MS4 maybe switching into rad onc

[lastminute2018]

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[RadOncDoc21]

I'm a 4th year considering switching into rad onc at the last minute. My problem is, I haven't actually had a rad onc rotation and my fall schedule is locked to where I won't be able to have one until January. Which means I will also have zero rad onc letters, with all my letters coming from the field I had been set on going in to. How badly is this going to hurt me, and what are my best ways to improve my odds of matching? I really feel like I prefer rad onc now, but I'm definitely going to apply to my other field too since I want to guarantee matching in one of the 2.

So would I be screwed with literally no rad onc experience or letters? I have a 247 Step 1, awaiting Step 2 results, 2-3 research experiences in non-rad onc areas with no publications but some posters and presentations, and Honors in every 3rd year clerkship. Still waiting to hear about AOA; there is a pretty good chance but not guaranteed. Thanks in advance.

That's a big decision to not be able to experience a rotation... I would suggest having at least 2 rotations in the field and get LOR's.

 

[radiaterMike]

Agree. Your chances of getting an interview to even have a chance at matching are close to zero if you have no Radonc rotations or letters.


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[scarbrtj]

Go talk to the rad onc chairman at your institution. See if you can get in on some side action of some sort between now and January. That is, maybe start data gathering for a research project. Come to the department a half day a week. Spend holiday days there. Talk to residents and see if you can come in for emergencies on weekends or after hours. Get the tumor board schedule and see if you can attend. Many departments have some 7am conferences of some sort or another once a week; try to make that. Talk to the physics people and see if you can come in off hours to learn about machine QA or IMRT QA. Try to make a presence rather than just assuming your lack of presence is a foregone conclusion. Dream the impossible dream. Run where the brave dare not go!

 

[DrfluffyMD]

Impossible dream? I just looked at charting outcome 2016 for US seniors. Every AOA member matched. There is a 91% match rate for US grad which is 1% higher than psych match rate (90%), and OP's numbers are good.

Is radonc really something impossible for OP to match into? I doubt it.

EDIT: 55 students with 240-250 applied, 50 matched...

To advise OP to avoid radonc would be poor advice. Given the recent residency expansion and worrisome job market radonc residency isn't as competitive anymore...

 

[metallica81788]

You may have a pretty good chance based on the numbers, but why do you want to do it? A rotation in the field really gives you an idea of what it is truly like and it will be tough to communicate this without that experience. Even after doing a community rotation before doing three aways (no home program for me) I had no clue what radiation oncology residency would be like. Those rotations were invaluable experience that confirmed it was the right choice. If I were a program director or anyone in a position of power, there is very little chance I would rank any student highly that hadn't spent at least one rotation in radiation oncology (unless some incredible extenuating circumstances). However, if you spend significant time with your home department/community physicians and can scrounge up some letters you may be able to get enough experience to explain in interviews and your personal statement.

 

[evilbooyaa]

Impossible dream? I just looked at charting outcome 2016 for US seniors. Every AOA member matched. There is a 91% match rate for US grad which is 1% higher than psych match rate (90%), and OP's numbers are good.

Is radonc really something impossible for OP to match into? I doubt it.

EDIT: 55 students with 240-250 applied, 50 matched...

To advise OP to avoid radonc would be poor advice. Given the recent residency expansion and worrisome job market radonc residency isn't as competitive anymore...

His scores and (obviously) AOA are not the issue. It's the lack of rotations in Rad Onc and lack of letters from Rad Onc attendings (ANY rad onc attendings) which will sink him here. Those data points are not captured in ERAS. Lack of Rad Onc (or even just Onc) research is difficult to reconcile as well, but as stated above, the possible dip in competitiveness due to factors discussed above may not be the deciding nail in the coffin.

To the above, If you were a Radiology PD, would you accept somebody who had zero radiology rotations under his/her belt, and no LoRs from a radiologist?

You need at least 1 rotation in Rad Onc, and at least 2 LoRs from radiation oncologists to even give yourself a legitimate shot. A letter from a non-Rad Onc as the 3rd letter will raise some eyebrows, but may give you a chance. 3 Letters from non Rad-Oncs, I imagine, would get your application in the trash.

