Rad onc is the only specialty in medicine I could see myself doing, what should I do?

Started by inomed
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inomed

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Is the job market so bad, that I should avoid rad onc as I am only competitive for a mid-tier place currently? I cannot see myself practicing any other field of medicine. What is the worst case scenario? An 8-5 job paying 300k? That's still better than being a hospitalist or PCP in my opinion.
 
inomed said:
Is the job market so bad, that I should avoid rad onc as I am only competitive for a mid-tier place currently? I cannot see myself practicing any other field of medicine. What is the worst case scenario? An 8-5 job paying 300k? That's still better than being a hospitalist or PCP in my opinion.
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The pay hasn’t been and isn’t the main issue. The location and the type of job are. Can you see yourself working at a community hospital in small town in Iowa with 10k population? How about a private practice in middle of nowhere south dakota? Because those may end up being your only options. If location and type of practice aren’t a priority for you, rad onc might be the best job in the world
 
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What would you recommend then? There is no other specialty I could see myself wanting to do. But I don’t want to end up in rural Iowa. The current class of graduates seems to be doing fine with jobs, is there a bubble that is about to burst?
 
inomed said:
What would you recommend then? There is no other specialty I could see myself wanting to do. But I don’t want to end up in rural Iowa. The current class of graduates seems to be doing fine with jobs, is there a bubble that is about to burst?
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read the FAQs thread. rings true from over a decade ago. from what it sounds like to me, you have genuine interest and experience in the field. you know the risks. you rather make 300k in rad onc than being a hospitalist.

if I had to bet money, I would bet good money that 80 percent of rad onc jobs don't disappear in 20 years. that would be really hard to imagine.

no one can predict the future, so only you can make the decision.
 
inomed said:
What would you recommend then? There is no other specialty I could see myself wanting to do. But I don’t want to end up in rural Iowa. The current class of graduates seems to be doing fine with jobs, is there a bubble that is about to burst?
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If you are open to working at an academic satellite center for the $300K range, you would find a job. A lot of these are in rural areas 1-2 hours from main campus and remember, a decent number of them are in mid sized cities to start with. I agree with you that our grads anre still getting jobs in good places and I don’t believe we are facing an immediate bubble. It is unlikely you would have to take a job in rural Iowa. But, it’s a small field and most of the current expansion is going towards the acquisition of small to medium centers. If rural living or having an hour long commute is completely unacceptable to you, I would say look more broadly at other fields.

I’ll let other people speak to the distant future. We’ve been 10-20 years from annihilation for at least the last 20 years for one reason or another. That’s not to say there are not valid concerns. Just that things are hard to predict. And if we really want to get into it, I think a lot of medical fields downplay the threat of AI over the long run. Even primary care could be at risk.
 
ramsesthenice said:
It is unlikely you would have to take a job in rural Iowa.
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I am still scarred from the late 2010s when this was the case. It wasn't that long ago.

I remember several of our grads who had previously never lived outside of urban/suburban east coast locations who went to rural midwest locations.

Then I had people calling me for recommendations who were skeptical because "why is this person trying to leave when they've only been in their first job for a year?" It was like nobody was aware of how bad the job market was. Even other faculty and residents would snicker that those senior residents just didn't "network enough" or whatever nonsense, so those new attendings were banished to the cornfields. It was a sad fate for the cream of the crop medical students of the early-mid 2010s.

Now that the job market isn't a complete disaster, our residency program is expanding again. It's as if nobody learned anything.
 
Neuronix said:
Now that the job market isn't a complete disaster, our residency program is expanding again. It's as if nobody learned anything.
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This hurts my soul but surprises me 0%.

I've been very consistent in my thinking and you and I largely seem to agree. I think for the foreseeable future there will be good years and bad years when it comes to hiring. Anyone entering this field has to be open to either living in a rural area or commuting to work in a rural clinic while living in a medium or larger sized city. That's not to say everyone (or even most new grads) will end up doing this, but this is where many of our jobs are, or are going, and if it is completely unacceptable to someone, this is a bad fit.
 
