is rad onc that interesting?

[tsj]

Hi,

I know this is one of the most sought after specialties, but I would like to know why it is so sought after. From my experience on the wards, radiation oncologists don't really "do" much other than determine where and how much radiation a patient should get. Also in tumor boards, they really don't have much to say about disease other than staying on top of the latest experimental trials. What is involved in trainging to be a radiation oncologist?

Do radiation oncologists have to know much about what makes medicine so interesting such as pathogenesis and pathophysiology. Or do they get the satisfaction that surgeon gets from operating?

I am at the very end of the fourth year, so it is would be a little late for me to rotate in it to see what it is all about.

---

Members don't see this ad.

 

[bustbones26]

I personally took in interest in radonc just because I am one of those math/physics kind of geeks. When I was on my psych rotation, my attending told me that when he was in med school, they had to beg people to go into radonc. So why is it so sought after now???

1) $$$$$$
2) Lifestyle

And just to complicate things a bit, there are not a whole lot of radonc programs out there, so that makes it tough too.

 

[radonc]

why is it so sought after? probably for the above reasons. but here are the reasons why i went into it. i enjoyed taking care of cancer patients but didnt like diagnosing them with cancer. when patients come to you, they already know their diagnosis and you can spend time with them/their family discussing their rx, disease state, and recovery (hopefully). also, you do a lot of palliative care and deal with end of life issues. secondly, it is an outpatient specialty with the ability to go into the OR and do small procedures (brachytherapy). you also work as a part of a team, dealing with surgeons, oncologists, urologists, ob/gyn, etc. finally, there is a lot of radiology involved, new/cool technology, and a lot of research/r&d opportunities.

 

[dpwsxw]

The fact that there is very little diagnostic work in rad onc is what really turned me off to the field. As the last poster mentioned, you often get a patient after they have been diagnosed, staged, and preliminarily treated (often surgically or with chemo) for their cancer. Then a lot of what you do is to use existing guidelines (rad onc is very evidence based oriented) to figure out much and how long they should be irradiated, which is often already decided for you by the literature.

Intellectually, at least for me, diagnostic rads is much more interesting. You are not confined to seeing only cancer (you have to know almost all pathology, head to toe) and you are often the first one to make the diagnosis.

Of course if more extended patient contact, dealing with cancer patients, etc is important for you, rad onc is definitely a better way to get this. But it just seemed like a very dry field to me.

 

[Thaiger75]

Originally posted by tsj
From my experience on the wards, radiation oncologists don't really "do" much other than determine where and how much radiation a patient should get. Also in tumor boards, they really don't have much to say about disease other than staying on top of the latest experimental trials.

What you observe the rad onc's role in tumor board will vary depending on which hospital you are at, in addition to which tumor board you attend to. In some hospitals, may have a prominent rad onc department and will have more of a "say" in things (ie. MD Anderson). For tumor site, radiation is key in the treatment of breast and head and neck to name a couple. In these sites, rad onc docs have alot of input in whether pts should or should not get radiation.

As far as addressing the previous post about diag rads and rad onc...what it comes down to is: Do you like to diagnose or do you like treat? Diag rads docs will get the satisfaction of being integral in diagnosing disease. Rad Onc docs get the satisfaction of being key in curing/treating cancer (hardly "dry" at all). Some cases, rad is totally curative by itself (ie. germ cell tumors). Rad Onc is akin to surgery where local control is the goal.

 

[QED]

I didn't find radiation oncology "dry" at all. First there is some diagnosis involved when following a pt during and post treatment for radiation toxicity. Radiologists might tell you there is a problem but radiation oncologist make an attempt at providing a solution to that problem. Figuring out a treatment plan based on evidence based research and the specific anatomy of a patient is a problem solving task. Doing research and furthering a young field through research and innovation is far from "dry". Also there is no comparison when comparing the technology between radonc and diagrad, radonc wins handsdown.

 

[QED]

Originally posted by dpwsxw
often get a patient after they have been diagnosed, staged, and preliminarily treated (often surgically or with chemo) for their cancer.

Sometimes this is the case but radiation can be used both palliative purposes but it is often used as the first attempt to cure pt in the very beggining to prevent the systemic spread of the cancer.

 

[QED]

Originally posted by dpwsxw


Intellectually, at least for me, diagnostic rads is much more interesting. You are not confined to seeing only cancer (you have to know almost all pathology, head to toe) and you are often the first one to make the diagnosis.

Why not do medicine or er? I find radonc much more intellectually stimulating than diagrad that is why I choose the field.

 

[Htowngsp]

IMHO, there is no need to be agitated. If someone feels rad onc is dry and love rays, that is an excellent development for them as it narrows down their specialty choice and lessens competition for rad onc spots. I agree as well that if you want a variety of ilnesses and like making diagnoses, rays is perferable of the three radiological specialties (i'm including nuc med). I found rays boring and dull, since I don't like seeing fifty different CXRs every half hour ( though I wouldn't post that on the radiology forum) but I loved rad onc's no diagnosis, treatment-only milieu; my perception is this differentiation between the fields is broadly similar, though our conclusions about which specialty is personally preferable may differ.

In reality, people who love rays are a bonus to rad onc. The better they detect early stage breast disease on mammo, or develop better MRI sequences for MRIspect or help to delineate gross tumor progression for pre-planning for IMRT, the better for me as a (future) rad onc. Thus, I want future radiologist colleagues to be really stoked about radiology and future surgical oncologists stoked about surgery. I isn't important to have my ego gratified by getting worked up when someone doesn't genuflect at the glory of my specialty.

 

[AlexanderJ]

Diagnostic rads and rad onc are both great specialties. These were my top two choices. I chose rad onc, but rads is great too. They are both great and let's leave it at that.

 

[stephew]

I never even considered radiology ("rays?") as I find that "dry". I also find surgery extremely boring but med onc was my second choice. This is the second time in nearly as many minutes im going to make a plug here but I addressed this in a chapter that came out a few months ago in the book "Ultimate guide to medical specialities" by Freeman. But the short version:

You are actually incorrect that radonc docs dont have much say in tumor boards; it depends upon where you go. At some hosptials med onc is the muscle at some surgery and some radonc. At the best they all work well together. I know I personally make treatment recommendations and considerations; sometimes strongly recommending radonc and sometimes strongly against it for a given patient. Sometimes its a balance. This is for both curative and palliative patients.

As for the notion that we just decide how much radiation- that's like saying a med onc decides how much chemo. But its a common misconception. radonc is very techically oriented in approach and a surgical comparison is the more apt. As a generalization, medoncs tend to support the pt through chemo while surgeons approach in 3D space and then go in for the "kill". So do radoncs. I need to know the anatomical lie of disease, normal tissue and tolerance dose before approach. I need to know the literature to know what works best in that disease and that senario (post op? Preop? no op?) I also take into account imaging findings, op reports, path reports and then decide angles, margins and conedowns. As well as script. I also decide what other tests are needed (because lord knows a large percent of the time they come to us inaqdeuately worked-up). It takes 5 years of training; medonc is 2-3 years after 3 years of IM residency. The joke is we just learn to push buttons. Which is fine; but if you really want to be an oncologist who knows what they're talking about, you'll come eventually to understand that its an academic and techique oriented field that combines both med and surgical approaches. That's what I love. And yes its good money and hours but so it has been for 40 years and only the last 5 have seen it so popular. My theory is that we are now graduating the first group of med students who are of a generation that not only is comfortable with technology but enjoys it. Before it was mostly real tech-heads.