Just the FAQs

Discussion in 'Radiation Oncology' started by stephew, Apr 19, 2004.

  1. stephew

    stephew SDN Super Moderator
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    As requested, here is a Rad Onc Faq. The questions were culled from various users (thank you). I will be updating these in the short term. Please feel free to add any to the thread that you find useful and if they're really good I'll add them to the main list.

    Isn?t radiation oncology a dying field?
    The layman?s common misconception is that first there was only surgery to treat tumors. Radiation became the new modality of the early and mid-twentieth century. Then chemotherapy ?superceded? radiation and soon there will be the magic bullet that will target cancer and when realized, bring a cure. In fact surgery, radiation and chemotherapy are complementary modalities. Pathology, surgery, patient related factors and other issues will sometimes determine which therapies are chosen, and more often than not, the multi-modality approach is used. In fact its become painfully clear that while chemotherapy is an essential component of anti-tumor therapy, it cannot single-handedly live up to the hope that it excited a couple of decades ago. Meanwhile advances is radiation delivery (radiolabeling, CT-based target verification, radiosurgery) permit us to improve outcomes by raising doses to tumor because we can simultaneously better protect normal tissue.

    Additionally radiation oncology is likely to get more important if chemo gets better (keep reading). Why? Because as a generalization, chemo deals best with microscopic disseminated disease. As they get better at that, the issue of local control will be more important. That is, as minute mets- currently the thing that kills people- is controlled, we'll need to redress getting local disease (primary) under control or else people won't be cured. Literature well shows that better local control equals better survival, and that recurrence in some cases is a harbinger of poor prognosis.

    This is already an issue in lung cancer.

    What are the average board scores?
    Right now most students invited to interview have 220 at minimum and the majority above 230. For lower scores the applicant usually has something else special in their application that makes them attractive.

    What do residency program directors look for?
    Aside from the great board scores? Outstanding letters of recommendation from your rad onc rotation are a must. A letter from an attending who is well known holds great weight. Radiation Oncology is a small field and letters are particularly important, moreso than in most fields. Scores, boards, letters, AOA, honors, and research will amount to naught if you come across poorly at interview. These people have to work with you for four years and claim you as their grad someday. They want to like you and be proud of your career. Be gracious. If you can?t do that, remember that if you try to screw over your peers at the interview, the admissions committees will see right through you. Other than that, you want scores, boards, letters, AOA, honors, and research. Research, either clinical or lab based, is increasingly important to the application and expected in some programs. Do not underestimate the interview.

    Is research experience important?
    Increasingly so. While not a ?must?, lack of some research activity may hamper you in a field were so many applicants are presenting and publishing, and have dual degrees (Ph.D; MS, MPH.)

    Ok then, does the research have to be in Rad Onc?
    No, not necessarily. Clinical research in radiation oncology, in medical physics or in radiobiology is quite favorable. Oncology related research in general also is a strong feature to have on your CV. But barring that, research in general shows an academic ?bent? and ability which is always attractive. Some have done well with research in what might be called ?outreach? fields such as Epidemiology, hospice or palliative care, all things related to taking care of cancer patients.

    Is a transitional year or a preliminary internship better?
    Honestly in practice it probably makes no difference. Transitional gives you a little exposure in a lot of things and more time for elective. Preliminary gives you slightly more focus in medicine. Some who are jonesing to do lots of procedures might consider a surgical internship, but personally I think you?d have to be nuts. Bottom line, do what you like.

    What?s the new technology then?
    Tomotherapy
    Stereotactic procedures/Cyber Knife/image guided RT/
    MRI and CT/PET sims. The gamma knife, for those wondering why that's not in this list, is over 50 years old.

    Is rad onc safe or will my baby have three heads?
    Your baby may have three heads, but we had nothing to do with it.

    Is a strong background in math and yucky physics required?
    No. No more than med oncs need a strong chemistry background to understand their drugs. You?ve been to college? Then you have the basic skills required. The math is mostly basic geometrical relationships and simple algebra. The physics actually is not like what you did in pre-med. It?s a discrete body of information that you will learn during your residency. It?s not very hard but it is the sort of thing that is ?high-yield? and will need to be reviewed prior to in-services and of course, your boards. However if you do have a strong background in either of these it makes life easier and you might have a nice career contributing to radiation oncology related physics, radiobiology or mathematical modeling.

