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Hi everyone,

Rising MS2 at a top 40 US med school here. I have been following this forum fairly closely so I am familiar with the general outlook for the radonc job market.

The thing is, I haven’t been able to find any alternatives that make as excited as Rad Onc. I have had pretty good exposure through research and shadowing and so far, things I like about it are:

- Using physics! It was always my favorite science subject in school and I love thinking about how the machines work.
- Patient population: I knew when I decided to become a doctor that I wanted to work with patients who are quite sick, would never want to do something like cosmetic derm for that reason. I don’t mind delaying with death and want to support my patients emotionally as well.
- cancer biology is absolutely fascinating (coolest thing I’ve studied in med school so far)
- reading CTs and MRIs is really fun and I enjoy that type of thinking.

With these factors in mind, do you all have suggestions on other specialties to explore? I have heme/onc, pulm/crit and radiology on the list so far—any pros or cons of those as well would be appreciated! Thank you.
 

GapCalc

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My vote would be for interventional radiology
Pros: you'll get to think about and do everything on your list except maybe the emotional support part.
Cons: you'll spend at least part of your training in the dark; you still have to deal with the American Board of Radiology

But the best part is... you'll have a job in a city where you might actually want to live when you graduate!
 
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My vote would be for interventional radiology
Pros: you'll get to think about and do everything on your list except maybe the emotional support part.
Cons: you'll spend at least part of your training in the dark; you still have to deal with the American Board of Radiology

But the best part is... you'll have a job in a city where you might actually want to live when you graduate!

Thanks GapCalc. Had a negative experience shadowing IR during my first semester, but I should probably give it another chance. Has a lot of pros
 
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Mandelin Rain

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1. You use very little physics in day to day practice. Like close to none. Thinking about how machines work is not a reason to pick any specialty but clinical engineering. You’re going to be a doctor. You’ll barely see the machine.

2. Rad Onc had been a great field for being the emotional support person until we decided as a field that we needed to shorten almost every treatment to 1-5 fractions. Nowadays, we’re trending more toward a technician specialty where you zap something and send them back. Think IR with X-ray beams.

3. Cancer biology is fascinating. Radiation biology is a small portion of that. Med onc iis much more cancer biology forward.

4. Reading CTs and MRIs is a big part of what we do, and a very necessary skill to have, no doubt. This is true for many specialties, but we are probably behind only diagnostic rads in terms of reliance on scans.



Just my 2 cents.
 
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RadRadRad

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agree with ir
Any interest in surgical fields (Surg onc, gyn onc, urology, ent, etc. )
 

scarbrtj

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Hi everyone,

Rising MS2 at a top 40 US med school here. I have been following this forum fairly closely so I am familiar with the general outlook for the radonc job market.

The thing is, I haven’t been able to find any alternatives that make as excited as Rad Onc. I have had pretty good exposure through research and shadowing and so far, things I like about it are:

- Using physics! It was always my favorite science subject in school and I love thinking about how the machines work.
- Patient population: I knew when I decided to become a doctor that I wanted to work with patients who are quite sick, would never want to do something like cosmetic derm for that reason. I don’t mind delaying with death and want to support my patients emotionally as well.
- cancer biology is absolutely fascinating (coolest thing I’ve studied in med school so far)
- reading CTs and MRIs is really fun and I enjoy that type of thinking.

With these factors in mind, do you all have suggestions on other specialties to explore? I have heme/onc, pulm/crit and radiology on the list so far—any pros or cons of those as well would be appreciated! Thank you.

You sound exactly like me once upon a time. And now I sound like @Mandelin Rain.

