Rad onc vs heme onc--lifestyle and practice

[rad_onculous]

I am choosing between rad onc and heme onc. I have done rotations in both, and have found in many ways they were more similar than different so I am having a hard time deciding between the two. Both have a similar clinical approach (i.e. see the patient, review imaging/studies, determine if they are a candidate for your therapy, and then follow for side effects and response). I would say that I enjoyed hearing about med onc research more and the med oncs seem to have had more flexible long-term careers (changing area of clinical focus over time), so based on subject matter med onc might have a slight advantage, but I have heard rad onc has a better lifestyle hours-wise.

What are the comparative lifestyles of these two fields as attendings? It was really impossible to tell while on rotation since I did not know what the attendings did when I was not with them, and I was with different attendings every few days. It was also not easy to ask them what the lifestyle is like without looking lazy. I could not tell what the hours of each are. I got the sense that med onc attendings had to come in more in the evening or overnight to admit patients for complications of their cancer or therapy, and that the med oncs had to do 2-3 weeks of inpatient service time per year, which was really busy. Also, most of the med oncs at my institution work 5 days per week but I met some rad oncs that work 3-4 days and are home for one or two days per week (all of these rad oncs had small children, like I hope to have, and physician spouses).

Any insight into med onc vs rad onc call/lifestyle?

---

Members don't see this ad.

 

[DermViser]

Do you want to go through 3 years of IM residency to get to Heme-Onc?

In general Rad-Onc tends to be much better in lifestyle.

 

[rad_onculous]

Do you want to go through 3 years of IM residency to get to Heme-Onc?

In general Rad-Onc tends to be much better in lifestyle.

Do you want to go through 3 years of IM residency to get to Heme-Onc?

In general Rad-Onc tends to be much better in lifestyle.

I do not mind IM residency. During third year, IM was my favorite rotation and I looked forward to being an IM resident before I thought about rad onc.

I am looking for specifics here, preferably from people in the field or headed into the fields.

 

[DermViser]

I do not mind IM residency. During third year, IM was my favorite rotation and I looked forward to being an IM resident before I thought about rad onc.

I am looking for specifics here, preferably from people in the field or headed into the fields.

I'll let people in Heme-Onc and Rad Onc answer, but just remember that your MS-3 rotation is not usually all-encompassing of what IM residency is like.

 

[MedStud!]

Any insight into med onc vs rad onc call/lifestyle?

I will be starting a Rad Onc residency after my intern year coming up. Is your question specifically about only call/lifestyle? If so, Rad Onc has a much better call/lifestyle over Med Onc. Radiation Oncologists usually don't do admitting or inpatient care, so their schedule is usually limited to clinic hours Monday through Friday as the treatment centers are not open on weekends. Call is also taken from home in Rad Onc, so you never have to stay overnight at the hospital. The observations you have made about Med Onc is correct so that is why their lifestyle and call is more demanding.

One thing you really have to ask yourself is if you love the medical management aspects of Oncology. Rad Onc doesn't do that side at all... so if you love the medicine part then Med Onc might be a better choice. Cancer patients can be VERY, VERY sick so you have to be a damn good IM doctor if you want to do Med Onc. Rad Onc is probably more akin to Surg Onc in the way the treatment is planned in that it is a local therapy where anatomy and location of malignancy is critical. I was considering Med Onc versus Rad Onc and I liked that in Rad Onc we typically treat many early stage patients where the goal is a cure. I also hate Hematology and have always been more interested in solid tumors, so Rad Onc was an easy choice for me. The lifestyle is a secondary bonus.

 

[Winged Scapula]

I will call @gutonc and @Gfunk6 for some attending level Med Onc/Rad Onc input.

 

[Gfunk6]

I work in a combined Med Onc/Rad Onc group. If the sole variable is lifestyle then Rad Onc has a better lifestyle. Most of this revolves around call responsibilities and inpatient rounding. Furthermore, Med Oncs tend to be the "face" of the practice when it comes to referring PCPs and IM-trained sub specialists (GI, Pulm).