    What should I do in medical school to help my chances?
    Aside from the obvious (great clinical performance), you might want to get involved in research early. Write an abstract, present some research, do a manuscript for peer-reviewed publication. As far as good rotations, medical oncology should be elected. You can benefit from ENT, pathology, radiology, Neurosurgery, orthopedics, and nuclear medicine. But med school is the last chance you?ll have to do stuff that?s not part of your career. Have fun.

    Why is Rad Onc so competitive?
    I don?t really know. The ?good money, good lifestyle? argument, while true, doesn?t quite explain it since it?s always fit that description, yet has only become so popular in the last 5-7 years. My theory is that we?re now graduating the first generation of doctors not only comfortable with technology (via the home computer), but who quite enjoy it. In previous years, the technology might have appealed to a select few. Now even those who aren?t tech-heads can enjoy the good money and good lifestyle. I shopped this one around. My Chairman suggests that "cancer is not so taboo and that one can cure many of the patients we see. Medschools have increasingly emphasized palliative care and end of life issues, again making them less taboo or scary. As radiation oncologists, for those we can't cure, we frequently can palliate and offer support at the end of life. Finally, I think many people now realize that for most specialties, a real and productive academic career is very tough to achieve, but Rad Onc still offers that opportunity, and opportunities that are increasingly more interesting, molecular and tech-based." So there.

    How do Radiology and Radiation Oncology differ?
    With the exception of having ?rad? in their names, they?re pretty different. Radiology is the science of interpreting diagnostic films. Radiation Oncology involves treating cancer patients with radiation. The level of exposure (if you will) to patients is quite different. The knowledge-base of each field quite distinct. Radiation Oncologists do develop some skill in reading films, but it?s fairly limited to particular aspects as relevant to their field in comparison with the skill of the radiologists. The radonc doc does have a depth and breadth of knowledge of cancer that is exhaustive (and exahausting).

    How do Med Onc (Heme Onc) and Rad Onc differ?
    Erm, that?s more difficult to explain because you have to talk about care on difference levels: technical issues, suoppotive issues etc.. There are enormous differences but the particular features of those differences really vary depending upon what kind of disease you?re treating. In broad strokes; rad onc is more like surgery in the approach to what you do to treat the patient. You take the info regarding the anatomy, pathology, histology, stage, and prior treatment (i.e. surgery) of the disease as well as the other general host-related issues (i.e. co-morbidities), and make your plan taking these all into account in three-dimensional space. You might vary your plan if much normal tissue is in the field for instance. Med onc delivers chemo, a systemic drug, and is less reliant on ?technique?. Medical oncologists prescribe their drug and modify based on the response of the patient and their well-being in general throughout the care. In terms of training, medoncs do 3-4 years of internal medicine before their 2-3 years of fellowship. Rad onc involves one internship year followed by 4 years of radonc specialty training (i.e. mostly oncology related training). Radonc also involves small procedures.

    Are there any procedures?
    Ok so you?re not reading these in order. Yes there are small procedures. Brachytherapy (Greek for ?close therapy?) involves the placement of temporary or permanent radioactive sources in a body cavity or interstitially to treat tumor. The radiation can be relatively high-dose since the dose gradient (drop-off) is sharp, and normal tissue is spared. Radiation oncologists perform brachytherapy procedures, typically with the help of urologists, neurosurgeons, otolargyngologists, ophthalmologists, orthopedic surgeons and gynecologists depending on the site.
     
  2. stephew

    stephew SDN Super Moderator
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    What is call like?
    Generally beeper call, usually for a week at a time. Don?t be fooled; at a major tertiary center it can be hell. But most of the time it?s not bad. Ask the residents at interview what its like for them. Not the attendings.


    Can DOs/FMG?s/IMG?s get Rad Onc?
    It?s increasingly difficult right now. This simply reflects the highly competitive nature of the field. A strong IMG who has performed well in a rotation in an ACGME approved radiation oncology program certainly may make it. This often means doing an ?outside? rotation and the IMG should be aware that outside rotations are not accepted towards credit to the MD degree by some states come residency/licensing time. This means that even if you go to the best radonc hospital in the country for your outside rotation, those states will not count those weeks as part of your MD, making you that many weeks short of the degree. Its up to the applicant to make sure that they know in which states this applies.