1) We have a guy or gal in all our depts called a "physicist." I'm not sure the physicists go around saying "I love to use medicine." The use of medical guidelines and "recipes" for want of a better word govern 95+% of our daily activities. Go outside when it's cold and don't slip on the ice... that's using physics, too. (I used a million percent more physics in Physics 1 than I do now.)
2) If you ran a breast or prostate radiation service (the two top indications for radiation in America) e.g., you hope the "sickness rate" before/during/after XRT is close to 0%. (And, overall "face to faceness" in rad onc with the sick or the well is declining, too.) Some patients are sick (head/neck patients), but I make darn sure most XRT patients are not sick by my hand though most times. If you want to work with patients who are "quite sick" as you say, rad onc is a bit of a weird choice. We're very outpatient-y. (God bless you for wanting that however.)
3) Cancer biology is cool. We get tested on it and learn about it ad nauseum and ad infinitum in residency. Then you get out in practice and for most rad oncs it's gonna be "Cancer biology... cool story bro." Radiobiology is a form of cancer biology. We use radbio some, but it's not that hard of a concept. If all of North America equals the sum total knowledge of cancer biology, the amount of cancer biology I use day-to-day is about the size of... Jersey? Manhattan? The lower west side?
4) Reading CTs and MRIs is entertaining and fun. But I never read as many MRIs and did as many interesting image-centric things as when I was with Patrick Kelly for a rotation. Many roads lead to Rome or "interesting and fun" things.

I derive happiness from the rad onc life. Time was, I thought I'd derive that rad onc happiness from many of the things you mention (physics! complex biology!). Turns out these were... a small part of the rad onc story. Others' mileages are sure to vary in this regard. "Heme/onc, pulm/crit and radiology"... a good list.
 
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cyclenerd

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I think these are great suggestions-- IR, heme onc, surg onc. The gyn oncs are awesome-- they basically do it all. As a jobless recent rad onc grad, I cannot tell you enough times to not do radiation oncology UNLESS you would be happy in Indiana, Nebraska, Arkansas, etc. There are many folks who want to stay in low-population areas for various reasons and in that case, it's a fun field with high pay. Agree that physics doesn't come in that often. Heme onc is nice because you have the IM training in case you change your mind and want to do something more general. With gyn onc you have a general ob/gyn training, with surgery you have general surg, etc, so if you ever want to do general work, charity work or move to a democracy, you have that in your bag. I hope you make the right choice for you!
 
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RollTideRadOnc

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Agree with HemOnc. Great field that will lead the way in oncology.
Also, I will give a vote for doing ENT plus an oncology/flap fellowship. HN anatomy is the most interesting (imo), and the variety of surgeries and malignancies is large. Plus, good interactions with MedOnc and RadOnc, but ENT runs the show usually.
 
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OTN

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Agree with HemOnc. Great field that will lead the way in oncology.
Also, I will give a vote for doing ENT plus an oncology/flap fellowship. HN anatomy is the most interesting (imo), and the variety of surgeries and malignancies is large. Plus, good interactions with MedOnc and RadOnc, but ENT runs the show usually.

I also think ENT is one of the coolest surgical subspecialties, but all the ENT docs I know are complaining constantly about reimbursement. They've gotten progressively more unhappy in the 11 years since I came out of training.
 
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RadRadRad

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I also think ENT is one of the coolest surgical subspecialties, but all the ENT docs I know are complaining constantly about reimbursement. They've gotten progressively more unhappy in the 11 years since I came out of training.

I think ent pays much better with high volume bread and butter +/- ownership of surgicenter. Unfortunately ent oncology doesn’t meet either of these criteria
 
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deleted605854

I think ent pays much better with high volume bread and butter +/- ownership of surgicenter. Unfortunately ent oncology doesn’t meet either of these criteria

Absolutely. It's a shame. I've known people who had done the requisite fellowship only to grow very bitter and sour then exit those academic oncologic jobs and do more bread and butter stuff in PP

Very sad stuff. I suppose that's the future of cancer care. "The stuff at the front of the shelf is alright (Sx,RT and chemo) but we hide the good stuff at the back (IO,targeted therapy...etc)"

Oh well, cheers
 
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Radiology and IR are cool fields with lots of options. Everyone in medicine, not just radiation oncologists, want to live in millennial cities like NYC, Seattle, Denver, etc., and that's much easier with remote teleradiology. You can even work a hospitalist-type schedule and essentially have 26 weeks of vacation, with income comparable to an established radiation oncologist.
 
D

deleted605854

Radiology and IR are cool fields with lots of options. Everyone in medicine, not just radiation oncologists, want to live in millennial cities like NYC, Seattle, Denver, etc., and that's much easier with remote teleradiology. You can even work a hospitalist-type schedule and essentially have 26 weeks of vacation, with income comparable to an established radiation oncologist.

To the topic creator, the above is true given what we know as of now.