Also, for the actual work that is done, Rad Onc is reimbursed at a higher rate. Some multi-specialty groups are of the opinion that Rad Oncs generate so much revenue in technical charges that it is not worthwhile for them to leave the clinic during business hours.

 

[DermViser]

I work in a combined Med Onc/Rad Onc group. If the sole variable is lifestyle then Rad Onc has a better lifestyle. Most of this revolves around call responsibilities and inpatient rounding. Furthermore, Med Oncs tend to be the "face" of the practice when it comes to referring PCPs and IM-trained sub specialists (GI, Pulm).

Also, for the actual work that is done, Rad Onc is reimbursed at a higher rate. Some multi-specialty groups are of the opinion that Rad Oncs generate so much revenue in technical charges that it is not worthwhile for them to leave the clinic during business hours.

You mean reimbursed higher at a higher rate than Med Onc? Why is radiation reimbursed at a higher rate than chemotherapy?

 

[Gfunk6]

Reimbursement for procedure codes is set by CMS (Feds) in close consultation with physicians who represent the spectrum of specialities and primary care. Private insurers and state Medicaid programs also tend to follow these rates closely.

Rad Onc has fixed costs that are inherent to our speciality. Whether you treat four or forty patients a day, you still need to pay for your machine costs and maintenance. Med Oncs on the other hand tend to have more variable costs. You only buy chemo if you are going to use it. It is too expensive to purchase en mass and store.

 

[Winged Scapula]

Also, for the actual work that is done, Rad Onc is reimbursed at a higher rate. Some multi-specialty groups are of the opinion that Rad Oncs generate so much revenue in technical charges that it is not worthwhile for them to leave the clinic during business hours.

This.

My group (surgeons) have been approached several times by Rad Onc/Multi-disciplinary Onc groups to join them and one of the "carrots" always floated was a piece of the Rad Onc pie, since they bring in so much revenue.

 

[Psai]

This.

My group (surgeons) have been approached several times by Rad Onc/Multi-disciplinary Onc groups to join them and one of the "carrots" always floated was a piece of the Rad Onc pie, since they bring in so much revenue.

What's the catch? Loss of autonomy?

 

[DermViser]

What's the catch? Loss of autonomy?

Having to be at the beck and call of a Radiation Oncologist. That's definitely a dealbreaker for any self-respecting surgeon.

 

[Winged Scapula]

What's the catch? Loss of autonomy?

1) definitely loss of autonomy; we like being in PP
2) the "carrot" wasn't large enough
3) the expectation that we would refer all of our patients to the med Onc and rad Oncs in the group rather than someone else whom we thought would be a better choice for the patient
4) alienating other med and rad Oncs in town from whom we get referrals

At the end of the day, they would have benefitted more than we would have (e.g, the referrals tend to flow from surgeon to rad Onc/med Onc, not the other way around)

 

[Kahreek]

Do you want to go through 3 years of IM residency to get to Heme-Onc?

In general Rad-Onc tends to be much better in lifestyle.

this is highly decisive.

Rad onc is somewhate more technical related, I think.

You like call, rounding the wards, placing catheters and chemo -> heme/onc
You like controlled schedule in the clinic and radiotherapy -> rad/onc

 

[stems]

1) definitely loss of autonomy; we like being in PP
2) the "carrot" wasn't large enough
3) the expectation that we would refer all of our patients to the med Onc and rad Oncs in the group rather than someone else whom we thought would be a better choice for the patient
4) alienating other med and rad Oncs in town from whom we get referrals

At the end of the day, they would have benefitted more than we would have (e.g, the referrals tend to flow from surgeon to rad Onc/med Onc, not the other way around)

But I want to remind you that even though you didn't take the job, there were 5 other surgeons who were more than happy taking the job. Any specialty/physician can be bought.

 

[chopes31]

For someone like the OP, would it be appropriate to apply to Rad Onc with IM as a backup?

 

[Winged Scapula]

But I want to remind you that even though you didn't take the job, there were 5 other surgeons who were more than happy taking the job. Any specialty/physician can be bought.

LOL -no.