    Should I schedule away electives?
    Well if you?re an IMG, perhaps but read above. Otherwise, its probably a good idea. Do well and otherwise be a strong applicant and you?ve got an advantage. But there are those who are hurt by it; if in spite of a strong CV you don?t ?fit in?, or make a weak showing, they may be grateful to you for helping them to slim down their application pool, but that wont help you to sleep well at night.

    How difficult is it to deal with dying patients everyday?
    It can be hard. But most doctors cope well with it. You have to know your strengths. I found that dealing with acutely ill patients in my prelim year of medicine on the wards was far more emotionally unsettling on a day to day basis. I think dealing with cancer patients doesn?t change you obviously, but rather slowly, incrementally over time and only really is really appreciated when comparing where you were at first with how you are after some time. It enriches the lives of many doctors. And, hey, 60% of our patients are curative!

    What?s the job market/ salary like?
    Right now, though getting a residency is difficult, the applicant is at the advantage come time to search for his/her first attendings position. This may change in the next few years as radonc programs graduate full classes but its hard to predict. About six years ago there was a national scare that there would be too many young radiation oncologists coming out of residency into the field. In response, residency spots were cut and some completely closed. In the light of day it turned out that in fact there were not enough trainees graduating and the field is now feeling the shortage. Academic jobs, which typically pay significantly less than private jobs, are feeling the squeeze in particular. This may (or may not) change over the next few years as the many MD, PhDs and research-oriented residents currently entering training leave residency.

    How did the Rad Onc moderator get so cute?
    Oh now don?t be silly. It?s all genetic and I can?t take any credit for it.
     
  3. Adawaal

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    Thanks a bundle, Steph! I know that over time the hours you put into this effort will be greatly appreciated by us grunts.... :love:
     
  4. Gfunk6

    Gfunk6 And to think . . . I hesitated
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    I agree! Superlative job, Steph! This will be an extremly valuable resource for the pre-residents.
     
  5. Savasana

    Savasana Junior Member
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    Thank you Steph, much appreciated!!
     
  6. stephew

    stephew SDN Super Moderator
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    Ive beefed up the "why radonc isn't a dying field" thanks to a conversation with a college.
    Thanks
     
  7. ptanpit1

    ptanpit1 Member
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    Hey stephew,

    I liked your description of rad. onc in the " Choosing a medical specialty" guide. What are you planning to do after you finish residency?

    -Peter
     
  8. stephew

    stephew SDN Super Moderator
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    Thank you very much.

    I plan on annoying the Bostonians and wearing my Yankee paraphanalia around there. I'm going to be an attending at Brigham and Women's/Dana Farber specializing in CNS disease.
     
  9. stephew

    stephew SDN Super Moderator
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    1,000 views of this thread and counting. Amazing!.
    steph
     
  10. McGillGrad

    McGillGrad Building Mind and Body
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    I didn't even notice that it was you until this comment. I should have guessed:).
     
  11. stephew

    stephew SDN Super Moderator
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    to be fair, the question was posed to me.
     
  12. happydays

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    In your opinion, what's the next hot thing in rad onc? (in other words, what's the latest and coolest technology being developed and/or available right now?)
     
  13. stephew

    stephew SDN Super Moderator
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    More of the same; Image guided RT; so tomo, trilogy, etc.
     
  14. CESIUM4EVER

    CESIUM4EVER New Member
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    :D EXCELLENT POST ! STEPH!!
     
  15. stephew

    stephew SDN Super Moderator
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    over 10,000 now, wow!.
     
  16. keforce

    keforce New Member
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    Thanks for the clarifications...they are really helpful!
     
  17. stephew

    stephew SDN Super Moderator
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    glad it helped.
     
  18. lost75

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    I am a board-certified internist graduated from a university based program with lower board scores, some research experiences with no publication. Do I stand a stand a chance for getting an interview. Any advice would be muchly appreciated.
     
  19. radioh3ad

    radioh3ad march 18th
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    thanks stephew. this guide is easy reading and quite informative. expect a pm from me some time ;)
     
  20. DS Portland

    DS Portland Hiphiphooray
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    Echo all sentiments above - I am going to be an MS1 this year, and all of your info on RadOnc has helped to keep me informed while shadowing RadOncs at the Med School I will be attending. Thanks! :thumbup:
     

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