resources became available, pass rates rose back to 90%.
“It’s just a 1-year issue, but that scares people,” Amini said.
Perception of radiation oncology continues to be a problem because of a lack of exposure in medical school.
“People don’t know exactly what we do,” Amini said.
“A lot of people still think radiation oncology is what we did 20, 30 years ago, which was really big fields of radiation that caused a lot of side effects with limited tumor control. The last 10, 20 years, our field has jumped because of technology,” he added. “That’s one of the things I love about it. If you’re a field that’s relying on technology, then it should continue to be novel, and it has been. That’s allowed us to be more targeted, treat more aggressively and have tumor control rates similar to surgery, for example, in lung cancer, which was not a thing 20, 30 years ago.”
Eliminating that outdated view is critical and requires exposure even Amini did not have.
“I completely had no idea what radiation oncology was,” he admitted.
Amini’s mentor, a medical oncologist, first stirred his interest in radiation oncology.
“When I described to him what I like, he thought I should look into radiation oncology. And I told him I don't want to be in a dark room. I want to see patients. I don’t like physics.”
Despite the objections, Amini’s mentor challenged him to “check it out” given his stated interests.
“It was completely different than what I thought,” he said. “I get to spend an hour with a new patient. Most of my day is seeing patients, and what we do is pretty cool.”
Many medical students do not know about this aspect of the profession. Amini explained it is time to get out of the basement and advocate for the field.
‘Breaking free of old ways’
Radiation oncology does not require a 2-week rotation to recruit candidates, Amini said, but a 1-hour talk once a year could open a lot of eyes.
It is an opportunity to explain the job market, he said. Whereas it may be difficult to get positions in major markets like Los Angeles or New York, there are many openings in smaller communities.
Additionally, radiation oncologists can help diversify their ranks by recruiting different types of students.
“It used to be medical students who want to do research. It should be people who are advocating for interest in other things,” he said.
“We have a resident who is interested in global health. We have a resident interested in disparities research,” he added. “We need to diversify our field because if you diversify, then you get people who are going to graduate and maybe become the best academic radiation oncologist or the best community practice radiation oncologist. Or maybe you’ll have someone who goes into industry and works with pharmaceutical companies to create proper trials that benefit patients.”
Amini said radiation oncologists also need to get involved with national clinical trial groups and pharmaceutical companies.
“If you have lots of data, as we do, that radiation is still really relevant — you want to be at the table,” he said. “You want to be able to offer multiple modalities that will help cure people. I have a colleague here who’s designing a trial incorporating radiation with [chimeric antigen receptor (CAR)] T cells because they looked at their analysis here, and the survival rates and tumor control rates went up when they incorporated radiation with it. It’s just about advocating more.”
Breaking free of old ways of thinking can reinvigorate interest in the field, he added.
Radiation oncology has endured as the field evolves and improves, Amini reflected. Those among its numbers must avoid relying on its former reputation as an “attractive specialty,” and help enlist a new generation of capable professionals to join them.
“We just got comfortable,” he said. “We need to continue to advocate and educate our future students.”
For more information:
Arya Amini, MD, can be reached at aamini@coh.org.
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