Ask an Radiation Oncologist Anything

[Winged Scapula]

Even among doctors, wouldn't you refer to yourself as a radiation oncologist even though the word oncology encompasses all the oncology-related fields?

Absolutely, hence my advice to the OP (which is especially important for the lay public but also relevant amongst medical professionals).

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[oncologydude2]

Might I suggest that you change the title of your thread to say "Radiation Oncologist" as the term "Oncologist" is typically assumed to be Med Onc especially to the lay public (which Pre Med students would be).

Ok, but can't seem to figure it out. Help would be appreciated.

 

[Winged Scapula]

Ok, but can't seem to figure it out. Help would be appreciated.

Only donors (and staff) can change thread titles. I didn't want to change it for you without your agreement.

Its done now.

 

[oncologydude2]

How do you feel about that? Are you doing anything to change that? Is there a big push from oncology to change it?

It is what it is. People studying/treating "underrepresented" cancers frequently bemoan the fact that that their patients are left behind. Personally, I am fine with the free market dictating it.

 

[oncologydude2]

Even among doctors, wouldn't you refer to yourself as a radiation oncologist even though the word oncology encompasses all the oncology-related fields?

Usually yes, but it depends on the context of the conversation.

 

[oncologydude2]

Besides radiation, what other decisions are you helping patients make with their cancer treatment? Other than the therapy used, what major differences are there between med onc and rad onc?

Patients frequently ask my opinion on other aspects of their care, surgery, chemo and hormone therapy.

Med Onc is 3 year residency and 3 year fellowship. Rad Onc is 1 year internship and 4 year residency. MO are more on the front line and handle benign heme (anemia, coag disorders). RO deal with most cancers, many benign conditions and occasional functional disorders. RO is very capital ($$) intense and requires more specialized staff to deliver.

 

[oncologydude2]

How involved are you in the follow-up of your patients after they are given radiation? I've read before that since med oncs pretty much become cancer patients' primary doctors, med oncs often are the ones who deal with the side effects associated with radiation.

Also, if you do some of these procedures yourself like brachytherapy, do you get exposed to a lot of radiation in your practice? Would someone else be doing these in a hospital?

Lastly, once you finished residency, how easy was it to find your current job (considering the saturation of rad oncs in the field)?

I follow up with most of my patients long term. Since we are all in the same practice it's not such a big deal. Sometimes patients object to multiple follow ups with different MDs due to time/expense. In those case usually goes to MO only.

We have Dosimetry badges to monitor radiation exposure and these are meticulously audited No exposure risk.

Finding my current job was easy in retrospect but I think I was extremely lucky and the timing oft graduation with a nearby opening synced perfectly.

 

[deleted407021]

Would RO be harder to establish in a rural area seeing as it is so depended upon both human and equipment capital? Do most ROs work in large health systems?

I know that the field is considered to be quite competitive. Do you foresee any changes in this in the future?

Thanks, doc!

 

[oncologydude2]

Would RO be harder to establish in a rural area seeing as it is so depended upon both human and equipment capital? Do most ROs work in large health systems?

I know that the field is considered to be quite competitive. Do you foresee any changes in this in the future?

Thanks, doc!

In rural areas it can be challenging. As you noted not just $$ and recruiting staff, but also with enough patients to treat. Rural centers tend to have a large catchment area. Most ROs are employed I would guess. Fewer and fewer go into business independently.

As long as work hours and $$ are good, the field will remain competitive. I don't see either changing anytime soon.

 

[BurghMed]

Hi oncologydude2, thanks so much for doing this.

I'm curious if a large percentage of ROs do clinical research, or if it requires being a part of large health system to do it. Also, I'm interested in whether or not contouring bores you at all if that's something you do on a day to day basis. I shadowed an RO for only a few days and the residents/fellows did all of that for the RO. I'm curious how much of your time is spent contouring if at all. Thanks so much!