There is a drive (exploratory only for now) among some major insurance companies to impose five fraction limit on very favorable breast cancer cases in their guidelines. As we all know the most common definitive RT case is breast cancer, and the most common breast cancer patient to get RT is a very favorable case. If you don’t think this will impact radiation oncology and the job market, then I would definitely encourage you to become a radiation oncologist.

EDIT: also a drive to impose 15 fraction limits for nodal RT and/or PMRT
 
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According to the supply and demand projection paper that was sanctioned by ASTRO there is a guaranteed oversupply from 2030 onward. Your employment is tied to the folks who recklessly overexpanded residencies to help their departmental budget and are keen to do this again.

No one knows the future. All the lines are pointing in the wrong direction. Most importantly, the folks in control are making sure the lines are pointing against you because it benefits them.

Breast and prostate are how we serve society the most. Breast is fading rapidly. Once SBRT prostate takes off the decline will be worse.

This is a field of medicine actively shrinking itself while training more folks than are needed. Nothing could go wrong
 
TheWallnerus said:
There is a drive (exploratory only for now) among some major insurance companies to impose five fraction limit on very favorable breast cancer cases in their guidelines. As we all know the most common definitive RT case is breast cancer, and the most common breast cancer patient to get RT is a very favorable case. If you don’t think this will impact radiation oncology and the job market, then I would definitely encourage you to become a radiation oncologist.
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Agreed. In 20-30 years, we will have quantum computers, AGI but somehow won’t be able to predict the 9/10 patients with favorable breast cancers in which xrt can be omitted. Corey Spears already is hawking a commercial product to do just that. It is completely plausible that this problem is solved in the 30 years.
And what abt supervision changes? I could easily run both centers in my network solo.
 
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RickyScott said:
Agreed. In 20-30 years, we will have quantum computers, AGI but somehow won’t be able to predict the 9/10 patients with favorable breast cancers in which xrt can be omitted. Corey Spears already is hawking a commercial product to do just that. It is completely plausible that this problem is solved in the 30 years.
And what abt supervision changes? I could easily run both centers in my network solo.
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We don’t talk about Bruno. Or the supervision changes. And yes the NNT (for recurrence! not survival!) for very favorable breast RT is about 10. If I’m an insurance company, I would easily spend 100 million to figure out the 9 who don’t need the RT. DeepSeek can probably do it for less than 10 million.
 
inomed said:
Is the job market so bad, that I should avoid rad onc as I am only competitive for a mid-tier place currently? I cannot see myself practicing any other field of medicine. What is the worst case scenario? An 8-5 job paying 300k? That's still better than being a hospitalist or PCP in my opinion.
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I think you are doing yourself a disservice by being inflexible in what specialty you select. Perhaps revisiting one you had previously written off would be of more value than focusing on RO.
 
inomed said:
Is the job market so bad, that I should avoid rad onc as I am only competitive for a mid-tier place currently? I cannot see myself practicing any other field of medicine. What is the worst case scenario? An 8-5 job paying 300k? That's still better than being a hospitalist or PCP in my opinion.
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In 2025, I'd look at rads, med onc, ENT or GU as viable options instead of rad onc as much as I love rad onc more than any of them as an actual job

Residency competitiveness ultimately comes down to the job market and employability and not just how it's doing in flyover states.

If you have flexibility though where you end up geographically then push forward. I think a solid mid tier program could still set you up for a great pp job
 
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"It is difficult to make predictions, especially about the future." - Yogi Berra

A

Thread 'isnt Rad Onc a dying field??'

i like rad onc i think its a cool field, but isnt it considered a dying field in medicine? probably a field that is likely to be replaced by heme onc and others??
maybe i just dont know enough about the field, can some people clear this up for me??
S

Post in: 'Job Market'

short version
late 1990's fear too many rad oncs and they shrunk residency program numbers
2000's- woops were wrong, not enough, expanding numbers.
 
