Ask an Radiation Oncologist Anything

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PlumbLine said:
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 $.
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I personally love my work and do not consider it routine . . . but ask me again in 10 years! Part of it depends on your expectations and philosophy - personally I find the 'diagnosis-puzzle' approach via Internal Medicine to be boring. To each his own.

NCCN is considered the 'benchmark' of acceptable cancer treatments in the United States. As long as you conform to these guidelines in your decision making I think you are safe from a efficacy and liability point of view. That being said, there are major differences in reimbursement between the high end and low end. Each of us must be comfortable with either treating 'aggressively' and earning more or treating 'conservatively' and sleeping better at night. Every one of us has a different philosophy and threshold. Though, to a certain extent, the 'aggressive' partners are the ones keeping the practice afloat. If everyone became 'conservative' overnight, the practice would fold.
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Not sure if it has been answered yet but where did you go to school? (if that's not too personal). Undergrad and after
 
Doctor Pham said:
Not sure if it has been answered yet but where did you go to school? (if that's not too personal). Undergrad and after
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Sorry too personal. But I can tell you that I went to a little known state school on the East Coast for undergrad (BS in Biology) and went to medical school in the south (~ top 30 school according to US News). Fortunately, I had absolutely zero educational debt in undergrad (scholarship + parents paid) or medical school (MSTP).
 
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How did you get out with no debt? Can you please explain? What's MSTP?
 
Oh I see. I'm wondering is there anything like that solely for those who just want to be an MD?
 
barsoum.michael said:
Oh I see. I'm wondering is there anything like that solely for those who just want to be an MD?
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You can get a a scholarship. I think cleaveland clinic has no tuition as well but their mission is to train physician scientists
 
So basically you can get a full ride only if you become a md phd or physician scientist?
 
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barsoum.michael said:
Oh I see. I'm wondering is there anything like that solely for those who just want to be an MD?
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As mentioned above, if you want a free ride through medical school you have a few options:

1. Have rich parents
2. Get accepted to a combined MD/PhD program (but you'll have to convince them by word and deed that you want to become a physician-scientist)
3. Get an armed forces scholarship; you will then need to be an active duty officer for a number of years and your options for residency may be correspondingly limited
4. Join a government sponsored rural health program; you will then need to practice as a primary care physician in an underserved area
5. Get a full scholarship; almost impossible at most schools due to how competitive they are
6. Come from a financially disadvantaged background and have your education funded through grants (possible at only select med schools)
 
oncologydude2 said:
As mentioned above, if you want a free ride through medical school you have a few options:

1. Have rich parents
2. Get accepted to a combined MD/PhD program (but you'll have to convince them by word and deed that you want to become a physician-scientist)
3. Get an armed forces scholarship; you will then need to be an active duty officer for a number of years and your options for residency may be correspondingly limited
4. Join a government sponsored rural health program; you will then need to practice as a primary care physician in an underserved area
5. Get a full scholarship; almost impossible at most schools due to how competitive they are
6. Come from a financially disadvantaged background and have your education funded through grants (possible at only select med schools)
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FWIW You can also get loan repayment from urban programs - you just need to work in a location that is considered underserved http://nhsc.hrsa.gov/index.html
 
You, sir, are amazing for this thread. Thanks a bunch.
I'm currently a M2 at a state school that does not have a rad-onc residency program, however, we do have a few radiation oncology physicians working in the university hospitals/clinics in the area. My interest in rad-onc is somewhat of a recent development and I currently do not have any publications or rad-onc related research experience.

SO, here are my questions:
1. What is the best way to acquire a publication and/or gain research experience over my next 2 years? Should I contact the rad-onc/med-onc physicians in my area to see if there is any research available?
2. I saw that you mentioned most medical students publish retrospective clinical research. How would one go about accomplishing this?
3. I'm planning on forming relationships with the rad-onc physicians currently on staff at our school's hospital. Do you feel that most rad-onc physicians have strong relationships with their "alma-mater-residency"? In other words, how much of a boost in a specific residency's application is a letter from an alumni?