 

[sunflower18]

Thanks so much for doing this!! I'm starting med school next year and am really interested in oncology (both medical and radiation), and am trying to get more exposure to rad onc.

1) I really like the idea of rad onc -- working with cancer, long term relationships with patients, treatment planning -- but I'm concerned about the amount of physics and math required. Should I not let those subjects deter me, or would it be unwise to pursue rad onc knowing full well that I don't like physics/math?

2) What are the training/job opportunities for pediatric radiation oncology?

3) Do most radiation oncologists at academic centers conduct basic or clinical research? Or is it widely varied?

Thank you so much again!! I'm really excited about this thread.

 

[oncologydude2]

Hi oncologydude2, thanks so much for doing this.

I'm curious if a large percentage of ROs do clinical research, or if it requires being a part of large health system to do it. Also, I'm interested in whether or not contouring bores you at all if that's something you do on a day to day basis. I shadowed an RO for only a few days and the residents/fellows did all of that for the RO. I'm curious how much of your time is spent contouring if at all. Thanks so much! - See more at: http://forums.studentdoctor.net/thr...-anything.1104071/page-2#sthash.9F6moxSc.dpuf

It depends what you mean by "clinical research." If you mean actually create clinical trials from scratch, then I would say < 10% of ROs do that. If you mean simply enroll patients on the clinical trials of others (e.g. cooperative group studies like RTOG) then that number is much higher. Possible as high as 35%, though I'm not sure.

In community practice, I do all of the contouring myself there are no fellows/residents. Personally, I really enjoy it. Software has increased by leaps and bounds over the last few years to facilitate these tasks.

 

[stewjds]

I am seriously considering a career as an Oncologist. I am pre-med and have a year and a half left before med school. My catch is that I am much older than most going through. I will be 31 when I start medical school. Would you think that I can still have a successful career in oncology even though I will be in my 40's before I finish school/residency/fellowship or due to my late start, would I be better in a career that doesn't require as much time after medical school? My passion is for oncology, but I am nervous about my competitiveness at my age, despite my academic achievements.

 

[oncologydude2]

Thanks so much for doing this!! I'm starting med school next year and am really interested in oncology (both medical and radiation), and am trying to get more exposure to rad onc.

1) I really like the idea of rad onc -- working with cancer, long term relationships with patients, treatment planning -- but I'm concerned about the amount of physics and math required. Should I not let those subjects deter me, or would it be unwise to pursue rad onc knowing full well that I don't like physics/math?

2) What are the training/job opportunities for pediatric radiation oncology?

3) Do most radiation oncologists at academic centers conduct basic or clinical research? Or is it widely varied?

Thank you so much again!! I'm really excited about this thread.

1. No, ok to pursue. For all the song & dance about Rad Onc is "math/physics heavy," the reality is far more basic. All med students will be familiar with far more sophisticated math than is required to function daily as a Rad Onc. Physics is slightly different. In the course of residency and board certification, you need to know a lot more physics than you actually use. However, in practice you use it far less particularly since you have PhD level physicists to support you.

2. All residency programs treat pediatric patients. Only a handful of private practices treat pediatrics and those that do are generally hospital departments due to necessity of pedi anesthesia & social work. Most pedi centers are academics. These types of jobs can be challenging to come by so if a job is not available upon graduation and your heart is set on peds then you may have to do a fellowship and bide your time.

3. Technically all academic faculty 'should' be doing research. However, there are faculty who work in satellites & adjunct faculty who teach without a significant research component or are simply 'workhorses' for the university.

 

[oncologydude2]

I am seriously considering a career as an Oncologist. I am pre-med and have a year and a half left before med school. My catch is that I am much older than most going through. I will be 31 when I start medical school. Would you think that I can still have a successful career in oncology even though I will be in my 40's before I finish school/residency/fellowship or due to my late start, would I be better in a career that doesn't require as much time after medical school? My passion is for oncology, but I am nervous about my competitiveness at my age, despite my academic achievements.

