I usually ignore anything on SDN having to do with which field is better or the rating of a medical specialty mainly since I dont think any field can be declared globally better than others, and I am not familiar with the rating system that medical students are referring to when they discussing something being over or under rated. A peer reviewed citation would help (please note the sarcasm in that comment). Despite my otherwise usual indifference to these posts, this time I felt the need to chime in, mainly for any students reading this thread that may actually think, for a moment, the incredible field of Rad Onc is by any system overrated. I feel strongly otherwise, however I encourage each student to independently evaluate both fields with a separate rotation, then apply your own rating system to make your final decision. I will supply my logic as to why Rad Onc is far and away better in my rating system than diagnostic Rads.
Like the vast majority of Rad Onc candidates I too strongly considered diagnostic Rads, undoubtedly the two fields draw similar personalities, students into technology, passionate about medical imaging, and intrigued by minimally invasive and minimally toxic treatment modalities, and also drawn to salary and lifestyle (could not leave that out).
When starting rotations in the two fields I quickly was able to rule out diagnostic Radiology. The main reason I went to medical school was what I think is the reason most people decided to devote their lives to medicine, patient relationships and directly helping people. Of course there were many other reasons, however what keeps me motivated and passionate about medicine is the long lasting and meaningful patient relationships. Talking to a patients and their families about how you are going to help them beat breast cancer, or a brain tumor, or a lung nodule, etc. Treating them with compassion, and reassuring them of their prognosis, is incredibly rewarding. This can also be a very hard part of the field. Explaining to a patient they are going to die from their disease, or that more treatment will likely not be effective, is terribly challenging, and fuels my passion for research. Either way I feel I am living my dream of being a medical doctor.
As a diagnostic radiologist my assessment was your roll was more an observer, and technician, than actual caring medical doctor. Most of your day will consist of sitting in a dark room, making observations about a black and white image, then occasionally doing a procedure where you barely known anything about the patient, and never seem them again. There are virtually no patient relationships, and the traditional idea of being a caring doctor is gone. Seeing Rad Onc patients at 2-5 year follow ups who are doing great, and disease free, is an amazingly rewarding experience putting Rad Onc already FAR above diagnostic rads on my rating system.
If this was not enough one of the other incredible rewarding aspects of Rad Onc is the emphasis on evidence based medicine central to the field, and the overwhelming need for research. Of course diagnostic rads involves research, and EBM, however the spectrum of available research and research type (ie basic science lab work, to new phase I trials, to large multicenter prospective randomized trials) pales in comparison to Rad Onc where this research dominates. This is what will keep the field incredible for the next 50+ years. This is also likely why Rad Onc draws far and away superior applicants to diagnostic rads, and has an unparalleled respect that is only growing in the cancer and medical community.
As for salary and lifestyle they are very similar for both fields and oddly around 100k higher than average salary in Derm. However this will be changing for diagnostic Rads, and changing minimally for Rad Onc (thanks ASTRO PAC). Rad Oncers do work very long days, however we generally have weekends free (note generally). WOW this came out long, I will cut this off now as I could continue, however I hope any student realizes that if you enjoy meaningful patient relationships, ground breaking research/trials, and actually feeling like a medical doctor in your daily work then steer clear of diagnostic Rads.
P.S. I agree with MOHS that diagnostic Rads will likely take a beating in the next 5 years, the ruling by CMS regarding Rad Onc has established an amazing precedent that will likely keep us safe for a while. However we could still be screwed by the ego of our socialist president that is willing to destroy American medicine to push his agenda forward. Wait, see, and vote is all we can do now.
