Is it true that the unwritten rule to match into RadOnc...

[BOSS Man]

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...is to be a MD/PHD? Is it really that competitive?

 

[tiedyeddog]

edit: I guess it's not that competitive, certainly don't need an MD/PhD but it would help.

 

[NickNaylor]

Also keep in mind that rad onc is an inherently research focused specialty. The expectation for research experience isn't wholly arbitrary.

 

[bucks2010]

IIRC the last Charting Outcomes on the Match demonstrated that roughly 50% of those matching into Rad Onc were MD/PhD's. So it's not an "unwritten rule", there are just a lot more MD/PhD's in RadOnc than in other specialties.

Edit: just checked Charting Outcomes. 22% of people that matched into RadOnc were MD/PhD's. however, research is still very important. for more info, I suggest you check out the RadOnc FAQ: http://forums.studentdoctor.net/showthread.php?t=674353

 

[JJMrK]

At one top 50 school, no one has matched without taking a year off for research.

 

[flatearth22]

How helpful is coming from a math/physics/engineering background? Is clinical research valued over bench research?

 

[tiedyeddog]

I am not gunning for Rad Onc, so don't take this as gospel. Maybe someone matching/matched/in residency will chime in.

How helpful is coming from a math/physics/engineering background?

Unless it helps you get published faster no one will care.

Is clinical research valued over bench research?

Basic is always better than clinical. For good reason, a lot of their job is tailoring specific drug cocktails to a given cancer. We are moving towards genetic analysis as a means of very specific cancer treatment, and the data used for this is constantly evolving at a fast pace. A lot of this data is generated in basic research, so demonstrating you can do it is a great sign for PDs. To do this job you will need to be able to read basic science research articles, decipher if the experiments were set up correctly and/or with bias, and then implement that. I think it's safe to say the important of understanding research is greatest in Rad Onc compared to any other specialty.

tl;dr: you should be doing research and be comfortable with it. Maybe even... like it?

I would guess Rad Onc also has the highest percent of HHMI fellows that match.

 

[El Dooderino]

Well if you look at readily available numbers you'll see that's not the case. I've never seen a specialty more overrated in terms of competitiveness than rad onc. It's really not that difficult to match into. The only specialties which really are a roll of the dice are plastics and derm

 

[Neuronix]

To match rad onc you want step 1 about their average or better, high rank in med school class, and several months to a year of research related in rad onc with publications. MD/PhD is absolutely not necessary. High step 1 score and AOA are far more valuable than a PhD.

 

[tiedyeddog]

Well if you look at readily available numbers you'll see that's not the case. I've never seen a specialty more overrated in terms of competitiveness than rad onc. It's really not that difficult to match into. The only specialties which really are a roll of the dice are plastics and derm

Yeah, after looking at Charting Outcomes 2011, It appears you are right. Rad Onc looks to be just about as competitive as Ortho and Neurosurg.

http://www.google.com/url?sa=t&rct=...8F50j7loURtKa9Cew&sig2=vvg-z-xIVv7m6St9seRqFw

 

[Kadava Reviva]

The secret is: You have to be a Mason!
I never told you this.

 

[Neuronix]

Yeah, after looking at Charting Outcomes 2011, It appears you are right. Rad Onc looks to be just about as competitive as Ortho and Neurosurg.

Because everyone knows ortho and neurosurg really are not that difficult to match into.

 

[Law2Doc]

Yeah, after looking at Charting Outcomes 2011, It appears you are right. Rad Onc looks to be just about as competitive as Ortho and Neurosurg.

http://www.google.com/url?sa=t&rct=...8F50j7loURtKa9Cew&sig2=vvg-z-xIVv7m6St9seRqFw

I think you have to be careful with these numbers as some fields involve more self selection than others. If you don't have the stats and tons of research you won't be applying for rad onc. So since folks make their own cuts these numbers don't reflect the true competitiveness.

 

[tiedyeddog]

I think you have to be careful with these numbers as some fields involve more self selection than others. If you don't have the stats and tons of research you won't be applying for rad onc. So since folks make their own cuts these numbers don't reflect the true competitiveness.

I was looking at it from the point of few that being a "superstar" might not even help you get in. I am going go guess there is also a similar amount of self-selection for those applying to Derm and Plastics. A decent percent have to think they have a shot who eventually don't get in, right?