For the most part you should be fine. There are only a few areas of Rad Onc (and even fewer for Med Onc) that rely on hand-eye coordination & muscle memory. I see a lot of Oncologists who practice well into their 70s.

 

[stewjds]

For the most part you should be fine. There are only a few areas of Rad Onc (and even fewer for Med Onc) that rely on hand-eye coordination & muscle memory. I see a lot of Oncologists who practice well into their 70s.

Thank you for your quick answer. One more question.

Do you feel that your salary is in the normal expected range for your career field? When you look for salary info on the web, the average salary is listed well below what you make. I'm just curious if we could expect similar results to yours, or if we should figure to be closer to what the "national average" claims.

 

[oncologydude2]

Thank you for your quick answer. One more question.

Do you feel that your salary is in the normal expected range for your career field? When you look for salary info on the web, the average salary is listed well below what you make. I'm just curious if we could expect similar results to yours, or if we should figure to be closer to what the "national average" claims.

Any salary that you find published on line (e.g. for free) is worthless. The best metrics are MGMA salary tables which cost hundreds of dollars to obtain and are extremely comprehensive. Based on that metric, my income is probably in the 45% percentile for my experience, location & practice setting (e.g. average).

 

[Dr. Retractor]

Any salary that you find published on line (e.g. for free) is worthless. The best metrics are MGMA salary tables which cost hundreds of dollars to obtain and are extremely comprehensive. Based on that metric, my income is probably in the 45% percentile for my experience, location & practice setting (e.g. average).

So do you think looking at Medscape or Merritt Hawkins for an idea of salaries in specific specialties is a waste of time? Also what caliber of med school and residency did you go to?

 

[helpabrotherout]

First of all, thanks for doing this!

My question is, how has your career affected your family life? Do you ever regret pursuing your specialty due to how much family time it takes away?

 

[oncologydude2]

So do you think looking at Medscape or Merritt Hawkins for an idea of salaries in specific specialties is a waste of time? Also what caliber of med school and residency did you go to?

I would put little/no stock in Medscape or MH. Med school = top 25 per US News. Residency = top 10 per Doximity

 

[oncologydude2]

First of all, thanks for doing this!

My question is, how has your career affected your family life? Do you ever regret pursuing your specialty due to how much family time it takes away?

It has affected my family life somewhat. My wife also works full-time so we put our children in extended daycare. The main issue is when I have meetings/duties outside of normal business hours which has caused minor stress.

Since Rad Onc is one of the best specialties for work-life balance I have absolutely no regrets.

 

[PlumbLine]

Thanks so much for doing this!

I'm curious where you think RO is headed in the next couple decades. With Medical Oncology it seems like I hear about new treatments on the horizon, and they get some attention regarding pharmacogenomics. Is there still plenty of room for innovation in RO? Are you excited for any new technologies on the horizon?


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[Dr. Retractor]

It has affected my family life somewhat. My wife also works full-time so we put our children in extended daycare. The main issue is when I have meetings/duties outside of normal business hours which has caused minor stress.

Since Rad Onc is one of the best specialties for work-life balance I have absolutely no regrets.

Would you still have gone into RO if the work/life balance wasn't as good?

 

[oncologydude2]

Thanks so much for doing this!

I'm curious where you think RO is headed in the next couple decades. With Medical Oncology it seems like I hear about new treatments on the horizon, and they get some attention regarding pharmacogenomics. Is there still plenty of room for innovation in RO? Are you excited for any new technologies on the horizon?

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There is plenty of room for innovation in Rad Onc, I am very excited for the future of the field.

New stuff includes radiation improving abscopal effect, combing XRT with immunotherapy, ever improving targeting and precision, MRI guided treatment and use of heavy ions.

 

[oncologydude2]

Would you still have gone into RO if the work/life balance wasn't as good?

Most probably, unless it was realty, really bad.

