Why I think Rad/Onc has a secure career and bright future

[RADOnCFUN]

When you rotated in the IR you will hear IR guys complaining about cardio and vascular take the lucrative part of their job away. The thing is, the technology IR uses is not exclusive, other specialities can use their equipment and do stuff. So even nephrologist are trying to take a bite from IR. Now, Rad/Onc has a great barrier that keep other specialities from touch, it is radioactive and needs good dosage / distribution calculations that none of any other specialities are allowed to do. So even through lots of people complain about rad Bio/physics, they are actually the stuff that make us unique and difficult to replace.

That being said, the technical barrier is not the excuse for leaders in the field to mess around. We need real research and we need to recruit smart people (I mean, please, not Just those book smart). For that, rad Onc has been doing exact opposite in last decade. People publish useless papers ( chart review, retrospectives, reviews etc) has been labeled as being productive and those doing lab research not on rad Onc related topics are in leadership positions in academic programs. Now when those people takes leadership positions, rad Onc will loss its momentum is discovering new treatments and indications.

Oncology is evidence based as it should be. When rad Onc slows down on research and clinical trials and other specialities are leaps and bounds on new drugs and tools, there is no indications to use radiation and rad onc physicians shall loss jobs. Honestly, When you put tons of your name in non rad Onc related papers while in rad Onc leadership positions, you are probably at the end of your career.

Anyway, the main tone of post is supposed to be positive

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[medgator]

We will always be needed. We just don't need the number of trainees we are graduating. Not a hard thing to figure out

 

[elementaryschooleconomics]

Now, Rad/Onc has a great barrier that keep other specialities from touch, it is radioactive and needs good dosage / distribution calculations that none of any other specialities are allowed to do. So even through lots of people complain about rad Bio/physics, they are actually the stuff that make us unique and difficult to replace.

 

[CurbYourExpectations]

Yeah, hopefully Dr. Shah and the workforce crew figure things out so I don't have to flee the country, change my name and become a bicycle/scooter renter in Italy

 

[RickyScott]

We will always be needed. We just don't need the number of trainees we are graduating. Not a hard thing to figure out

Exactly. Field has to grow substantially to keep pace with the doubling of resident numbers, but indications and fractions are shrinking. No one has ever said xrt will disappear. Btw: there are still travel agents, just don’t need as many as in the pre internet era.

 

[RickyScott]

View attachment 346374

View attachment 346375

In totality, Dermatologists deliver more fractions of xrt than radoncs.

 

[Mandelin Rain]

I don't know why anyone thinks other docs can't use the linac you don't own.

Most of us work at/for a hospital system that owns the tech and staff (including the dosimetrists and therapists).

If a cardiologist said they wanted to do their own ablations on the linac and could demonstrate proficiency, you think the system would say no?

Ditto a neurosurgeon with SRS. Or even a CT surgeon with Lung SBRT (though this is more dubious).

These people don't have to learn the whole of cancer biology, epidemiology, workup, staging, etc.... or physics or rad bio or whatever. They have to learn how to safely order, review, and deliver a highly targeted dose of XRT for a highly specific indication. That's a week long course, and 10 supervised procedures away from getting privileges.



It would be analogous to a surgeon thinking no other docs could use a scalpel.

 

[TheWallnerus]

I don't know why anyone thinks other docs can't use the linac you don't own.

Most of us work at/for a hospital system that owns the tech and staff (including the dosimetrists and therapists).

If a cardiologist said they wanted to do their own ablations on the linac and could demonstrate proficiency, you think the system would say no?

Ditto a neurosurgeon with SRS. Or even a CT surgeon with Lung SBRT (though this is more dubious).

These people don't have to learn the whole of cancer biology, epidemiology, workup, staging, etc.... or physics or rad bio or whatever. They have to learn how to safely order, review, and deliver a highly targeted dose of XRT for a highly specific indication. That's a week long course, and 10 supervised procedures away from getting privileges.



It would be analogous to a surgeon thinking no other docs could use a scalpel.

"It would be analogous to a surgeon thinking no other docs could use a scalpel."