 

[Chartreuse Wombat]

PD for nearly 20 years; completely agree with booyaa; the pool of applicants is so large that programs look for reasons to exclude applicants. No RO experience is an easy exclusion criteria, regardless of Step I etc

 

[DrfluffyMD]

Actually, I never had a single diagnostic rad rotation nor had a diagnostic letter prior to matching diagnostic radiology because I only did diagnostic for IR....

Point is, the numbers are clearly in this guy's favor and rad onc isn't on the same page as ortho and ENT anymore. I still remember some guy I knew who got talked out of going to rad onc and settled for rads and became deeply unhapply.

Remember, all he needs is one spot.

 

[medgator]

Actually, I never had a single diagnostic rad rotation nor had a diagnostic letter prior to matching diagnostic radiology because I only did diagnostic for IR....

Point is, the numbers are clearly in this guy's favor and rad onc isn't on the same page as ortho and ENT anymore. I still remember some guy I knew who got talked out of going to rad onc and settled for rads and became deeply unhapply.

Remember, all he needs is one spot.

Are you sure? How would you define that exactly?

Bottom line is that it's been competitive for several years and rad onc specific research and letters were considered necessary for most of us to match, even then some did not. Rad onc isn't as usmle score driven as some of those others like derm, ortho and plastics

 

[radiaterMike]

With no rad onc rotations or letters there is simply no chance of getting an interview. One could have 260 board scores (many applicants do), a PhD, 10 publications and AOA and get no interest if the applicant has shown no genuine interest in the field. Why would a program waste a spot on someone who may hate the field once that person is actually exposed to it.

Edit - to the OP. This doesn't mean you can't be a rad onc but rather you need to switch your schedule around now or be prepared to take a year out. No rad onc research will bump you out of a lot of programs but certainly not all of them. But no rad onc rotations until 2018 will result in no interviews in rad onc.


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[DrfluffyMD]

Are you sure? How would you define that exactly?

Bottom line is that it's been competitive for several years and rad onc specific research and letters were considered necessary for most of us to match, even then some did not. Rad onc isn't as usmle score driven as some of those others like derm, ortho and plastics

Take a look at charting outcome in 2016. Radonc has a 91% match rate. Ortho has 75% and derm has 77%. Unless the applicant pools are drastically different (which according to the USMLE score table, they aren't), radonc isn't the most competitive subspecialty.

 

[DrfluffyMD]

With no rad onc rotations or letters there is simply no chance of getting an interview. One could have 260 board scores (many applicants do), a PhD, 10 publications and AOA and get no interest if the applicant has shown no genuine interest in the field. Why would a program waste a spot on someone who may hate the field once that person is actually exposed to it.

Edit - to the OP. This doesn't mean you can't be a rad onc but rather you need to switch your schedule around now or be prepared to take a year out. No rad onc research will bump you out of a lot of programs but certainly not all of them. But no rad onc rotations until 2018 will result in no interviews in rad onc.


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Again, OP needs to do as many research and show interest between now and March, but my understanding as told by radonc residents and people close to me is that this is no longer a field where you need to take a year out just to match somewhere with good stats. He may not get MSK, but he may get somewhere.

 

[medgator]

Take a look at charting outcome in 2016. Radonc has a 91% match rate. Ortho has 75% and derm has 77%. Unless the applicant pools are drastically different (which according to the USMLE score table, they aren't), radonc isn't the most competitive subspecialty.

That doesn't indicate who matched and who didn't or why. And while it may be easier to match now, as others have said, no RO rotations or letters will hurt your chances big time.

And when comparing it to radiology like you did before, remember that most med students get radiology exposure during med school even without a formal rotation. Not true for RO.


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[winstonfoot5]

Radonc has a 91% match rate. Ortho has 75% and derm has 77%.

Is this very different from prior years? An increasing match rate could simply reflect an increase in the number of spots. To say that an increasing match rate, in the setting of a known increase in the number of positions, may be due to a "worrisome job market" might be a stretch

 

[smq123]

I'm a 4th year considering switching into radiology at the last minute. My problem is, I haven't actually had a radiology rotation and my fall schedule is locked to where I won't be able to have one until January. Which means I will also have zero radiology letters, with all my letters coming from the field I had been set on going in to. How badly is this going to hurt me, and what are my best ways to improve my odds of matching? I really feel like I prefer radiology now, but I'm definitely going to apply to my other field too since I want to guarantee matching in one of the 2.

