Ask an Radiation Oncologist Anything

[Dare2Dream]

Thanks for doing this, really appreciate it!

1. How does work life balance and salary compare between Rad Onc and Med Onc?
2. Is salary for Rad Onc much lower working for a hospital/health center compared to a physician group as is your case? If so, how much lower?
3. Do you feel some pressure to see X patients per week? Does you pay directly depend on the # patients you have?
4. When you say that it helps publish 1-2 papers during Med school, what kind of papers are you talking about and are these first author?
5. Is it true that getting into Med Onc has the extra risk of finding the right fellowship after the IM residency or are there programs that guarantee you the fellowship at the start of residency?

Thanks in advance, grateful to learn from someone with your experience/background.

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[oncologydude2]

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?

No, absolutely not. We shield the heck out of everything and carry around dosimetry badges that audit the amount of radiation that we receive each month. On average, I would say we receive LESS than average radiation exposure compared to the average physician. Certainly a lot lower than interventional cardiologists and radiologists.

 

[Lawgiver]

cool thx. also, do you consider rad onc a very sciency specialty? Where you use lots of the basic sciences you learned in med school?

 

[oncologydude2]

Thanks for doing this, really appreciate it!

1. How does work life balance and salary compare between Rad Onc and Med Onc?
2. Is salary for Rad Onc much lower working for a hospital/health center compared to a physician group as is your case? Is so, how much lower?
3. Do you feel some pressure to see X patients per week? Does you pay directly depend on the # patients you have?
4. When you say that it helps publish 1-2 papers during Med school, what kind of papers are you talking about and are these first author?
5. Is it true that getting into Med Onc has the extra risk of finding the right fellowship after the IM residency or are there programs that guarantee you the fellowship at the start of residency?

Thanks in advance, grateful to learn from someone with your experience/background.

1. Generally speaking, slightly higher average salary (but lower variance) for Rad Oncs compared to Med Oncs. Life strongly favors Rad Onc.
2. Starting salary is generally higher for hospital based practices compared to physician owned groups. However, after a few years this is reversed.
3. Yes, I would say so. I do feel nervous if I don't see a lot of patients in a week. Since patients is how my income is generated, it is important that there be a lot of them!
4. First author is always best. Most med students publish retrospective clinical research (e.g. so called 'chart studies.').
5. Unlike Rad Onc, Med Onc fellowships are more variable in quality. There are definitely some programs that guarantee fellowship, but you do run the risk of not matching into a competitive program.

 

[Dare2Dream]

1. Generally speaking, slightly higher average salary (but lower variance) for Rad Oncs compared to Med Oncs. Life strongly favors Rad Onc.
2. Starting salary is generally higher for hospital based practices compared to physician owned groups. However, after a few years this is reversed.
3. Yes, I would say so. I do feel nervous if I don't see a lot of patients in a week. Since patients is how my income is generated, it is important that there be a lot of them!
4. First author is always best. Most med students publish retrospective clinical research (e.g. so called 'chart studies.').
5. Unlike Rad Onc, Med Onc fellowships are more variable in quality. There are definitely some programs that guarantee fellowship, but you do run the risk of not matching into a competitive program.

Thank you, really appreciate your insights and advice!

 

[oncologydude2]

cool thx. also, do you consider rad onc a very sciency specialty? Where you use lots of the basic sciences you learned in med school?

Not especially. At the end of the day we are treating patients like everyone else. Although there is some aspects of science, most of what we do is clinical medicine. Not much role for 'basic science' in day-to-day functioning of a Rad Onc though there are minor aspects of this. Probably more so than the average medical specialty.

 

[oncologydude2]

Thank you, really appreciate your insights and advice!

You're welcome!

 

[MaduNotSoff]

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.

I didn't know that was even an option! But then I see the other side though, where patients feel that they want to do anything/everything to heal themselves and get sucked into those "alternative" treatments. It must be horrible to see them in that situation.

Another question just came to mind about this. What is the overall level of "trust" that your patients have in the treatments you recommend? How do you convince a patient like the above-mentioned, who questions the treatments, to follow your plan?

 

[optimistic3]

Your "don't make yourself miserable with dietary restrictions" comment reminded me of another question - how do you feel about sugar and cancer? Do you think it feeds tumors and do you ask your patients to avoid it? Your comment makes me think no but I wanted to ask specifically.