Imagine another universe where there is a surgologist, and in the O.R. you have a sliceimetrist and scalpel tech. The surgologist prescribes the amount and location of the surgerizing, which is calculated and planned by the sliceimetrist and carried out on the patient by the scalpel tech. No doctor ever actually personally uses and operates the scalpel: that's the role of the scalpel techs. (Of course the surgologist must be in the O.R. while the scalpel tech is scalpeling.) Nor does the doctor actually personally plan the surgery, but he gives general guidelines to the sliceimetrist to do so. There is a physicist who also checks that the torque on the scalpel is calibrated to the correct newtons (no one ever really sees the physics guy though, but he is licensed by the state to commission every scalpel... no doctors commission or check the scalpel torque personally obv).

Another doctor who's not a surgologist in this alternate universe goes to his admin one day: "Is there a way I could be a titular surgologist... because I might have ten times the potential patient volume of the surgologist... what do you think?"

 

[RickyScott]

While IR may have some overlap with other specialties at the margins, there are tons of procedures in IR that no other specialty would touch or have any interest in performing. (I have never come across an ir who isn’t overwhelmingly busy) More importantly. Indications for IR are growing, We are a one trick pony with a shortening act. Dermatologists already perform more radiation than radoncs. Ever perform gamma knife with an involved neurosurgeon? Radonc is a babysitter. (Neurosurgeons did invent gamma knife, cyber knife, and the first commercial imrt system, the nomos peacock)

 

[TheWallnerus]

If a cardiologist said they wanted to do their own ablations on the linac and could demonstrate proficiency, you think the system would say no?

We are a one trick pony with a shortening act.

Varian Receives FDA "Breakthrough Device Designation" for its Cardiac Radioablation (CRA) System for Treatment of Refractory Ventricular Tachycardia (VT)​

 

[Mandelin Rain]

Now, Rad/Onc has a great barrier that keep other specialities from touch, it is radioactive and needs good dosage / distribution calculations that none of any other specialities are allowed to do.

I do agree that I would treat Rad Onc as though it is radioactive though. Lock the thought away in a closet of your brain with a sign that reads "Hot Lab" on the door and hope there is enough shielding to prevent it from ever coming out again.

 

[elementaryschooleconomics]

I don't know why anyone thinks other docs can't use the linac you don't own.

Most of us work at/for a hospital system that owns the tech and staff (including the dosimetrists and therapists).

If a cardiologist said they wanted to do their own ablations on the linac and could demonstrate proficiency, you think the system would say no?

Ditto a neurosurgeon with SRS. Or even a CT surgeon with Lung SBRT (though this is more dubious).

These people don't have to learn the whole of cancer biology, epidemiology, workup, staging, etc.... or physics or rad bio or whatever. They have to learn how to safely order, review, and deliver a highly targeted dose of XRT for a highly specific indication. That's a week long course, and 10 supervised procedures away from getting privileges.



It would be analogous to a surgeon thinking no other docs could use a scalpel.

I think in the modern era, most "young" (read: <45 or so) physicians can't conceive of a world where you're "allowed" to do anything without officially completing some sort of training pathway or getting a certificate from one of the main specialty boards or some other type of stamp of approval from an "authority".

The truth is, legally: if you 1) graduate from an accredited medical school, 2) complete the USMLE exam sequence, 3) complete 1-2 years of supervised "training" after medical school (depending on the state), the license to practice medicine you can acquire has no limits (at least, none that I know of). You are legally allowed to open your own Plastic Surgery practice even if you've never held a scalpel before.

Now, will you get hospital privileges or get reimbursed by insurance? No. Will you lose the first malpractice suit brought against you? Probably.

Obviously, our system, as it is currently designed, incentivizes physicians who have graduated from an ACGME-accredited Radiation Oncology program and are board certified/board eligible to operate the linear accelerators, most of the time. But there's nothing that really ropes off the use of therapeutic radiation as definitive cancer treatment as "ours".

I wish there was. You better believe if there was some federal law that you couldn't deliver external beam radiation therapy without passing the ABR's Radiation Physics and Radiation Biology exams, I would turn into the biggest cheerleader of those tests immediately!

 

[evilbooyaa]

I thought the authorized user stuff from NRC provided some level of protection against randos coming in for stuff, or is that just for radioactive isotope stuff?

 

[madchemist89]

I think we are safe as reimbursement and payment will go low enough that no one else will have an interest in the field.

 

[BobbyHeenan]

I thought the authorized user stuff from NRC provided some level of protection against randos coming in for stuff, or is that just for radioactive isotope stuff?

I think there's an energy component to it too. That's my understanding how ortho and derm are getting around it....not using megavoltage.

I may be wrong on this though.

 

[Mandelin Rain]

NRC AU is solely about radioactive materials IIRC.