But no one can tell you what the landscape will look like with protracted pandemic pandemonium, creep of AI (decreasing the need for diagnostic radiologists since AI will supercharge the productivity of the ones already in practice. ) and declining reimbursement.

If geography is no 1 then radiology and IR are great but see above. IM will always have flexibility and so does psychiatry.
 
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scarbrtj

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Radiology and IR are cool fields with lots of options. Everyone in medicine, not just radiation oncologists, want to live in millennial cities like NYC, Seattle, Denver, etc., and that's much easier with remote teleradiology. You can even work a hospitalist-type schedule and essentially have 26 weeks of vacation, with income comparable to an established radiation oncologist.
Some of the telerads emails I get nowadays promise 850K for 15-20 shifts a month. 15 if you wanna work weird hours.
 

KHE88

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Cardiology --> electrophysiology
Diagnostic or interventional radiology

All far better choices that rad onc. I look at EP job postings sometimes if I want to feel depressed (what other fields consider a "tight" job market, rad onc makes it seem wide open in comparison).

Also worth learning about early on whether you would be cool working as an employee for a hospital the rest of your life or if you want to own your practice. If the latter, then you may have to be more flexible with specialty. Also not something rad onc really has going for it. (Free lesson: working for a hospital sucks).
 
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Haybrant

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The problem when you’re young is you say what sounds good and have no idea what you actually want. Literally every single one of us here played the I want to be in academics card for like 4 years med school 5 years residency. Imagine that for a decade saying you want something you really don’t. Some people really want this and turns out to be a good fit. Something like 50-60% don’t realize how much they hate it, they keep saying it for years and years after residency only to find out holy **** look what I sacrificed to fulfill this statement and my life is nowhere near where I actually want it. Many of those people later realize they were in a bad situation. A good percentage of them just suck at it, they were never going to cut it in academics but didn’t get the guidance that it’s ok to not like it. A lot of these latter few groups end up here Feeling like they were duped.

I say this Bc you may be in an early stage where you’re not actually realizing what matters. Medicine is not science it’s not physics. It’s about having people skills to work with a team (often a team that is far less skilled and smart than you are which is frustrating as **** often) to help control the neuroses of a patient and ultimately change their life for the better - and you as the rad onc have that ability which nobody else on the team will, often nobody else in the hospital will. You have to be a generally optimistic person that sees the good in the things that you do and enjoys analyzing them to be happy. Not oh I like using physics or cancer bio or patient population that’s all bs unfortunately.

I’ve never seen anything in my life promise so much and teach so much useless **** than medicine and literally not deliver on 95% of it in what you ultimately do. Not a single day of med school or residency goes into managing people Bc it’s the blind leading the blind in this regard. In many ways with medicine you need to have this jaded part to help emerge much stronger in any situation you find yourself in. You in particular need to focus on what you want from life first and foremost and then you can figure out specialty (Geography, lifestyle, money, vacation). Do not go into rad onc if you don’t want to have to work with people who aren’t as smart as you. It’s something I don’t mind Bc I get along with people but man do I hate having to rely on people who’s qualifications are trash to manage components of patient engagement with the department and their care, and when they hand wave about those components it’s blood boiling. It’s like your whole team is basically just their to make sure you get end up in a malpractice suit and often other specialists too all of them not realizing it!

It’s the least favorite thing for me, working in teams in Medicine Bc in medicine its working in teams with people who are like way dumber than you. That’s a big time part of rad onc. Contrast this with working at google where everyone is smart. it can be fun Though to bring your expertise to that team and you all operate to cure disease which is cool and That doesn’t exist in other specialties. From the outside though that independent work aNd ability to control many more aspects of the patient care makes something else much more appealing than rad onc. That said the other specialists won’t realize this so they have their own set of problems to concern themselves with.
 
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Haybrant

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I think in any job there are always people who are way dumber than you around you.

That is true but few where you have the life of a patient directly on the line and so much of the liability. In a public company the company as an individual entity hold the liability and it’s diluted out to sharholders so even if the execs mess up Or oversee a mess they walk out with a fatty payouts. You’re also trained to deal with it, literally not a single day in medicine or residency goes into this
 
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seper

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Agree with everything, but I will add a point. It's true that we have to spend all our wake hours working and dealing with people who are less smart, which is frustrating. However, you get to spend time with many folks who a lot better looking than you, younger than you are, know better than you how to go out and have a good time. They would want to spend time with you since you're a physician. It is rewarding. RadOnc is OK for that, but other specialties are better.