My group is the largest breast surgery group in the southwest, includes a former national Society president who is well known in our field internationally and we wield a considerable amount of power. These multidisciplinary groups were told that if they hire their own surgeons they could forget about Rad Onc and Med Onc referrals from us. That would translate into a significant financial loss for them as we are their largest referral source. Its been several years and they have not hired any surgeons. I live in a heavily private practice town where very few surgeons are employed by other groups or institutions.

Never say never of course, but right now we have no plans to change that situation.

 

[atomi]

For someone like the OP, would it be appropriate to apply to Rad Onc with IM as a backup?

This is actually very easy to do and does not require interviewing for two categorical residencies because rad-onc requires a preliminary year. What is commonly done for fields that require a preliminary year where the applicant is borderline is to apply to a bunch of strong academic IM prelim med programs and rank these at the bottom of their rank list (vs. applying to cusy TYs). This gives the partially-matched applicant the option of either continuing to pursue the originally residency by getting an advanced spot outside the match or going through the match again, or changing his direction and going into IM, which should be possible with a PGY-1 IM year at a strong academic program (either staying on at the program they did the prelim at or getting an open PGY2 spot elsewhere). The important thing here is that it needs to be an academic IM prelim. Do not do a community IM prelim, a TY, and especially do not do a surgery prelim.

 

[DermViser]

LOL -no.

My group is the largest breast surgery group in the southwest, includes a former national Society president who is well known in our field internationally and we wield a considerable amount of power. These multidisciplinary groups were told that if they hire their own surgeons they could forget about Rad Onc and Med Onc referrals from us. That would translate into a significant financial loss for them as we are their largest referral source. Its been several years and they have not hired any surgeons. I live in a heavily private practice town where very few surgeons are employed by other groups or institutions.

Never say never of course, but right now we have no plans to change that situation.

 

[Winged Scapula]

I can name you 5 radonc practices that have hired surgeons. Your experience is specific for you or your town but not the field as a whole. Whether you like it or not, there are many, many more general surgeons that have a hard time finding a job in major cities and would gladly work for these multidisciplinary clinics. Also Arizona is not the most desired location for most people to be practicing in, which is probably why there are fewer surgeons looking for jobs there.

Where did you get the idea that I claimed my experience was the norm? You're getting your panties in a bunch for no reason, IMHO. I have no problem with surgeons working for Multi-Disciplinary groups. I'm not sure why you think I do or why your response is so unpleasant.

C'mon its Rad Onc - you guys are supposed to be relaxed! 😉

My original response was to agree that Rad Oncs tend to bill higher and be reimbursed more than Med Oncs. If you'll re-read my post, it was filled with "we" and "I" and no mention of "everyone" or "all surgeons".

Lastly, given that the Southwest has the largest growing population of anywhere in the US, with a nice lifestyle and lower COL than the coasts, I'm not sure why you claim that there are fewer surgeons looking for jobs here. I'm under the impression that the hospitals and others looking to hire surgeons have very little difficulty in finding people who wish to come here. But I do not claim to be an expert on that.

 

[Kahreek]

But I want to remind you that even though you didn't take the job, there were 5 other surgeons who were more than happy taking the job. Any specialty/physician can be bought.

attn. we got a badass over here.

 

[Winged Scapula]

Also I want to remind you that the field of oncology is changing. Most groups are being bought out by larger hospital based conglomerates. For example in Arizona there's now Mayo and MDACC that are going to be drawing many of the patients away causing many of the privates to close. So at the end of the day in about 20 years or so everyones going to be an employee


You implied that it was normal for surgeons to refuse to work for multidisciplinary clinics, just read your own comment. Secondly I wasn't talking about the Southwest, I was talking about Arizona which I've never heard anyone saying they desire to live in, and practices in Arizona pay a lot more to recruit a physician than practices in desirable locations in the country. For Radonc that's 200K more! Finally in Phoenix, Az both MDACC and Mayo (Multidisciplinary clinics) have setup shop there and I'm pretty sure they're going to be absorbing many private practices' patients so I doubt yours is going to be the largest for long.