The beam is regulated by the states.

 

[Mandelin Rain]

I think we are safe as reimbursement and payment will go low enough that no one else will have an interest in the field.

 

[RickyScott]

I do agree that I would treat Rad Onc as though it is radioactive though. Lock the thought away in a closet of your brain with a sign that reads "Hot Lab" on the door and hope there is enough shielding to prevent it from ever coming out again.

NRC AU is solely about radioactive materials IIRC.

The beam is regulated by the states.

plenty of IRs in my state are AU for sir spheres?

 

[medgator]

plenty of IRs in my state are AU for sir spheres?

Yup ir does them around us without us getting involved

 

[Mandelin Rain]

plenty of IRs in my state are AU for sir spheres?

Right. I'd imagine, every nuc med is an AU. Any radioactive material needs someone to oversee it. PET tracers, Tc-99, therapeutic isotopes, etc...

 

[radiaterMike]

check out the COI of those 8 "qualified dermatologists", and the funding support for this article.

 

[RickyScott]

Right. I'd imagine, every nuc med is an AU. Any radioactive material needs someone to oversee it. PET tracers, Tc-99, therapeutic isotopes, etc...

And cardiology sometimes performs/reads cardiac nuc med scans .

 

[dieABRdie]

plenty of IRs in my state are AU for sir spheres?

My understanding is the NRC certification is through ABR... so that is how IR is AU for Y90 and nuc med for radioactive iodine

 

[Mandelin Rain]

The NRC certification is through the federal government (U.S.N.R.C.). It is in place basically to ensure that persons handling, using, and disposing of radioactive material (editor's note: contrary to the opening post in this thread, the vast majority of radiation oncology is decidedly not "radioactive") do so in a safe, responsible manner. ABR is one (of many) board certifications that can lead to NRC certification of one kind or another.

Specialty Board(s) Certification Recognized by NRC Under 10 CFR Part 35

www.nrc.gov

I'm a bit surprised there is so much confusion about this.

 

[TheWallnerus]

My understanding is the NRC certification is through ABR... so that is how IR is AU for Y90 and nuc med for radioactive iodine

The NRC certification is through the federal government (U.S.N.R.C.). It is in place basically to ensure that persons handling, using, and disposing of radioactive material (editor's note: contrary to the opening post in this thread, the vast majority of radiation oncology is decidedly not "radioactive") do so in a safe, responsible manner. ABR is one (of many) board certifications that can lead to NRC certification of one kind or another.

Specialty Board(s) Certification Recognized by NRC Under 10 CFR Part 35

www.nrc.gov

I'm a bit surprised there is so much confusion about this.

Any doctor in any specialty can get NRC AU status... with (enough proper) training (by another AU). To prove the point, endocrinologists get AU status to do I-131. And they would bill the same codes a rad onc or nuc med would (and get paid of course).

 

[Mandelin Rain]

Certification Board of Nuclear Endocrinology is one of the recognized boards. One that I had no idea existed.

Basically the feds don't want just any dope walking around with radium in their pocket. Terrorists win again.

 

[Ray D. Ayshun]

 

[elementaryschooleconomics]

The "easiest" way to get NRC AU status is completing a RadOnc or Radiology residency, but it's not the only way:

 

[ramsesthenice]

We will always be needed. We just don't need the number of trainees we are graduating. Not a hard thing to figure out

I once heard someone say Walmart is a great place to work...if you are a member of senior management or an executive. The field isn't going anywhere as a whole and those of us who are already in should by and large probably have pretty good careers (as long as we don't end up needing to urgently move to a specific location for say family reasons). But competition for the sweet gigs is only going to get worse for the foreseeable future. And there is no magic fix. Short of an epic cancer boom (which literally NO ONE should be pulling for) the next 5-10 years at least are basically set.

 

[fiji128]

I once ….. the next 5-10 years

I’ve stated before on these forums that we have about a 10 year horizon before the bottom starts falling out. Make sure you can either FIRE out or retrain by then!

 

[jondunn]

I’ve stated before on these forums that we have about a 10 year horizon before the bottom starts falling out. Make sure you can either FIRE out or retrain by then!

10 years from now? Not sooner?

 

[Lamount]

I’ve stated before on these forums that we have about a 10 year horizon before the bottom starts falling out. Make sure you can either FIRE out or retrain by then!

What is "FIRE out"? asking for a friend...