 

[helpabrotherout]

It has affected my family life somewhat. My wife also works full-time so we put our children in extended daycare. The main issue is when I have meetings/duties outside of normal business hours which has caused minor stress.

Since Rad Onc is one of the best specialties for work-life balance I have absolutely no regrets.

Thank you for answering!

 

[occams_razor]

Thank you for taking the time to do this!

1. If a pre-med is interested in RO, would you advise only applying to MD programs? What if they can only get accepted to a DO program?

2. How do you cope with the really tough cases, like when you have a patient who is a young person who is terminal?

 

[lelz]

sup thanks for doing this. do you feel your creativity in practice is restricted at all with having protocol to follow? i.e. are there procedures that you agree/disagree with that may be excluded/included in the protocol you mentioned earlier?

 

[oncologydude2]

Thank you for taking the time to do this!

1. If a pre-med is interested in RO, would you advise only applying to MD programs? What if they can only get accepted to a DO program?

2. How do you cope with the really tough cases, like when you have a patient who is a young person who is terminal?

1. Allopathic schools will definitely give you the best shot. Not impossible for osteopaths but deck is stacked against you.

2. Professionally, we have very strong peer review to make sure everyone agrees that my treatment plan is optimal. Psychologically everyone decompresses in their own way. Like family, friends, hobbies, drinking, etc .

 

[oncologydude2]

sup thanks for doing this. do you feel your creativity in practice is restricted at all with having protocol to follow? i.e. are there procedures that you agree/disagree with that may be excluded/included in the protocol you mentioned earlier?

There is definitely creativity. Guidelines are written in such a way that there is range of accepted treatments. If you go outside this, you need to have a good reason that is literature based depending on the specifics of a patients case.

 

[oncologydude2]

Thank you for answering!

You're welcome!

 

[optimistic3]

1. How do you feel about proton therapy radiation compared to standard photon radiation?

2. Can you tell me about follow ups, let's say 1 year after radiation is finished? If the patient is having no problems/side effects, do you still want and expect them to come in?

3. How often would you say that you see patients with long term side effects from radiation? For example, secondary cancers or heart and lung issues. And do you have a way of knowing if it was caused by the radiation or something else?

Thanks for doing this thread!

 

[BrCo]

What was the most difficult part of your training?

Do radiation oncologists seem to share a certain personality type? What characteristics allow one to be successful at this profession?

It seems as if medical oncologists are more involved in the totality of patient care. Is this true? If it is, do you ever wish to have more involvement.

How did you do on Step1 and how were the RO boards compared to Step1?

Any advice for an incoming M1 interested in RO? When should I start research? Is a year off for research time a necessity? It seems a lot of RO have a PhD. Does this put general MD applicants at a disadvantage?

 

[oncologydude2]

1. How do you feel about proton therapy radiation compared to standard photon radiation?

2. Can you tell me about follow ups, let's say 1 year after radiation is finished? If the patient is having no problems/side effects, do you still want and expect them to come in?

3. How often would you say that you see patients with long term side effects from radiation? For example, secondary cancers or heart and lung issues. And do you have a way of knowing if it was caused by the radiation or something else?

Thanks for doing this thread!

1. Protons are highly useful in specific clinical scenarios - skull base tumors, pediatric cancers, tumors in close proximity to the brainstem/spinal cord. However, current fee-for-service reimbursement encourages proton use for common cancers with no proven benefit like prostate to make $$. Eventually, the bubble will burst. Until then people will make off like bandits.

2. Long-term follow-ups constitute a lot more than "are your radiation side effects gone." Other key issues are recurrence, secondary cancers from chemo/XRT, and survivorship. The latter is particularly important nowadays as quality of care is taking precedence.

3. Usually acute side effects of radiation are gone within a month or two after treatment. Secondary cancers usually have a latency of 10-30 years, so you have to follow for a LONG time to see these. People tend to blame everything on radiation. For instance, I treated a patient for brain cancer who develop colitis and radiation was blamed! :/

 

[oncologydude2]

What was the most difficult part of your training?

