Oncology Vs Surgery

[HEME-ONC]

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I am at a crossroads and trying to decide between a IM residency and fellowship in oncology or a five year surgical residency.

I have always loved oncology and dont know the pros and cons of both programs.

Can anyone share some insight on these two career paths for me.

I must say that patient contact is a big thing for me.



thanks
Heme-ONC

 

[Winged Scapula]

Moving to General Residency Issues Forum...

 

[Winged Scapula]

Well, the difference between a typically non-procedural IM specialty like Heme-Onc (although they do do BM biopsies and a few other procedures) and general surgery are vast.

I'm not sure where you are in the training route, but if you haven't done your clinical rotations, this should help you immensely. Generally students either find they love or hate the OR and the surgical lifestyle. When this occurs, it generally makes the decision somewhat easier.

But let's say you've already done your cores and still can't decide. What are the differences between the two worlds?

First, exclude the issue of "patient contact" from the equation. Despite the propaganda, surgeons have plenty of patient contact - patients are seen pre-op, intra-op and post-op - often for months or years at a time. I can honestly say I spend as much time with patients on surgical services as I did on medical services....not including rounds (because I don't count standing around in a large group in the patient's room as valuable patient contact time). So lets assume patient contact is equal or at the very least comparable betwen the two specialties.

While gen surg and its subspecialties obviously deal with sick patients, I would venture that more Heme-Onc patients are critically ill and more often. How often do you want to deal with the issues of critical illness, death and dying - especially in the young (children and adults)?

How long do you like to wait to see the results of your interventions? With Heme-Onc its longer and you run the risk of recurrence - obviously this is also the case with some surgical patients as well, but again I would venture its more common with the Heme-Onc patients.

Gen Surg tends to have more in-house call and more emergencies; most Heme-Onc patients, at least initially, are consults and while there are emergent crises, less frequent.

At any rate, I'm not really qualified to speak in detail about the daily activities/lives of Heme-Onc physicians. I do know it to be one of the more competitive IM specialties, but perhaps others can give you a better picture of what the field is like than I.

 

[Brewster]

Why not look into surgical oncology?

 

[vuillaume]

I faced this issue as a medical student. My scientific interests have been oncologic and my father is a Medical Oncologist, so this seemed to be a natural choice.

As it turned out, I very much like the OR, and don't find the prospect of rounding all day all that palatable, so chose surgery.

As an academically-oriented person with an MD/PhD, the rational choice would have been to "short-track" internal medicine, i.e. the NIH-supported Clinical Scientist track which allows you to finish internal medicine in 2 and immediately start into fellowship. You'd be fellowship-trained in 4-5 years (dependent on whether you want Hem board eligibility). Where if you choose surgery with an interest in Onc, you're almost required to take 2 more years of Surg Onc fellowship for a grand total of 7-9 years (depending on your program's research requirements).

If all things Onc are your interest, I'd think seriously about applying in Medicine to programs that have the medicine short-track option. If you have a love of cutting that overwhelms your sense of urgency in terms of becoming an attending ASAP, by all means, consider Surg Onc.

One choice is rational, one is attitudinal. You'll have loads of patient contact regardless.

 

[HEME-ONC]

Can you elaborate a little on what you wrote about becoming an attending?

 

[vuillaume]

Simply, if you choose an academic Internal Medicine short-track into Medical Oncology fellowship, you'll be done and sub-specialty board eligible in 4-5 years.

If you choose Surg Onc, which is inherently an academic career path, you'll have to finish General Surgery residency in 5 years at minimum, and still have a 2 year Surgical Oncology fellowship to go, totalling 7 years. In reality, as someone pointed out in the Surgical Forum, Surg Onc fellowships are not that easy to get (especially the ones at Memorial Sloan-Kettering and M.D. Anderson) and a couple of years of research are almost a prerequisite. So this tallies to a grand total of 9 years.

Note that these career paths are academic. It's unlikely that one could get a short-track Internal Medicine position unless academia was one's stated goal, and that one's record reflected this (i.e. research experience).