anes vs rads vs rad onc

[ALTorGT]

hi all
was debating btw rad and anes..and someone threw up rad onc...after doing a bit more reading, discoverd it to be a real interesting field....just wondering though..and I think you will concur with me...

anesthesiology and diag/intv rads seem like more bread and butter and well grounded specialities right? Given that I'm interested in Pvt. Practice, is rad onc too small and esoteric to be considering?

thanx.

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[Thaiger75]

hi all
was debating btw rad and anes..and someone threw up rad onc...after doing a bit more reading, discoverd it to be a real interesting field....just wondering though..and I think you will concur with me...

anesthesiology and diag/intv rads seem like more bread and butter and well grounded specialities right? Given that I'm interested in Pvt. Practice, is rad onc too small and esoteric to be considering?

thanx.

No and no.

"Bread and butter" and "well-grounded" are very vague terms. In the general sense in the minds of the public and medical students, anes and rads are probably more bread and butter, as they get more exposed to them. In oncology and certainly for specific tumor sites, rad onc is very much bread and butter. Not sure what you mean by well-grounded.

 

[ALTorGT]

anesthetics and radiology seem like specialties with a lot more opportunity in the sense that more positions available and more flexible..everytime someone goes under the knife, theres the anesthetist, or radiologist...i know this is a somewhat tenuous argument...in that i'm not recognising the importance that the size of the profession plays in the matter....there are a lot fewer rad once people around so more than enough work to keep them busy (simple supply vs demand rite?)......but still..rad onc seems catered more towards research and academic practice...not much chance you can start off on your own with a gamma knife ...well i suppose the same applies to rads but not really to anesthetics?

 

[AlexanderJ]

Private practice is a great option in rad onc. What you need to do is this: do a rotation in rad onc, rads, and gas. Get a feel for each field and ask your attendings a lot of questions. Try to get out and shadow some private practice docs too and get their spin on things. Most of all, see which field you like best and then make your decision. You have to experience all of these fields and ask lots of questions (don't be shy!) before you can make an intelligent decision. Good luck.

 

[Thaiger75]

anesthetics and radiology seem like specialties with a lot more opportunity in the sense that more positions available and more flexible..everytime someone goes under the knife, theres the anesthetist, or radiologist...i know this is a somewhat tenuous argument...in that i'm not recognising the importance that the size of the profession plays in the matter....there are a lot fewer rad once people around so more than enough work to keep them busy (simple supply vs demand rite?)......but still..rad onc seems catered more towards research and academic practice...not much chance you can start off on your own with a gamma knife ...well i suppose the same applies to rads but not really to anesthetics?

Although I can't speak for what exactly goes on in private practice, I have rotated through academic departments that are run more like a PP. From what I can gather, part of the difference, as you pointed out, are facilities and resources. In PP, you aren't going to be directly involved in alot of clinical trials and protocols and won't get to play with all the new toys (i.e. gamma knife). However, some new technologies such as intensity-modulated radiation therapy (IMRT) will most likely make it to everyday PP in the future. Actually, as the current trend stands, I hear there are alot more PP jobs available compared to academic positions.

 

[stephew]

Most med students (and lets face it, md's) dont understand radonc. Thaiger is correct that the answers are "no" and "no". take a look at the rad onc faq on this forum.

For the radoncs out there: had a pt today s/p gamma knife for benign lesion. Subsequently had swollen tounge (2nd to other condition not related to lesion or any meds/allergy). The dx of the genius in the ER? "Oh your tounge is swollen cos you had radiation". Brilliant!

 

[stephew]

Although I can't speak for what exactly goes on in private practice, I have rotated through academic departments that are run more like a PP. From what I can gather, part of the difference, as you pointed out, are facilities and resources. In PP, you aren't going to be directly involved in alot of clinical trials and protocols and won't get to play with all the new toys (i.e. gamma knife). However, some new technologies such as intensity-modulated radiation therapy (IMRT) will most likely make it to everyday PP in the future. Actually, as the current trend stands, I hear there are alot more PP jobs available compared to academic positions.

Have to here: pet peeve: gamma knife is an OLD toy (1950's) and frankly we can do more with linac-based systems or other neat gimmicks. GK just has great press. When we get rid of it as a major utility I will be thrilled.

 

[AnnK73]

Im my mind the main difference between rad onc and these fields is patient contact. Sometimes there seems to be this mistaken impression that radiation oncologists spend their time doing physics calculations but I think its just as patient care intensive as med onc. And obviously the other important issue is if you like caring for cancer patients. People seem to really like it or really dislike it. As with everything, try it and see what you think.

Ann

 

[stephew]

Im my mind the main difference between rad onc and these fields is patient contact. Sometimes there seems to be this mistaken impression that radiation oncologists spend their time doing physics calculations but I think its just as patient care intensive as med onc. And obviously the other important issue is if you like caring for cancer patients. People seem to really like it or really dislike it. As with everything, try it and see what you think.

Ann

I would semi-agree. Most of radonc time is with patients however I wouldnt say its the "main difference" that is a big feature yes; but radonc is a field steeped in technique, surgical in that regard. I just had the pleasure of going through the bread and butter of radonc planning to introduce our new Tomotherapy to the Onc Center today. it was very gratifying to hear the medoncs get really excited about what we do because they never really knnow. I loved hearing "Cool!"

 

[Adawaal]

Most med students (and lets face it, md's) dont understand radonc. Thaiger is correct that the answers are "no" and "no". take a look at the rad onc faq on this forum.

For the radoncs out there: had a pt today s/p gamma knife for benign lesion. Subsequently had swollen tounge (2nd to other condition not related to lesion or any meds/allergy). The dx of the genius in the ER? "Oh your tounge is swollen cos you had radiation". Brilliant!

Steph, I had a frighteningly similar experience in my final med school clinical rotation: Cook County Hospital ER. My attending was one of those big famous name folks. We had an AA male in his 50's with a H&N lesion, RT completed 6-8 months prior to presentation. He had awakened the day before with a "weird feeling" in his mouth and had progressive dysarthria/dysphagia over the ensuing 24 hours. In the ER, he had this massive right-sided glossal hemihypertrophy, taking up most of his mouth. He also had a very warm, angry red (and he was a VERY dark black man) right jaw that just screamed cellulitis.

My attending (who loved to teach) confidently pointed out these findings to show me (since he knew I was going into Rad Onc) what was "obviously just one of the very nasty side effects of giving radiation." I actually stood there with my jaw open for about ten seconds before recovering. As we were in front of the patient, I slowly reinforced to Dr. X the history of both the RT and the symptom timeline for him. After a few seconds of staring at the patient, he responded, "Yes, it's clearly the radiation."

So the patient was admitted to a medicine service with a diagnosis of a threatened airway secondary to radiation effects. I talked to the admitting resident, explained what was really going on, and ordered some IV Abx while the patient had his 5-hour wait for a bed upstairs. I checked in on the patient two days later, and he looked great!

 

[stephew]

i hope you told your attending. Let this be a lession to all docs, present and fututre. If you dont know, say so. You can kill the patient because of smugness or arrogence. It happens all the time. those medical errors you hear so much about? this is a MAJOR cause.

With regard to people not knowing much about radiation- yes Im sure your cellulitis patient would have much rather been spared the effects of the radiation and left with the cancer. Hopefully that attending one day will prove the point by shunning radiation jus tso he can show how much better it is to have cancer. Or the benign entity that is systemic pois...er chemotherapy.