Do radiation oncologists seem to share a certain personality type? What characteristics allow one to be successful at this profession?

It seems as if medical oncologists are more involved in the totality of patient care. Is this true? If it is, do you ever wish to have more involvement.

How did you do on Step1 and how were the RO boards compared to Step1?

Any advice for an incoming M1 interested in RO? When should I start research? Is a year off for research time a necessity? It seems a lot of RO have a PhD. Does this put general MD applicants at a disadvantage?

1. My PhD - my mentor was a beast. One of the most harrowing periods of my life. As one of my friends used to say, "the worst day of medical schools is better than the best day of graduate school."

2. Personality is all over the map. But if I had to generalize, I would say ROs tend to be easy-going, technically oriented, and approachable.

3. Med Oncs do have more involvement overall, they are considered the "primary oncologist." That also means that they have to deal with a lot of "nitty-gritty" issues like hospital admission paperwork, ordering frequent labs, and managing general medicine issues. If you like doing that (I don't) then perhaps Med Onc is for you.

4. My Step 1 score was slightly higher than the mean score (mid 220s) the year that I took it. Step 1 is joke compared to Rad Onc boards. You have to take a series of three written examinations (clinical oncology, radiobiology, physics) and an oral examination (without question the hardest exam I've taken in my life).

5. Express early interest to your RO department. Perhaps shadow or be involved in a simple research project. Year off for research not needed. However, you still need to crank out a publication or two. You can try to do this in the summer between MS2 and MS3. A lot of PhDs but keep in mind that 75% of applicants are MD only - you may have difficulty getting into programs that fancy themselves research powerhouses. Otherwise, shouldn't be a hurdle.

 

[MaduNotSoff]

Thanks for doing this!

With the recent trend shifting away from single-doc private practices to more group practices like yours, where do you see private practice in the future? For example will there be more practices bought by hospitals (with the benefit of guaranteed salary, job security, etc.) or will group private practices continue to be the norm for years to come?

Also are there any fields that will be less "in demand" in upcoming years? More "in demand"?

 

[smarts1]

So going off one your recent answer and given the age range you've given us and the program you did your residency at, what do you think helped you match into a top 10 program with a Step 1 score in the 220s?
Also, regarding rad onc boards... I've heard that there are some horror stories related to this. Is it really that difficult (in your opinion and also in relation to other fields) and do a lot of people fail their rad onc exams? You have to take them again every 10 years to get recertified, correct?

 

[oncologydude2]

Thanks for doing this!

With the recent trend shifting away from single-doc private practices to more group practices like yours, where do you see private practice in the future? For example will there be more practices bought by hospitals (with the benefit of guaranteed salary, job security, etc.) or will group private practices continue to be the norm for years to come?

Also are there any fields that will be less "in demand" in upcoming years? More "in demand"?

It's all about consolidation. With capitated reimbursement and bundled payments increasingly replacing fee for service, it is important that a group covers the full spectrum of clinical care. In addition, there are onerous requirements by the federal government to continue being reimbursed for Medicare patients (robust EMR, quality measures, etc.). Both these things make it increasingly unlikely that small groups will survive. You can either become employed by a hospital/health system or you can start merging your group with like-minded, independent physicians. We have opted for the latter.

"In demand" is a bit hard to predict. Technically speaking, there is a dearth of primary care physicians in the country. Most medical schools have made it their mission to meet this need. However, primary care reimbursement is still poor so I'm not sure how successful this will be. The problem is that "in demand" doesn't equal "more pay." The latter is going to go down for all specialists over time.

 

[oncologydude2]

So going off one your recent answer and given the age range you've given us and the program you did your residency at, what do you think helped you match into a top 10 program with a Step 1 score in the 220s?
Also, regarding rad onc boards... I've heard that there are some horror stories related to this. Is it really that difficult (in your opinion and also in relation to other fields) and do a lot of people fail their rad onc exams? You have to take them again every 10 years to get recertified, correct?

