Optho vs. Rad Onc.

[Columbia22]

There's been a lot of talk on these boards about the future of these two specialties. Which one, would you guys say, in the next 10-20 years, would offer the most continual stability and financial security? Furthermore, how are the lifestyles between these two fields different? Is one regarded as more rigorous than the other? Does one carry more prestige?

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[medgator]

Excellent things to look at in a future field. Maybe you might want to try tacking on "which field would interest me more and give me greater fulfillment?"

They are both regarded as "lifestyle" fields as far as medical fields go. It's probably splitting hairs to pit the two against each other. No one can predict stability over the next 10-20 years. In the not so distant past, radiation oncology had a terrible job market and everyone believed that the magic chemotherapy bullet for all "cancer" was right around the corner. The reality now is a little different.

As far as financial stuff goes, Medicare cuts have reared their ugly head amongs all of the specialties. In the future, I don't think radiation oncology will be exempt from this.

 

[Thaiger75]

As far as financial stuff goes, Medicare cuts have reared their ugly head amongs all of the specialties. In the future, I don't think radiation oncology will be exempt from this.

I will have to disagree with this. I know for a fact that they have been cracking down on rad oncs. When IMRT 1st came out, it was not uncommon for alot of places (mainly private practices) to go "hey, let's IMRT everyone". Health care has gotten smarter about this and frequently audit programs to make sure things, such as IMRT, are being appropriately used and billed for.

But I'm sure we'll be coming up with more technology to overbill pple in the future (kidding).

 

[G'ville Nole]

There's been a lot of talk on these boards about the future of these two specialties. Which one, would you guys say, in the next 10-20 years, would offer the most continual stability and financial security? Furthermore, how are the lifestyles between these two fields different? Is one regarded as more rigorous than the other? Does one carry more prestige?

1) In 20 years, people will continue to have both eyes and cancer. I guess ophtho may be under some fire because of optometrists lobbying for an expanded scope, but rad onc will not experience the same crisis.

2) Lifestyle and compensation are about the only things these two fields have in common. I agree with medgator that you should explore whether you prefer dealing with cancer patients or eye problems, because even 50 hours a week can seem like a long time if you hate your job.

3) Ophtho is a surgical specialty. As an ophtho resident, you will spend a fair chunk of time in the OR. In practice, you can be as clinic based or as OR based as you wish. Rad onc is predominantly clinic based. Our procedures are usually "same day" affairs. Because of that, we probably spend less time in-house than ophtho residents. That said, rad onc is academically VERY rigorous. Rad onc residents spend a good chunk of time reading, and as comprehensive oncologists, we must be conversant with just about the entire body of cancer literature.

4) Rad onc is more prestigious, with the caveat that we compare ourselves to other specialties by height.

 

[stephew]

putting aside the obvious question of whcih you personally like better- this is always dangerous territory. Because docs are famously bad at prognosticating on these issues. The end of cancer within our lifetime declared in the 1970's; ask any old timer in radonc and they'll tell you that every time there is some development in chemo someone starts the death knell of radonc...which only comes back in favor again. BAck in favor if the chemo doesnt work as well as expected...or if it does, and local control begins to take on a new survival benefit. Then there are the predictions that were made while i was interviewing for residency; the famous "no jobs out there!" scare that lead programs to cut spots...and four years later, whoops, not enough docs coming out! (not 10 or 15 years later...three-four years later). So careful of prognostications.

 

[G'ville Nole]

I don't know, Steph. I feel pretty confident in my prediction that people will still have eyes in 20 years

As far as the future of rad onc is concerned, I have two thoughts. One, if cancer is cured in our lifetime, I'll gladly pack it in and find something else to do. Two, I just don't see it happening. Unless everyone puts down their cigarettes today, I'll still be seeing lung, head and neck, bladder ca, etc. for the forseeable future. I'll actually be able to contribute to curing a fair number of them, so that's kind of nice. Breast cancer will likely not be eradicated, but it's nice that we're now catching it early, and we've got great evidence that 1) No current (I know, I know, we have no crystal ball) chemo or hormonal therapy can take the place of radiation in BCT, and 2) radiation confers a survival benefit in this population (at least according to the newest EBCTCG data; check out this months Lancet). One notable exception is cervical cancer. If this vaccine is as good as advertised, we could potentially turn this one into a historical footnote. That's pretty exciting.

...which is just a convoluted way of saying that rad onc will certainly not come crashing to a halt in the forseeable future. Improvements in chemo and surgery may change our role in management in certain areas, but the three modalities are inextricably linked when it comes to standard of care in oncology.

As for the job market, my chiefs have had no problems, but talk to me again in three years...

 

[stephew]

ever see the old SNL with kirsty alley staring as the women who's eye evolved on their chests as that's where men looked anyway?

I don't know, Steph. I feel pretty confident in my prediction that people will still have eyes in 20 years

As far as the future of rad onc is concerned, I have two thoughts. One, if cancer is cured in our lifetime, I'll gladly pack it in and find something else to do. Two, I just don't see it happening. Unless everyone puts down their cigarettes today, I'll still be seeing lung, head and neck, bladder ca, etc. for the forseeable future. I'll actually be able to contribute to curing a fair number of them, so that's kind of nice. Breast cancer will likely not be eradicated, but it's nice that we're now catching it early, and we've got great evidence that 1) No current (I know, I know, we have no crystal ball) chemo or hormonal therapy can take the place of radiation in BCT, and 2) radiation confers a survival benefit in this population (at least according to the newest EBCTCG data; check out this months Lancet). One notable exception is cervical cancer. If this vaccine is as good as advertised, we could potentially turn this one into a historical footnote. That's pretty exciting.

...which is just a convoluted way of saying that rad onc will certainly not come crashing to a halt in the forseeable future. Improvements in chemo and surgery may change our role in management in certain areas, but the three modalities are inextricably linked when it comes to standard of care in oncology.

As for the job market, my chiefs have had no problems, but talk to me again in three years...

 

[G'ville Nole]

ever see the old SNL with kirsty alley staring as the women who's eye evolved on their chests as that's where men looked anyway?

How do you keep the optic nerve under 50 when doing breast tangents?

Man, I'm way too into this stuff!

 

[stephew]

How do you keep the optic nerve under 50 when doing breast tangents?

Man, I'm way too into this stuff!

that is a very very good point. Just keep it out of the boost. Id be more worried about the retina...