Any Regrets?

[RadOncDoc21]

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Hi,

I will be starting my pgy-2 in Rad Onc in a couple of weeks! However, as time gets closer, I just wanted to ask if any resident or attending had any regrets about going into Rad Onc vs. going into any other specialty?

Don't get me wrong, I love this field and could not see myself doing anything else but just wanted to know since we only hear all the great things about Rad Onc. Part of this could be because I'm very nervous about starting my residency and all I see on this forum are "go-getter gunner-type" personalities and I'm not sure if I can be around that all the time.

Thanks in advance for your input,

-R

 

[thesauce]

Also starting PGY2 shortly. I personally have not heard of any radoncs saying they regret this decision - to me, that was probably one of the big attractions of this field.

I do sometimes consider the downside to becoming a radonc. The main one, which has been discussed on here many times, is that it's hard to be picky about location. I love my hometown and want to go back there but there's no gaurantee that it'll happen. If I had done rads (my #2 choice), I could have trained and no doubt practiced there as well.

Still, a wise man once said: "I'd rather do radonc in Bozeman than any other specialty anywhere else." Or something to that effect.

In regards to the "gunner" comment, judging from what I've seen, I think we're pretty lucky in who we get to call our colleagues.

 

[mdphdgirl]

I think some people have a hard time dealing with having so many seriously ill patients, so you need to know whether you can handle that. And maybe plan some outlets, to ensure that when you come home you don't bring it all with you.

But in my experience the people in rad onc are far from gunners. Go-getters, yes, but not super-competitive. But I'm a year behind you, so what do I know?! :-D

 

[RadOncDoc21]

I used the term "gunner" because all I see on this forum are applicants posting ridiculous stats and people telling them they need to do more in order to have a decent shot. Trust me I understand that the field is competitive but all I ever hear is how 15-20 years ago, people were basically handed a position.

Is preparing for the boards demanding especially for non-phd's that didn't major in physics or engineering? I guess my biggest fear is not knowing anything when I start. I'm looking forward to the next step, but trying to get a handle on everything as well.

Thanks again for all your advice

-R

 

[Gfunk6]

Any average graduate from an average medical school can master Rad Onc. Just because the applicant pool is skewed, it does not mean you need to be a gunner to excel in this field.

Everyone knows nothing when residency starts and it will take years before you stop feeling like an idiot, trust me. As for boards, you will do fine as long as you have a good grasp of basic geometry, physics and algebra. I don't think having a technical background is particularly helpful.

 

[mikedc813]

A more senior resident, so I'll put in my 2 cents.

While I was never one to love the floors or other specialties, but the one thing I regret it that as rad oncs we get so involved in our specialty and the challenges involved that many of us lose the ability to practice basic medicine. My wife is a FM resident and it amazes me that in the 3 years since internship I have lost the ability to manage basic medical problems. I wouldn't trade what I do for the world but sometime I wish I had retained more of the everday doctor skills I once had.

100% agree with everything above

 

[Scatter]

100% agree with everything above

Me, too. My husband is studying for his Boards and just looking through his review books makes me crestfallen at how much I've forgotten. Yeah, I can tell you what an antineutrino is, but if someone asked me to identify a right bundle branch block on an ECG, I'd go into asystole. Seriously ...
The other day I couldn't remember which bacterium caused syphillis and it crushed me. He even gave me a hint, and still nada.

 

[Charles_Carmichael]

A more senior resident, so I'll put in my 2 cents.

While I was never one to love the floors or other specialties, but the one thing I regret it that as rad oncs we get so involved in our specialty and the challenges involved that many of us lose the ability to practice basic medicine. My wife is a FM resident and it amazes me that in the 3 years since internship I have lost the ability to manage basic medical problems. I wouldn't trade what I do for the world but sometime I wish I had retained more of the everday doctor skills I once had.

100% agree with everything above

Me, too. My husband is studying for his Boards and just looking through his review books makes me crestfallen at how much I've forgotten. Yeah, I can tell you what an antineutrino is, but if someone asked me to identify a right bundle branch block on an ECG, I'd go into asystole. Seriously ...
The other day I couldn't remember which bacterium caused syphillis and it crushed me. He even gave me a hint, and still nada.

This sort of begs the question then: are the four years of med school and one year of internship necessary (or an efficient path) for becoming a radiation oncologist? Or can a modified/shortened path produce radoncs equivalent in competency, etc, to those who go through med school, internship, and residency?

Don't get me wrong. I'm not advocating for a change in the current pathway. But I've seen comments about people forgetting/not using much of what they learned in med school and internship when they're pursuing certain specialized fields (ex. radiology, radonc, etc). So I'm just curious as to what you guys think.

 

[Gfunk6]

This sort of begs the question then: are the four years of med school and one year of internship necessary (or an efficient path) for becoming a radiation oncologist? Or can a modified/shortened path produce radoncs equivalent in competency, etc, to those who go through med school, internship, and residency?

This issue is certainly not unique to Radiation Oncology. For med students headed to primary care, for instance, it was once suggested that the fourth year of medical school be ejected and replaced by internship. This has since been implemented by Texas Tech where an FMAT program allows three years of medical school for those who commit to a Family Practice residency.

I tend to agree with this approach for students who are truly committed to one specialty. As an MD/PhD graduate, my fourth year was highly accelerated and consisted of three months of rotations.

However, removal of the fourth year across the board will probably never happen unless medical education is completely revamped. Also, the ERAS timeline will have to be pushed back one year which will cause all kinds of problems. Finally, you would be allowing medical students with three and two years of schooling to compete with each other and it will be difficult for the latter group to compete.