And Neuornix, I totally agree all of those fields are very competitive. But just based on # matched/#unmatched and Step 1 Matched/Step 1 unmatched it appears Plastics is on it's own level, then derm, then maybe Ortho/Rad Onc/Neurosurg/some others. All are competitive, and there is probably a lot more self selection out for the surgeries, just based on lifestyle.

Anyway you look at it, Rad Onc has a pretty high match rate while having on par Step 1 Scores/Pubs Data/AOA as many other specialities. It looks like if you have "average" Rad Onc Numbers, you have a great shot to get in. Those Average numbers are still pretty superstar-ish.

 

[Sephiroth]

All are competitive, and there is probably a lot more self selection out for the surgeries, just based on lifestyle.

Are the surgeries supposed to have a better lifestyle? I thought the lifestyle was the appeal for rad onc, derm, oto and the like.
I don't know about attending level, but the residencies for surgery look brutal from what I can tell. Am I wrong? I sure hope I am, because surgery definitely interests me.

 

[MegMurry]

At one top 50 school, no one has matched without taking a year off for research.

did that school not have a home radonc program?

also, do ASTRO abstracts/posters you're on prior to starting med school count or help in any way?

 

[tiedyeddog]

Are the surgeries supposed to have a better lifestyle? I thought the lifestyle was the appeal for rad onc, derm, oto and the like.
I don't know about attending level, but the residencies for surgery look brutal from what I can tell. Am I wrong? I sure hope I am, because surgery definitely interests me.

Students that would be competitive for Nsurg, Ortho do not apply due to lifestyle. Also, many people do no apply, even if they really wanted whatever residency, because they realized or were told they had a very low chance of getting a spot with their numbers.

You are not wrong, hours are brutal.

 

[MegMurry]

The first rule of radonc is that you do not talk about radonc.

Sent from my DROID BIONIC

you're an asst mod now? what the what?

 

[Neuronix]

also, do ASTRO abstracts/posters you're on prior to starting med school count or help in any way?

A little bit if at all. If you were just named on an abstract/poster as opposed to being first author, it's not very impressive anyway. What you do in medical school (or with PhD/year out research) is far more important.

 

[Law2Doc]

I was looking at it from the point of few that being a "superstar" might not even help you get in. I am going go guess there is also a similar amount of self-selection for those applying to Derm and Plastics. A decent percent have to think they have a shot who eventually don't get in, right? ....

Sure theres some self selection, but theres less -- there really arent that many rad onc slots compared to something like ortho. from the perspective of someone who has been through the match and seen what superstar peers got/didn't get, (total unscientific, but you'll have the same take when you get to this point) I would say that neurosurg is the hardest to get, then rad onc is probably the second hardest to get, followed closely by derm and plastics. Things like ortho, rads are more attainable. A lot of this is simply a function of the number of spots.

 

[drizzt3117]

Plastics is a little deceptive bc you can get into it from multiple routes whereas that's not possible for derm.

I was looking at it from the point of few that being a "superstar" might not even help you get in. I am going go guess there is also a similar amount of self-selection for those applying to Derm and Plastics. A decent percent have to think they have a shot who eventually don't get in, right?

And Neuornix, I totally agree all of those fields are very competitive. But just based on # matched/#unmatched and Step 1 Matched/Step 1 unmatched it appears Plastics is on it's own level, then derm, then maybe Ortho/Rad Onc/Neurosurg/some others. All are competitive, and there is probably a lot more self selection out for the surgeries, just based on lifestyle.

Anyway you look at it, Rad Onc has a pretty high match rate while having on par Step 1 Scores/Pubs Data/AOA as many other specialities. It looks like if you have "average" Rad Onc Numbers, you have a great shot to get in. Those Average numbers are still pretty superstar-ish.

 

[El Dooderino]

Sure theres some self selection, but theres less -- there really arent that many rad onc slots compared to something like ortho. from the perspective of someone who has been through the match and seen what superstar peers got/didn't get, (total unscientific, but you'll have the same take when you get to this point) I would say that neurosurg is the hardest to get, then rad onc is probably the second hardest to get, followed closely by derm and plastics. Things like ortho, rads are more attainable. A lot of this is simply a function of the number of spots.

You don't need to be a 'superstar' to get anything. Do well on step 1, attempt some research, be a normal, hardworking person who gets along with people at your home program and then do some aways at attainable places. Step 1 is really the rate limiting thing because you can't fake that. Plastics and derm are the only two that potentially also need a little luck. Play the game and it's not hard to match SOMEWHERE in any field

 

[thesauce]

Plastics is a little deceptive bc you can get into it from multiple routes whereas that's not possible for derm.

