Heme Onc vs. Rad Onc

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Jul 2, 2004
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I just started my fourth year of medical school. I am impressed by the amount of information on this site and the very helpful commments. It really is a testament to the type of people participating in this forum. That is why I am seeking advice about a dilemma: Shoud I pursue Heme Onc or Rad Onc?

My career goals: I want to stay in oncology and in academic medicine. I want an enviornment where I can work with cancer patients and have a significant amount of time to start up a lab to work on developing new cancer therapies. I am more focused on basic/clinical research but I am not willing to give up patient care completely. As if I'm not already asking for too much, I want enough free time to avoid having a dysfunctional family.

The pros/cons for Heme Onc: I really enjoyed my Heme Onc rotation. I'm hearing that the Heme Onc section is interested in me staying on as a resident-fellow and may even offer funding for research during my residency+fellowship (its a top 10 if not top 5 program)!! And the 80/20 program as an attending is very attractive. But, the IM residency tends to make people pretty bitter and the time commitment may not be conducive to research until I am way into my fellowship. It seems like a lot of delayed gratification.

The pros/cons for Rad Onc: I right now started my Rad Onc rotation. I can gain a comprehensive background in oncology. There's a lot of interesting and cutting edge radiotherapies out there. The structure of RadOnc may be more conducive to research during the residency. I've only seen happy Rad Onc residents. The research in radiobiology is extremely fascinating. But it's extremely competitive to get into a residency. The research involves radiobiology so much so that research in other important aspects of cancer biology may not get well deserved attention. You may not have the patient base to conduct or direct clinical trials like the Heme Oncs can. Would Rad Onc programs offer funding for research during the residency (like the potential offer I may get in Heme Onc)? Is there an 80-20 program as a rad onc attending.

Right now I vascillate between Rad Onc and Heme Onc on a daily basis even though I am slightly leaning toward Rad Onc. Although most people on this site likely favor rad onc, I was wondering if the viewers could post a balanced position of why they chose Rad Onc over Heme Onc (if they considered the two). I will make a decision soon but I just want to hear multiple viewpoints before I make that decision and go after it. Thanks for taking the time to read this long post and provide any insight.

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I will pitch in my two cents because many of the reasons you gave were the reasons that turned me to radiation oncology.

For starters, I was also interested in Hematology/Oncology, and did enjoy the rotation as a 3rd year. Although traditionally Hematologist/Oncologists were considered the "oncologists", I was disenchanted to find that besides hematologic maligancies (lymphoma, leukemia) and GI cancers, the medical oncologists are not as involved in cancers of other locations, such as the head/neck, brain, breast, prostate, and gynecologic cancers, since they are handled on the most part by the respective surgical specialties such as ENT, Neurosurgery, general surgery, urology, and gyn oncology. When I discovered about radiation oncology, I was pleased to find that rad onc is probably the most comprehensive of all the oncology fields (in my opinion) since radiation is involved in all of these areas (maybe not so much in leukemia, and probably arguably less so in lymphoma) as well as in many of the GI cancers (pretty much all except colon). The Hem/Oncs training is not to be desired, since you need to trudge through 3 years of internal medicine and 3 more years of fellowship, and afterwards you are then qualified to sign a chemo order. In rad onc, there is lots of hands on stuff and lots of technology to play with, which is fun. I also like the fact that radiation takes on a "surgical" approach of localized treatment and consideration of "margins" rather than the "systemic" approach of chemotherapy which carries with it tremendous amount of side effects for the patient.

Besides the clinical stuff that I was drawn to, I also love the fact the rad onc, like hem/onc, is very academic. I was a MSTP student who had the exact same career objectives: I want research but also time to be in the clinic, as well as enough time for family. I want it all, and I do believe rad onc is probably one of the few specialities in medicine that gives you all that.

I have to differ on your assumption that radiation oncologists' research is mostly focused on radiobiology. Although mixing radiation in the research question is very important in translating the basic research into clinical utility for treating patients, a radiation oncologist is very much an "oncologist" who can do very, very basic science research looking at oncogenes, tumorgenesis, angiogenesis, and any other aspect of oncology you can think of. But what's nice is that eventually whatever is discovered is always brought back to a radiobiology side of things to look at how radiation interacts with the system. I feel this is an advantage, and not a disadvantage, to being a radiation oncologist.

If one doesn't mind the physics and in tinckering with technology, I feel radiation oncology gives one the opportunity to deal comprehensively with many many type of cancers and to do incredible research in not only biology, but also computer science, physics, etc, that you will never, ever be bored with work....

...No wonder the radiation oncology residents are always so happy! ;)
I think it's hard to make a wrong decision when choosing between Hem/Onc and Rad Onc. During medical school, I rotated multiple times in both specialties, and liked them both equally. As is already stated, there are plusses and minuses to each specialty. I personally chose Rad Onc because I like its problem based focus, with less of an emphasis on admitting patients (Rad Oncs can admit patients, but many choose not to). I also did my internship in Internal Medicine, which I didn't particularly care for. Rad Onc allows me to pursue what I'm interested in after only 1 year, rather than 3 years of IM. That said, had I not matched in Rad Onc, I would certainly have pursued Hem/Onc.
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some other things that may affect your opinion....

in hemeonc, you may have to deal with the diagnosis and telling the patient they have cancer. at my hospital, all suspected masses were admitted to the inpatient hemeonc service where we would run the protocols in diagnosis of CA's and other things on the differential. in radiation oncology, you likely will not have to deal with diagnosis.

also, in hemeonc, you deal with some fairly sick bone marrow transplant (BMT) patients when dealing with liquid tumors. if you like medicine, dealing with inpatients, that may be a pro of going into hemeonc.

why i chose radonc?
in no specific order:
its mostly outpatient, technology, can do procedures, work as a 'consultant' with many specialties, like cancer patients and dealing with palliation issues, and i enjoy looking at films. i feel its one of the most 'complete' fields of medicine.
As mentioned by radonc, one of the major drawback of the field is not being able to do the workups for the initial cancer diagnosis. Most, if not all, of the patients seen in consultation already have the workup completed by one of the other onc fields (med onc, surg onc, ent, gyn, urology). If you are really into the initial patient encounter and doing the full cancer workup, then for sure rad onc wouldn't be the field for you.

It is fun, but if you can bypass that aspect, rad onc, in my opinion, far exceeds all other fields as mentioned above.