It's something I've heard quite a bit but when I asked my own med onc about it, he said "well, it feeds us too" and left it at that. Since then, I haven't changed my diet but sometimes I feel the judging from people who know I had cancer and strongly believe that sugar is very bad for cancer.

 

[TheBatman]

what's your salary?

 

[Dare2Dream]

what's your salary?

Answered twice already in previous posts.

 

[oncologydude2]

Your "don't make yourself miserable with dietary restrictions" comment reminded me of another question - how do you feel about sugar and cancer? Do you think it feeds tumors and do you ask your patients to avoid it? Your comment makes me think no but I wanted to ask specifically.

It's something I've heard quite a bit but when I asked my own med onc about it, he said "well, it feeds us too" and left it at that. Since then, I haven't changed my diet but sometimes I feel the judging from people who know I had cancer and strongly believe that sugar is very bad for cancer.

Sugar feeds cancer. Sugar also feeds your brain and other vital organs. So if you 'starve' your cancer then you are basically killing yourself. With that said, there are alternative diets being tested in a scientifically vigorous way such as ketogenic diet for glioblastoma. Until positive data is published, I feel comfortable to stick to my guns.

Any Oncologist will tell you that a patient who loses weight during treatment will do poorly. Going on a diet or other major lifestyle changed during treatment for your cancer is generally a bad idea.

 

[oncologydude2]

what's your salary?

$500k

 

[Lawgiver]

What's take home, broken down alphabetically?




Jk hehe.

 

[ridethecliche]

Have you seen many radiation induced sarcomas and such?

 

[FranzLO]

Are you involved at all in the long term treatment or wound care for your patients with post-irradiation damage? Or do you just zap them and move on?

 

[oncologydude2]

Have you seen many radiation induced sarcomas and such?

I've seen a few. However, keep in mind that the latency of these secondary malignancies is 10-30 years and I have only been in practice for < 5. That being said, I've seen them in training and they can be a disaster in terms of patient morbidity. I've also seen chemotherapy-induced malignancies especially fatal leukemia induced by anthracycline therapies.

 

[oncologydude2]

Are you involved at all in the long term treatment or wound care for your patients with post-irradiation damage? Or do you just zap them and move on?

I'm very closely involved in post-radiation wound care. The extent of my involvement depends on if the radiation created a new problem or exacerbated an existing one (e.g. opened up an existing surgical scar). In the latter case, the surgeon and I manage the patient together.

Simple interventions for wound care include antibiotics and topical medications. More serious or refractory problems may necessitate referral to a wound clinic, use of hyperbaric oxygen or (very rarely) skin grafting/reconstruction. Nowadays, Radiation Oncologists have become very good at predicting tissue toxicities so these extreme scenarios are ever fewer.

 

[Dare2Dream]

1. For someone starting now, what would you advise they do in addition to high STEP 1 and clinical grades to match Rad Onc?
2. How many programs did you apply to? If all, how many is that and what was your backup plan?
3. Is there anything one can do in the 6-8 months of less burdened time before starting medical school to help become more competitive for Rad Onc residency?

 

[oncologydude2]

1. For someone starting now, what would you advise they do in addition to high STEP 1 and clinical grades to match Rad Onc?
2. How many programs did you apply to? If all, how many is that and what was your backup plan?
3. Is there anything one can do in the 6-8 months of less burdened time before starting medical school to help become more competitive for Rad Onc residency?

1. Do research, publish it. Also try to do as many away rotations as you can and impress the hell out the faculty.
2. All, ~61. If not matched I would have probably done a Medicine internship anyway and then tried to match directly into a PGY-2 (advanced) position.
3. Not much you can do BEFORE starting medical school. However, if you can pull it off, it might not be a bad idea to shadow a Rad Onc to see if the field is something you might be interested in pursuing.

 

[Dare2Dream]

1. Do research, publish it. Also try to do as many away rotations as you can and impress the hell out the faculty.
2. All, ~61. If not matched I would have probably done a Medicine internship anyway and then tried to match directly into a PGY-2 (advanced) position.
3. Not much you can do BEFORE starting medical school. However, if you can pull it off, it might not be a bad idea to shadow a Rad Onc to see if the field is something you might be interested in pursuing.

Thank you, really appreciate it! So how many interviews did you receive from the 61? I am assuming all the away rotations would need to be Rad Onc to be useful.

 

[thesauce]

Great thread, OP!