IonsAreOurFuture said:
I personally think that proton therapy is going to ride in on a white horse and save the day, keeping those good high paying jobs in the big cities on the coast and other desirable metro areas, but I've been wrong before.
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1738089034650.gif
 
Just a n=1 but over the past few years the number of stage IA ER/PR+ breast cases that I treat has definitely gone way down to the point where I usually only have one or two under beam these days. Also the number of neoadjuvant esophagus has somehow entirely disappeared where as previously I would get 6 to 8 a year.
 
fiji128 said:
Just a n=1 but over the past few years the number of stage IA ER/PR+ breast cases that I treat has definitely gone way down to the point where I usually only have one or two under beam these days. Also the number of neoadjuvant esophagus has somehow entirely disappeared where as previously I would get 6 to 8 a year.
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I'm seeing a definite rebound with external beam partial breast and still treat a lot of stage I ER+ breast ca. Esophageal, GE junction, and gastric cancers have dropped off the cliff as expected with the data.
 
Fpg1245 said:
I think you are doing yourself a disservice by being inflexible in what specialty you select. Perhaps revisiting one you had previously written off would be of more value than focusing on RO.
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In the long run, once you get comfortable treating most things, most of the job will become just inputting data into an EMR.
 
radiation said:
"It is difficult to make predictions, especially about the future." - Yogi Berra

A

Thread 'isnt Rad Onc a dying field??'

i like rad onc i think its a cool field, but isnt it considered a dying field in medicine? probably a field that is likely to be replaced by heme onc and others??
maybe i just dont know enough about the field, can some people clear this up for me??
S

Post in: 'Job Market'

short version
late 1990's fear too many rad oncs and they shrunk residency program numbers
2000's- woops were wrong, not enough, expanding numbers.
Click to expand...
It surely is difficult to predict the future. But no one has refuted the projections in the supply and demand paper. Nor the data showing we can safely be omitted from treating breast cancer.

Those are stronger pieces of current information than an argument of “people posted this online before, therefore those posting it online now must be wrong”
 
Fpg1245 said:
I’ve literally lost all actual physician skills in this job.

General medical knowledge? - virtually gone
Differential dx: differentio?? What
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that's the summation of physician skills to you? there area bunch of other specialists who can't call themselves doctors either then.
 
I enjoy physics, treatment planning, and referencing study statistics, and I don't enjoy coming up with a differential dx. If I didn't do rad onc, I'd strongly consider a non-clinical career. Would you all recommend that (e.g., consulting, pharma) over rad onc? I've considered IM and heme onc, but I think I like that much more as a science than day to day practice.
 
Meh, don't let all the doomsayers on this board scare you. If this is literally the only specialty that works for you, go for it and stop worrying about trying to predict the future. Nobody knows what is going to happen in five years, let alone 10, 15 or the entire course of your working life. It's a great job, can still pay extremely well for much less time spent in the hospital as compared with most specialties, and offers some of the best patient interactions that medicine can offer.
 
Pointless said:
Meh, don't let all the doomsayers on this board scare you. If this is literally the only specialty that works for you, go for it and stop worrying about trying to predict the future. Nobody knows what is going to happen in five years, let alone 10, 15 or the entire course of your working life. It's a great job, can still pay extremely well for much less time spent in the hospital as compared with most specialties, and offers some of the best patient interactions that medicine can offer.
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There are other careers I'd consider that are of high interest too that don't need a residency, so I wonder if it's worth the risk? I think I'd still rather do rad onc than those careers though, but not if I'm living in Iowa forever.
 
inomed said:
There are other careers I'd consider that are of high interest too that don't need a residency, so I wonder if it's worth the risk? I think I'd still rather do rad onc than those careers though, but not if I'm living in Iowa forever.
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If there are other realistic non-clinical careers that would work for you, then why not go through residency and see what shakes out at the time of the job search?

I would imagine it would be hard to go have a non-clinical career after the MD then come back for residency years later. Not impossible, I know of at least 1 current resident (or recent grad?). But not common.
 
inomed said:
There are other careers I'd consider that are of high interest too that don't need a residency, so I wonder if it's worth the risk? I think I'd still rather do rad onc than those careers though, but not if I'm living in Iowa forever.
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Could lateral into a job later from your first job .

But again no guarantee of where and when
 
inomed said:
There are other careers I'd consider that are of high interest too that don't need a residency, so I wonder if it's worth the risk? I think I'd still rather do rad onc than those careers though, but not if I'm living in Iowa forever.
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I would not expect to just walk into a good pharma job with no additional training. Especially one with an oncology focus. Or at a sponsor company. You would definitely be expected to cut your teeth and prove your worth in middle management for a bit.
 
