Where have all the students gone?

Where have all the students gone?

Anees B. Chagpar, MD, MPH

@AneesChagpar
Jul 25, 2011
There seems to be an impending shortage of oncologists. We’ve known this for a while, and while potential solutions to transition patients to primary care providers have been proposed, there seems to be a looming shortage of them as well. Furthermore, while increasing the number of oncology training slots may help increase the oncologic workforce, this will only be effective if medical students and residents actually choose to go into oncology, and thus far, there seems to be record low numbers of medical students choosing general internal medicine or surgery (the gateways to medical and surgical oncology). While many lament this fact, it is perhaps not unexpected...

With the ever-rising burden of medical student debt, it cannot be truly surprising that medical students are choosing highly lucrative fields that happen to have a good lifestyle to boot—is it truly any wonder why dermatology, ophthalmology and orthopedics are on the rise? A recent article in Forbes makes the financial argument abundantly clear.

On top of which, medical students are deciding earlier on their subspecialty...when one considers that specialties like plastic surgery and neurology no longer require the more general background of a primary residency, the pool of students entering an undifferentiated general surgery or internal medicine residency wanes. In addition, the concept of doing a general medicine or surgery residency followed by an oncologic fellowship is a painful extension to what many consider an already long educational tenure.

Still, you and I did it...and would likely do it again—it seems for many of us unfathomable that every student isn't completely enamoured by oncology...So why aren’t students these days interested in oncology at the get-go? If you think back to your med student days, I would argue there are a number of reasons why students do not get bitten by the oncology bug early:
  1. Lack of experience: do students get enough exposure in medical school to oncology, or are they only exposed to other subspecialties that they enter as a straight residency? And when they are on our rotations, how involved are they? Do students feel like they are actively engaged, or are they treated like they are just a “tag along”?
  2. Lack of mentorship: are we, as practicing oncologists, able to provide enough time and energy to nurture our future colleagues? And do we show them our true passion and enthusiasm for what we do, or are there days when the frustration that is inevitably part of what we do creeps into their experience?

We are never going to have the prestige of the neurosurgeons, the lifestyle of the dermatologists, nor the remuneration of the cardiologists. We do what we do because we love it—there is an intense satisfaction about being able to treat cancer. It is an unbelievably rewarding relationship you have with your patient, and the ability to translate what is increasingly mind-blowing science into meaningful results in the clinic is one of the most amazing experiences ever. So to all the med students out there, remember Confucius: “Find a job you love, and you’ll never work a day in your life”...and the first step to finding a job that you love is to find a mentor who loves theirs (preferably in oncology)!

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