I've seen these posts elsewhere and like to ask about it when shadowing, so thought it might be fun here. Maybe some things about different types of practices, how the field has changed, and how it is changing for the future might be neat too.
Radoncs, would you do it again?
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Yes
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Hell yes
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Digging the enthusiasm!any additional comments on the other parts to the question? Perhaps some insights into what appeals so much to you?
I'm still in residency but I'm thankful nearly every day that I chose rad onc. Great patients, really cool technology and home in time for dinner. Win-win-win.
MOST definitely. I love the technology, the ever-changing nature of oncology, and the interaction we have with all fields of medicine. The work is interesting and challenging, but at the same time the hours are usually pretty darn good for medicine.
The main caveat: If you absolutely HAVE to be in x/y/z/ city/state, it might not be for you. It's a small field, so there's no guarantee you'll end up in any particular geographic location. That and the difficulty of getting into a residency program are the two main drawbacks.
The main caveat: If you absolutely HAVE to be in x/y/z/ city/state, it might not be for you. It's a small field, so there's no guarantee you'll end up in any particular geographic location. That and the difficulty of getting into a residency program are the two main drawbacks.
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Agree with all of that. We're probably the most comprehensive of the oncological fields, devoting our entire training to that area of medicine. We often understand the surgical management/anatomy/radiology of patient care better than med oncs, and the role/type of chemo better than surg oncs/specialists.
The patient care aspects are incredibly fulfilling and the work is interesting IMO. People ask me if I would have done a backup speciality and I can resoundingly say absolutely not. If you really like rad onc for the right reasons, no other field occupies a similar niche in medicine. The caveats above are absolutely true, and the market has been tightening, and I don't see reimbursement going up any time soon. Still wouldn't change my decision for a second.
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Just how tight of a job market are we talking? I've scoured the forum for the past week and there are people echoing the same sentiments. I don't have a geographic restriction per se... I am very interested in radiation oncology for many of the same reasons that a lot of you are, but it is very important to me that I live in an area near a medium-sized/big city and not rural America. I know that there are no guarantees in life, but is there enough of a concern that I should seriously be reconsidering my interest in this field?
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No. As long as that medium-sized city could end up being in the midwest rather than the west coast or northeast.
Thanks for the replies guys! Neat insights, I am really interested in the field, love the things brought up, as well as the patient population and interaction. At least at the home institution (only place I have shadowed radoncs) the dynamic feels unique to me, very teamwork oriented with the patient, not super rushed, basically very focused on the patient and it is special to be there helping them through the challenge of cancer. The job market has been the one nagging thing in the back of mind that makes me worried. I unfortunately do have a strongly preferred region, and my dream market is super tight (SLC is rough, not a lot of places from what I can tell and a fairly low cancer rate pop. as well :/). That being said I would be fine ending up anywhere west of colorado really, don't really care about being in a large city, would almost prefer not to, just not super rural (are there really that many really rural radonc clinics though? It seems like you have to have at least decent infrastructure for the machinery and such, I could be totally off though). I just love to mountain bike, hike, etc., and the idea of not having mountains kind of kills me haha. I kinda figure though that A. the job market may be different here in 8.5yrs (maybe?) and B. I don't think I could force myself into another field that I wouldn't have interest in just for the location (not to mention utah is a fairly tight market from what I hear for many specialties...).
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If I am unwilling to live in the midwest, then would you recommend that I find a different field? I don't want to appear to be an inflexible person, but I have a non-traditional family which I don't believe will be well-received in the midwest (I was on the receiving end of a lot of hate as a child and don't want my kids to go through it).
I feel exactly the same about radiation oncology. Unfortunately the market will become more saturated in 8.5 years due to a continual increase in residency slots without the same increase in the job market. There was a long thread about this a few weeks ago which I wish were not true...
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If specific geography trumps everything else, perhaps yes. That being said, pittsburgh, Cleveland and Kansas city have all been decent in my experience, I've heard good things about Oklahoma city as well.