-PERSONAL QUESTIONS-
4. Any good books you'd recommend a M2 to read to get a better grasp of radiation-oncology? Like a 'Radiation Oncology for Dummies' book (Gosh, I wish this book existed)
5. I see you mentioned having a family. How hard was it for you to manage having a new family during your residency? How hard was it for your significant other?
6. I'm also planning/hoping to apply to all of the rad-onc residencies. How would you suggest I go about funding this if family is an unavailable source? Are there loan opportunities?

Thanks for your time!
 
NS_hopeful said:
You, sir, are amazing for this thread. Thanks a bunch.
I'm currently a M2 at a state school that does not have a rad-onc residency program, however, we do have a few radiation oncology physicians working in the university hospitals/clinics in the area. My interest in rad-onc is somewhat of a recent development and I currently do not have any publications or rad-onc related research experience.

SO, here are my questions:
1. What is the best way to acquire a publication and/or gain research experience over my next 2 years? Should I contact the rad-onc/med-onc physicians in my area to see if there is any research available?
2. I saw that you mentioned most medical students publish retrospective clinical research. How would one go about accomplishing this?
3. I'm planning on forming relationships with the rad-onc physicians currently on staff at our school's hospital. Do you feel that most rad-onc physicians have strong relationships with their "alma-mater-residency"? In other words, how much of a boost in a specific residency's application is a letter from an alumni?

-PERSONAL QUESTIONS-
4. Any good books you'd recommend a M2 to read to get a better grasp of radiation-oncology? Like a 'Radiation Oncology for Dummies' book (Gosh, I wish this book existed)
5. I see you mentioned having a family. How hard was it for you to manage having a new family during your residency? How hard was it for your significant other?
6. I'm also planning/hoping to apply to all of the rad-onc residencies. How would you suggest I go about funding this if family is an unavailable source? Are there loan opportunities?

Thanks for your time!
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He hasn't been on since last year. :(

@oncologydude2
What type of people does RadOnc attract? Is it true RadOnc docs get patients who tend to have higher chance of survival? Is a pediatrics fellowship really required for RadOnc if you want to work with kids?
 
NS_hopeful said:
Yeah, but it has only been 3 months. I'm hopeful he'll get around to seeing us lol
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I think he will. Surgeon AMA's do tend to die out, though.lol They get all busy and stuff.
 
I'm baaaaack . . .

SO, here are my questions:
1. What is the best way to acquire a publication and/or gain research experience over my next 2 years? Should I contact the rad-onc/med-onc physicians in my area to see if there is any research available?

Try to get a gig over the summer between M2/M3 if you can swing it. Rather than just blindly applying for research positions, it would be better if you looked through your faculty roster to determine if anyone's research interests you. I would gravitate towards Rad Onc > Med Onc for research.

2. I saw that you mentioned most medical students publish retrospective clinical research. How would one go about accomplishing this?

Find a mentor that has a robust database (hopefully that means EMR and not physical charts), come up with a research question, go through the charts to collect the data, and then write a paper.

3. I'm planning on forming relationships with the rad-onc physicians currently on staff at our school's hospital. Do you feel that most rad-onc physicians have strong relationships with their "alma-mater-residency"? In other words, how much of a boost in a specific residency's application is a letter from an alumni?

It doesn't mean a great deal. Getting a passionate, lengthy LOR from a Rad Onc who knows you well is the best. If they are a big name, that is icing on the cake.

-PERSONAL QUESTIONS-
4. Any good books you'd recommend a M2 to read to get a better grasp of radiation-oncology? Like a 'Radiation Oncology for Dummies' book (Gosh, I wish this book existed)

Read the Rad Onc FAQ in Residency forum.

5. I see you mentioned having a family. How hard was it for you to manage having a new family during your residency? How hard was it for your significant other?

Not too bad. I planned it out ahead of time so had good support from my co-residents. My wife took FMLA leave from work so not too bad for her either.

6. I'm also planning/hoping to apply to all of the rad-onc residencies. How would you suggest I go about funding this if family is an unavailable source? Are there loan opportunities?