I"m rather bemused by what seems to be your penchant for assuming you know about my practice, or the practice here in Arizona.

Thank you for the "reminder" that the field of oncology is changing. I'm well aware that all of medicine is changing and that private practice is not as common anymore. I may indeed be an employee at some point in time but its really presumptuous of you to tell me about how I or my practice is run.

As for moving to Arizona, to each his own. I actually chose to move here as do many others; its close to home in California, has lots of resources and great weather as far as I'm concerned. The medical community has been very welcoming and its a heavily PP town. Given that I'm friends with and socialize with both surgeons and rad oncs/med oncs from both MDACC and Mayo, I can verify that they are not "absorbing" our patients. Mayo has been here for years and we've seen no decline in the number of patients seen. There is plenty of work to go around here and only a few patients prefer a large tertiary care center. Let me assure you that I know more about the patient population and practices here in Arizona than you do. FWIW, MDACC is a good 45 minute drive from my office; most patients don't feel its worth it and those that do, come back reporting that they were told the same thing as the Rad Oncs/Med Oncs and surgeons on our side of town.

I'm not sure why we're even arguing this; I've lived and practiced in this comunity for years. One of my partners was born and raised here, and has been in practice for 30 years. Surely he and I know much more about SURGICAL practices and local community preferences and referral patterns than you do. I would never deem myself arrogant enough to tell you how Rad Onc is practiced in your community. I'll thank you to do the same courtesy for me.

 

[SouthernSurgeon]

I'm not telling you how to run your practice. I'm informing those who are medstudents of what the future holds for them. By implying to medical students they don't have to work for Multidisciplinary clinics and can be autonomous if they are surgeons, is flat out false, considering how reimbursements are changing, and groups being absorbed. Just look at US Oncology for an example.

There's a lot of absolutes in this post...

 

[SouthernSurgeon]

and a lot of truths

Really, cause all I see is a lot of false self-assuredness and sweeping generalities?

I'm informing

what the future holds

flat out false

 

[SouthernSurgeon]

Name one thing about what I said that is false.

All of it?

You claim an absolute. Which means all that is needed to disprove it is an anecdote. Which has been readily supplied above.

Is it hard for any practice (surgeon or otherwise) to maintain autonomy in the current climate? Sure. But you act like it is an impossible pipe dream; which is a narrow and false view.

And us surgeons don't particularly need a non-surgical resident "informing" us of what our future holds. Thanks.

 

[DermViser]

All of it?

You claim an absolute. Which means all that is needed to disprove it is an anecdote. Which has been readily supplied above.

Is it hard for any practice (surgeon or otherwise) to maintain autonomy in the current climate? Sure. But you act like it is an impossible pipe dream; which is a narrow and false view.

And us surgeons don't particularly need a non-surgical resident "informing" us of what our future holds. Thanks.

Keep in mind he's a radiation oncology resident. So in that scenario, it's not surprising that he thinks that "Whether you like it or not, there are many, many more general surgeons that have a hard time finding a job in major cities and would gladly work for these multidisciplinary clinics". He'll be shocked when General Surgeons tell him to go f- himself.

Now I know why specialties cheer when another specialty gets reimbursement cuts. Up next - proton beam therapy cuts.

 

[DermViser]

Well luckily I've got a job in academia starting soon so I don't have to be worried about getting bought up or hiring anyone 😛

Yes, with a concomitant salary decrease compared to private practice.

 

[SouthernSurgeon]

We're saying the same thing using different wording. Of course nothing is ever absolute.

No we aren't. I'm saying you're being an arrogant douchenozzle for approaching the conversation with such a simplistic perspective and essentially trying to shout down an attending with years experience as a private practice partner, and acting like you're doing med students a favor by "telling them how it is" when you in fact have an extremely limited comprehension of what is out there.

 

[DermViser]

I'm happy with their offer.

It's absolutely irrelevant if you're "happy" with their offer. The point is that a radiation oncologist in PP tends to make more in salary than his/her academic counterpart.