 

[oncologydude2]

Thank you, really appreciate it! So how many interviews did you receive from the 61? I am assuming all the away rotations would need to be Rad Onc to be useful.

It's been a while since I thought about this but if I recall correctly I was invited to about 15 programs and was able to attend 10-12 due to scheduling conflicts. Some programs do not give 'away' medical student rotators any special consideration for residency selection; others guarantee an interview. YMMV.

 

[oncologydude2]

Great thread, OP!

Glad you find it useful.

 

[clonoGnic]

Would a rad onc publication (in top rad onc journal) from undergrad "count" when applying to rad onc residency? It was translational bench work.

 

[Dare2Dream]

It's been a while since I thought about this but if I recall correctly I was invited to about 15 programs and was able to attend 10-12 due to scheduling conflicts. Some programs do not give 'away' medical student rotators any special consideration for residency selection; others guarantee an interview. YMMV.

Thanks, your advice is invaluable to many of us!

 

[malick1]

take with a grain of salt all you read on an internet forum, when it comes to medical school admissions there are great well intentioned adcoms here, but at the end of the day every application, and every school is unique to their process, and there is no perfect formula to apply! I know someone who graduate from Brown had a 3.9 cGPA a 4.0 sGPA, and a 36 on the MCAT, also great LOR and extracurriculars, he applied to several us schools and got not a single offer, now he is studying at mcgill medical school!

 

[thesauce]

take with a grain of salt all you read on an internet forum, when it comes to medical school admissions there are great well intentioned adcoms here, but at the end of the day every application, and every school is unique to their process, and there is no perfect formula to apply! I know someone who graduate from Brown had a 3.9 cGPA a 4.0 sGPA, and a 36 on the MCAT, also great LOR and extracurriculars, he applied to several us schools and got not a single offer, now he is studying at mcgill medical school!

Talk about off-topic.

In other news, the Giants won the World Series.

 

[oncologydude2]

Would a rad onc publication (in top rad onc journal) from undergrad "count" when applying to rad onc residency? It was translational bench work.

Yes, it would absolutely be relevant. I'd say that achieving such as an undergrad is quite unique, kudos!

 

[oncologydude2]

. . . there is no perfect formula to apply! . . . .

I agree that there are no guarantees in life. However, if you are aware of trends and prepare your application accordingly you can certainly maximize your chances of getting with you want.

 

[malick1]

Talk about off-topic.

In other news, the Giants won the World Series.

Lol I was reading two threads back and for , I was meant to post this to one that ask how do we know that adcoms here are not fake, opps.

 

[Lawgiver]

What role to allied health trained Radiation Therapist play, in general?

 

[oncologydude2]

What role to allied health trained Radiation Therapist play, in general?

A Radiation Therapist/Technologist (RTT) is one of the most satisfying and lucrative positions in healthcare. RTTs are responsible for operating the linear accelerator (e.g. greeting the patient, escorting them to machine, positioning them properly, taking appropriate imaging to ensure fidelity, troubleshooting if setup is not perfect). The also perform CT simulations which entail setting up the patient in a reproducible position with appropriate immobilization devices and performing a CT scan (can involve IV/oral contrast, 4D imaging, PET, MRI, etc.).

Salary range is widely variable but 90% are probably in the $70-120k range.

 

[Fedxup]

How much physics do you need to know?!!

 

[thesauce]

How much physics do you need to know?!!

Already answered in post 64

 

[Fedxup]

Already answered in post 64

Thank you!

 

[barsoum.michael]

So you have become less upset about deaths? How hard did it hit you when your first started?

 

[oncologydude2]

So you have become less upset about deaths? How hard did it hit you when your first started?

I've definitely felt it less over time. Since you experience a lot of death during training (medical school + residency), you are generally 'ready' for it as an attending. During training, kids (especially < 14 years old) hit the hardest. Nowadays, I only treat adults so it is not as bad. However when treating young adults it can still be challenging emotionally. Each of us has different coping mechanisms (some are healthier than others :/).

 

[barsoum.michael]

Wow. Thanks for telling me. Do you deal with brain tumors? I wonder because I've seen departments of neuro-oncolgy

 

[oncologydude2]

Wow. Thanks for telling me. Do you deal with brain tumors? I wonder because I've seen departments of neuro-oncolgy

Yes, I deal with brain tumors quite often. We have a good relationship with a local group of neurosurgeons and probably see more neuro-oncology than your average community oncology group.