Just the standard loan sources as far as I am aware. That would probably mean (relatively) high interest loans from banks.
 
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The Buff OP said:
What type of people does RadOnc attract? Is it true RadOnc docs get patients who tend to have higher chance of survival? Is a pediatrics fellowship really required for RadOnc if you want to work with kids?
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Rad Onc tends to attract accomplished yet laid back medical students who love Oncology and technology. Rad Onc patients run the gamut from 100% cure rate to pure palliation for patients with end-stage disease. If you go to a big residency program with a lot of pediatrics, you absolutely do NOT need to do a separate fellowship. However, if your residency program 'farms out' their pediatrics requirement to another institution for 1-2 months, then you probably need a dedicated fellowship.
 
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palatopharyngeus said:
what is your favorite TV show?
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It's been a long time since I've had the time or desire to watch TV. But when I did my favorite shows included: Sopranos, Nip/Tuck, and Oz. I also stopped going to the movie theatre except to take my kids to see Disney films once every other year or so. Most watching is done by Netflix/Amazon streaming.
 
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Not sure if asked this already. How close is the field getting to producing a consistently reliable alternative treatment to chemo/radiation? I'm hearing a lot about immunotherapy and oncogene sequencing, but how long do you think it will be before the next breakthrough that increases life expectancies significantly? Kind of a bread question but I'm curious about the progress oncology is making.
 
UNMedGa said:
Not sure if asked this already. How close is the field getting to producing a consistently reliable alternative treatment to chemo/radiation? I'm hearing a lot about immunotherapy and oncogene sequencing, but how long do you think it will be before the next breakthrough that increases life expectancies significantly? Kind of a bread question but I'm curious about the progress oncology is making.
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We are NOWHERE near that. Keep in mind that immunotherapy is not a new concept, it has been around for at least three decades and people are still talking about "the cure." As for oncogene sequencing, we generate a lot of data but, most of the time, we don't know what to do with it.

Honestly, I don't see a tremendous breakthrough for at least 50 more years. In the meantime, we will continue to make 'smaller' advances that will continuously improve the survival rates and morbidity of cancer treatment. However, when/if we move to case based reimbursement this whole process of development may have the rug pulled out from underdneath.
 
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oncologydude2 said:
I'm baaaaack . . .

SO, here are my questions:
1. What is the best way to acquire a publication and/or gain research experience over my next 2 years? Should I contact the rad-onc/med-onc physicians in my area to see if there is any research available?

Try to get a gig over the summer between M2/M3 if you can swing it. Rather than just blindly applying for research positions, it would be better if you looked through your faculty roster to determine if anyone's research interests you. I would gravitate towards Rad Onc > Med Onc for research.

2. I saw that you mentioned most medical students publish retrospective clinical research. How would one go about accomplishing this?

Find a mentor that has a robust database (hopefully that means EMR and not physical charts), come up with a research question, go through the charts to collect the data, and then write a paper.

3. I'm planning on forming relationships with the rad-onc physicians currently on staff at our school's hospital. Do you feel that most rad-onc physicians have strong relationships with their "alma-mater-residency"? In other words, how much of a boost in a specific residency's application is a letter from an alumni?

It doesn't mean a great deal. Getting a passionate, lengthy LOR from a Rad Onc who knows you well is the best. If they are a big name, that is icing on the cake.

-PERSONAL QUESTIONS-
4. Any good books you'd recommend a M2 to read to get a better grasp of radiation-oncology? Like a 'Radiation Oncology for Dummies' book (Gosh, I wish this book existed)

Read the Rad Onc FAQ in Residency forum.

5. I see you mentioned having a family. How hard was it for you to manage having a new family during your residency? How hard was it for your significant other?

Not too bad. I planned it out ahead of time so had good support from my co-residents. My wife took FMLA leave from work so not too bad for her either.

6. I'm also planning/hoping to apply to all of the rad-onc residencies. How would you suggest I go about funding this if family is an unavailable source? Are there loan opportunities?