There's a derm fellowship after peds and (I believe) a dermatopath route from path.

 

[tiedyeddog]

Sure theres some self selection, but theres less -- there really arent that many rad onc slots compared to something like ortho. from the perspective of someone who has been through the match and seen what superstar peers got/didn't get, (total unscientific, but you'll have the same take when you get to this point) I would say that neurosurg is the hardest to get, then rad onc is probably the second hardest to get, followed closely by derm and plastics. Things like ortho, rads are more attainable. A lot of this is simply a function of the number of spots.

So, based on your observational data, what determines if you get a spot in say, Neurosurgery, if it doesn't depend on your numbers? I know numbers are not an end all to end all, PD's consider more than that. But everyone in the allo boards talks about how step 1 and clinical grades are always the biggest factor. Are you saying the institutional name matters more than I think it does or some other factor?

I don't understand why the numbers say Plastics is that much harder to get in? If Neurosurgery were harder to get in, wouldn't the average matched number be higher that plastics? Does that mean people just apply knowing they can still match gen surg and then hopefully land a fellowship? I guess that would mean more people self-select out of the neurosurgery pool, knowing there isn't a back-up way in?

I guess it doesn't really matter. I can't really change medical schools, haha.

Plastics is a little deceptive bc you can get into it from multiple routes whereas that's not possible for derm.

True. I have never seen anyone on here say how hard it is to land plastics fellowships. I just know the combined residencies are hard to land via the match. There has to be a decent number of fellowship spots, right?

 

[thesauce]

Well if you look at readily available numbers you'll see that's not the case. I've never seen a specialty more overrated in terms of competitiveness than rad onc. It's really not that difficult to match into. The only specialties which really are a roll of the dice are plastics and derm

Then get in while you can! Radonc is such an amazing field.

 

[thesauce]

So, based on your observational data, what determines if you get a spot in say, Neurosurgery, if it doesn't depend on your numbers? I know numbers are not an end all to end all, PD's consider more than that. But everyone in the allo boards talks about how step 1 and clinical grades are always the biggest factor. Are you saying the institutional name matters more than I think it does or some other factor?

I don't understand why the numbers say Plastics is that much harder to get in? If Neurosurgery were harder to get in, wouldn't the average matched number be higher that plastics? Does that mean people just apply knowing they can still match gen surg and then hopefully land a fellowship? I guess that would mean more people self-select out of the neurosurgery pool, knowing there isn't a back-up way in?

I guess it doesn't really matter. I can't really change medical schools, haha.

My experience was a bit different from L2D. We regularly had 3-4 match in neurosurg. Not always the top of the class. This was because our chair was VERY well known.

 

[El Dooderino]

Then get in while you can! Radonc is such an amazing field.

Not my cup of tea. Are they going to get hammered by the fact that you can't bill for your own diagnostic studies anymore, or is that only for things like MRI's at ortho's offices?

 

[JJMrK]

did that school not have a home radonc program?

It does.

 

[Law2Doc]

.... Are you saying the institutional name matters more than I think it does or some other factor?

I have no clue where you got this out of my prior post. I said nothing of the sort.

 

[tiedyeddog]

I have no clue where you got this out of my prior post. I said nothing of the sort.

You didn't, I agree. I was just asking what factors go into it if Step 1 scores don't determine competitiveness.

 

[quiltlady]

Personality actually does make a difference. I know someone with fantastic scores and grades from a top 5 med school and did not match at all. Finally his home school found prelim spot for him. Why didn't he match? really weird personality.

 

[Law2Doc]

You didn't, I agree. I was just asking what factors go into it if Step 1 scores don't determine competitiveness.

PDs look at (1) step 1, (2) your clinical year evaluations, (3) how you did on away rotations, where applicable, (4) other connection/networking related things, (5) your interview and (6) research/publications. For fields like rad onc, the research/pubs are more important than for a number of other fields.

 

[Law2Doc]

Personality actually does make a difference. I know someone with fantastic scores and grades from a top 5 med school and did not match at all. Finally his home school found prelim spot for him. Why didn't he match? really weird personality.

