Interview Summary

Dr. Smith is a radiation oncologist, a physician specializing in treating cancer with targeted radiation therapy. Radiation oncology is a relatively small and specialized field, and many people are unfamiliar with it unless they or a family member have received treatment. It combines advanced technology with direct patient care, offering both precision and compassion in cancer treatment.
Dr. Smith majored in cell biology in college before working in a laboratory for several years. After realizing he wanted to see the direct impact of his work on patients, he decided to apply to medical school. Although he was initially uncertain about starting medical school later than most students, he excelled and went on to complete his residency at Stanford before becoming a radiation oncologist.
Radiation oncologists use advanced imaging and planning tools to develop personalized treatment plans. Radiation oncology takes a highly targeted approach to cancer treatment that is similar to surgery in its precision except that the work is performed from outside the body. The role involves significant direct patient contact as well as collaboration with other medical professionals to ensure the best outcomes.
Radiation oncologists typically work five days a week, averaging about 60 hours per week. They are not usually called in after hours, but they often spend additional time outside the clinic designing treatment plans.
To become a radiation oncologist, one must complete four years of undergrad, four years of medical school, a one-year internship, and four years of residency.

Radiation Oncologist Interview With Dr. Smith

What does a day in your life as a radiation oncologist look like?

My schedule is Monday through Friday, with on-call duties that are usually handled by phone. My on-call duties usually consist of taking patient calls after hours, managing medications for a patient, or coming in to see patients if there is an emergency. Our clinic starts at 8:00 a.m., but it’s not uncommon for us to have some meetings beforehand. I typically see two to three new patients a day, and these are individuals who may eventually start treatment. The treatment process starts with a CAT scan, along with other imaging, to design a personalized treatment plan. I design these treatments using knowledge about where that tumor is, as well as the other normal structures that are nearby that we want to try to avoid.

Treatment planning takes one to three hours per patient, and that time isn’t always built into our clinic schedule. In addition to new patients, I see follow-up patients who are coming back for scan reviews months or years after treatment. I work with advanced practice providers, such as nurse practitioners and physician assistants, who oftentimes help manage follow-up visits while I am doing treatment designing or seeing other patients. We also do inpatient consults, which are unplanned and require us to make time in our schedule to assess a patient.

Our days can be kind of hectic, so a lot of times the treatment design work gets pushed off until the end of the day, after 5:00 p.m. I can log in from home, so sometimes I’ll go home to eat dinner and then log in during the evening to work on treatment designs. Some weeks this happens often, and other weeks not at all. Also, it is not uncommon for us to be catching up on some treatment design work during the weekend. On average, I work about 60 hours a week, though it can vary.

What does radiation oncology mean to you?

Radiation oncology is a medical specialty focused on treating cancer using radiation. We work closely with medical oncologists, who treat cancer using systemic therapies such as chemotherapy. So, anything sort of internal that is either oral or intravenous would be in the medical oncology realm. We also work closely with our other colleagues, the surgical oncologists.

Radiation oncology is very interesting because it uses a more focused viewpoint in the treatment of cancer, similar to a surgeon’s viewpoint, where they are going to go in and resect a cancer. Medical oncology follows a broader, whole-body approach to giving systemic therapy because the therapy is pretty much going to go everywhere throughout the body. Radiation oncology is a little more focused, kind of like surgery. We use imaging tools like MRIs and CT scans to precisely locate tumors, then design treatments that target those tumors while sparing surrounding healthy tissue. Balancing an effective tumor-killing dose with the need to protect nearby organs is one of the most challenging and vital parts of our work.

Our field is also highly technology-driven. We do a lot of imaging and computer planning, even performing CAT scans on the treatment machine to locate the exact location of the tumor in order to treat it. So, it’s a very imaging and technology-based field, but I think it has a really unique role in the sense that we can sometimes complement what the surgeon has done. For example, maybe the surgeon has removed the tumor, but it was hard to really get a large margin around it. In that case, we can sometimes come in with radiation to try to treat a larger volume of the tumor to reduce the risk of a recurrence in the tumor. Other times, radiation is used with patients who can’t have surgery, which can hopefully take care of the tumor. We do this sometimes for brain tumors, kidney tumors, and lung cancers. We have techniques developed over the last decade or so where we give high-dose, focused treatments that aim to control or even cure the cancer. It’s very interesting because we have a more local anatomical focus that is similar to a surgeon except that we’re doing it from the outside and not invasively.

Radiation oncology involves a lot of patient interaction. We meet with patients to discuss the possibility of using radiation, its process, and potential side effects. Treatments usually last three to five weeks, with daily sessions Monday through Friday. We meet with patients weekly during treatment to monitor how they are doing. After treatment, we follow up with the patient and use imaging to assess how they are doing and if there are any side effects we need to help manage. So, it’s just as much patient contact in this job as a medical oncologist. We have full clinic days where we’re seeing patients, we do treatment design, and then we also deliver the treatments.

One common misconception is that radiation oncologists are radiologists. I’m not a formal radiologist, and I’m not trained to read or interpret imaging studies. But, we work with the radiologists quite closely, and over the years, we develop a pretty good sense of what the normal and abnormal anatomy looks like.

Can you tell us about yourself?

I was raised in Minnesota and grew up in the Twin Cities. I majored in biology in college, specializing in cell biology. This sparked my interest in cancer, which is really the study of abnormal cell biology. That interest to me working in a cancer research lab for some time. Eventually, I wanted to be more involved in direct patient care and to have an immediate impact on patients and their lives, so I pursued medical school.

