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July 2004 Manic Depression By Michael J. Katin, MD

July 1 has arrived, the day that 17 dedicated and hard-working physicians have anticipated for years, some since childhood and some even longer: the beginning of their Radiation Oncology residency.

The number may be slightly higher but the fact remains that selection for these programs is still highly competitive and will remain so until oncology care is totally taken over by molecular therapy, certainly not before 2006. A previous column (April, 2002) discussed the difficulty of obtaining a residency position. The applicants all thought they knew what to expect over the next four years and for their careers beyond that. They may be about to find some minor deviations from their expectations.

Some of these surprises may be deferred due to the somewhat protected environment of academia, but in fact the main difference between the academic environment and private practice may be that enemies are more easily identified and the battlefields more restricted.

Anticipation	Reality
Looking forward to working with distinguished scholars in the field of oncology.	The distinguished scholars are all at meetings; you learn from the second-year resident.
Major new technologic advances will be rapidly integrated into patient care.	HHS doesn't want  to pay for anything but even if it did, by the time the University committees decide to buy something  you'll already be done with the residency
Learn to work closely with mutual respect for other specialties.	You'll be viewed with loathing and envy.
Work with physicists and dosimetrists to generate complicated treatment plans with homogeneous doses to the target volume and maximal protection of normal tissue.	AP-PA
The study of cancer cause and control will help to reduce the impact of this disease on   the next generation.	Need to learn the location of designated smoking areas if you want to find some of the RTTS and nurses.
Take advantages of all modalities of treatment   for your patients, integrating surgery, chemotherapy,   and immunotherapy with radiation therapy	Can't even get two staff members in the same department to work together
Innovate radiation therapy treatment programs based on the principles of radiobiology you           learned in the course you were farmed out to         take.	1.  Only if a grant can be generated 2.  Only if you can get physicists and RTTs to treat at odd hours 3.  These principles don't work in the human.
Learn the basics of radiation oncology business practice to be able to make a successful living in the outside world in the free enterprise system	You don't learn that in residency   but that's OK, since   by the time you're   ready to go into practice, regulations and   restrictions will   make that impossible.

Let it be said to those entering our specialty:  after twelve years of primary and secondary school, four years of college, four years of medical school, and one year of postgraduate education, you're finally going to get educated.  

Is it going to turn out the way you expected?  Well, for some reason, out of the 7,800 medical programs you could have sought, you had decided on this one, so you might as well follow it through.  Just remember, things could always be worse.  

email: mkatin@radiotherapy.com