MEDICAL ONCOLOGY

Medical oncology is a board-certified subspecialty of internal medicine concerned with diagnosing and treating benign and malignant tumors and other forms of cancer. It was originally a part of hematology and in some training programs, these two disciplines are still taught together. Oncologists typically identify individuals at risk for malignancy and counsel them regarding risk reduction and screening, investigate clinical symptoms and syndromes suggestive of underlying malignancy, undertake the palliative care of patients with solid and hematologic tumors, identify neoplasms with a potential for cure, and manage appropriately. They administer chemotherapy for malignancy and work with surgeons and radiotherapists on other treatments for cancer. They often see patients who are seriously ill and require extensive treatment. Although the specialty is mainly office-based, oncologists provide a significant amount of consultation and primary inpatient care.

Profile
The following information reflects responses from 17 oncologists who completed the 2003 Pathway Physician's Survey. A. Respondents by types of areas
Small City
23.53%

B. Respondents by gender
Female
6.25%

Large City
35.29%

Metropolitan City
41.18%

Male
93.75%

C. Respondents by years in practice

10

Number of Responses

1-5 yrs

6-10 yrs

11-15 yrs

16-25 yrs

26-30 yrs

More than 30 yrs

Perspectives
A. Respondents' satisfaction with current specialty/area of work
14 12

Number of Responses

10 8 6 4 2 0

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

B. Would you choose this specialty again?

Yes
100.00%

C. Respondents by practice environment

12 10

Number of Responses

8 6 4 2 0

Academic instution

Acdemic med ctr

Managed care

PPO

IPA

Affiliated w/group

Business/industry

Community

Hospital

D. Respondents' satisfaction with practice environment

10

Number of Responses

Very satisfied

Somewhat satisfied

Neither statisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

Solo practitioner

Hospital other

Practice other

HMO

Mgr care other

Rating and Weighting of Critical Factors

Critical Factors represent significant aspects of physicians experiences in their practices. The rating represents their assessment of their current practice characteristics, while the weighting represents the importance of each factor to physicians. A. Caring for patients: How much time do you spend directly seeing and caring for patients? Rating

= 2.54
7.3

10

No time at all

Most of my time

Weighting

= 0.72
4.5

Not at all important

Very important

B. Continuity of care: How much continuity of care do you have with patients, (i.e., the length of patient relationships)? Rating

= 2.10
7.8

10

Short Term

Long Term

Weighting

=0.77
4.3

Not at all important

Very important

C. Autonomy: To what extent do you have the final word on the treatment of your patients? Rating

=0.99
8.9

10

Very limited autonomy

Great deal of autonomy

Weighting

=0.99
4.1

Not at all important

Very important

D. Diversity: How much routine (similar work) or diversity (different tasks/activities) is involved in your work? Rating

= 1.52
7.8

10

Great deal of routine

Great deal of diversity

Weighting

=0.71
4

Not at all important

Very important

E. Personal time: Does your work allow you to control the scheduling and amount of time you spend on personal activities, (i.e., family, leisure)? Rating

= 2.11
5.7

10

Very little flexibility

A great deal of flexibility

Weighting

=0.83
4.1

Not at all important

Very important

F. Expertise: How broad is the scope of your work? Rating

=2.76
5.3

10

Narrow expertise

Broad Expertise

Weighting

=0.62
4.5

Not at all important

Very important

G. Income satisfaction: Compared to all physicians, do you feel you are fairly compensated for the amount of time and effort you spend? Rating

= 2.32
6.1

10

Very dissatisfied

Highly satisfied

Weighting

=0.87
3.5

Not at all important

Very important

H. Creativity: To what extent does your work provide opportunity for creativity? Rating

= 1.94
7.6

10

Little opportunity

Great deal of opportunity

Weighting

=0.90
4.1

Not at all important

Very important

I. Certainty of outcomes: How much certainty of clinical outcomes does your work provide? Rating

=1.80
5.7

10

Very little, often "wait and see"

A great deal, outcomes usually clear

Weighting

=0.26
2.9

Not at all important

Very important

J. Clinical decision-making: On what basis are your clinical decisions made? Rating

= 1.02
7.6

10

Application of theory to a situation

Based on prior evidence of clinical outcomes

Weighting

=0.53
3.8

Not at all important

Very important

K. Patient decision-making: To what extent do your patients have input into decisions about their health care? Rating

=1.35
8.2

10

Little opportunity

Great deal of opportunity

Weighting

=0.89
4

Not at all important

Very important

L. Interacting with other physicians/members of health-care team: To what extent does your work provide opportunities for you to interact with other physicians/ members of a health-care team? Rating