 

[jondunn]

Financial Independence, Retire Early

Not really my thing but there’s tons of internet space about this targeted towards docs. Some people in high burnout fields like EM and hospitallist medicine pursue this

 

[IonsAreOurFuture]

There is no inherent reason why UroRad couldn't show up as PulmoRad. I know of a large academic group of thoracic surgeons who bought their own PETCT unit in the LA area back in 2005 or so, probably because they saw how much money they were sending out the door. Their patients probably got faster, friendlier service in-house, with lower cost and overhead than at the hospital across the street.

Buying a freestanding center that's on its knees and hiring a Rad Onc to run it could be a viable business plan. The big pulmonary/thoracic group could send all their cancers their, not just SBRT but also stage III, IV and adjuvant cases. I think they would still retain the Rad Onc professional to run it, but the Rad Onc would not retain much autonomy.

 

[deleted941485]

I once heard someone say Walmart is a great place to work...if you are a member of senior management or an executive. The field isn't going anywhere as a whole and those of us who are already in should by and large probably have pretty good careers (as long as we don't end up needing to urgently move to a specific location for say family reasons). But competition for the sweet gigs is only going to get worse for the foreseeable future. And there is no magic fix. Short of an epic cancer boom (which literally NO ONE should be pulling for) the next 5-10 years at least are basically set.

Why? It puts a smile on my face when I see someone smoking or vaping or drinking too much or not getting the hpv vax. I don’t feel like I have any obligation to stop them. They can’t say they haven’t been told.

 

[deleted941485]

There is no inherent reason why UroRad couldn't show up as PulmoRad. I know of a large academic group of thoracic surgeons who bought their own PETCT unit in the LA area back in 2005 or so, probably because they saw how much money they were sending out the door. Their patients probably got faster, friendlier service in-house, with lower cost and overhead than at the hospital across the street.

Buying a freestanding center that's on its knees and hiring a Rad Onc to run it could be a viable business plan. The big pulmonary/thoracic group could send all their cancers their, not just SBRT but also stage III, IV and adjuvant cases. I think they would still retain the Rad Onc professional to run it, but the Rad Onc would not retain much autonomy.

They’ll pay you 200 to run it and pocket the rest of the peg fees in addition to tech. If uro Rads is any guide.

 

[ramsesthenice]

Why? It puts a smile on my face when I see someone smoking or vaping or drinking too much or not getting the hpv vax.

First, that’s the part you may think but don’t say out loud 😉

Second, that is the point of the analogy. The field as a whole isn’t dying. But compared to other specialties the limited job options and bargaining power are only getting worse. Most people didn’t put in years of work just to pull a paycheck. It’s the worst kind of self inflicted wound. We made ourselves a field for med students with with no better options. The impressive thing about it is how fast we tanked it. I’m only about 10 years out from med school and it was one of the three most competitive specialties then. I hate it. I really do think I have one of the coolest jobs in the hospital and yet, I can’t enthusiastically tell promising med students to go for it.

 

[jondunn]

There is no inherent reason why UroRad couldn't show up as PulmoRad. I know of a large academic group of thoracic surgeons who bought their own PETCT unit in the LA area back in 2005 or so, probably because they saw how much money they were sending out the door. Their patients probably got faster, friendlier service in-house, with lower cost and overhead than at the hospital across the street.

Buying a freestanding center that's on its knees and hiring a Rad Onc to run it could be a viable business plan. The big pulmonary/thoracic group could send all their cancers their, not just SBRT but also stage III, IV and adjuvant cases. I think they would still retain the Rad Onc professional to run it, but the Rad Onc would not retain much autonomy.

Need Med onc to make it more viable

 

[elementaryschooleconomics]

I really do think I have one of the coolest jobs in the hospital and yet, I can’t enthusiastically tell promising med students to go for it.

Totally agree.

Yesterday, one of my nurses was venting to me about how some of the higher-ups had treated her and the other nurses poorly that day, and how upset they were. Her theme was that, especially right now, especially in the Oncology space, a nurse can sneeze and find another job, and unprofessional behavior wouldn't be tolerated. While telling me this, she goes "nursing isn't like the RadOnc docs or even the therapists, if you guys want to stay in this area you're very limited, so you're forced to put up with more abuse unless you want to uproot your family and move somewhere else".

The truth of that was just a dagger coming from someone who has no idea about all the turmoil on the physician side of things. Even in the best of times, geographic preference was tough for us...and the best of times are currently a memory.