My PhD, relevant research and a favorable away rotation was probably the magic formula that helped me match.

For Rad Onc boards, the pass rates are as follows from 2013:

Clinical Oncology Written = 93%
Clinical Physics = 91%
Clinical Radiation Biology = 96%
Oral Boards = 89%

Though the pass rates are relatively high, keep in mind that you are dealing with an intelligent group of highly motivated test takers. It is VERY stressful to study for multiple exams this way. The re-cert exam you take every 10 years is a (relatively) straight forward written exam which is designed to have a pass rate > 95%.

 

[anbuitachi]

how much money do you make? and how many weeks of vacation?

 

[oncologydude2]

how much money do you make? and how many weeks of vacation?

500k and 6 weeks

 

[anbuitachi]

500k and 6 weeks

wow that's beautiful. no wonder its so competitive!


what area of the country is this in?

 

[oncologydude2]

wow that's beautiful. no wonder its so competitive!


what area of the country is this in?

West of the Mississippi. Sorry can't be more specific, I don't want to completely cede my anonymity.

 

[solitarius]

What's the likelihood of getting sued in Rad Onc relative to other medical specialties (e.g., less than surgery, more than X)? How do the malpractice premiums compare to the other fields?

 

[oncologydude2]

What's the likelihood of getting sued in Rad Onc relative to other medical specialties (e.g., less than surgery, more than X)? How do the malpractice premiums compare to the other fields?

Premiums are highly variable by state. However, in general Rad Onc has one of the lowest costs for malpractice insurance of any specialty. This is because 40% or so of treatments are palliative (pts don't live long enough to sue), sometimes its hard to distinguish between recurrent tumor and radiation-induced damage, and since you are generally dealing with a life-threatening conditions patients often feel that it is 'worth it' to be cured. Rad Onc also tend to spend longer with their patients and are able to provide fairly precise risks of severe short and late term side effects.

 

[The Buff OP]

@oncologydude2
Is Radioactive by Imagine Dragons your favorite song?

 

[oncologydude2]

@oncologydude2
Is Radioactive by Imagine Dragons your favorite song?

My personal favorite "cancer-themed" song is 'Live Like You Were Dying' by Tim McGraw. I'm not a huge country music fan but I really liked this song.

 

[MaduNotSoff]

What is your opinion on supplemental/nutritional anti-cancer claims. For example I've heard taking large amounts of ginger will reduce your risk of cancer x amount and possibly shrink tumors, taking x supplement will reduce risk, etc. Is it something where you tell your patients that it won't hurt to supplement their medications, even if there is not a large amount of data behind various claims?

 

[Lawgiver]

Are rad onc at higher risk of developing cancer due to being around equipment that emits radiation on regular basis? Do you ever worry and or have info you can share?

 

[oncologydude2]

What is your opinion on supplemental/nutritional anti-cancer claims. For example I've heard taking large amounts of ginger will reduce your risk of cancer x amount and possibly shrink tumors, taking x supplement will reduce risk, etc. Is it something where you tell your patients that it won't hurt to supplement their medications, even if there is not a large amount of data behind various claims?

I think it's a racket. Once in a while, I get a patient with the attitude of, "Doctors are just trying to profit off of my cancer, pumping me full of toxins. I am going to [insert random country] to receive holistic therapy." After a few months of vitamin infusion of Mexico (coincidentally costing thousands of dollars), they end up with metastatic/horrendous disease and come back for treatment. Usually it's for palliation at that point . . .

For more normal patients, I have no issues with supplements. The only two caveats I give patients are don't spend a lot of money on something that is unproven and don't make your life miserable through dietary restrictions.

One unique thing about radiation therapy is that it kills cancer cells through oxidation. Technically speaking, if you take mega-doses of anti-oxidants there is a risk of 'shielding' the cancer from treatment.