I know this is going to shock you but not every physician wants to live in Boston, LA, or NYC. Especially the ****hole known as NYC with its high regulatory burden and high taxes. There are tons of nice, affluent places across the United States including in the SW (i.e. Scottsdale, AZ for example).

I realize that you think you're a bad***, just bc you finished Radiation Oncology residency, but you know JACKSQUAT when it comes to medical economics when it comes to affecting current physician practices and different practice models. I'm not saying one shouldn't note trends, but to make sweeping generalizations that somehow General Surgeons will be begging for Radiation Oncology's scraps is ridiculous. You are hardly one to give advice when it comes to how things will play out exactly, when those who have been in medicine (both physicians and not) for decades don't know how this will play out.

As WS said, her practice can wield a great amount of market share due to the quality and credentials of physicians she has in her practice, and thus tell the Rad Oncs to buzz off. It's any wonder you're running to the protection of academia instead of competing in private practice. Once CMS cuts your ability to garner facility fees, things should get quite interesting.

 

[DermViser]

I'm pretty sure I've been to more oncology meetings (ASCO, ASTRO, RSNA, ASH) over the past 2 years than most. In addition I've interviewed at over 10 academic and private practice clinics over the past year, so whether you like it or not, I do know quite a bit about what's coming.

Yes, interviewing for jobs that are currently available and going to conferences sponsored mainly by academia (bc your residency requires it) makes you a complete expert in the healthcare market with regards to consolidation. You should work the NYSE. Can you tell me what stocks I should buy?

http://opinionator.blogs.nytimes.co...-is-it-worth-more/?_php=true&_type=blogs&_r=0
http://www.npr.org/blogs/health/2013/05/31/187350802/proton-beam-therapy-sparks-hospital-arms-race

 

[DermViser]

Have you gone to any meetings lately? Half the time their talking about the business of healthcare. Finally, as you know, private practices are failing (3 did in my city which were swallowed by the bigger groups) due to the differential in reimbursements. I'm not saying this to be arrogant or mean, I'm just saying what's happening in today's health care so that medical students be aware.

Like I said, it's absolutely fine to note trends. It's another thing altogether to say black and white rules.

You said: "For example in Arizona there's now Mayo and MDACC that are going to be drawing many of the patients away causing many of the privates to close."

WS said: "Given that I'm friends with and socialize with both surgeons and rad oncs/med oncs from both MDACC and Mayo, I can verify that they are not "absorbing" our patients. Mayo has been here for years and we've seen no decline in the number of patients seen. There is plenty of work to go around here and only a few patients prefer a large tertiary care center. Let me assure you that I know more about the patient population and practices here in Arizona than you do. FWIW, MDACC is a good 45 minute drive from my office; most patients don't feel its worth it and those that do, come back reporting that they were told the same thing as the Rad Oncs/Med Oncs and surgeons on our side of town." Thus proving that you are a fool as Mayo and MDACC have existed for decades, and yet PP magically exists.

Please see this article: http://www.kevinmd.com/blog/2013/05/physicianowned-hospitals-making-teaching-hospitals-pay.html Once you no longer get the protection of being an academic medical center, and have to compete on outcomes with private practice with P4P, http://www.modernhealthcare.com/article/20130907/MAGAZINE/309079978, things will get much more interesting.

The point is you know absolutely nothing about the surgery job market, even though you think you do. I understand noting trends, but to say that in 20 years, private practice will cease to exist, when even primary care has found a way to do so with concierge/direct pay models, is ludicrous.

 

[DermViser]

I'm going to end this conversation. There's really no point in arguing with you guys.

Especially when you have no idea what you're talking about and don't realize that the world has nuance, and isn't black & white.

 

[Winged Scapula]

Is someone calling me an "old physician " in this thread?

 

[DermViser]

Is someone calling me an "old physician " in this thread?

If so, we should all have your plastic surgeon on speed-dial.

 

[Gfunk6]

If I may chime in as a private practice Rad Onc . . .

There is little question that profit is highest for single speciality practices and this profit slowly goes down as you add additional specialties. This simple fact is supported by virtually all metrics including MGMA.