So would I be screwed with literally no rads experience or letters? I have a 247 Step 1, awaiting Step 2 results, 2-3 research experiences in non-rads areas with no publications but some posters and presentations, and Honors in every 3rd year clerkship. Still waiting to hear about AOA; there is a pretty good chance but not guaranteed. Thanks in advance.

I'm a 4th year considering switching into rad onc at the last minute. My problem is, I haven't actually had a rad onc rotation and my fall schedule is locked to where I won't be able to have one until January. Which means I will also have zero rad onc letters, with all my letters coming from the field I had been set on going in to. How badly is this going to hurt me, and what are my best ways to improve my odds of matching? I really feel like I prefer rad onc now, but I'm definitely going to apply to my other field too since I want to guarantee matching in one of the 2.

So would I be screwed with literally no rad onc experience or letters? I have a 247 Step 1, awaiting Step 2 results, 2-3 research experiences in non-rad onc areas with no publications but some posters and presentations, and Honors in every 3rd year clerkship. Still waiting to hear about AOA; there is a pretty good chance but not guaranteed. Thanks in advance.

Not to be a party pooper (especially as I'm not a rad onc), but OP - which is it? You posted that first post on Monday, and posted that second post on Wednesday. So which specialty do you want to do? And what were you planning on applying to? Radiology and Radiation Oncology are NOT all that similar, from what I understand.

 

[DrfluffyMD]

Not to be a party pooper (especially as I'm not a rad onc), but OP - which is it? You posted that first post on Monday, and posted that second post on Wednesday. So which specialty do you want to do? And what were you planning on applying to? Radiology and Radiation Oncology are NOT all that similar, from what I understand.

A lot of people dual apply to rad onc and rad and those two could not be more different than say...surgery and psychiatry or IR vs DR.

I have seen people giving up rad onc because the percieved difficulty of matching but given the way things are going it just isn't true anymore. Don't settle for something different from your dream.

 

[evilbooyaa]

Actually, I never had a single diagnostic rad rotation nor had a diagnostic letter prior to matching diagnostic radiology because I only did diagnostic for IR....

Point is, the numbers are clearly in this guy's favor and rad onc isn't on the same page as ortho and ENT anymore. I still remember some guy I knew who got talked out of going to rad onc and settled for rads and became deeply unhapply.

Remember, all he needs is one spot.

Yes but when you applied (before the advent of direct IR residency), IR was considered a radiology rotation. And I'm sure you did at least one of those, and had letters from board-certified radiologists (regardless of whether they were doing IR only or DR). Rad Onc doesn't have an equal to that scenario.

Yes, Rad Onc may not be at the same page of Ortho or ENT (I don't know that on a purely Step score basis that they ever were) but it is somewhat unique that if you don't show interest in the field, you're not going to get in. People can get into Ortho with minimal to no research experience and a high Step 1. Not as sure about ENT. For most Rad Onc places, that's not going to fly. Rad Onc has a high average Step 1, but as a field, they are not nearly as Step 1 dependent as Ortho/ENT, meaning those applicants with 220s and 230s, with great research and/or great LoRs, can still have a shot at the field.

As a radiology resident's advice compared to Rad Onc residents, attendings, and especially Rad Onc program directors, I think your "just go for it man, you can dooooooooooo it" is in disagreement with everybody else.

I see OP has created a similar thread in the Radiology forum. I certainly wouldn't go into the Rads forum and tell him what his chances are, because you and your colleagues would do a much better job of it.

I agree that OP doesn't have to take a research year to match. He better do at least one Rad Onc rotation before likely October, and definitely before January, and get LoRs from it.

 

[radiaterMike]

I doubt any match to either specialty without ever having done a rotation in it or without any relevant letters.

Dr Fluffy - IR is relevant to a diagnostic radiology residency since they are within the same department so you are not really an exception.