So, bottom line, it's a good idea in principle but not really compatible with existing infrastructure.

 

[thesauce]

This sort of begs the question then: are the four years of med school and one year of internship necessary (or an efficient path) for becoming a radiation oncologist? Or can a modified/shortened path produce radoncs equivalent in competency, etc, to those who go through med school, internship, and residency?

Don't get me wrong. I'm not advocating for a change in the current pathway. But I've seen comments about people forgetting/not using much of what they learned in med school and internship when they're pursuing certain specialized fields (ex. radiology, radonc, etc). So I'm just curious as to what you guys think.

An interesting article from the red journal:
http://www.ncbi.nlm.nih.gov/pubmed/19135313

"A majority of radiation oncology residents positively acknowledged their internship for their development as a specialist and an even greater majority valued it for their development as a physician. This affirmative opinion was registered more frequently by those completing an internal medicine internship compared with a transitional internship."

Wrapping up with internship myself, I guess I see what they're saying. I now feel more confident writing orders and talking to patients. I also understand the logistical aspects of patient care a lot better now.

 

[subatomicdoc]

This sort of begs the question then: are the four years of med school and one year of internship necessary (or an efficient path) for becoming a radiation oncologist? Or can a modified/shortened path produce radoncs equivalent in competency, etc, to those who go through med school, internship, and residency?

I think the time spent in training is important. While I may not remember the medicine I learned for managing floor patients in internship, I can still tell from experience when a patient look acutely ill, determine whether workup/treatment needs to be immediate or not, etc. And the sauce makes an excellent point about internship still being of great value.

I don't know what the future holds, but if Anthony Zietman's vision is accurate then we'll spend more time training, not less -- and it will include more of the medical skills we learn.

I have zero regret about going in to rad onc. It's the perfect fit for me, and although PGY-2 is a steep learning curve I'm sure you can do it after internship. Success in medicine depends more on teamwork and communication than brilliance, so some gunners may have more trouble than you if they try to be snipers.

Also, don't get dazzled by the technology. It's just one of many tools we should have to help our patients. Radiation is a subatomic drug with a complex delivery system we need to understand and to try to improve the therapeutic ratio. But that's it. It can be used wisely or unwisely -- so trust your judgment and cherish the training you've had.

 

[Scatter]

I think the time spent in training is important. While I may not remember the medicine I learned for managing floor patients in internship, I can still tell from experience when a patient look acutely ill, determine whether workup/treatment needs to be immediate or not, etc. And the sauce makes an excellent point about internship still being of great value.

I don't know what the future holds, but if Anthony Zietman's vision is accurate then we'll spend more time training, not less -- and it will include more of the medical skills we learn.

I have zero regret about going in to rad onc. It's the perfect fit for me, and although PGY-2 is a steep learning curve I'm sure you can do it after internship. Success in medicine depends more on teamwork and communication than brilliance, so some gunners may have more trouble than you if they try to be snipers.

Also, don't get dazzled by the technology. It's just one of many tools we should have to help our patients. Radiation is a subatomic drug with a complex delivery system we need to understand and to try to improve the therapeutic ratio. But that's it. It can be used wisely or unwisely -- so trust your judgment and cherish the training you've had.

So sayeth the wise man. 🙂

 

[RadOncDoc21]

Thank you guys for the comments and advice. It seems for the most part, like I thought, Rad Onc is a great field for a variety of reasons.

Here's to a new journey and looking forward to getting started!

-R

 

[DukeNukem]

The main one, which has been discussed on here many times, is that it's hard to be picky about location. I love my hometown and want to go back there but there's no gaurantee that it'll happen. If I had done rads (my #2 choice), I could have trained and no doubt practiced there as well.

Still, a wise man once said: "I'd rather do radonc in Bozeman than any other specialty anywhere else." Or something to that effect.

I second this. When you're trying to match to either rad onc or a TY, you need to be willing to go ANYWHERE. I thought I had a pretty strong application and a strong desire to be in a certain region with plenty of connections there. I didn't even get interviews in that region, then matched on the other side of the country for both TY and rad onc. Now I'm being told the job market isn't a whole lot better in this regard--especially in academics. I hope rad onc is enough to keep me happy for the next few years or I could see myself potentially switching to rads where I really wanted to live.

That being said... They have rad oncs in Bozeman?! Sign me up!

 

[thesauce]

I second this. When you're trying to match to either rad onc or a TY, you need to be willing to go ANYWHERE. I thought I had a pretty strong application and a strong desire to be in a certain region with plenty of connections there. I didn't even get interviews in that region, then matched on the other side of the country for both TY and rad onc. Now I'm being told the job market isn't a whole lot better in this regard--especially in academics. I hope rad onc is enough to keep me happy for the next few years or I could see myself potentially switching to rads where I really wanted to live.

That being said... They have rad oncs in Bozeman?! Sign me up!

http://www.bozemandeaconess.org/physician_detail.php?type=&id=163&from=medservices

 

[DubZteR]

A more senior resident, so I'll put in my 2 cents.

While I was never one to love the floors or other specialties, but the one thing I regret it that as rad oncs we get so involved in our specialty and the challenges involved that many of us lose the ability to practice basic medicine. My wife is a FM resident and it amazes me that in the 3 years since internship I have lost the ability to manage basic medical problems. I wouldn't trade what I do for the world but sometime I wish I had retained more of the everday doctor skills I once had.

Definitely agree! we have 22 staff rad oncs here and the department has been trying for several years to lose their inpatient "admitting" privileges and become strictly a consult service.