= 1.37
8.6

10

Very little

A great deal

Weighting

=0.57
4.1

Not at all important

Very important

M. Manual/mechanical activities: How often do you use manual/mechanical activities for highly skilled tasks (i.e., following procedures, performing operations)? Rating

= 1.77
3.5

10

Never

Most of the time

Weighting

=0.81
2.6

Not at all important

Very important

N. Pressure: How much pressure do you have in your work (i.e., dealing with clinical crises, need for immediate decisions about patients, dealing with multiple patients simultaneously). Rating

=2.26
6.7

10

Minimal pressure

High pressure

Weighting

=0.85
3.1

Not at all important

Very important

O. Responsibility: How much responsibility do you assume for patient outcomes in your work? Rating

= 1.92
8.1

10

Limited responsibility

Sole responsibility

Weighting

=0.89
4.1

Not at all important

Very important

P. Schedule: What type of schedule do you have in your work? Rating

=2.08
4.7

10

Regular hours

Irregular and unpredictable hours

Weighting

=0.81
2.6

Not at all important

Very important

Q. Security: How much professional security do you have in your position, (i.e., know where you stand and are certain of your future professionally, will there be a need for your services in the future)? Rating

=1.17
8.1

10

Little security

Great deal of security

Weighting

=0.72
3.9

Not at all important

Very important

R. Sense of accomplishment: To what extent does your work provide the opportunity to see end results? Rating

= 1.09
7.8

10

Little opportunity

Great deal of opportunity

Weighting

=0.73
4.5

Not at all important

Very important

Weekly distribution of time According to the survey, oncologists spend their week as follows: Activity Patient care activities On-call(in contact) On-call(available) Administrative Professional travel Continuing education Community service Research Other professional Average Hours per week (may overlap) 33.18 16.46 49.62 6.50 3.79 4.64 3.83 12.60 6.43

Patient profile
A. Patient encounters per week
70 60

Number of Patients

50 40 30 20 10 0

Ambulatory

Inpatient

Nursing Home

Telelphone

Terminally Ill Other Encounters

B. Patient characteristics By age Infants(0-2 yrs) Children(3-18 yrs) Adults(19-64 yrs) Older adults(65+ yrs) % 0.00 0.14 50.24 49.71 Percentage of patient encounters that deal with: % Routine check-ups 18.75 Acute illness 22.19 Chronic illness 62.50 Terminal illness 24.00 Percentage of time per patient encounter devoted to: Acute conditions Chronic conditions Preventitive health

% By race Underrepresented minority (URM) 20.00 Non-URM 80.00 By type of insurance Medicaid/Medicare Uninsured Other % 55.63 11.13 33.24

% 32.94 69.12 10.25

C. Five types of illnesses/conditions most frequently encountered Number of responses Myeloid cancers(leukemia, lymphoma, 52 myeloma) Lung cancer 33 Breast cancer 32 Colon cancer 27 Prostate cancer 11

Specialty: Oncology

Total survey responses: 17

Summary of comments for question: List up to three other factors, if any, you would advise students to consider carefully before selecting your specialty? Physicians who completed the Pathway Physicians Survey, 2003, submitted the following comments. The majority of comments are categorized by the Critical Factors that are rated and weighted in another section. Numbers in parentheses indicate the total number of responses for a particular comment. 1. Caring for Patients Willingness to interact with the patients family (Usually not compensated) Enjoy primary care aspects of patient care 2. Continuity of Care 3. Autonomy 4. Diversity 5. Personal Time Personal interests 6. Expertise Interest in basic science Need for critical thinking Expectation of interaction of scientific discovery and patient care Oncology is half research and half medicine; learn to separate emotions and experimentation 7. Income Satisfaction 8. Creativity 9. Certainty of Outcomes 10. Clinical Decision Making 11. Patient Decision Making 12. Interacting with Other Physicians/Members of Health-care Team Ability to work as a team member Colleagues 13. Manual /Mechanical Activities

14. Pressure Ability to deal with stress 15. Responsibility 16. Schedule Time requirement 17. Security Job opportunities Future trends in that specialty 18. Sense of Accomplishment 19. Patient Characteristics Patients often have limited life spans 20. Types of Illnesses Must learn to deal with death Dealing with terminal illness 21. Practice Environment Decide early: academic vs. private practice based 22. Health Care Environment 23. Personality/Temperament Compassion Can you help people to find their comfort with approaching the end of life? Able to deal with success and failure Patience and empathy Collegiality Inward motivation (2) Diligence 24. Miscellaneous Comments Rate location to live and practice - difficult to move in private practice Personal satisfaction You cannot save everyone Life partner who is supportive and understands you, also intellectual equal, someone you can talk with about life, family issues Research in that area