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[DrfluffyMD]

Yes but when you applied (before the advent of direct IR residency), IR was considered a radiology rotation. And I'm sure you did at least one of those, and had letters from board-certified radiologists (regardless of whether they were doing IR only or DR). Rad Onc doesn't have an equal to that scenario.

Yes, Rad Onc may not be at the same page of Ortho or ENT (I don't know that on a purely Step score basis that they ever were) but it is somewhat unique that if you don't show interest in the field, you're not going to get in. People can get into Ortho with minimal to no research experience and a high Step 1. Not as sure about ENT. For most Rad Onc places, that's not going to fly. Rad Onc has a high average Step 1, but as a field, they are not nearly as Step 1 dependent as Ortho/ENT, meaning those applicants with 220s and 230s, with great research and/or great LoRs, can still have a shot at the field.

As a radiology resident's advice compared to Rad Onc residents, attendings, and especially Rad Onc program directors, I think your "just go for it man, you can dooooooooooo it" is in disagreement with everybody else.

I see OP has created a similar thread in the Radiology forum. I certainly wouldn't go into the Rads forum and tell him what his chances are, because you and your colleagues would do a much better job of it.

I agree that OP doesn't have to take a research year to match. He better do at least one Rad Onc rotation before likely October, and definitely before January, and get LoRs from it.

I think we are in agreement. I am basically saying he needs to bust his ass getting connection now and it's worth it to try. I mean no disrespect, and even though I am an IR, I have many family members who are radonc so I have intimate knowledge of the field.

There is nothing similar between radiology and rad onc. Honestly, diagnostic radiology bores me to death and I don't even know how I survived residency. I am very open to my staff about how I see DR as a stepping stone and would prefer to be in surgery if IR isn't available and they respect me for it.

Point is, radiology is so nonclinical that the chance for OP to regret going to rad will be higher than a hasty switch into rad onc, where he will essentially be an oncologist but using a specific treatment modality.

 

[smq123]

A lot of people dual apply to rad onc and rad and those two could not be more different than say...surgery and psychiatry or IR vs DR.

They do?

 

[evilbooyaa]

They do?

It's not as infrequent as I would have expected, given the big differences in day-to-day activities. I imagine some people like imaging and the physics behind both radiology and Rad Onc, and aren't as picky about treating cancer vs diagnosing conditions with that overall modality. Or they know that Rad Onc is competitive, and are truly OK with doing DR (or even IR) as a back-up. Some IR docs can go on to do mostly interventional oncology, depending on the institution. Things like Y-90, Xofigo, and diagnostic/therapeutic interventions in cancer patients (Thora/Paracenteses, Port placement, US/CT/MRI-guided biopsies, etc.)

Even on the interview trail just a few years ago, I saw people who were whole-heartedly applying to Rad Onc (Rad Onc LoRs, Rad Onc research, etc.) , who applied to Radiology as a 'backup' because they had strong geographic restrictions (which can be tough for matching Rad Onc). Given that we were at Rad Onc interviews, I didn't delve into how their Radiology interview trail was going, nor did I really care at the time.

I think we are in agreement. I am basically saying he needs to bust his ass getting connection now and it's worth it to try. I mean no disrespect, and even though I am an IR, I have many family members who are radonc so I have intimate knowledge of the field.

There is nothing similar between radiology and rad onc. Honestly, diagnostic radiology bores me to death and I don't even know how I survived residency. I am very open to my staff about how I see DR as a stepping stone and would prefer to be in surgery if IR isn't available and they respect me for it.

Point is, radiology is so nonclinical that the chance for OP to regret going to rad will be higher than a hasty switch into rad onc, where he will essentially be an oncologist but using a specific treatment modality.

Fair enough. Didn't assume disrespect with your comments, so you're good on that aspect. I agree with bolded. OP needs clinical rotation(s) in Rad Onc and LoRs, and he will have a chance. His chance of matching will be (likely) significantly lower than it would be if he also had some Rad Onc research, but it's not zero. Agree that if he has his heart set on Rad Onc (although I'm not sure how that is without having done a rotation or having any exposure to it) he should go for it. Same for Rads.