Yeah while numbers are important, this isn't strictly by the numbers kind if thing. You are going to be interacting with patients, attendings, teaching med students etc. In a Lot of ways you will be representing the hospital on a Daily basis. So no PD us going to overlook a bad personality for a high Step 1. And "top 5 med school" is not nearly as meaningful to PDs as it apparently is to premeds. All PDs have schools they have had good residents from and not so good residents from. If a place consistently puts out quality residents, they get a look again next year. If they are inconsistent, perhaps not. ive seen cases where big name grads don't get a Look at a certain competitive residency because in prior years the residents from there have lacked in clinical skills, and I've seen no name schools who put grads into prestigious residency programs every year because of historic quality. How premeds or US News ranks a program doesn't really play into it -- each PD has his own ranking and a lot of it is based on experience with prior year residents.

 

[Skinceutical]

There's a derm fellowship after peds and (I believe) a dermatopath route from path.

That's not really comparable.

General surgery residents who complete PRS fellowships become board-certified plastic surgeons, and are indistinguishable from people who did integrated PRS residencies (unless you dissect the clinical training section of their CV).

There are a small handful of pediatric dermatology fellowships that unofficially accept peds residents (I think 2 or 3 programs total). However, people who have not completed a derm residency are NOT allowed to sit for the board exams, and therefore peds-trained people cannot be board certified in pediatric dermatology.

As for dermatopathology, path residents can indeed sit for the dermpath boards, but obviously are not trained or qualified to practice clinical derm.

 

[thesauce]

That's not really comparable.

General surgery residents who complete PRS fellowships become board-certified plastic surgeons, and are indistinguishable from people who did integrated PRS residencies (unless you dissect the clinical training section of their CV).

There are a small handful of pediatric dermatology fellowships that unofficially accept peds residents (I think 2 or 3 programs total). However, people who have not completed a derm residency are NOT allowed to sit for the board exams, and therefore peds-trained people cannot be board certified in pediatric dermatology.

Obviously you're more knowledgeable about derm than I, but what would be the point to pediatrician doing that fellowship if they can't be board certified in the specialty?

As for dermatopathology, path residents can indeed sit for the dermpath boards, but obviously are not trained or qualified to practice clinical derm.

They went into path, clearly that's not what they want.

 

[bassvp]

So, what's the big to do about RadOnc? I would venture to say that this isn't a likely area that most premeds would know anything about, but apparently it's some kind of Holy Grail or something.

 

[thesauce]

So, what's the big to do about RadOnc? I would venture to say that this isn't a likely area that most premeds would know anything about, but apparently it's some kind of Holy Grail or something.

In general, the salary is quite good and the lifestyle is great even during residency. Malpractice tends to be low as well. The field is growing and the technology has been rapidly advancing in recent decades, even replacing surgery for some indications. The patient population is wonderful - they appreciate anything you can do for them. In addition, you generally aren't the ones to break the bad news or manage minor issues.

Things can (and probably will) change with respect to salaries and lifestyles in all fields. But I find myself very satisfied in this specialty.

 

[flatearth22]

So, what's the big to do about RadOnc? I would venture to say that this isn't a likely area that most premeds would know anything about, but apparently it's some kind of Holy Grail or something.

In short, they've basically turned cancer patients into cash cows.

 

[El Dooderino]

In short, they've basically turned cancer patients into cash cows.

haha, so true. With cuts coming it's going to be fairly easy for government bureaucrats to have difficulty seeing the benefits of spending tens of thousands of dollars so grandma can live 3 months longer. Finite resources will put the focus of which interventions are really cost-effective

 

[thesauce]

haha, so true. With cuts coming it's going to be fairly easy for government bureaucrats to have difficulty seeing the benefits of spending tens of thousands of dollars so grandma can live 3 months longer.

Now I'm wondering if you're actually a doc. This isn't a typical radiation indication. You rarely see a survival benefit for radiation in the elderly - it's generally used for palliation for brain or bone mets. This sounds like a chemotherapy scenario.

Finite resources will put the focus of which interventions are really cost-effective

Then radonc isn't going anywhere. Not too long ago, there was an article showing that all of the radiation oncology services in the US costs less than the cost of just one drug, Epogen.

 

[thesauce]

In short, they've basically turned cancer patients into cash cows.

Kind of a strange statement. Pediatricians have turned kids into cash cows. Cardiologists have turned heart patients into cash cows. Anesthesiologist have turned people in pain, drug seekers, and surgery patients into cash cows. Emergency physicians have turned EM patients into cash cows. Surgeons have turned people in need of surgery into cash cows. Dermatologists have turned people with skin problems into cash cows. Psychiatrists have turned the mentally ill into cash cows. Dentists have turned people with teeth issues into cash cows.

Where were you going with this? Gotta love the pre-med crowd.

