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Choosing a career in radiation oncology in India: A survey among young radiation oncologists


1 Department of Radiation Oncology, Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand, India
2 Department of Radiotherapy, Narayana Superspeciality Hospital, Howrah, India
3 Department of Radiotherapy, Midnapore Medical College and Hospital, Midnapore, West Bengal, India

Date of Submission20-Sep-2019
Date of Decision22-Nov-2019
Date of Acceptance07-Jan-2020
Date of Web Publication19-Oct-2020

Correspondence Address:
Praloy Basu,
9B Queens Park, Kolkata - 700 019, West Bengal
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_779_19

 > Abstract 


Background: Radiation oncology in India is much debated as a career option to take up. This survey among young radiation oncologists (YROs), the first of its kind, attempts to assess the career expectations and concerns that affect most of us.
Materials and Methods: This survey was conducted using the online survey tool of SurveyMonkey in October 2018. The Association of Radiation Oncologists of India (AROI) members' database was used to send the survey link over E-mail to recipients (AROI life member after 2004).
Results: Out of 1685 invitees, 492 (29.19%) recipients took the survey. Most (69.14%) of the respondents were males who worked as senior residents and junior consultants and employed in private hospitals and state-level teaching institutes. Postspecialization (MD/DNB) experience was mostly <3 years (56.52%). Most of YROs worked in Tier-I city (48.9%) mostly in telecobalt-based facilities. Most of our respondents (73.01%) aspired to work in academic teaching hospital/research institute, and the primary concern was academics/research (39.88%) followed by income (23.31%). There was a similar distribution of respondents with respect to their desire to shift to medical oncology. There was marked dissatisfaction over remuneration, job openings, job security, and poor scope of career improvement. 56.50% of respondents believed that they need to move abroad to improve their quality of life. However, 76.69% of respondents still felt very passionate about their professional choice. Finally, 61.97% of professionals believed that this survey will correctly reflect the present scenario among YROs.
Conclusions: The survey portrays a mixed picture as expected. Major policy changes are required to improve the infrastructure and job opportunities of this profession.

Keywords: Career in radiation oncology, survey, young oncologists



How to cite this URL:
Mukherjee A, Manir KS, Basu P, Mallik S, Goswami J. Choosing a career in radiation oncology in India: A survey among young radiation oncologists. J Can Res Ther [Epub ahead of print] [cited 2020 Dec 2]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=298622




 > Introduction Top


Radiation oncology in India is much debated as a career option to take up. The junior and middle-tier radiation oncologists are faced with dilemmas related to their profession life. This survey among young radiation oncologists (YROs), the first of its kind, attempts to assess the career expectations and concerns that affect most of us.


 > Materials and Methods Top


The authors developed a survey [Figure 1] composed of 26 questions. This survey was conducted using the online survey tool of SurveyMonkey ® in August 2018. The Association of Radiation Oncologists of India (AROI) members' database was used to send the survey link over E-mail to recipients. The survey link was E-mailed to 1685 radiation oncologists. The radiation oncologists included were life members of AROI with an experience of ≤15 years in the field of radiation oncology including residency. The study was closed in October 2018 with a response rate of 29.19%.
Figure 1: Young radiation oncologists' survey questionnaire

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The questions were developed to seek information regarding factors that may have influenced or correlated with their decisions regarding their future careers, including academic exposure available during residency, workload, resource constraints, opportunities, financial expectations, and satisfaction. The questions were broadly divided into five categories: (1) baseline information, (2) workplace scenario, (3) training, (4) career expectations and outlook toward profession, and (5) psychological aspect.


 > Results Top


Out of 1685 invitees, 492 (29.19%) recipients took the survey.

The median age was 32 years. Most (69.14%) of the respondents were males [Figure 2] who worked as senior residents (28.22%) and junior consultants (27.84%) [Figure 3] and employed in private hospitals and state-level teaching institutes (38.21%). Postspecialization (MD/DNB) experience was mostly <3 years (278; 56.52%) followed by 3–6 years (128; 26%). Most of the respondents worked in Tier-I cities (241; 48.9%), 64.42% worked in a telecobalt-based setup [Figure 4], and brachytherapy was available to 84.75% [Figure 5]. Most of our respondents (73.01%) aspired to work in academic teaching hospital/research institute, and the primary concern was academics/research (39.88%) followed by income (23.31%).
Figure 2: Gender distribution of respondents

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Figure 3: Current position in workplace

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Figure 4: Availability of external beam radiation therapy equipment

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Figure 5: Availability of brachytherapy?

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The responses over change of stream and/or shifting to medical oncology were nearly equally dispersed over disagreement (44.78%) to agreement (38.04%) on a Likert scale [Figure 6].
Figure 6: Shifting to medical oncology - Worthwhile option?

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There was marked dissatisfaction over remuneration and job openings (81.07%). There was also marked job insecurity (71.13%) and poor scope of career improvement (61.38%) as felt by the respondents. 24.85% of YROs felt distressed with the unavailability of IGRT and allied technologies. 56.50% of respondents believed that they need to move abroad to improve their quality of life.