 

[barsoum.michael]

Thanks for sharing. I really appreciate the feedback

 

[Dare2Dream]

A few more questions:

1. Do you have any advice on away rotations in medical school? How many and how to choose where to do them?
2. Did your medical school have a home program in Rad Onc and was it critical to you matching into Rad Onc?
3. At what point in Med school did you do research and was it difficult to get published?

 

[sunflower18]

I have a few more questions too.... I am really really interested in Rad Onc, and as a newly accepted medical student, I'm starting to think seriously about which schools will provide me with the greatest opportunity to pursue my career of interest and if Rad Onc is something I could/should seriously pursue. I know I've asked you about this before, but I'm still pretty hung up on the physics/math thing... I don't think it would be a problem in practice, but I'm concerned that I will have a really hard time making it through residency. Are there any resources you can direct me to that I can use to figure out if the physics/math would be a complete dealbreaker for me? I don't actually even know what type of physics or math would be necessary for Rad Onc, so it's hard for me to definitively say whether or not I'd hate it, but I certainly have a strong dislike of calculus and physical chemistry. It's just something that I really want to explore with further depth in the next few months, so that I can determine whether or not I should use the presence of Rad Onc residency/research opportunities as a valid criteria for selecting which school to attend.

 

[oncologydude2]

A few more questions:

1. Do you have any advice on away rotations in medical school? How many and how to choose where to do them?
2. Did your medical school have a home program in Rad Onc and was it critical to you matching into Rad Onc?
3. At what point in Med school did you do research and was it difficult to get published?

1. Be yourself during away rotations. Hopefully 'being yourself' entails politeness, respectfulness to all staff, hard work and humility. You'd think this was a no-brainer but you would be surprised at how many medical students lack insight into their own behavior. If you come from a school with a strong Rad Onc program (e.g. it has its own residency program) then 1-2 away rotations are a good number. If not, then 2-3. Ideally you should do 1 away rotation where you'd really like to Match and have a legitimate shot based on your stats. There are mixed opinions about rotating at "top" places where you may not have a shot, but you can still obtain good references.

2. Yes. YES! Recommendations from my Rad Onc Chair and Program Director went a LONG way to helping me match.

3. I was MD-PhD so I'm not the best person to answer this question.

 

[oncologydude2]

Are there any resources you can direct me to that I can use to figure out if the physics/math would be a complete dealbreaker for me?

I can tell you the following: I hate math and tolerate physics. I AP'd out of math as a high school senior so I never took a math course in college. I AP'd out of one semester of physics in high school and took the second semester in college.

All the math/physics that I learned in high school/college was FAR more advanced than what I needed in Rad Onc. In terms of calculations, it is mostly algebra sprinkled with some easy trigonometry (if you can calculate sines, cosines, and tangents on your calculator, then you are set). Some of the concepts that you learn in physics can be a bit wonky to understand, but once you hear them repeated a few times you should get the hang of it.

One of the best "beginner's guide" to radiation physics is this: http://www.amazon.com/Applied-Physi...98&sr=8-2&keywords=physics+radiation+oncology
Al

Also consider reading the section on radiation physics in this book: http://www.amazon.com/Handbook-Evid...5209715&sr=8-2&keywords=eric+hansen+radiation

 

[sunflower18]

I can tell you the following: I hate math and tolerate physics. I AP'd out of math as a high school senior so I never took a math course in college. I AP'd out of one semester of physics in high school and took the second semester in college.

All the math/physics that I learned in high school/college was FAR more advanced than what I needed in Rad Onc. In terms of calculations, it is mostly algebra sprinkled with some easy trigonometry (if you can calculate sines, cosines, and tangents on your calculator, then you are set). Some of the concepts that you learn in physics can be a bit wonky to understand, but once you hear them repeated a few times you should get the hang of it.

One of the best "beginner's guide" to radiation physics is this: http://www.amazon.com/Applied-Physics-Radiation-Oncology-Revised/dp/1930524404/ref=sr_1_2?ie=UTF8&qid=1415209398&sr=8-2&keywords=physics radiation oncology
Al

Also consider reading the section on radiation physics in this book: http://www.amazon.com/Handbook-Evidence-Based-Radiation-Oncology-Hansen/dp/0387929878/ref=sr_1_2?ie=UTF8&qid=1415209715&sr=8-2&keywords=eric hansen radiation

Thank you so much!! This is extremely helpful and reassuring. I will look into these books, but I feel a lot better knowing your feelings about math and physics. I can do trigonometry! Thank you!!

