- Email: [email protected]
In Reply to Leung
Volume 88 Number 1 2014 6. Cowen D, Troncoso P, Khoo VS, et al. Ki-67 staining is an independent correlate of biochemical failure in prostate cancer treated with radiotherapy. Clin Cancer Res 2002;8:1148-1154. 7. Pollack A, Cowen D, Troncoso P, et al. Molecular markers of outcome after radiotherapy in patients with prostate carcinoma: Ki-67, bcl-2, bax, and bcl-x. Cancer 2003;97:1630-1638.
Factors That Determine Academic Versus Private Practice Career Interest in Radiation Oncology Residents in the United States: Results of a Nationwide Survey In Regard to Chang et al To the Editor: I read with great interest the recent article by Dr Chang and his colleagues (1). We have just recently completed the first Faculty of Radiation Oncology survey of trainees in Australia and New Zealand (2). Our survey dealt specifically with experiences and perceptions on work practices and choice of specialty (2). A part of our survey analyzed preferences for academic or private practice and the reasons for these preferences. It is interesting to compare our results with those of the United States. Our survey analyzed other variables apart from academic versus private practice, such as reasons for choosing radiation oncology as a career, satisfaction with the network, clinical hours per week, and several other areas of interest. Our response rate was 83% (130 of 157) (2). In Australia and New Zealand, the main reasons for preferring academic practice were research opportunities, teaching opportunities, lifestyle, and job availability (2). It was interesting to note that only 4% of trainees in Australia or New Zealand want to work in private practice (2). It would be interesting to see the American figures. Women account for half of our trainees but only 30% of radiation oncologists (2, 3). Chang et al noted that having a PhD postgraduate year level, research elective time, obtaining grant funding during residency, and number of publications before residency were factors that correlated with interest in academic practice. In Australia and New Zealand, most medical courses have been undergraduate, so it is unusual for our trainees to hold a PhD. In fact, only 5% held a PhD (2). This is changing though, with more medical courses becoming postgraduate. It is also very unusual for our trainees to obtain research elective time or obtain grants during residency and to have any publications before residency. Our trainees may do a fellowship after passing their final examinations, and this gives them the opportunity to be involved in research. However, trainees indicated that their main reasons for doing a fellowship were to improve their skills and become more competitive in the job market (2). Chang et al’s comments that baseline interest before residency, academic role models, research opportunities, and academic pressure are influential factors in deciding what type of practice trainees wish to embark in the future make intuitive sense (1). However, job availability is the overriding determinant of what trainees will eventually do. There has been a huge increase in the number of trainees in Australia and New Zealand as in the United Statesdso much so, that there is a concern that not all trainees will find a job (2-5). Therefore, even if you have a preference for either academic or private practice, you might not necessarily end up there, depending on job availability.
Comments
241
The article by Chang et al seems to focus more on academic rather than private practice (1). This is especially shown in the choice of the 10 most influential factors affecting career choice and the discussion section, which focuses heavily on a career in academia. Although this is worthwhile, perhaps it would have been reasonable to balance out the discussion with more emphasis on private practice as well. For instance, although the authors acknowledge that baseline interest before residency, academic role models, and academic pressure and obligations were the 3 most influential factors for residents interested in private practice, little else is discussed about private practice. Finally, the distinction between academic and private practice does not have to be black and white, as it seems to be. In Australia, private practices are now involved in training, teaching, and research. Conversely, there is no reason why academic practices cannot become more involved in a service- and business-focused approach. Perhaps the most satisfied and balanced radiation oncologist will be the one who has elements of both academic and private practice, rather than just one or the other. John Leung, MB, BS, FRACR Department of Radiation Oncology Adelaide Radiotherapy Centre Adelaide, Australia http://dx.doi.org/10.1016/j.ijrobp.2013.10.017
References 1. Chang DT, Shaffer JL, Haffty BG, et al. Factors that determine academic versus private practice career interest in radiation oncology residents in the United States: Results of a nationwide survey. Int J Radiat Oncol Biol Phys 2013;87:464-470. 2. Leung J, Le H, Turner S, et al. Faculty of Radiation Oncology 2012 trainee survey: Perspectives on choice of specialty training and future work practice preferences. J Med Imaging Radiat Oncol 2013 Oct 10 [epub ahead of print]. doi: 10.1111/1754-9485.12105. 3. Leung J, Vukolova N. Faculty of Radiation Oncology 2010 workforce survey. J Med Imaging Radiat Oncol 2011;55:622-632. 4. Shah C. Expanding the number of trainees in radiation oncology: Has the pendulum swung too far? Int J Radiat Oncol Biol Phys 2013;85: 1157-1158. 5. Leung J. Expanding the number of trainees in radiation oncology: Has the pendulum swung too far? In Regard to Shah. Int J Radiat Oncol Biol Phys 2013;87:233.