Being a Radiation Oncologist is absolutely one of the coolest jobs in the hospital. How we find ourselves in the position we're currently in is...maddening. The primary negotiating power any individual has when dealing with an institution/employer is the ability to walk away. I think it's safe to say the vast majority of us can't "walk away" without facing a high likelihood of moving to a different area of the country. That's one thing if you're single without ties to an area, but is an entirely different prospect if you have a spouse/partner, children, extended family, own property, etc.

But this is often overlooked in the arms of race careerism in medicine, and when discussing oversupply in RadOnc. It's why some factions think the <5% unemployment rate from the ARRO new grad survey means everything is ok.

I assume those are the same people who would consider a retrospective chart review published only in abstract form with a population of 27 reporting some intervention with a statistically significant improvement in a radiographic response compared to historical controls as "practice changing".

 

[medgator]

Need Med onc to make it more viable

Nope, esp not with buy in from some surgical specialists

 

[medgator]

They’ll pay you 200 to run it and pocket the rest of the peg fees in addition to tech. If uro Rads is any guide.

There were some pretty decent urorads gigs even a decade ago.

i still think, on net, it's better financially than being junior academic faculty at a satellite in 2021

 

[jondunn]

Nope, esp not with buy in from some surgical specialists

Read the post again.

If you’re taking a stage 1 specialist/SBRT center, agree. (But would be fairly small practice)



Not the rest. Especially stage IV.

Also it’s possibly likely that even stage 1 SBRT patients will get IO in the future. Definitely stage 1/2 surgical patients will be getting systemic neoadjuvantly and adjuvantly

The idea of a thoracic RadOnc practice definitely needs Med onc to keep the patients flowing to the extent as described above

 

[Volfo]

You are right OP.
But this toxic hyperbole forum is trying so hard to make it look otherwise. Because they are scared that some medical student might see this thread and he might get interested in the field. It's actually quite sad that they think the solution for the oversupply is by ****t#ng on the field that put food on their table.
Radiation oncology is a great field with technical and knowledge barriers that make it impossible for midlevels or M.Ds to get into, but God damn man it have some awful toxic weirdos.

 

[medgator]

You are right OP.
But this toxic hyperbole forum is trying so hard to make it look otherwise. Because they are scared that some medical student might see this thread and he might get interested in the field. It's actually quite sad that they think the solution for the oversupply is by ****t#ng on the field that put food on their table.
Radiation oncology is a great field with technical and knowledge barriers that make it impossible for midlevels or M.Ds to get into, but God damn man it have some awful toxic weirdos.

Please feel free to bring facts regarding supply demand issues and the job market to your post. Platitudes don't get you very far in this forum.

We are all ears

 

[medgator]

Read the post again.

If you’re taking a stage 1 specialist/SBRT center, agree. (But would be fairly small practice)



Not the rest. Especially stage IV.

Also it’s possibly likely that even stage 1 SBRT patients will get IO in the future. Definitely stage 1/2 surgical patients will be getting systemic neoadjuvantly and adjuvantly

The idea of a thoracic RadOnc practice definitely needs Med onc to keep the patients flowing to the extent as described above

Where do you think med onc is getting their referrals from? (Hint: eventually everyone drinks from the same lake). Would say a rad onc partnered with ent, gu and thoracic would absolutely crush it and probably end up employing the med onc if they did it right

 

[metallica81788]

You are right OP.
But this toxic hyperbole forum is trying so hard to make it look otherwise. Because they are scared that some medical student might see this thread and he might get interested in the field. It's actually quite sad that they think the solution for the oversupply is by ****t#ng on the field that put food on their table.
Radiation oncology is a great field with technical and knowledge barriers that make it impossible for midlevels or M.Ds to get into, but God damn man it have some awful toxic weirdos.

There are 100% many awful toxic weirdos in RadOnc - I just don't think they are here.
They are chairing academic departments, selling large private practice groups and not promoting partners, and not retiring as the next generation does their work for them with near zero ability to move laterally or make even half of their career earnings.

I'll be the first to admit RadOnc (especially before the last 5-10 years) had some of the weirdest antisocial personalities in any field of medicine I saw - it almost turned me off to the field entirely. Just because people are smart doesn't mean they can converse and interact normally with humans or that you'd want to have a beer with them.