 

[Dare2Dream]

Thank you very much for the advice!

It looks like the number of residency spots has been increasing over time and the job market is becoming challenging:

http://forums.studentdoctor.net/threads/what-to-do-after-residency-if-no-job-offers.1106354/

With the success in immune therapy lately, it is also to be seen how that may impact the use of radiation for the treatment of cancer in the future.

 

[PlumbLine]

I am wondering if you can give some advice on what to prioritize in regards to research while in medical school -- basic science, clinical, or medical education related research? I am an M1 that is interested in Radiation Oncology, and so I would like to start reaching out to PIs early. Are these pros/cons valid? Do you have any recommendations?

Basic Science
Pros: Would expand my skill-set because I have zero experience in basic science research. Would look good on CV. Could probably work in the RO Department Chair's lab.
Cons: I have no experience and would take a while to learn, making it difficult to get much publishing credit. Projects tend to take longer (and can be more difficult to get published?). Also right now I'm not very interested in basic science research.

Clinical
Pros: I have some experience. More likely to be middle author +. Projects tend to be shorter term.
Cons: Does not look as strong on residency applications as having some basic science experience (is this correct?)

Medical Education (related to RO)
Pros: Very interesting to me. More likely to be middle author +.
Cons: Residency directors may not see this as strongly relevant to RO?

Side question: If I went through all of med school with no basic science research, does that severely weaken a RO residency application?
Also, I'll try not to get ahead of myself, as I know the most important items are clinical grades and step 1.

 

[oncologydude2]

I am wondering if you can give some advice on what to prioritize in regards to research while in medical school -- basic science, clinical, or medical education related research? I am an M1 that is interested in Radiation Oncology, and so I would like to start reaching out to PIs early. Are these pros/cons valid? Do you have any recommendations?

Basic Science
Pros: Would expand my skill-set because I have zero experience in basic science research. Would look good on CV. Could probably work in the RO Department Chair's lab.
Cons: I have no experience and would take a while to learn, making it difficult to get much publishing credit. Projects tend to take longer (and can be more difficult to get published?). Also right now I'm not very interested in basic science research.

Clinical
Pros: I have some experience. More likely to be middle author +. Projects tend to be shorter term.
Cons: Does not look as strong on residency applications as having some basic science experience (is this correct?)

Medical Education (related to RO)
Pros: Very interesting to me. More likely to be middle author +.
Cons: Residency directors may not see this as strongly relevant to RO?

Side question: If I went through all of med school with no basic science research, does that severely weaken a RO residency application?
Also, I'll try not to get ahead of myself, as I know the most important items are clinical grades and step 1.

Sorry for the delay, I didn't realize this thread was still going. Happy to continue to contribute!

I think your pros/cons are valid. To be successful in basic science, you will probably have to dedicate a few month block to research (e.g. summer between MS1-MS2) and/or work part-time during medical school. Continuity is key. For clinical research, you should probably limit yourself to retrospective-type chart reviews as physics projects may be challenging without a good background in radiation physics. Medical education research is quite interesting it would be worth it to pursue, particularly if you are personally interested.

You don't need basic science research per se, but you definitely need to have SOME form of published research.

 

[PlumbLine]

Sorry for the delay, I didn't realize this thread was still going. Happy to continue to contribute!

I think your pros/cons are valid. To be successful in basic science, you will probably have to dedicate a few month block to research (e.g. summer between MS1-MS2) and/or work part-time during medical school. Continuity is key. For clinical research, you should probably limit yourself to retrospective-type chart reviews as physics projects may be challenging without a good background in radiation physics. Medical education research is quite interesting it would be worth it to pursue, particularly if you are personally interested.

You don't need basic science research per se, but you definitely need to have SOME form of published research.

Thank you! I have a couple other questions that I am curious about, if you don't mind.

Have you ever become frustrated with your work becoming routine? One hesitation I have about RO is that there doesn't seem to be much diagnosis work. Are there still "puzzles" that you need to solve? enough to keep things interesting?

Also, in private practice, how much pressure do you feel from other stakeholders? Are you ever frustrated with the business side impacting the way you practice? e.g. I have heard that a few treatments of high cGy can be as effective as many treatments at low cGy, but that physicians get some pressure to go the route of more treatments for more $.