You may just as well end up getting a pp job in southern California or SF, but the competition may be more intense and you may have to take a hit on salary and job quality as a result. It's a very tricky market to predict, year to year
There are many great places to live in the South and in the Midwest. If you are ok with that then rad onc is a great field. If you are wanting to go to the bay area or NYC then it may not be the field for you.
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Yes, I would, and I also agree with medgator. This field is small and with increasing residency positions, I can't say the job market is going to get better soon. It probably will get worse going forward. If you can't see yourself living in a small to medium sized city in the Midwest like West DeMoines or in the South like Birmingham in the future, then it would probably be best for you to consider other fields over this one. Personally for me, home is in the Midwest and that's where I went to college and med school so the idea of moving back here wasn't a big issue for me, and location didn't play much of a role for me when I was applying.
From your time range of 8.5 years, it seems that you must be a first or second year. You haven't even started clerkships. Even if you have an interest in radiation oncology now, it's very unlikely that you will end up choosing this field when it comes time to submit ERAS.
As an outsider, it seems that radiation oncology is a great field, and it has been for me. I have enjoyed my time in it, but that being said, we also deal with a unique patient population and the field is small. We are also dealing with other issues in this field. You have to enjoy spending time with cancer patients and if you're the kind of person who gets annoyed easily or can't handle some of the people in your own class, it might not be the best field for you anyway.
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Thank you for the honest and thorough reply medgator. I've just been interested in this field since my undergraduate career (physics major) and can't see myself doing anything else, but I don't want to be unrealistic. Asking questions on a forum can be hard in terms of deciphering credibility but I really feel like your response is well-rounded and practical.
I'm a second year so I haven't started clerkships, but as a physics enthusiast I honestly can't see myself changing my mind. I am very social and love talking to people and have experience with cancer patients so I'm very comfortable in this environment. Thanks for your advice.
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^^^How much physics do you guys regularly use day-to-day?
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conceptually, plenty. calculation-wise, nil. We do have physicists after all
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Based on talking with folks having gone through the job hunt recently I concur with what everyone says. I do also want to add that there are other specialties that have problems with geography as well, not just radiation oncology.
They way I explain it to colleagues is that physics is to rad onc as pharmacology is to medicine. Meaning, you have to have an understanding of pharmacology to know what drug, how much and how often to prescribe it. However, most of the time you aren't sitting there thinking of the detailed pharmacology concerning you prescribing Levaquin for someones pneumonia. In the same way, when you are thinking about prescribing radiation, most of the time the physics needed is conceptual and in the background of your mind.
In both cases, sometimes you need to think harder about the basic science: drug interactions? bad liver? germ resistance? And in rad onc: SBRT possible? re-treatment? Should we hypo fractionate? Dose too high to normal structures?
Hopefully that helps!
They way I explain it to colleagues is that physics is to rad onc as pharmacology is to medicine. Meaning, you have to have an understanding of pharmacology to know what drug, how much and how often to prescribe it. However, most of the time you aren't sitting there thinking of the detailed pharmacology concerning you prescribing Levaquin for someones pneumonia. In the same way, when you are thinking about prescribing radiation, most of the time the physics needed is conceptual and in the background of your mind.
In both cases, sometimes you need to think harder about the basic science: drug interactions? bad liver? germ resistance? And in rad onc: SBRT possible? re-treatment? Should we hypo fractionate? Dose too high to normal structures?
Hopefully that helps!
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We use it everyday, though we have physicists who do the nitty gritty calculations for us.
No problem. I am certainly not trying to dissuade you from entering the field, but I am trying to give you all the information you need so you can make an informed decision. It does strike me as odd that you know you want to enter radiation oncology without haven't done a radonc rotation or having done any clerkships. Medicine is different in practice than on paper, and that certainly applies to this field. But then again, one of my good friends during medical school was set on doing ophthalmology since day 1 of med school, and that's all he wanted going into 4th year.