 

[El Dooderino]

Now I'm wondering if you're actually a doc. This isn't a typical radiation indication. You rarely see a survival benefit for radiation in the elderly - it's generally used for palliation for brain or bone mets. This sounds like a chemotherapy scenario.



Then radonc is going anywhere. Not too long ago, there was an article showing that all of the radiation oncology services in the US costs less than the cost of just one drug, Epogen.

I was kidding, chill out, radonc is a great field

 

[flatearth22]

Kind of a strange statement. Pediatricians have turned kids into cash cows. Cardiologists have turned heart patients into cash cows. Anesthesiologist have turned people in pain, drug seekers, and surgery patients into cash cows. Emergency physicians have turned EM patients into cash cows. Surgeons have turned people in need of surgery into cash cows. Dermatologists have turned people with skin problems into cash cows. Psychiatrists have turned the mentally ill into cash cows. Dentists have turned people with teeth issues into cash cows.

Where were you going with this? Gotta love the pre-med crowd.

Stopped reading right there

 

[thesauce]

Stopped reading right there

Then you missed all the good stuff

 

[thesauce]

I was kidding, chill out, radonc is a great field

Not as worked up as it sounds. I like a good debate.

 

[Skinceutical]

Obviously you're more knowledgeable about derm than I, but what would be the point to pediatrician doing that fellowship if they can't be board certified in the specialty?

Without board certification, they're certainly not going to be getting academic positions (which is where almost all board certified peds derm specialists end up). However, there's nothing stopping them from going into private practice and advertising themselves as "fellowship trained in pediatric dermatology." It's still a lot less hokey than the burned-out FPs & OBs who take a weekend course on Botox and fillers and start advertising their "advanced training in cosmetic dermatology."

They went into path, clearly that's not what they want.

I realize that. What I'm trying to say is that I don't really consider a training pathway that doesn't prepare you for any semblance of clinical practice to be a "backdoor" into dermatology.

Is neuropathology a backdoor into neurosurgery too?

 

[thesauce]

Without board certification, they're certainly not going to be getting academic positions (which is where almost all board certified peds derm specialists end up). However, there's nothing stopping them from going into private practice and advertising themselves as "fellowship trained in pediatric dermatology." It's still a lot less hokey than the burned-out FPs & OBs who take a weekend course on Botox and fillers and start advertising their "advanced training in cosmetic dermatology."


I realize that. What I'm trying to say is that I don't really consider a training pathway that doesn't prepare you for any semblance of clinical practice to be a "backdoor" into dermatology.

Is neuropathology a backdoor into neurosurgery too?

Neuropath isn't a fellowship of neurosurgery

 

[tiedyeddog]

I have a question, Thesauce,

Do you think PP rad onc guys in general do bad job of staying on top of current treatment protocols, new drugs, etc, etc compared to academic guys?

For example, if your grandmother(sister, mom,dad,third cousin, whatever) was diagnosed with whatever, small cell lung cancer, would you automatically take her to an academic center?

 

[thesauce]

I have a question, Thesauce,

Do you think PP rad onc guys in general do bad job of staying on top of current treatment protocols, new drugs, etc, etc compared to academic guys?

For example, if your grandmother(sister, mom,dad,third cousin, whatever) was diagnosed with whatever, small cell lung cancer, would you automatically take her to an academic center?

Great question. There are a few things that make radonc a little unique in this respect. First is the emphasis on research. So many of the applicants are MD/PhD or took a year off for research or otherwise published their shirts off, so they tend to be more connected with the literature, etc even if not in academics, per se. Second is the fact that there are so few radonc programs that nearly all of them are at major academic centers getting direct training from published attendings. So most pick up the academic mindset during residency. This is different from some other fields where half of residents are being trained at a random community center and may be taught wildly different approaches. Thirdly, major trials for radonc are few and far between. It isn't often that a game-changing phase III or even meta-analysis comes along that creates a new treatment paradigm. When there is, it's usually all over newsletters, journals, and NCCN guidelines. Thus, it isn't terribly hard to keep up.

The second question would depend on the specific case. For small cell no, probably not. Community docs see enough of it. Now if they had some funky thymoma, an intracranial chondrosarcoma, or an esthesioneuroblastoma - definitely. For kids, I would always send them to a major center to be treated on protocol.

 

[Skinceutical]

Neuropath isn't a fellowship of neurosurgery

OK fine. I guess that wasn't the best analogy.

Is PM&R a backdoor into anesthesia, as both can do pain fellowships? Is neurology a backdoor into rads, since both can do interventional neuroradiology fellowships?