The Role Of An Oncologist:
There are two main subtypes of non-surgical oncologists - medical oncologists and clinical oncologists.
1 - Medical oncologists perform diagnostics and assessment of cancer patients and subsequently treat and manage patients to provide the best possible outcome. They conduct research with practical applications alongside their clinical careers.(1)
An Oncologist’s job usually revolves around making cancer diagnosis, discussing the treatment options with the patient and arranging and overseeing the drug treatment and the entire therapy process, including the patients’ progress post-treatment.(1)
They commonly perform chemotherapy, endocrine therapy, antibody or other biological therapies, and immunotherapy.(1) Medical oncologists treat diseases such as gastrointestinal cancers, lung cancer, genitourinary tract cancers, melanoma, leukaemia etc.(1)
There is no CCT subspecialty for medical oncology, however many oncologists choose to focus on different types of cancers, such as urological cancers, cancers of the blood and lymphatic system, etc, or develop an interest in paediatric oncology, imaging techniques (eg, CT, MRI, CAT,…) in relation to cancer diagnosis and treatment, or palliative care.(1)
2 - Clinical oncologists work with radiotherapy, and systemic therapy techniques such as chemotherapy, biological agents and hormone therapy to treat cancer patients.(2) They mainly use radiological treatments and chemotherapy, while medical oncologists work with non-radiological treatments.(2) Although they rarely make the cancer diagnosis, clinical oncologists are the ones who patients address with concerns and enquiries about their condition.(2)
They assess treatment plans which are presented to patients before an informed treatment choice is made. They also help patients understand and deal with their condition. Clinical oncologists tend to concentrate on one or two types of cancer as they progress with their careers, however there are no defined sub-specialties in clinical oncology. (2)
Advances in cancer treatment technologies such as proton beam therapies, progress in cancer genome research and other projects suggest opportunities for further improvement of oncological treatment and care for cancer patients, thus suggesting further development of oncology as a medical field.(3)
The proportion of female trainees and consultants in oncology continues to grow. The clinical oncology UK workforce census in 2018 recorded that 49% of current clinical oncology consultants were female, and the number of female oncology trainees is increasing.(4)
A Typical Week:
Medical oncologists carry out most of their work in cancer centres, and cancer patients often receive their care in outpatient conditions, ie in clinics and day care wards.(3) Consultants regularly hold outpatient clinics in which they see new patients or assess follow-up patients and prescribe and organise patient treatment.
Medical oncologists also carry out inpatient assessment and hold multidisciplinary team meetings, as well as dedicate some of their time to teaching and training roles.(3) They often support clinical audit and take part in National Cancer Research Network trials carrying out research with clinical applications in oncology.(3) The proportion of consultants who are regularly on-call during weekends is just under 40%.(3)
Medical oncologists will work with clinical oncologists, specialist nurses, and administrative staff, as well as surgical oncologists, radiologists, histopathologists, other healthcare professionals and research practitioners and other professions related to medicine.(3)
Clinical oncologists spend most of their time in specialist cancer hospitals, bigger teaching hospitals, and general hospitals and may need to travel between workplaces during the day.(5)
At the start of each shift there will be a multidisciplinary team meeting in which the plans for the day are discussed, after which clinical oncologists will usually go to the outpatient clinic and carry out ward rounds to see and assess the inpatients.(5) A big proportion of an oncologist’s workload is dedicated to direct clinical care of patients.(5)
The on-call demand for consultants is approximately one in eight, however it is unusual for a clinical oncologist to be called out during the night, and most of the on-call workload comprises providing over-the-phone advice to colleagues.(5) A proportion of a clinical oncologist’s time is spent writing notes, putting together reports for GPs and other doctors and other administrative work.(5)
Consultants should spend some time teaching their junior colleagues or medical students, and undertaking research is also a key component of a clinical oncologist’s work. Research is often carried out with the aims of developing new technologies for cancer treatment to benefit the patients and clinical oncologists often run and participate in clinical trials.(5)
Clinical oncologists work alongside surgeons, clinicians, medical oncologists, specialist nurses, radiographers, pathologists and a range of other medical professionals, researchers and scientists.(5)
The Route To Becoming An Oncologist:
After the two-year UK foundation training programme, or an equivalent.(6,7), prospective medical and clinical oncologists have the choice of two pathways - a two-year core medical training (CMT) programme, or a three-year acute common care stem (ACCS) programme in acute medicine.