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Yeah I’m aware of the challenges in that path and you definitely don’t need a residency to be on the strategy side, but I think rad onc as a clinical practice would be way more fun and fulfilling.
 
TheWallnerus said:
We don’t talk about Bruno. Or the supervision changes. And yes the NNT (for recurrence! not survival!) for very favorable breast RT is about 10. If I’m an insurance company, I would easily spend 100 million to figure out the 9 who don’t need the RT. DeepSeek can probably do it for less than 10 million.
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Actually...

what is the NNT for blood pressure medicine or statins to prevent stroke or a major cardiac event
what is the NNT for antidepressants to 'clinically significantly' improve symptoms of depression (not cure of mental illness or survival)
what is the NNT for back surgery to 'clinically significantly' reduce back pain (not survival)
what is the NNT for kyphoplasty or epidural injections for non-durable relief of back pain (not survival)
what is the NNT for adding Verzenio for stage II breast cancer progression-free survival (not overall survival)

etc, etc, etc.

Arguably, a NNT of 10 for breast cancer local recurrence actually performs pretty well considering the importance of the endpoint. Personalized medicine can be pursued for many disciplines of medicine.
 
OTN said:
I'm seeing a definite rebound with external beam partial breast and still treat a lot of stage I ER+ breast ca. Esophageal, GE junction, and gastric cancers have dropped off the cliff as expected with the data.
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OTN is right. Those on this board should not discount the SOUND/INSEMA trial results applicable to the favorable HR+/HER2- stage IA breast cancers. Go to tumor board, appropriately advocate for SLNB omission in these patients and you will have them back on beam for their adjuvant radiation. Now that EUROPA prelim results are in, have your Med Oncs and surgeons explain to patients why “Choosing Wisely” means omission of XRT instead of omission of ET. I think the tides are turning back in our favor for early stage BC
 
Desrazita said:
OTN is right. Those on this board should not discount the SOUND/INSEMA trial results applicable to the favorable HR+/HER2- stage IA breast cancers. Go to tumor board, appropriately advocate for SLNB omission in these patients and you will have them back on beam for their adjuvant radiation. Now that EUROPA prelim results are in, have your Med Oncs and surgeons explain to patients why “Choosing Wisely” means omission of XRT instead of omission of ET. I think the tides are turning back in our favor for early stage BC
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You mean omission of et instead of xrt?
 
The other option I could think of is doing an IM residency at a more chill place just to have some formal training and maybe I find a fellowship I like. What would you suggest?
 
medgator said:
You mean omission of et instead of xrt?
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I think they were saying it doesn't make sense to omit XRT given the EUROPA data, so they wanted the surgeons and medoncs to explain why they would choose to do that.

As soon as prelim EUROPA data came out, I made the rounds to my medoncs and explained that if "either ET or XRT" was going to be proposed (which BASO II established as an option), I would advocate for XRT over ET. The medoncs weren't particularly happy, but the data is what it is, and they know I feel like it's my job to advocate for the best for my patients, regardless if it's going to hurt feelings.
 
If a med student is aware of the job market issues (which have anecdotally rebounded over past few years, but TO BE SEEN if it will persist beyond 2026) and still wants to proceed, go ahead.

Be aware that the most optimistic modeling of Rad Onc supply still showed significant oversupply 2030 and onwards. So significant that they took down the video of the only time it was discussed in a public forum with any sort of dissenting thoughts/opinions.
 
OP, I love my job, I also couldn't see myself doing any other specialty. I share everyone's concerns about the future job market but honestly everyone I know in the field is doing fine. There is legitimate concern about the long term viability of the field and concerns about over-staffing. Someone else mentioned this above, but I would assume that your earning potential will go down the farther you are in your career and save/invest accordingly. Save with the plan to be financially independent after 15 years of practice, then you will have the freedom to bail if it all goes to hell.
 
OTN said:
I think they were saying it doesn't make sense to omit XRT given the EUROPA data, so they wanted the surgeons and medoncs to explain why they would choose to do that.

