Emergency Medicine vs Rad Onc

[Bioengineer]

weird title for a thread, I know, but let me explain:

I have been interested in and hoping to get into rad onc since before med school started. I have 5 pubs all cancer related, a masters degree from duke, experience at St Jude, worked at MD Anderson for a month, etc. and I still really enjoy it; however, my step scores are 213 and 212 and that is an achilles heel of course. I will have really good LORs if I want them though, which should help.

Since my first year of med school I have been very interested in emergency medicine too. I have been an officer in my EM club and have done a 4th year rotation in EM and love it. I could see myself doing this as a career just as easily as I could see myself doing rad onc.

Any advice? I thought of applying to both and deciding on my final rank list by February. This would mean alot of applications to both fields and basically double the footwork. Another option is to make a decision now and sorta "go for broke" for one or the other. I'd love some advice from the veterans on this one. I've been posting and lurking on this board since 2005. Thanks for all your comments and help.

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[qwert]

Dermatology vs. CT surgery!
It's hard to imagine that someone would be happy doing either of two specialities. ED is stress, time pressure, night shifts, working on Thanksgiving. RadOnc is completely opposite.

weird title for a thread, I know, but let me explain:

I have been interested in and hoping to get into rad onc since before med school started. I have 5 pubs all cancer related, a masters degree from duke, experience at St Jude, worked at MD Anderson for a month, etc. and I still really enjoy it; however, my step scores are 213 and 212 and that is an achilles heel of course. I will have really good LORs if I want them though, which should help.

Since my first year of med school I have been very interested in emergency medicine too. I have been an officer in my EM club and have done a 4th year rotation in EM and love it. I could see myself doing this as a career just as easily as I could see myself doing rad onc.

Any advice? I thought of applying to both and deciding on my final rank list by February. This would mean alot of applications to both fields and basically double the footwork. Another option is to make a decision now and sorta "go for broke" for one or the other. I'd love some advice from the veterans on this one. I've been posting and lurking on this board since 2005. Thanks for all your comments and help.

 

[LCK]

I would definitely try to pick the one you prefer as far as ranking purposes, but you could always apply to both if you decide rad onc is your first choice and just rank EM behind your rad onc programs. I mostly have heard of internal med as a back up, but I don't see a reason you couldn't have EM as they go through the NRMP match. Your scores definitely may be an issue, but you have major strengths in other areas. Doing an away somewhere may help as well b/c then board scores can be overshadowed by your personality and eagerness to be a radiation oncologist.

Now I may not be a veteran (I am only a prelim currently who will be doing rad onc next year), but I would really think about the patient population when deciding. I felt compelled to write b/c I just finished my first ward month on heme/onc in July and am finishing up EM this August (am a medicine prelim). I really can compare the difference in patients. I know I am biased, but my cancer patients were the nicest, most thankful patients (with a few outliers of course). The EM patients, on the other hand, are so different. At the university hospital, about 1/3 seem to be psych cases (I want to kill myself, etc. etc.) or "I need to get off drugs". I've even had multiple patients there for other reasons (not psych or drugs) get mad at me b/c after a full negative work up we wanted to send them home. We weren't doing enough for them, blah, blah, blah. The hours seem pretty good, but man I couldn't do this for a career. But who knows, could just be my hospital (though with the widespread use of the ED as a primary care facility, it seems unlikely). You sound like you already have experience in the ER, but just something I would consider highly in your choice.

 

[deleted4401]

Man, those are two different fields. I've never heard anyone in our field that liked their EM rotation! I'd rather be on the floors ... The whole process of EM is exactly the opposite. They shoot first and ask questions later ... We really focus and wrap ourselves around a problem before 'beam on'.

I think a backup plan is a good idea, but based on your brief background, I really think you will match. Step 1/2 scores are a little low, but everything else is solid. You seem like you'll do just fine.

I'm not sure how much it will matter to the rad-oncs if you are double applying, but it may annoy the EM programs that you are using them as a "backup", so I'd say be discreet. Was anyone honest about having a backup specialty??

-S

 

[MHotep]

Regardless of the specialty we all have the same degree behind our names, M.D. (or D.O.).

I find it TOTALLY reasonable to have multiple interests, even if one has a "nice" patient population and one has a "less-than-ideal" patient population.