The problem when you’re young is you say what sounds good and have no idea what you actually want. Literally every single one of us here played the I want to be in academics card for like 4 years med school 5 years residency. Imagine that for a decade saying you want something you really don’t. Some people really want this and turns out to be a good fit. Something like 50-60% don’t realize how much they hate it, they keep saying it for years and years after residency only to find out holy **** look what I sacrificed to fulfill this statement and my life is nowhere near where I actually want it. Many of those people later realize they were in a bad situation. A good percentage of them just suck at it, they were never going to cut it in academics but didn’t get the guidance that it’s ok to not like it. A lot of these latter few groups end up here Feeling like they were duped.

I say this Bc you may be in an early stage where you’re not actually realizing what matters. Medicine is not science it’s not physics. It’s about having people skills to work with a team (often a team that is far less skilled and smart than you are which is frustrating as **** often) to help control the neuroses of a patient and ultimately change their life for the better - and you as the rad onc have that ability which nobody else on the team will, often nobody else in the hospital will. You have to be a generally optimistic person that sees the good in the things that you do and enjoys analyzing them to be happy. Not oh I like using physics or cancer bio or patient population that’s all bs unfortunately.

I’ve never seen anything in my life promise so much and teach so much useless **** than medicine and literally not deliver on 95% of it in what you ultimately do. Not a single day of med school or residency goes into managing people Bc it’s the blind leading the blind in this regard. In many ways with medicine you need to have this jaded part to help emerge much stronger in any situation you find yourself in. You in particular need to focus on what you want from life first and foremost and then you can figure out specialty (Geography, lifestyle, money, vacation). Do not go into rad onc if you don’t want to have to work with people who aren’t as smart as you. It’s something I don’t mind Bc I get along with people but man do I hate having to rely on people who’s qualifications are trash to manage components of patient engagement with the department and their care, and when they hand wave about those components it’s blood boiling. It’s like your whole team is basically just their to make sure you get end up in a malpractice suit and often other specialists too all of them not realizing it!

It’s the least favorite thing for me, working in teams in Medicine Bc in medicine its working in teams with people who are like way dumber than you. That’s a big time part of rad onc. Contrast this with working at google where everyone is smart. it can be fun Though to bring your expertise to that team and you all operate to cure disease which is cool and That doesn’t exist in other specialties. From the outside though that independent work aNd ability to control many more aspects of the patient care makes something else much more appealing than rad onc. That said the other specialists won’t realize this so they have their own set of problems to concern themselves with.
 

Mandelin Rain

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Man, people actually walk around thinking, "I can't believe everyone is so much dumber than me, this is so frustrating!!!!!"?
 
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thecarbonionangle

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The great george carlin, may he RIP, has the quote about dumb people, something like “Think of how stupid the average person is, and realize half of them are stupider than that.”
 
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KHE88

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you get to spend time with many folks who a lot better looking than you, younger than you are, know better than you how to go out and have a good time. They would want to spend time with you since you're a physician.

Am I the only one who is baffled by this comment?
Do people really go into medicine so they can hang out with good looking cool younger people when they are 40+?
I mean, I guess I've seen it at ASTRO with the middle aged attendings creeping on the younger med students, techs, and pharm reps.
That's not the way my clinic works though.

I’ve never seen anything in my life promise so much and teach so much useless **** than medicine and literally not deliver on 95% of it in what you ultimately do. Not a single day of med school or residency goes into managing people Bc it’s the blind leading the blind in this regard.

The system is fundamentally broken. We waste decade of the prime of our lives stuck in the library (college and med school and to some degree residency) cramming facts that we will never use and thereby never retain. It's sad. Unfortunately we don't have the perspective until we are all done that memorizing all of those reactions in O-chem was about as helpful and as good of a use of time as memorizing vocabulary in Esperanto.

Oh and then there's the fact that we have to pay massive 6 figure sums + interest if you have to borrow it to even have the privilege of wasting your time like that. Higher ed is a complete and total scam.
 
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RickyScott

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Radonc is a special calling and if you are worthy, you will gladly take a low paying rural job thousands of miles from family. You are so blessed that you don’t have cancer.
 
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