In Reply to Leung To the Editor: We sincerely appreciate the interest Dr Leung has shown in our study (1, 2) and thank him for providing his perspective regarding the professional landscape of our specialty in Australia and New Zealand. We especially appreciate the interesting data he provided from a similar survey study he conducted, showing differences and similarities among our countries and training systems. It does seem that the nature of the training system, along with perhaps cultural differences in Australia and New Zealand, present some challenges in allowing medical trainees to attain a postgraduate doctoral degree and devote significant time for
242
Comments
research. As he notes, it seems unusual for trainees in his region to obtain a PhD (5%) or research publications before residency, whereas among the analyzed respondents in our study nearly 21% held a PhD, and 63% indicated at least one first-authored publication before residency. Furthermore, in our study, both of these factors strongly correlated with an academic career interest; yet despite this difference, Dr Leung notes that in Australia and New Zealand only 4% of trainees were interested in private practice. One might speculate that “burnout” may be a factor in the United States. It is important to note that our study only surveyed the interest level that US trainees had in pursuing an academic versus private practice career and does not report the actual career that trainees subsequently choose. Dr Leung correctly notes that job market forces and availability ultimately limit the proportion of trainees who take academic positions upon graduation, and the majority of graduates will end up taking jobs in the private sector. The main purpose of our study was to determine what factors might predict for a trainee’s interest in academia, so that training program directors could better identify those trainees and provide resources to support their interests. Ultimately the decision is multifactorial and comes down to personal choice based not only on professional desires but also lifestyle and family, which are much more difficult to measure in a single, pregraduation survey. Dr Leung notes that our study emphasizes academic career interests and overlooks factors associated with choosing a career in private practice. We agree that a follow-up study focusing more on private practice is warranted, but we also believe that our study still provides useful insight about why trainees choose a private practice career path over an academic one. Again, because most trainees in the United States take private practice positions, our primary interest as current or former training directors was to understand how we can better support trainees with an academic career interest. As shown in our study, during their first year of residency the vast majority of trainees are interested in academic careers or are undecided (83%), which drops to 59% by their final year of training, with the remainder expressing an interest in private practice. We also agree whole-heartedly that the distinction between academia and private practice radiation oncology is not black and white. There are certainly many examples of physicians in private practice who engage in academic activities, such as publishing research studies, teaching, mentoring, participating in clinical trials,
International Journal of Radiation Oncology Biology Physics and acquiring leadership positions in national organizations. Likewise, academic physicians must be mindful of the economics and business of radiation oncology practice, particularly in the everincreasing uncertainty of the health care landscape. We appreciate Dr Leung highlighting these realities. Our survey was not designed with any specific definition of “academic” versus “private practice” provided, and respondents were free to answer according to their own individual opinion of what these types of careers entailed. However, as suggested by Dr Leung, most positions, regardless of being primarily “academic” or “private practice,” likely have elements of each, and training programs should consider providing some formal education on both of these spheres in order to produce well-rounded and balanced physicians prepared for the realities of the postgraduate world. Daniel T. Chang, MD Department of Radiation Oncology Stanford University Stanford, California Bruce G. Haffty, MD Department of Radiation Oncology University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School New Brunswick, New Jersey Lynn D. Wilson, MD Department of Therapeutic Radiology Yale University School of Medicine New Haven, Connecticut http://dx.doi.org/10.1016/j.ijrobp.2013.10.018
References 1. Chang DT, Shaffer JL, Haffty BG, et al. Factors that determine academic versus private practice career interest in radiation oncology residents in the United States: Results of a nationwide survey. Int J Radiat Oncol Biol Phys 2013;87:464-470. 2. Leung J. In regard to Chang et al. Int J Radiat Oncol Biol Phys 2014; 88:214.