On the brighter side, 76.69% of respondents still felt very passionate about their professional choice. Finally, 61.97% of professionals believed that this survey will correctly reflect the present scenario among YROs.


 > Discussion Top


The Association of Residents in Radiation Oncology (ARRO) conducted surveys among radiation oncology residents in the United States in 2000–2002.[1] However, their value was limited because of low response rates. The 2003 ARRO survey [2] achieved a high response rate of 44% among the residents. This study was designed to provide an insight into the various factors which influence a YRO in India regarding a future career in radiation oncology and achieved a response rate of 29.19%. Senior residents and Junior consultants/assistant professors formed the majority of the respondents.

Smith et al.[3] concluded from their survey that in institutes having groups of two to three radiation oncologists, site-specific practice was limited. However, institutions having four to eight radiation oncologists showed a higher inclination toward site-specific practice. Only 9.09% of respondents in our study reported site-specific practice. However, such stratification based on the number of available radiation oncologists was not attempted. Technique-specific practice was limited to 2.6% of the responders.

Stewart and Kleihues.[4] stated that among the radiotherapy units in developing countries, telecobalt continues to play a predominant part, and linear accelerators constitute just 30% of facilities. By contrast, linear accelerators constitute 85% of the units in the developed world. This study concurred with these findings with 64.42% of respondents practicing in facilities equipped with telecobalt machines only. One positive finding was the availability of brachytherapy facilities for 84.75% of the respondents. A survey by Guedea et al.[5] on brachytherapy practices in European countries showed that 42% of the responding institutions provided brachytherapy.

Pillay et al.[6] in a systematic review opined that the current literature provides evidence that MDT meetings lead to significant changes in the way cancer patients are assessed and managed; however, it is unclear if various changes in assessment and treatment lead to clinically significant differences in patient experience or quality of life. 57.14% of the respondents had availability of a multidisciplinary tumor board.

A survey by Wilson et al.[7] showed that 66.23% of the respondents had presented papers at some conference. 53.37% of the respondents in this study had attended a YROs' conference at the time of participation. Wilson et al.[7] also showed an inclination to pursue fellowships to secure academic careers in 65% of respondents. However, the proportion of respondents in this study pursuing a fellowship or observership of any nature was small.

The 2003 ARRO survey [2] showed that a majority of the respondents (46%) wished to pursue private practice, with financial remuneration being a strong motivating factor in 85% of such respondents. Conversely, this survey demonstrated a motivation of practicing in an academic institution in 73.01% of the respondents. A desire to pursue academics and research over financial remuneration appeared to explain such a response.

A striking feature of the ARRO [2] survey was the reported job satisfaction, with 78% of the respondents being very pleased and 20% being somewhat pleased with their decision to pursue a career in radiation oncology. In this study, 76.69% of the respondents were found to be passionate about a career in radiation oncology. Majority of the respondents enjoyed the company of colleagues and peers in the workplace. While workload did not appear to be a major factor, low financial remuneration and lack of modern radiotherapy facilities at most centers was a source of discontent among the radiation oncologists. 38.04% of respondents had considered shifting to medical oncology as a worthwhile alternative.

Finally, majority of the respondents agreed that this survey would accurately reflect the present scenario for a YRO in India.


 > Conclusions Top


This survey portrays a mixed picture of the current situation faced by YROs in India. It is necessary to make medical graduates aware of pros and cons of a career in radiation oncology. Major policy changes and investment are required to improve infrastructure. Although this survey reflects a general sense of job satisfaction, job opportunity is a major concern for YROs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Jagsi R, Chronowski GM, Buck DA, Kang S, Palermo J; Association of Residents in Radiation Oncology Executive Committee. Special report: Results of the 2000-2002 Association of Residents in Radiation Oncology (ARRO) surveys. Int J Radiat Oncol Biol Phys 2004;59:313-8.  Back to cited text no. 1
    
2.
Jagsi R, Buck DA, Singh AK, Engleman M, Thakkar V, Frank SJ, et al. Results of the 2003 Association of Residents in Radiation Oncology (ARRO) surveys of residents and chief residents in the United States. Int J Radiat Oncol Biol Phys 2005;61:642-8.  Back to cited text no. 2
    
3.
Smith GG, Thrall JH, Pentecost MJ, Fleishon HB, Knipp HC, Adams MJ, et al. Subspecialization in radiology and radiation oncology. J Am Coll Radiol 2009;6:147-590000.  Back to cited text no. 3
    
4.
Stewart BW, Kleihues P. IARC, World Cancer Report. Lyon: International Agency for Research on Cancer; 2003.  Back to cited text no. 4
    
5.
Guedea F, Ellison T, Venselaar J, Borras JM, Hoskin P, Poetter R, et al. Overview of brachytherapy resources in Europe: A survey of patterns of care study for brachytherapy in Europe. Radiother Oncol 2007;82:50-4.  Back to cited text no. 5
    
6.
Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev 2016;42:56-72.  Back to cited text no. 6
    
7.
Wilson LD, Flynn DF, Haffty BG. Radiation oncology career decision variables for graduating trainees seeking positions in 2003-2004. Int J Radiat Oncol Biol Phys 2005;62:519-25.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

 
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