Just the standard loan sources as far as I am aware. That would probably mean (relatively) high interest loans from banks.
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Thanks for the advice! A researcher at a local Cancer Research Center contacted me back on some rad-onc related research. I just sent my CV to him and I have an interview next week. He says he's willing to work with me around my school schedule once I start rotations this summer, so I'm excited!

I'm so ready to start learning more about rad-onc! I've been doing a lot of research on applying to residency. And had a few other questions:

1. What are your thoughts on Prelim vs. Transitional year? Is it really that difficult to get accepted into a Transitional program? I've found acceptance statistics on national websites and it looks to be just as competitive as Rad-Onc residency.

2. What do you suggest be strong on an application if one was to apply to do away rotations at a competitive location? Preclinical grades? Step 1 score? Research?
 
Thanks for this thread! I'm matriculating to a MSTP this year, and I was wondering what your thoughts were on your MD/PhD training. Do you regret the PhD? How did you decide on the program you ended up going to? Would you have done something differently during your training given what you know now? Thanks!
 
What are your thoughts on gene therapy for the treatment and management of cancer, and have you seen/heard of the applications directly or indirectly through your work? Based on your understanding of the field now, do you feel like gene therapy has the possibility of drastically improving patient outcomes in the next 10 years?

Also, if you could re-visit your undergraduate days, which stresses (personal, academic, or professional) would you eliminate from your life the second time around?
 
NS_hopeful said:
1. What are your thoughts on Prelim vs. Transitional year? Is it really that difficult to get accepted into a Transitional program? I've found acceptance statistics on national websites and it looks to be just as competitive as Rad-Onc residency.
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There are multiple threads on this in the Rad Onc forum. My opinion is that it is utterly irrelevant. SOME transitional programs are very competitive due to their 'cushness,' generous stipends (some include country club membership!), and multiple electives.

2. What do you suggest be strong on an application if one was to apply to do away rotations at a competitive location? Preclinical grades? Step 1 score? Research?
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I wasn't actually aware that these were competitive; I thought simply first come, first serve. Is that not the case anymore?
 
astridperth said:
Thanks for this thread! I'm matriculating to a MSTP this year, and I was wondering what your thoughts were on your MD/PhD training. Do you regret the PhD? How did you decide on the program you ended up going to? Would you have done something differently during your training given what you know now? Thanks!
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I don't regret the PhD for the pragmatic reasons of (1) I would not have known about Rad Onc until too late if not for my PhD, and (2) I credit much of my success to the PhD, despite not embarking on a proper physician scientist career.

For my program I looked at specific mentors in the area that I was interested (gene based therapeutics for cancer) and also looked for integration between grad school and med school.

If I had to start over again, I would have probably avoided the PhD and made a beeline to Rad Onc. However, during the process of my MSTP there were so many life lessons I learned and important people I met so I would be somewhat loathe to give that up.
 
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funsnp said:
What are your thoughts on gene therapy for the treatment and management of cancer, and have you seen/heard of the applications directly or indirectly through your work? Based on your understanding of the field now, do you feel like gene therapy has the possibility of drastically improving patient outcomes in the next 10 years?

Also, if you could re-visit your undergraduate days, which stresses (personal, academic, or professional) would you eliminate from your life the second time around?
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It's a pie in the sky. Money will keep being thrown at it and nothing will ever come from it until about 50 years when physical scientists/engineers start getting involved.

I really enjoyed my undergraduate time from an academic and professional perspective. However, if I had to do it over I would take more time to make and keep long-lasting friendships. I am somewhat of an introverted person.
 
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oncologydude2 said:
I wasn't actually aware that these were competitive; I thought simply first come, first serve. Is that not the case anymore?
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Oh, idk lol it might be? I just figured a rad-onc away rotation at, like, MD Anderson would be more competitive at, say, a rotation at your everyday Tom-Dick-&-Harry School of Medicine.
 
The medical school I will be attending doesn't have a radiation oncology department/residency. I understand this means I should do more away rotations than someone at a school with one. However, what can I do about getting adequate research? Look for research opportunities at other schools in the summer or do research in a different department at my own school? Thanks a lot for doing this!
 
