med2006McGill said:
I have only a few days left before I have to submit my rank list (Canadian schools). The problem is I still can't make up my mind about rad onc vs med onc.
I know they are very different fields, and I've done elective in both and enjoyed both. Below is my reasoning:
Rad onc over med onc
Pros: cool techniques, good lifestyle, good pay
Cons: limited jobs (esp in Canada)
Med onc ver rad onc
Pros: more jobs available, lots of interesting research at all levels (basic to clinical)
Cons: 3 years of internal
Was anyone just as undecided as me at one point?
Any advice would be greatly appreciated!
Wow. Short question, complex to answer. I think you're looking at the choice from the wrong perspective, though. If good pay and good lifestyle are your pros, the best way to do this is to go to Cornell, get an MS in actuarial science and move to New York. You'll be pulling in six figures within a two years, working 9-4 M-F for a big health insurance company and within two years after than, more than a quarter mill (or more) /year if you do it right. Lots of easy ways to make lots more money, if that's your thing.
Your med-onc con should be carefully considered, as you will be dealing with internal medicine type issues in both fields, but ever so much more so in medical oncology. You could consider pediatric oncology and substitute med-peds.
Had the same quandary but mine was RT v. Surgery. I tend to think of surgery as a very fast paced active profession where we fix the problem that we can see right now, this minute in the OR.
RT on the other hand with a few exceptions moves at a measured and deliberate pace. We take the time to think things through, and carefully plan what we are doing. Then we perform our "surgery" which takes between 10 days and 10 weeks to complete, using daily treatments.
I know people always suggest the "lifestyle" as a pro in RT, but the field is fast moving, and there is a huge amount of ongoing research that you must keep current on if you are to be a good radiation oncologist. There are RTs that keep surgeon's hours and work 60-80 hours a week. If you work at a busy center, you will get called out of the theater to see a patient with an impending cord compression, but I grant it is far less frequent than that of a medical oncologist.
RT is an extremely interdisciplinary field as should be medical oncology and surgical oncology, but sometimes they are not. As an RT, you should be conversant in the techniques and advances in med-onc, so you can understand what your peers are talking about and know when they work, and when they don't and under what circumstances.
Med-onc is a rapidly progressing field as well, and they too have "cool" techniques, and the newest growth factor receptor drugs and our increasing knowledge about cellular microbiochemistry is going to dramatically increase the effectiveness of chemotherapy or radiotherapy, as we are already seeing in certain treatments. With those advances, though come unexpected adverse outcomes as well.
But surgery and radiation are the best options for local control, we are diagnosing disease earlier when it can be curable, and with medical oncology, every advance adds a very small incremental improvement, with an occasional leap (taxol type drugs, and now VEGF/EGFR blockers). With a few exceptions, a doubling of the effectiveness of current medical treatments of cancer might improve outcomes from 3 to 6%, whereas in RT, a doubling of outcomes might improve from 20 to 40%. In terms of raw numbers, a small incremental improvement in RT techniques is very significant.
In both fields you will have to deal with death and dying on a daily and personal basis as you treat your patients. RTs see this earlier in the process, but to be good in the field you must be able to relate to your patients, and sometimes this aspect of patient care interferes with the good lifestyle you cited as a reason for being a radiation oncologist.
Medical oncologists are certainly far more mobile than rad oncs, as the cost of capital equipment is very much higher in RT, restricting you to larger population areas. The big Canadian problem is the serious lack of funding for RT capital equipment which is on the verge of forcing many Canadians to seek care abroad and Canadian RTs are emigrating. Most regional cancer centers are full, there is a long wait for RT, particularly in the northern communities, and judging from the First Minister's conference on Health Care in Halifax a couple of years ago, this situation is not going to change soon, despite the pressing need in Canada.
There is a similar situation developing in the US, although not nearly as stark as Canada. The latest RVRBS reimbursement figures are dramatically lower in some areas and the proposed budget for Medicare is likely to make this much worse, if it comes to pass, at least for RT. I don't know about medical oncology.
So, the bottom line, do it for the love of the patients and the love of the specialty, not because of the "good" lifestyle or the "good pay." In both of your pros you cited cool techniques and good research, which applies equally to both fields.
Bottom line, they are both good fields. Good luck.