Both fields are exciting. In EMed you can actually make the diagnosis. In oncology the patient generally has the diagnosis by the time they get to you--how boring is that. In oncology though you can build very worthwhile doctor-patient relationships, and have the ability to help people through some of the most difficult periods of their lives. Yes, in oncology patients are generally very motivated...but BEWARE...there will still be some major head cases coming through your door. In EMed you get them a lot more frequently, but at the end of the shift they are no longer your problem...until they come to the ER again. In onc they are yours until they die.

 

[stephew]

ive known someone who had narrowed his fields down to radonc and EM. and a lot of folks deciding between seemingly disparate fields such as psych and surgery. not so uncommon. anyway, apply to what you want most. and keep in mind you may not get it..but you certianly might.

 

[LCK]

Just to clarify my prior post, I was in no way trying to say that I couldn't understand having very different interests. I was deciding between rad onc and pathology (with internal med a close third). Some people looked at me like that was crazy, but I had my reasoning.

I was, however, trying to point out that the patient populations do seem very different (albeit alive, unlike in pathology). I also happen to think oncology patients tend to be extremely grateful which is motivating for me- even when compared with other medicine fields. Bottom line I guess is to do some soul searching and pick which field is overall best for you. And if rad onc seems like your top choice, I say go for it.

 

[Bioengineer]

To everyone that replied. thanks! maybe it helps others who have varied interests. good luck to everyone during interview season!

 

[Reaganite]

I really can compare the difference in patients. I know I am biased, but my cancer patients were the nicest, most thankful patients (with a few outliers of course). The EM patients, on the other hand, are so different. At the university hospital, about 1/3 seem to be psych cases (I want to kill myself, etc. etc.) or "I need to get off drugs". I've even had multiple patients there for other reasons (not psych or drugs) get mad at me b/c after a full negative work up we wanted to send them home. We weren't doing enough for them, blah, blah, blah.

I think you're giving our patients too much credit . Yes, I think our field is one of the few fields where you rarely, if ever, get frustrated or angry with your patients, but I think this has more to do with the nature of our field than the patients themselves. To tell you the truth, I'm not willing to concede that our patients are any better than any other patients. Our patients still probably complain about negative workups, demand unnecessary tests, etc. when they are with their PMDs. (In fact, I know they complain, because they complain to me about their PMDS!). It's just that our field doesn't give them these kinds of opportunities like other fields. We aren't making diagnoses. We're treating something that's already been diagnosed. The patient's input means little when it comes to our treatment decisions. I don't have to sit up for 2 hours at 3 AM trying to get a history from a patient who doesn't speak English, who doesn't know what medication he is on, who doesn't know what surgeries he's had, who doesn't know what medical conditions he has, and whose chief complaint is "weak and dizzy." All the things that made you hate your patients on internal medicine just don't occur in radonc...and I think that makes us a little biased when it comes to our patients. I guarantee you that our colleagues in internal medicine don't feel so warm and fuzzy about these patients like we do! And this is, btw, one of the amazing things about radiation oncology. I truly believe it is one of the few fields in medicine where you can really enjoy the doctor-patient relationship.

 

[IndyXRT]

I think you're giving our patients too much credit . Yes, I think our field is one of the few fields where you rarely, if ever, get frustrated or angry with your patients, but I think this has more to do with the nature of our field than the patients themselves. To tell you the truth, I'm not willing to concede that our patients are any better than any other patients. Our patients still probably complain about negative workups, demand unnecessary tests, etc. when they are with their PMDs. (In fact, I know they complain, because they complain to me about their PMDS!). It's just that our field doesn't give them these kinds of opportunities like other fields. We aren't making diagnoses. We're treating something that's already been diagnosed. The patient's input means little when it comes to our treatment decisions. I don't have to sit up for 2 hours at 3 AM trying to get a history from a patient who doesn't speak English, who doesn't know what medication he is on, who doesn't know what surgeries he's had, who doesn't know what medical conditions he has, and whose chief complaint is "weak and dizzy." All the things that made you hate your patients on internal medicine just don't occur in radonc...and I think that makes us a little biased when it comes to our patients. I guarantee you that our colleagues in internal medicine don't feel so warm and fuzzy about these patients like we do! And this is, btw, one of the amazing things about radiation oncology. I truly believe it is one of the few fields in medicine where you can really enjoy the doctor-patient relationship.

I have, however, had the patient who had "some radiation" in Mexico. Good luck getting those records.