 

[thecarbonionangle]

Take a look at charting outcome in 2016. Radonc has a 91% match rate. Ortho has 75% and derm has 77%. Unless the applicant pools are drastically different (which according to the USMLE score table, they aren't), radonc isn't the most competitive subspecialty.

Those numbers are deceiving. Theres a lot of self-selection in rad onc, more so than other fields I think. Many medical schools do not have a radonc department and the majority of medical students have zero exposure to it. Many people end up applying to ENT, ortho, derm with a back up specialty, more so than rad onc which is a very small field.

 

[thecarbonionangle]

I'm a 4th year considering switching into rad onc at the last minute. My problem is, I haven't actually had a rad onc rotation and my fall schedule is locked to where I won't be able to have one until January. Which means I will also have zero rad onc letters, with all my letters coming from the field I had been set on going in to. How badly is this going to hurt me, and what are my best ways to improve my odds of matching? I really feel like I prefer rad onc now, but I'm definitely going to apply to my other field too since I want to guarantee matching in one of the 2.

So would I be screwed with literally no rad onc experience or letters? I have a 247 Step 1, awaiting Step 2 results, 2-3 research experiences in non-rad onc areas with no publications but some posters and presentations, and Honors in every 3rd year clerkship. Still waiting to hear about AOA; there is a pretty good chance but not guaranteed. Thanks in advance.

You could try but it is likely a huge waste of money with little to zero chance of matching. Rad onc is just a very very small field and there are plenty of people to replace your application. Let's be honest, your CV sounds average. Sorry mate.

 

[DrfluffyMD]

Those numbers are deceiving. Theres a lot of self-selection in rad onc, more so than other fields I think. Many medical schools do not have a radonc department and the majority of medical students have zero exposure to it. Many people end up applying to ENT, ortho, derm with a back up specialty, more so than rad onc which is a very small field.

I don't necessarily think that rad onc has more self selection than other specialty. I think it's time to frankly look at the data about competitiveness in the match.

 

[radiaterMike]

I don't necessarily think that rad onc has more self selection than other specialty. I think it's time to frankly look at the data about competitiveness in the match.

You seem overly obsessed about comparing competitiveness between different specialties. Not sure why you care. The OP frankly has no shot at either specialty he or she is considering based solely on the fact that there are no rotations or relevant letters in the application. That somehow got twisted into a discussion on competitiveness. If you re-read carbons post the implication is not that rad onc is more competitive but rather fewer apply to backup specialties (which seems to imply a lower level of competitiveness).

 

[DrfluffyMD]

You seem overly obsessed about comparing competitiveness between different specialties. Not sure why you care. The OP frankly has no shot at either specialty he or she is considering based solely on the fact that there are no rotations or relevant letters in the application. That somehow got twisted into a discussion on competitiveness. If you re-read carbons post the implication is not that rad onc is more competitive but rather fewer apply to backup specialties (which seems to imply a lower level of competitiveness).

I still remember a classmate who got talked out of doing radonc even though he wanted to do it. I am merely utilizing the numbers here to try to convince the OP that it's unwise to write a specialty off just because someone on a forum said so. I am providing a different view point.

 

[medgator]

I still remember a classmate who got talked out of doing radonc even though he wanted to do it. I am merely utilizing the numbers here to try to convince the OP that it's unwise to write a specialty off just because someone on a forum said so. I am providing a different view point.

The reason to talk the OP out of it is lack of rotations, experience and research in the field. People match into rad onc with numbers that wouldn't get into derm or plastics, but do so because of the above

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[RadOncDoc21]

The reason to talk the OP out of it is lack of rotations, experience and research in the field. People match into rad onc with numbers that wouldn't get into derm or plastics, but do so because of the above

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Agree... Let's say somehow they do get an interview. How will they answer the question "why rad onc?"

 

[Ray D. Ayshun]

I still remember a classmate who got talked out of doing radonc even though he wanted to do it. I am merely utilizing the numbers here to try to convince the OP that it's unwise to write a specialty off just because someone on a forum said so. I am providing a different view point.