What technologies are you familiar with? Do you utilize proton beam therapy? Is that the "next big thing" in radiation oncology?
 
oncologydude2 said:
I have had so many patients die that it doesn't impact me anymore. However, I still can't shake it when young adults get terminal cancer. That can still hit hard.

About 60% of patients are in curative situations.

I am extremely satisfied with my salary and lifestyle. However there is always someone who earns more. You have to make peace with that.
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Hey there, thanks for doing this. I'm a first year trying to lock in rad onc research, hopefully I can get one or two chart reviews done before the summer is over!

You mentioned that death typically doesn't affect you anymore, but did it affect you when you first started? Was there a thought process you used to initially get through it?
 
Hello, thank you for making this thread. I was wondering if you could give an example of the level of math you use in rad onc (algebra, calculus, trig, etc.)? What about the type of physics you use? Can you give an example of a physics problem you would see in the clinic?
 
oncologydude2 said:
Sorry too personal. But I can tell you that I went to a little known state school on the East Coast for undergrad (BS in Biology) and went to medical school in the south (~ top 30 school according to US News). Fortunately, I had absolutely zero educational debt in undergrad (scholarship + parents paid) or medical school (MSTP).
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I'm going to guess Mary Washington.
 
lelz said:
The medical school I will be attending doesn't have a radiation oncology department/residency. I understand this means I should do more away rotations than someone at a school with one. However, what can I do about getting adequate research? Look for research opportunities at other schools in the summer or do research in a different department at my own school? Thanks a lot for doing this!
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Well, you have e couple of options. You can stay at your school and do Oncology (but not Radiation Oncology) research or, like you said, try to roll an away rotation into an away research elective. The problem is that unless you go to a powerhouse program with a very robust research infrastructure, you will find it hard to produce something relevant in a month - let alone when you are also doing a clinical rotation.
 
RSB715 said:
What technologies are you familiar with? Do you utilize proton beam therapy? Is that the "next big thing" in radiation oncology?
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3D-conformal radiation, brachytherapy, intensity modulated radiation, stereotactic ablative radiation, stereotactic radiosurgery, volumetric arc radiation therapy

Do not use protons. Protons are the 'next big thing' in terms of reimbursement but not in technology. Two interesting things going on in Rad Onc now are studies on the abscopal effect and treatment delivery using an MRI instead of CT for target verification.
 
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Entering2019MD said:
Hello, thank you for making this thread. I was wondering if you could give an example of the level of math you use in rad onc (algebra, calculus, trig, etc.)? What about the type of physics you use? Can you give an example of a physics problem you would see in the clinic?
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Basic trigonometry. Physics is also basic from the calculation end. Nowadays, barely ever do manual calculations - done by physics using multi-core processors.
 
How is the job market in radonc? I want to stay in the midwest (ex. Milwakee, Detroit, St. Louis, Kansas City). I keep reading that it is hard to find jobs in mid-large size towns as a new grad?
 
Entering2019MD said:
How is the job market in radonc? I want to stay in the midwest (ex. Milwakee, Detroit, St. Louis, Kansas City). I keep reading that it is hard to find jobs in mid-large size towns as a new grad?
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If you need a job and location is removed from the equation, then you will have no problems whatsoever. Jobs in the Midwest are actually quite plentiful (especially in the cities you cited). The hardest places to find jobs are in the NYC metro (NY-NJ-PA), West Coast (SF, LA, SD in CA and Portland/Seattle).
 
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Can you give me more info on surgical oncology? I know its not your field but I didn't find much info on it
 
Can you expand on proton beam therapy? Do you think it has significantly superior utility over IMRT and other other forms of RT? Does it have potential to be the next standard of care? I work at an institution that uses protons and my Dr. is absolutely in love with them, so it'd be nice to get another perspective. Also how do you feel about prostate screening with PSA? still standard? Should it be? Will carbon ion therapy ever catch on in the US?

Sorry if that's a lot at once. I really like Rad Onc and would love to pursue it.
 
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