Pediatric rad onc? (?s from an MS4)

[janedoe4]

I'm a 4th year med student and have been pretty convinced I was going to end up in Peds Heme/Onc, despite the monkey wrench that while I really like working with kids, I'm not sure how I feel about working with pediatricians. A couple of people have suggested I look into Rad Onc, since it would provide a path to taking care of peds onc patients without actually being a pediatrician (or a surgeon, which I am absolutely not cut out for). I'm set to take my school's 4th year Rad Onc elective later this summer and hopefully will get a good sense of what the people, the mindset, and the day-to-day are really like, but I'm still unclear on the big-picture career opportunities of peds rad onc. How common is it for people who practice pediatric rad onc to have that exclusively as their clinical work vs. seeing pediatric patients in addition to adults? (I'm not categorically opposed to the latter, just trying to understand what the landscape is.) Is it more or less common/possible if you want an academic career vs. a private practice one?

And, if anyone is in a generally thoughtful mood, how would you characterize the differences between you as a radiation oncologist and your medical/surgical/pediatric/gynecologic oncology colleagues?

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[clinonc]

Whilst radiation is used in the treatment of childhood cancer, and will continue to be used for some time yet, the pressure is relentlessly away from its use given the perceived long term toxicities. You will forever be fighting that particular battle. Going into radonc just to work with children is therefore, to my mind, unwise.

I'm not sure what you mean by your barbed comment that you don't want to work with pediatricians. Is this because you have met some unpleasant ones at your current institution? I've got news for you: there are difficult people in every specialty, just as there are great people. You wont survive in medicine if you can't deal with that. As a radiation oncologist you would be working closely with pediatricians anyways, as part of a team. It's the nature of medicine in general, and cancer care in particular.

My advice? If you want to work with children who have cancer, be a pediatric medical oncologist.

 

[Pewl]

Peds rad onc is typically done at a large academic center. I have yet to see peds rad onc being done in a private practice type setting. Radiation is kind of considered a "boogie man" when it comes to pediatrics. Most rad oncs I've met who've specialized in peds see adults as well as kids.

Compared to the other oncs, rad oncs have the unique distinction of going straight from med school into onc (not counting intern year, of course). We do 4 straight years of onc while those other so-called oncs do fellowships on top of their normal residencies. Generally speaking, rad oncs have the best lifestyle but we are often at the end of the referral chain. We rely on a lot of other specialties for patient referrals in certain private practice settings. But, honestly, rad onc is really cool in how interdisciplinary it is. It's not a field that you get very much exposure to during med school but it is a very deep field with endless academic and edifying aspects!

 

[janedoe4]

Is this because you have met some unpleasant ones at your current institution?

Nope. It's because I've found there's a grain of truth to most specialties' reputation/stereotype (surgery is aggressive and action-oriented, neurology admires disease but does not treat it, etc.) and me and peds are not the ideal fit. I'm a pretty cerebral person, I like analytic thinking and careful appraisal of evidence (fully understanding that you often have to make decisions without evidence, just wanting to be very clear about when that's what I'm doing), I definitely want an academic career. And yet I like kids and they like me. I also agree with you about the importance of collaboration among specialties and the high degree of it in oncology, but my perception has been that the value and potential contributions of other fields are somewhat undervalued in many areas of pediatrics (though obviously less so and by necessity in peds onc). None of these are absolutes and I'm sure there's a niche in a department of pediatrics somewhere that would be perfect for me, but by that token there are likely niches in internal medicine and ob/gyn and other places that I would also be happy in (see above re: no opposition to working with both pediatric & adult patients). I'm just trying to figure out if rad onc would join the list of places that might have a place for me, and go from there.

 

[radonc]

you seem like a perfect fit for a pediatric radiation oncologist, but your entire 4 years of training will be predominantly adult patients (>95%). of the 450 cases you log in residency, a minimum of 12 have to be pediatric cases and most residents see less than 25-30 cases/training.

you will be spending most of your time learning about breast cancer, prostate cancer, h&n, GI, GYN, and all these other tumors that do not apply to pediatrics. moreover, unless you work at st jude or harvard, most peds radonc also have to see other sites, just to keep their numbers up.

 

[gorgias]

... and me and peds are not the ideal fit. I'm a pretty cerebral person, I like analytic thinking and careful appraisal of evidence (fully understanding that you often have to make decisions without evidence, just wanting to be very clear about when that's what I'm doing), I definitely want an academic career.

Some of the most cerebral people I know are neonatologists. Their practice also requires a significant amount on analytic thinking as their patients are often complex and are typically poor historians.

I understand that a peds residency isn't for everyone, but if your goal is a peds fellowship, you will only have 3 years of residency, and you will have the third year to fantasize about your fellowship for motivation since you will have hopefully matched by then.

 

[deleted4401]

There are a few private practices that treat children. There is a group in Northern Virginia that has been trying to hire someone for pediatrics for over a year now. I interviewed with private groups in South Florida (Hollywood/Miami) and New Orleans that treat children. The thing is, kids are best treated at pediatric cancer centers by a dedicated specialist. And as someone else said, both academic and private practice are about volume. With just peds cases, you wouldn't get the necessary numbers (aside from a few major centers). Even here at UPMC, the peds specialist sees breast, prostate, and GI.

It takes a very special person to be able to treat children. In follow-up, we see that even though there is survivorship, we mess them up pretty bad. Hard to live with that.

-S

 

[Dillatar]

Riley Hospital has a large pediatric rad onc department. Check it out. Maybe it could be an option for you. If you did your residency here in Indianapolis, I'm sure you would rotate through Riley.

Good Luck

http://rileychildrenshospital.com/physicians/med-sub-specialties/ro/radiation-oncol.jsp

 

[stlo]

We have high exposure to peds in our program, and two attendings see peds patients - one also sees breast & the other also sees CNS. We are lucky in that we have a very well-respected childrens' hospital associated with our program, and I probably met my peds' criteria for cases in one rotation with the more senior attending. So, I feel comfortable treating peds cases without doing a fellowship. However, one of our other residents has become interested in specializing in peds because of our program, and may pursue a peds fellowship on top of our experience because of our program. (I have always been private-practice minded, myself, but the exposure is great). So, there are some things in particular that you can look for when you are looking for residency programs that may help with your decision.

But I would agree that even in our program with fairly vocal Radoncs, the med oncs still see radiation as something to be avoided, and so tumor boards can be vocal discussions, and you can get into heated discussions about why certain patients need to be treated with radiation. It's good to be able to articulate why we do good things once in awhile, though In general, though, they are supportive of what we do.

 

[Brim]

Pediatric Hematology/Oncology is a wonderful field, and I admire you for choosing to go into this (or Peds Rad Onc).

As others above have noted, Radiation Oncology has relatively little pediatrics exposure (depending on where you train). Most Pediatric Radiation Oncologists are in academic centers. There are a few private practices that treat pediatrics, but it would be difficult finding a PP job where you can treat peds patients exclusively.

If Pediatric Rad Onc is what you desire, it is certainly feasible to go this route, understanding that you would mostly be seeing adult patients during your residency, so you'd better have an interest in Rad Onc in general. It's worth doing the elective to see if this is a good fit for you.

Good luck.