The point is not that the op, who is never returning, is not competitive enough from a scores pov. It's that there's no reason for a PD or program to risk taking the op, who heard rad onc is fun or something, and possibly have an open spot to fill after he or she changes his or her mind during intern year, or pgy2. I don't think the op would even be interviewed.

 

[maruchan]

bottom line: if OP really wants to do rad onc, that's fine but he really needs to take a 5th year and do rad onc rotations, research, and get letters. Both for the purpose of confirming for himself that rad onc is what he wants to do and for the purpose of putting together a real application.

 

[DrfluffyMD]

The data from charting the outcomes don't tell the whole story. Everyone on here replying from the radonc viewpoint understands the subtleties of matching in this field. It is not as "cook book" as high step 1+ AOA = match. Who cares if it is not as competitive as ENT/Derm/Ortho (although I would challenge that assertion) - the point is there are plenty of well qualified applicants who have demonstrated an interest in the field and no one needs to take a chance on someone who is AOA and clearly just shopping "lifestyle" specialties. I can not imagine any PD valuing AOA over experience and demonstrated commitment to the field. It is a small, unique field that is not for everyone and taking someone with no experience increases the chances that that person will be unhappy which is bad for everyone. I also agree that there is more self selection in radonc. Some people apply Ortho/ENT with general surgery as backup. I have not seen this as much in radonc but of course that is anecdotal. I think the OP would be wise to heed the advice of the opinions of the many radiation oncologists here unless they would like to go unmatched. They dont need to write radonc off forever, but at this point they probably need to take a year off to get some experience.

A lot of people apply to both radonc and rad, which is silly because those two fields could not be more different.

 

[PruritisAni]

Y not just apply and see what happens? If you don't get any nibbles, take the year off if you really are committed to it. No harm in applying other than eating the cost. That's what I'd do rather than just resign to taking a year off. Just make up some BS in your personal statement and ride it.

 

[medgator]

Y not just apply and see what happens? If you don't get any nibbles, take the year off if you really are committed to it. No harm in applying other than eating the cost. That's what I'd do rather than just resign to taking a year off. Just make up some BS in your personal statement and ride it.

Disagree.... your first shot is your best one.
If you look like a noob with an obvious flawed app, people will think you went through the motions to get in the second time around instead of really wanting to do it

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[PruritisAni]

Disagree.... your first shot is your best one.
If you look like a noob with an obvious flawed app, people will think you went through the motions to get in the second time around instead of really wanting to do it

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Interesting. This may very well be the case, but how would a program really know/vet/or remember your initial application if you ended up taking the year off anyway? Is it primarily that applying as a post-grad is a red flag and with a low chance as it stands that being a bad approach? Otherwise, I don't see the harm.

 

[medgator]

Interesting. This may very well be the case, but how would a program really know/vet/or remember your initial application if you ended up taking the year off anyway? Is it primarily that applying as a post-grad is a red flag and with a low chance as it stands that being a bad approach? Otherwise, I don't see the harm.

Something like that... damaged goods. Again, it's going to be case by case, but you'll always take somewhat of a hit reapplying after the MS4 year, in my very subjective opinion

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[smq123]

Y not just apply and see what happens? If you don't get any nibbles, take the year off if you really are committed to it. No harm in applying other than eating the cost. That's what I'd do rather than just resign to taking a year off. Just make up some BS in your personal statement and ride it.

If he hasn't done any rad onc rotations, then how does he know that he likes it? If he applies, and by some chance gets a spot, but then finds that he hates it, then he's screwed. Better to do at least some rotations, even if that means taking an extra year, to make sure that you can do that specialty for the rest of your working career.

 

[DrfluffyMD]

OP mentioned that he is applying to radonc. I think it's the right thing to at least try for the field when the apps are down.

 

[medgator]

OP mentioned that he is applying to radonc. I think it's the right thing to at least try for the field when the apps are down.

The right thing to do is at least modify the fall schedule to have a rad onc rotation and figure out whether one wants to do it or not

 

[DrfluffyMD]

The right thing to do is at least modify the fall schedule to have a rad onc rotation and figure out whether one wants to do it or not

Sounded like he wanted something a least a bit clinical. Radiology couldn't be more different from any other kind of medicine.

I do agree about the rotations. Hopefully he had one.