Factors That Determine Academic Versus Private Practice Career Interest in Radiation Oncology Residents in the United States: Results of a Nationwide Survey In Regard to Chang et al To the Editor: I read with great interest the recent article by Dr Chang and his colleagues (1). We have just recently completed the first Faculty of Radiation Oncology survey of trainees in Australia and New Zealand (2). Our survey dealt specifically with experiences and perceptions on work practices and choice of specialty (2). A part of our survey analyzed preferences for academic or private practice and the reasons for these preferences. It is interesting to compare our results with those of the United States. Our survey analyzed other variables apart from academic versus private practice, such as reasons for choosing radiation oncology as a career, satisfaction with the network, clinical hours per week, and several other areas of interest. Our response rate was 83% (130 of 157) (2). In Australia and New Zealand, the main reasons for preferring academic practice were research opportunities, teaching opportunities, lifestyle, and job availability (2). It was interesting to note that only 4% of trainees in Australia or New Zealand want to work in private practice (2). It would be interesting to see the American figures. Women account for half of our trainees but only 30% of radiation oncologists (2, 3). Chang et al noted that having a PhD postgraduate year level, research elective time, obtaining grant funding during residency, and number of publications before residency were factors that correlated with interest in academic practice. In Australia and New Zealand, most medical courses have been undergraduate, so it is unusual for our trainees to hold a PhD. In fact, only 5% held a PhD (2). This is changing though, with more medical courses becoming postgraduate. It is also very unusual for our trainees to obtain research elective time or obtain grants during residency and to have any publications before residency. Our trainees may do a fellowship after passing their final examinations, and this gives them the opportunity to be involved in research. However, trainees indicated that their main reasons for doing a fellowship were to improve their skills and become more competitive in the job market (2). Chang et al’s comments that baseline interest before residency, academic role models, research opportunities, and academic pressure are influential factors in deciding what type of practice trainees wish to embark in the future make intuitive sense (1). However, job availability is the overriding determinant of what trainees will eventually do. There has been a huge increase in the number of trainees in Australia and New Zealand as in the United Statesdso much so, that there is a concern that not all trainees will find a job (2-5). Therefore, even if you have a preference for either academic or private practice, you might not necessarily end up there, depending on job availability.
Comments
241
The article by Chang et al seems to focus more on academic rather than private practice (1). This is especially shown in the choice of the 10 most influential factors affecting career choice and the discussion section, which focuses heavily on a career in academia. Although this is worthwhile, perhaps it would have been reasonable to balance out the discussion with more emphasis on private practice as well. For instance, although the authors acknowledge that baseline interest before residency, academic role models, and academic pressure and obligations were the 3 most influential factors for residents interested in private practice, little else is discussed about private practice. Finally, the distinction between academic and private practice does not have to be black and white, as it seems to be. In Australia, private practices are now involved in training, teaching, and research. Conversely, there is no reason why academic practices cannot become more involved in a service- and business-focused approach. Perhaps the most satisfied and balanced radiation oncologist will be the one who has elements of both academic and private practice, rather than just one or the other. John Leung, MB, BS, FRACR Department of Radiation Oncology Adelaide Radiotherapy Centre Adelaide, Australia http://dx.doi.org/10.1016/j.ijrobp.2013.10.017
References 1. Chang DT, Shaffer JL, Haffty BG, et al. Factors that determine academic versus private practice career interest in radiation oncology residents in the United States: Results of a nationwide survey. Int J Radiat Oncol Biol Phys 2013;87:464-470. 2. Leung J, Le H, Turner S, et al. Faculty of Radiation Oncology 2012 trainee survey: Perspectives on choice of specialty training and future work practice preferences. J Med Imaging Radiat Oncol 2013 Oct 10 [epub ahead of print]. doi: 10.1111/1754-9485.12105. 3. Leung J, Vukolova N. Faculty of Radiation Oncology 2010 workforce survey. J Med Imaging Radiat Oncol 2011;55:622-632. 4. Shah C. Expanding the number of trainees in radiation oncology: Has the pendulum swung too far? Int J Radiat Oncol Biol Phys 2013;85: 1157-1158. 5. Leung J. Expanding the number of trainees in radiation oncology: Has the pendulum swung too far? In Regard to Shah. Int J Radiat Oncol Biol Phys 2013;87:233.