These programmes consist of 4-6 placements in different medical specialties including some time in acute medicine.(6,7)
To apply for higher specialty training in medical oncology, the trainees will need to hold the full Membership of the Royal College of Physicians (MRCP UK).(6) Higher specialty training in medical oncology starts in ST3 and lasts a minimum of four years.(6) Some trainees aim to obtain a dual CCT in medical oncology combined with another specialty, and those will need to apply for a programme that is clearly stated to be a dual training programme.(6)
Medical oncology trainees are required to have sat, and passed, a Specialist Certificate Exam (SCE) before they can obtain a CCT in medical oncology.(6)
If a trainee wishes to apply for higher specialty training in clinical oncology after the core training, they will need to have achieved MRCP UK part 1 before they apply, and part 2 before the start of their clinical post.(7) Higher specialty training in clinical oncology starts in ST3 and continues until ST7.(7)
Training thus lasts five years, after which a successful trainee will achieve a CCT in clinical oncology. The higher specialty training is divided into three main components - core clinical oncology training (ST3-4), intermediate training (ST4-5) and advanced training (ST6-7).(7)
By the end of core clinical oncology training, the trainees must pass the first Fellowship of the Royal College of Radiologists (FRCR), and by the end of advanced clinical oncology training, the trainees will need to have passed the final FRCR before they can obtain their CCT in clinical oncology.(7)
There are opportunities to take time out of programme and undertake research, or gain experience form different cancer centres in the UK.(7) It is encouraged that clinical oncology trainees undertake research during training, and it is possible to take up to 6 months of full-time research in the specialty or sciences related to it. If need be, this can be extended to 12 months.(7)
It is also desirable that a clinical or medical oncology trainee has an intercalated BSc or equivalent, a higher degree such as MSc or PhD, some experience in care for cancer patients, and training and skills in managing acute medical emergencies.(7)
Medical students aiming to work in oncology should join oncology-related societies in their universities, and choose a relevant supervised research project.(7)
Foundation trainees preparing to apply for training in medical or clinical oncology should focus on being able to demonstrate the skills gained from foundation training, and aim to get as much experience in oncology or related specialties as possible by applying for taster experiences or placements.
They should also try and undertake teaching and management roles, enter essay prizes and competitions and be sure to keep their ePortfolios accurate and detailed.(7)
Core and specialty trainees in medical or clinical oncology are encouraged to ensure they have sound knowledge of acute general medicine and assess the pros and cons of the specialty by speaking to their senior and more experienced colleagues. It is also recommended that they try to get their work published and present it at conferences, as well as participate in Journal clubs to improve their critical appraisal and scientific writing skills.(7)
In 2019, the competition ratios for ST3 entry in medical oncology and clinical oncology were 3.68 and 2.50 applicants per post, respectively.(8)
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
The mean total annual income of consultants in medical oncology recorded in 2008 was £128,805, with the ratio of private income to NHS income of 0.70.(9) For clinical oncology consultants, the mean total income was £124,496 with the private to NHS income ratio of 0.67.(9)
According to data published in the Independent Practitioner Today, oncologists in 2018 earned £143,000 a year (mean value), out of which £41,000 was used for necessary expenses, thus resulting in the profit of £102,000 per year.(10)
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
It is recommended that prospective oncology trainees research as much about the specialty as possible. Websites of professional bodies are a valuable resource for this, for example the Royal College of Physicians and the Royal College of Radiologists websites, or the GMC and the BMA websites.
There are also other ways to find out what the profession is truly like, such as the Talking Cancer podcast by the Macmillan Cancer Support foundation, or books like Specialist Training in Oncology by T Ajithkumar and H M Hatcher.
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Careers
Health careers NHS, Medical oncology, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/medical-oncology, (accessed Aug 2020)
Health careers NHS, Clinical oncology, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/clinical-oncology, (accessed Aug 2020)
Health careers NHS, Working life (medical oncology), https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/medical-oncology/working-life, (accessed Aug 2020)
The Royal College of Radiologists, Clinical oncology UK workforce census report 2018, pdf, published mar 2019, https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfco192-co-workforce-census-2018.pdf, (accessed Aug 2020)
Health careers NHS, Working life (clinical oncology), https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/clinical-oncology/working-life, (accessed Aug 2020)
Joint Royal College of Physicians Training Board, Specialty training curriculum for medical oncology, pdf, published Aug 2010, https://www.jrcptb.org.uk/sites/default/files/2010%20Medical%20Oncology.pdf, (accessed Aug 2020)
Health careers NHS, Training and development (clinical oncology), https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/clinical-oncology/training-and-development, (accessed Aug 2020)
Health Education England, Specialty recruitment competition ratios 2019, pdf, https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf, (accessed Aug 2020)
Journal of the Royal Society of Medicine, Table 3- conditional mean income by specialty, pdf, published Jul 1 2008, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2442143/table/tbl3/, (accessed Aug 2020)
Consultants’ revenue, expenses and profit by specialty table for 2017 and 2018, Independent Practitioner Today, (accessed Aug 2020) (via author’s supervisor)