Scarce literature is available worldwide about the perceptions of medical students or doctors about oncology as a field.9 Their decisions about choosing or not choosing oncology in future are likely to be based on or are influenced by their perceptions i.e. what they think of oncology as a career. Since not a lot of students in Pakistan opt for this field as a career 5, our study aimed to highlight their views, be it their subjective assumptions or actual ground facts. Our results showed that the presence of an oncologist in the family was associated with a preference for oncology in future, provided the merit policies and score implications are ignored. The preference was also higher among House Officers/Internees (versus Postgraduate Trainees), those who planned to work/live abroad in future and those who have had a cancer survivor or death due to cancer in their family. Lack of preference for oncology was found among those who believed that poor patient prognosis can have a negative impact on their career choice.
Oncology is a highly competitive field. The research-oriented nature of the field, the ever-growing literature and the advancements in drugs and new regimens showing up from time to time pose a challenge to oncologists to keep up with the medical literature10–14. The drive towards distinction, largely gained through substantive research credentials or higher qualifications, the dearth of good jobs and opportunities and the need to ‘keep up’ are some of the tough experiences described by trained oncologists.15 While the lack of research trend, facilities and novel treatments in Pakistan might ‘ease off’ the challenges as compared to those of oncologists working in developed countries, the competitive nature of the field, the shortage of opportunities, peer pressure and the need to excel are nearly universal issues. Majority of the respondents in our study believed that oncology is a highly progressive and challenging specialty (Table 2) but the association of whether or not it impacted their choice was not clear. This is probably a concern because young doctors may either believe that Pakistan lacks these facilities and culture in general or their other negative perceptions outweigh this positive perception in career choice.
The paucity of oncologic workforce is a global problem, extending to developed countries like USA which expects a shortage of 2,550 to 4,080 oncologists between the years 2005 and 2020.16 The single biggest factor contributing to the discrepancy between supply and demand of oncologic services is the shortage of oncology training slots.16 Pakistan is no different in terms of this shortage. There are only 20 cancer hospitals and 50 other hospitals which exclusively care for cancer patients. There are only 125 trained oncologists, 25 radiotherapy machines, 6 oncology-centric conferences all over Pakistan and Pakistan is yet to publish an oncology journal.4 There is a gross deficit of oncological services in its most populous province ‘Punjab’, with the ratio of medical oncologists to population being 0.027 per 100, 000.17 The increasingly competitive nature of oncology as discussed previously, along with lack of substantial research opportunities, inadequate learning avenues like conferences and the inability to stay up-to-date with new medical literature18 hamper a physician’s growth and result in inability to effectively compete with international peers. All these factors when combined with the lack of slots available in Pakistan might explain the association found between preference of oncology as a career and the decision to live or work abroad.
Since the beginning of time, no disease has paralleled cancer in bringing more dread and dismay to the human race. When it embraces an individual, it embraces a family. The suffering is mutual and long lasting.19 While there has been published work describing these constraints, little is known about its impact in shaping someone’s opinion regarding career in the future. Our study found that those who had gone through this toil of cancer, had had a cancer survivor or death due to cancer in their family, were more likely to choose oncology as a career in future. As much as the loss of a loved one leaves you dejected, it may also instill in you the wish to heal the suffering of fellow cancer-stricken or the psychological will to overcome what has defeated you in the past. These might be the same doctors who grow up to believe that the tussle between ‘importance of intimacy’ and ‘art of detachment’ in the field of oncology is one of its core quality and uniqueness that draws people into it, according to a qualitative study conducted in Australia on Medical Oncologists in 2016.15
Lack of preference and more negative perceptions were found among Post Graduate trainees as compared to the House Officers/Internees. This may actually reflect their subjective bias where they see their own field as being ‘superior’ since they have made up their minds, or it may actually reflect a better understanding, exposure and knowledge about ground facts in oncology working culture, as oncology has been found to have low job satisfaction and high physician burnout.13,17,20 House Officers/Internees on the other hand, are either free of this subjective bias or are less likely to have enough exposure so they make ‘naive’ perceptions.
In a nationwide study, young ‘oncologists’ in France21 listed the following main reasons for choosing a career in oncology: cross-sectional nature, the depth and variety of human relations and the multi-disciplinary field of work. Our study mainly focused on young doctors that are fresh graduates. Following were the most popular positive perceptions about oncology in the descending order: progressive field, gender neutral specialty, stable working hours, financially healthy specialty and work-family balance. The top negative perceptions were lack of oncologic facilities in Pakistani hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load and depression. The perceptions of male and female doctors were almost aligned with slight variations in the perception of depression and concern for radiation exposure in the field.
Since the study is conducted in a developing country like Pakistan, some of its findings (e.g. lack of facilities) are not comparable to the developed countries with a quality healthcare setup but the majority of findings are generalizable, and the scarcity of oncologists and the ever growing cancer burden is a global problem.9,18 The study is unique in the sense that no study in Pakistan or abroad has been solely dedicated to identify the perceptions of majorly ‘early’ and ‘unbiased’ career doctors with a considerable focus on oncology.