 

[elementaryschooleconomics]

You are right OP.
But this toxic hyperbole forum is trying so hard to make it look otherwise. Because they are scared that some medical student might see this thread and he might get interested in the field. It's actually quite sad that they think the solution for the oversupply is by ****t#ng on the field that put food on their table.
Radiation oncology is a great field with technical and knowledge barriers that make it impossible for midlevels or M.Ds to get into, but God damn man it have some awful toxic weirdos.

In a vacuum, the actual medicine and practice of Radiation Oncology is amazing, and I have rarely (if ever) heard anyone say otherwise, here or elsewhere.

But life doesn't happen in a vacuum. A living, breathing person, with hopes and dreams and desires, has to choose to practice Radiation Oncology. The opportunity cost of becoming a specialty-trained physician in America is so high that you're essentially committing to that path for life.

The "solution for oversupply" is largely in the hands of a small group of senior people, and consists of reducing the number of residents trained per year. Barring that, the "toxic hyperbole" to which you're referring mostly serves to remind medical students that they are, in fact, people too (despite an educational system which tries to get them to forget it). If someone falls in love with the medicine and practice of Radiation Oncology, and is aware of and understands the potential significant limitations pursuing the specialty might place on their life outside of work, then I look forward to meeting them at a future ASTRO meeting.

Speaking of hyperbole - there are no technical or knowledge barriers making it "impossible" for mid-levels or non-RadOnc physicians to use ionizing radiation therapeutically. This thread alone has multiple examples, the most glaring of which is the Dermatologists and skin cancer.

If anyone lurking in this thread thinks the ABR and residency training in Radiation Oncology builds an impenetrable fortress around radiation therapy, please go Google "dermatology superficial radiation". Take a look at how many practices are advertising it on their websites. See the machines that are for sale.

Here's a fun passage to consider, from a paper published in 2015:

As always, the therapeutic use of ionizing radiation is an incredible way to practice medicine, and if that's the only thing someone needs to have a fulfilling life as a doctor, great. If you have other things to balance in your life, such as geographical considerations for your spouse, children, family, community, etc - perhaps a different specialty would be just as rewarding and won't result in divorce.

 

[RickyScott]

Totally agree.

Yesterday, one of my nurses was venting to me about how some of the higher-ups had treated her and the other nurses poorly that day, and how upset they were. Her theme was that, especially right now, especially in the Oncology space, a nurse can sneeze and find another job, and unprofessional behavior wouldn't be tolerated. While telling me this, she goes "nursing isn't like the RadOnc docs or even the therapists, if you guys want to stay in this area you're very limited, so you're forced to put up with more abuse unless you want to uproot your family and move somewhere else".

The truth of that was just a dagger coming from someone who has no idea about all the turmoil on the physician side of things. Even in the best of times, geographic preference was tough for us...and the best of times are currently a memory.

Being a Radiation Oncologist is absolutely one of the coolest jobs in the hospital. How we find ourselves in the position we're currently in is...maddening. The primary negotiating power any individual has when dealing with an institution/employer is the ability to walk away. I think it's safe to say the vast majority of us can't "walk away" without facing a high likelihood of moving to a different area of the country. That's one thing if you're single without ties to an area, but is an entirely different prospect if you have a spouse/partner, children, extended family, own property, etc.

But this is often overlooked in the arms of race careerism in medicine, and when discussing oversupply in RadOnc. It's why some factions think the <5% unemployment rate from the ARRO new grad survey means everything is ok.

I assume those are the same people who would consider a retrospective chart review published only in abstract form with a population of 27 reporting some intervention with a statistically significant improvement in a radiographic response compared to historical controls as "practice changing".

You are so fd if your department becomes toxic or you end up working/beholden to some toxic ass- bill regine, Adam dicker, Sylvia formentie, lisa kachnic or an administration like upitt.

 

[jondunn]

Formenti is a total destroyer of departments. She also gaslights. Toxic.

 

[metview]

You are right OP.
But this toxic hyperbole forum is trying so hard to make it look otherwise. Because they are scared that some medical student might see this thread and he might get interested in the field. It's actually quite sad that they think the solution for the oversupply is by ****t#ng on the field that put food on their table.
Radiation oncology is a great field with technical and knowledge barriers that make it impossible for midlevels or M.Ds to get into, but God damn man it have some awful toxic weirdos.

It seems like one of the many toxic personalities has found his/her way to SDN. Look at derm practices. They prescribe superficial RT like crazy, and they haven’t spent a single day learning about physics or rad bio. You can do better bud.