As soon as prelim EUROPA data came out, I made the rounds to my medoncs and explained that if "either ET or XRT" was going to be proposed (which BASO II established as an option), I would advocate for XRT over ET. The medoncs weren't particularly happy, but the data is what it is, and they know I feel like it's my job to advocate for the best for my patients, regardless if it's going to hurt feelings.
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Shocking. Many of the younger med oncs I know hate giving it. Such toxic treatment like ADT for such a marginal benefit. They are happy to give RT and be done with it.

Economically, it's a generic drug. They are making zilch on it, maybe some money if they have to give prolia I guess?
 
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If this is what you love and you're committed, then so be it. Your passion for the field will also motivate you to fight for its salvation (and your own).

However, the concerns noted here are accurate. Leadership has not course corrected. All optics indicate they've doubled down on poor decisions. I would strongly encourage you to develop alternative skills and professional networks.
 
randomname2018 said:
If this is what you love and you're committed, then so be it. Your passion for the field will also motivate you to fight for its salvation (and your own).

However, the concerns noted here are accurate. Leadership has not course corrected. All optics indicate they've doubled down on poor decisions. I would strongly encourage you to develop alternative skills and professional networks.
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Nailed it

1990s leadership course corrected appropriately in the mid 90s. Rad onc leadership in 2010 and beyond just DGAF, sadly
 
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inomed said:
There are other careers I'd consider that are of high interest too that don't need a residency, so I wonder if it's worth the risk? I think I'd still rather do rad onc than those careers though, but not if I'm living in Iowa forever.
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Ultimately, nobody on this board can know your situation well enough to give good advice; my only point was that rad onc is still a great field. No one knows what the future may hold, despite the long line of people who insist that they, in fact, do. You can overanalyze this to death, or just do what feels right.
 
inomed said:
I enjoy physics, treatment planning, and referencing study statistics, and I don't enjoy coming up with a differential dx. If I didn't do rad onc, I'd strongly consider a non-clinical career. Would you all recommend that (e.g., consulting, pharma) over rad onc? I've considered IM and heme onc, but I think I like that much more as a science than day to day practice.
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In daily, clinical practice, there will be essential zero "physics" or recitation of study statistics. There will be some treatment planning, but much more note creation or image checking. Gotta learn to love the mundane and helping people with cancer.

I say this only because if physics and statistics are 2 of the 3 main reasons you can "only" see your self doing rad onc, I fear you'll be sorely disappointed independent of any job market concerns.
 
inomed said:
The other option I could think of is doing an IM residency at a more chill place just to have some formal training and maybe I find a fellowship I like. What would you suggest?
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If you love Rad Onc and cant see yourself doing anything else, Id go in to Rad Onc. You just have to know that there will be restrictions in terms of geography and where you work, and that might frustrate you. Probably a lower chance you will be unemployed, but it is not impossible. Alos realize if you are boarded in radiation oncology, it is hard to go find another clinical job outside this field.

If you are interested in other fields, want to be more flexible geographically, what you are doing or where you are working, IM residency will offer you all of that.

There is no way to reliably predict the future.
 
If you like physics, Physicists have much more future career stability, demand, and geographic flexibility.
However if you're already in med school it's probably too late for that.

As mentioned here before, I would much rather do RadOnc for the same salary hours etc vs hospitalist, PCP, and other specialties. I am making hay while the sun shines, though.
 
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Quite possible that a remote, low cost of living rad onc job in 2035 consists of doing gyn brachytherapy somewhere in the global south

Rural Iowa would look like paradise in comparison!
 
NotMattSpraker said:
If you love Rad Onc and cant see yourself doing anything else, Id go in to Rad Onc. You just have to know that there will be restrictions in terms of geography and where you work, and that might frustrate you. Probably a lower chance you will be unemployed, but it is not impossible. Alos realize if you are boarded in radiation oncology, it is hard to go find another clinical job outside this field.

If you are interested in other fields, want to be more flexible geographically, what you are doing or where you are working, IM residency will offer you all of that.

There is no way to reliably predict the future.
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Is the job market this year (strong) at all indicative of the job market in 5 years?
 
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