I was fortunate to attend the University of Minnesota for both undergraduate and medical school. In radiation oncology, after medical school, you complete a residency that typically lasts three to five years, depending on the specialty. Some fields, such as anesthesiology and radiology, require a one-year internship before residency. After I completed my internship, I did my residency at Stanford University. Once I finished, I returned to Minnesota and have been here ever since.

Full Q&A With Dr. Smith

What is your favorite part of being a radiation oncologist?

My favorite part is interacting with patients. Every situation is different, but having the ability to intervene in someone’s life at a critical point is a very unique and rewarding opportunity. Each person is different, so you need to see where they are at and help them go from there. Some patients aren’t ready to discuss a whole lot, but others want all the information you have. So, trying to come in at the level they are at and proceeding from there is really important.

We can’t separate the physical and emotional aspects of cancer care. A diagnosis affects not just the patient’s body but also their emotional well-being and family dynamics. Working as part of a team to create the best plan for each patient is one of the most fulfilling aspects of my job.

How much education is required to become a radiation oncologist?

After earning my undergraduate degree, I worked in a lab for several years before deciding to apply to medical school. I was a little concerned about going to medical school and finding success because I was older than most of my peers. But I met some other students who were also a little bit older, and I found their perspectives to be really valuable. Once I became interested in radiation oncology, I interviewed at multiple residency programs. Radiation oncology is a small field, and I heard advice that going to a top residency program would provide the best opportunities for me. So, I was fortunate enough to be able to attend Stanford for my residency. Some medical careers including radiation oncology, radiology and anesthesiology require a one year internship prior to starting the residency program in that speciality. Generally, the medical student will match into both programs in the Match Day process in March of the 4th year of medical school. My year of the internship was hard. I did my internship in internal medicine, and I was on call for every fourth night of most months. After that, I went to Stanford for my four-year radiation oncology residency.

Overall, my training was a total of five years after medical school. I also took written board exams partway through residency and then oral boards at the end. After that, I interviewed for positions and got a job as a radiation oncologist.

How did you become interested in radiation oncology?

I was interested in cancer, so I went to work in a cancer research lab at the University of Minnesota for a while. Physicians would occasionally come in as part of their training, and I had the opportunity to talk with them. I started to talk to some of the physicians who were involved in oncology, and I was so interested in how my research could be used in the clinic. After talking to these physicians, I realized that I wanted to see more of the impact of my work. I was kind of more at a basic biochemical cell biology research level, so I was uncertain whether my lab work would ever directly impact a patient. That uncertainty about the clinical impact of my research, along with encouragement from the physicians I met, led me to consider medical school.

I went to medical school a little bit older because I was working in the lab for a number of years, so I didn’t start medical school until age 32. By that time, I was going to medical school because I wanted to be an oncologist. A lot of the other first-year medical students were younger than I and were going to school to become doctors, but they didn’t really know exactly what area they wanted to practice in. It wasn’t until partway through medical school that I learned about radiation oncology. I really liked surgery, but I wasn’t sure if I was the type of person who could be a surgeon. Radiation oncology offered a focused, localized approach to cancer treatment much like surgery but in a non-invasive way. I thought that was very interesting and an area where I could be an oncologist, but maybe not necessarily a surgeon. It’s a small field and not well known outside of people who maybe either have had radiation or have family members who have had radiation. So, I’m lucky that I came across this field.

I never really considered becoming a doctor earlier in life. In college, I was leaning toward engineering, but after taking some biology classes, I found cell biology very interesting and decided to major in it.This led to my work in the lab and, ultimately, to medicine.

What advice would you give to someone who is interested in the healthcare field and is trying to figure out what profession is best for them?

I think that shadowing opportunities can give you a really good experience and insight into the field. Shadowing is a great hands-on way to understand what a job is like, and it gives you the opportunity to ask questions and learn from real-world experience.

What is the career outlook for a radiation oncologist?

I think the career outlook is good. For a while, there was a perception amongst medical students that our field was limited or in decline, so the number of applicants to radiation oncology programs went down. So, I think these programs have tried to get the word out that our field is growing. Unfortunately, the cancer burden is growing with more people getting diagnosed with cancer, especially as the baby boomers are getting older. Because of all this, I think the career opportunities would be very good.

I think that the question is about how AI might impact our field. Right now, we’re seeing some development of AI models in our treatment planning that can help us with designing some of the normal structures in the body, like the heart and lungs. This saves us time so that we can focus on more complex tasks like targeting tumors, which is hard for AI to do because each person’s target is a little different. I think AI will definitely help us with time management, but I don’t foresee that it will replace radiation oncologists’ positions.

What is the biggest challenge of being a radiation oncologist?

The hardest part is knowing that sometimes we can’t cure a patient. A medical oncologist who was a mentor of mine once said something that stuck with me. Basically, he had told me that you can’t change a patient’s past or diagnosis, but you can help them from this point forward. For some patients, it is just trying to relive the pain for the short time that the patient has left. For others, it is trying to cure the patient. So, I thought that approach of not taking on the burden of the patient’s diagnosis was interesting. It is definitely sad, but you have to remember that you can only start from the point where the patient is at and move forward to try to help them as best as possible.

Another challenge with this job is the complexity and time involved with it. The real-life cases we see are rarely as straightforward as textbook examples. There are always unique complications, so treatments often need to be adapted from established protocols. Additionally, it can be difficult to keep up with all the new treatments being created and used. Lastly, trying to manage the paperwork with this job can be quite time-consuming. We use electronic medical records that were supposed to hopefully make things easier, but in a way, they are actually adding a lot of complexity and challenges. Some of these electronic systems are hard to maneuver through, so they actually add more time to the paperwork. This, combined with the growing complexity of patient care, often pushes work into evenings and weekends. So, I think the time and complexity involved are definitely a challenge. Hopefully, future improvements in these systems will reduce this burden.