Thanks for all the discussion guys! I am a first year and have obviously not been through rotations. As far as the interest in radonc, it is the field that really sticks out to me at this point for a variety of reasons (I've spent a fair amount of time with the faculty here and while I understand that that is a far cry from a rotation i feelin have an ok grasp on the feel of the specialty) and in order to meet a lot of the requirements I think an earlier start is advantageous. Plus, I find the research very interesting and wouldn't really want to do anything else... Basically at this point I figure it is the field that I'm am by far most interested in at this point this I am heading in that direction... If per chance I end up changing to something else later then I figure if i am competitive in rad onc I would be fairly competitive in a few other fields. Honestly I would be a little surprised if it changed just cause that's how I generally roll (get something I like and just go for it lol). Honestly the only bothersome thing is the geography (my wife has very strong preference for the westernish side of the U.s. as well), but I don't worry too much for now since I figure going to something I dislike for location seems kinda silly and more regrettable in the end. Idk perhaps that's naive or off base... But I figure even if it means living somewhere where I don't like, gaining experience, continue networking etc, I should be able to score somewhere in like utah,Id, Arizona, Colorado, Oregon,Washington, Nevada maybe type areas?
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as residents at our program, we work quite hard and most often not home for dinner. Still love the field. But it's hard work for us, and that's not uncommon.
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Do you mind elaborating on these for me? The easily annoyed thing isn't a problem for me, but were you referring to the patients you typically see? I can easily imagine that it could be a drag, but in a depressing sort of way rather than annoyance.
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Yes, we still have our weekends to catch up on reading and research.
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And see consults. Despite what may be "lore", they do happen with some frequency in both PP and academics. The "three A's" of PP would suggest that you be available for consults anytime, anywhere to help keep your referring MDs happy (and destroy the notion you're an 8-5 M-F doc) along with your outpatient volume.
I go in several times a year, generally within 24 hrs of being called, whether it's a "routine" or "urgent" consult. Not just for brain mets, cord compression, bleeding etc. but also new diagnoses
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What warrants a weekend consult?
Medically - very little outside of the standard rad onc emergencies (cord compression, etc).
But in reality, especially in competitive market places where patients and referring docs have choices as to where they can get their radiation...getting a consult on the weekend means it's in your best interest to see the patient. Patients and referring docs appreciate it, even if it's just to introduce yourself, the concept of radiation, and explain why you have to do what you do in the outpatient setting with optimal CT-sim, planning, etc.
Some hospital bylaws also mandate that a consult be seen within 48 hours. It's not binding, but you can get a slap on the wrist if you get a Friday evening consult and wait until Monday to see the patient.
Medically - very little outside of the standard rad onc emergencies (cord compression, etc).
But in reality, especially in competitive market places where patients and referring docs have choices as to where they can get their radiation...getting a consult on the weekend means it's in your best interest to see the patient. Patients and referring docs appreciate it, even if it's just to introduce yourself, the concept of radiation, and explain why you have to do what you do in the outpatient setting with optimal CT-sim, planning, etc.
Some hospital bylaws also mandate that a consult be seen within 48 hours. It's not binding, but you can get a slap on the wrist if you get a Friday evening consult and wait until Monday to see the patient.
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I kinda said that above, not sure what wasn't clear about it to the other poster, but yes you are correct. In fact, many bylaws actually have a 24 hour rule for consults.
The bottom line is, how do you want to be viewed? 1) A radiation tech/pharmacist who "dispenses" XRT between the hours of 8:30-5 PM M-F or a 2) a radiation "oncologist" that manages cancer patients anytime, anywhere. I choose #2 and I've seen plenty of older docs who have been comfortable with #1. It's not just a mindset in terms of work schedule either. Some older docs won't write for decadron, pain meds, do oncologic w/u etc.
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LMAO. Gunners gonna gun'