In Reply to Leung To the Editor: We sincerely appreciate the interest Dr Leung has shown in our study (1, 2) and thank him for providing his perspective regarding the professional landscape of our specialty in Australia and New Zealand. We especially appreciate the interesting data he provided from a similar survey study he conducted, showing differences and similarities among our countries and training systems. It does seem that the nature of the training system, along with perhaps cultural differences in Australia and New Zealand, present some challenges in allowing medical trainees to attain a postgraduate doctoral degree and devote significant time for
242
Comments
research. As he notes, it seems unusual for trainees in his region to obtain a PhD (5%) or research publications before residency, whereas among the analyzed respondents in our study nearly 21% held a PhD, and 63% indicated at least one first-authored publication before residency. Furthermore, in our study, both of these factors strongly correlated with an academic career interest; yet despite this difference, Dr Leung notes that in Australia and New Zealand only 4% of trainees were interested in private practice. One might speculate that “burnout” may be a factor in the United States. It is important to note that our study only surveyed the interest level that US trainees had in pursuing an academic versus private practice career and does not report the actual career that trainees subsequently choose. Dr Leung correctly notes that job market forces and availability ultimately limit the proportion of trainees who take academic positions upon graduation, and the majority of graduates will end up taking jobs in the private sector. The main purpose of our study was to determine what factors might predict for a trainee’s interest in academia, so that training program directors could better identify those trainees and provide resources to support their interests. Ultimately the decision is multifactorial and comes down to personal choice based not only on professional desires but also lifestyle and family, which are much more difficult to measure in a single, pregraduation survey. Dr Leung notes that our study emphasizes academic career interests and overlooks factors associated with choosing a career in private practice. We agree that a follow-up study focusing more on private practice is warranted, but we also believe that our study still provides useful insight about why trainees choose a private practice career path over an academic one. Again, because most trainees in the United States take private practice positions, our primary interest as current or former training directors was to understand how we can better support trainees with an academic career interest. As shown in our study, during their first year of residency the vast majority of trainees are interested in academic careers or are undecided (83%), which drops to 59% by their final year of training, with the remainder expressing an interest in private practice. We also agree whole-heartedly that the distinction between academia and private practice radiation oncology is not black and white. There are certainly many examples of physicians in private practice who engage in academic activities, such as publishing research studies, teaching, mentoring, participating in clinical trials,
International Journal of Radiation Oncology Biology Physics and acquiring leadership positions in national organizations. Likewise, academic physicians must be mindful of the economics and business of radiation oncology practice, particularly in the everincreasing uncertainty of the health care landscape. We appreciate Dr Leung highlighting these realities. Our survey was not designed with any specific definition of “academic” versus “private practice” provided, and respondents were free to answer according to their own individual opinion of what these types of careers entailed. However, as suggested by Dr Leung, most positions, regardless of being primarily “academic” or “private practice,” likely have elements of each, and training programs should consider providing some formal education on both of these spheres in order to produce well-rounded and balanced physicians prepared for the realities of the postgraduate world. Daniel T. Chang, MD Department of Radiation Oncology Stanford University Stanford, California Bruce G. Haffty, MD Department of Radiation Oncology University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School New Brunswick, New Jersey Lynn D. Wilson, MD Department of Therapeutic Radiology Yale University School of Medicine New Haven, Connecticut http://dx.doi.org/10.1016/j.ijrobp.2013.10.018
References 1. Chang DT, Shaffer JL, Haffty BG, et al. Factors that determine academic versus private practice career interest in radiation oncology residents in the United States: Results of a nationwide survey. Int J Radiat Oncol Biol Phys 2013;87:464-470. 2. Leung J. In regard to Chang et al. Int J Radiat Oncol Biol Phys 2014; 88:214.