With that being said, there is security in numbers. Furthermore, many find that joining a physician-owned, multi-specialty practice is superior to being a faceless cog in a corporate machine.

We employ surgeons but also invite them to be partners. The push to consolidate has variable inertia depending on your geographic market.

 

[KinasePro]

I know this is going to shock you but not every physician wants to live in Boston, LA, or NYC. Especially the ****hole known as NYC with its high regulatory burden and high taxes. There are tons of nice, affluent places across the United States including in the SW (i.e. Scottsdale, AZ for example).

This x1000. Even tho I'm far too early in my career to comment on the main topic of this thread, I've lived in and visited these "desirable" areas long enough to know I want to avoid them like the plague moving forward. Dollar for dollar, I'll take the midwest/SE/SW over NYC/LA/Boston any day of the week.

It's funny, when I lived in those areas during my previous career, most of my coworkers expressed their envy of the flexibility that medicine provides to move to smaller cities that provide a far better QOL. They were all "stuck" in the big cities because that's where the jobs are. Some of the top high schools in the country are in places like VA, TX, FL, AZ, and even GA. The fastest growing metro area for young people is Atlanta. America has a lot to offer in the "middle of nowhere" cities and towns between NYC and LA.

 

[rad_onculous]

I work in a combined Med Onc/Rad Onc group. If the sole variable is lifestyle then Rad Onc has a better lifestyle. Most of this revolves around call responsibilities and inpatient rounding. Furthermore, Med Oncs tend to be the "face" of the practice when it comes to referring PCPs and IM-trained sub specialists (GI, Pulm).

Also, for the actual work that is done, Rad Onc is reimbursed at a higher rate. Some multi-specialty groups are of the opinion that Rad Oncs generate so much revenue in technical charges that it is not worthwhile for them to leave the clinic during business hours.

Thanks for the response @Gfunk6. I was wondering how much this difference amounts in terms of hours per day extra that you see heme/oncs work and how much they tend to be up overnight taking calls or coming into the hospital. Is the inpatient rounding just 1 hr/day outside of the controllable clinic time (which is comparable to rad onc)? And how much time per night on call does a heme/onc spend awake in the middle of the night? Is a patient admitted almost every time on call (like cardiology), requiring a trip to the hospital, or is there just a patient with a question at 9 PM that you answer in 15 minutes over the phone?

Also, can @gutonc give his/her thoughts as well?

I am still undecided between these two fields and am slightly more interested in med onc from a content perspective, so I am interested in lifestyle as a tiebreaker, but want to know how much better of a lifestyle rad onc is. If the hours/call are only marginally better in rad onc, I will be more inclined to choose med onc but if med onc has up-all-night kind of all and 7 am-7 pm daily hours (as opposed to 9-6 of rad onc), I might choose rad onc.

 

[SouthernSurgeon]

The fastest growing metro area for young people is Atlanta. America has a lot to offer in the "middle of nowhere" cities and towns between NYC and LA.

I'm really hoping there are some jobs available in Nashville in 5 years or so when I finish training...Nashville is so hot right now...

 

[KinasePro]

I'm really hoping there are some jobs available in Nashville in 5 years or so when I finish training...Nashville is so hot right now...

Awesome town, would love to end up there too. Or Charleston, Charlotte, Austin, Savannah, etc... My list gets longer every time I visit the SE.

 

[tco]

I'm really late to the party here, but I would totally move to Arizona as long as WS is there <3

 

[evilbooyaa]

I'm really late to the party here, but I would totally move to Arizona as long as WS is there <3

Lmao. I think WS is going to be an impetus for a large influx of extremely smart doctors (this being SDN and all) moving to AZ just because they're all crushing on her.

 

[tco]

Lmao. I think WS is going to be an impetus for a large influx of extremely smart doctors (this being SDN and all) moving to AZ just because they're all crushing on her.

I've been crushing on her for going on 6 years now. One way love.

 

[Southplains]

Awesome town, would love to end up there too. Or Charleston, Charlotte, Austin, Savannah, etc... My list gets longer every time I visit the SE.

:thumbs up: