Radiology to radiation oncology

[questionmarker]

Hi all,

I'm a current radiology resident who is having huuuuge career doubts. I didn't really do a formal rads rotation in residency but ended up being indecisive and settling on DR last second. Now that I'm doing it I feel miserable every day and am deeply unsatisfied with my choice.

I'm a long time lurker on this sub and I actually did undergraduate research in radiation oncology so I have some experience in the field. I really do love the cutting edge aspect of the field, the patient care (miss this the most) and obviously the lifestyle is quite desirable. I read scans for currently treated patients every day and the RO docs seem so busy around here!

I know this sounds crazy but does anyone have any advice? I know the state of the job market is an absolute disaster but anything is better than what I'm going through now.

For reference, I didn't do a formal RO rotation but I was a competitive applicant in the 2021 match (265+ step 1, 15 plus publications mostly in rads, top 10 MD school). My thought was that if I attended a top tier academic program, that might obviate a tiny bit of the concern re: job market. I'm not *that* picky with location.

Thanks so much for all your help.

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[RadRadRad]

What year are you?
Could you do IR or breast where you have more patient contact ?

 

[questionmarker]

What year are you?
Could you do IR or breast where you have more patient contact ?

Thanks for the reply. I'm earlier on in my training.

And I actually had those rotations and I was really really banking on liking them but ultimately they weren't for me.

 

[RickyScott]

Let’s say you get a job, the game is not over. Having 0 lateral mobility and being treated like sht over a 40 year career may not be your cup of tea. 20 years from now, it is possible that xrt is a shell of its former self with a much smaller footprint in cancer. Why take existential risks?

 

[medgator]

.

For reference, I didn't do a formal RO rotation but I was a competitive applicant in the 2021 match (265+ step 1, 15 plus publications mostly in rads, top 10 MD school). My thought was that if I attended a top tier academic program, that might obviate a tiny bit of the concern re: job market. I'm not *that* picky with location.

Thanks so much for all your help.

You're literally looking at taking a job in 2027+ where there will be several years of oversupply graduated into the workforce, you may have very little choice of job type, quality or location.

Recent ASTRO president (Eichmann) said something to that effect that getting "a" job was considered a marker of success.

Contrast that to rads where there is literally demand all over the country with plenty of hospital and private practice options.

 

[RadRadRad]

I would stay with Rads. Lots of jobs. Variety of different practice settings.
If you must switch I’d look at something else besides RO.
Can you get in with your CV….yes

 

[yesmaster]

I feel miserable every day and am deeply unsatisfied with my choice.

If it helps, I felt miserable during my PGY-2 year in radiation oncology and part of my PGY-3 year. By my PGY-4 and PGY-5 years, I was quite happy, minus job market anxieties.

Don't switch from rads to rad onc. Rads is awesome. Such a hot job market, like med onc. My rads buddy pulls in a couple bucks shy of 7 figures and he works 4 days a week with 12 weeks of vacation. He's an early career attending at an academic practice. Good luck finding that in rad onc.

 

[questionmarker]

If it helps, I felt miserable during my PGY-2 year in radiation oncology and part of my PGY-3 year. By my PGY-4 and PGY-5 years, I was quite happy, minus job market anxieties.

Don't switch from rads to rad onc. Rads is awesome. Such a hot job market, like med onc. My rads buddy pulls in a couple bucks shy of 7 figures and he works 4 days a week with 12 weeks of vacation. He's an early career attending at an academic practice. Good luck finding that in rad onc.

Thanks for the kind words. I'm glad that things got better for you!! I literally hate getting up for work every morning. I don't know if you felt that, but it's quite exhausting for months on end 😅

 

[yesmaster]

Feel free to DM me. A lot of my friends from med school, and close friends in general, are radiologists.

 

[metallica81788]

Residency sucks no matter what you do. Don't switch.

If you still hate it in a few years - find the highest paying job you possibly can, save all your money, and retire in 10 years

 

[elementaryschooleconomics]

I'm a long time lurker on this sub and I actually did undergraduate research in radiation oncology so I have some experience in the field. I really do love the cutting edge aspect of the field, the patient care (miss this the most) and obviously the lifestyle is quite desirable. I read scans for currently treated patients every day and the RO docs seem so busy around here!

"The cutting edge aspect of the field"

Man, it's been so long, I forgot this was a common "selling point" for RadOnc. We're not "cutting edge". At least not the physician side of it. At the end of the day, our involvement with technology is pretty close the MS Paint. I've watched countless colleagues struggle to write a note in Epic. One of the docs I work with right now doesn't know how to use remote access, and will literally ask the secretaries to print out the NCCN Guidelines before tumor board, because using the web interface is "too confusing". All the technology is handled by the Physicists, or the industry crew and their AI software, or...literally anyone but us. DR is, at worst, the same level of "cutting edge". I would argue it's more tech-heavy, but...if you're already in DR, and the technology isn't satisfying to you, then RadOnc won't be satisfying to you either.

"The patient care"

Yeah, we definitely have more patient contact. But almost every specialty besides Pathology has more patient contact than DR. With the move towards SBRT and hypofrac, these "longitudinal relationships" the old timers sell kids on are increasingly rare. If you took my exact same patient mix as of today, September 2nd 2022, and compared it to September 2nd, 1998 - I would estimate I interact 30%+ less with my patients. Breast is the easiest example. In 1998, breast cancer regimens were mostly 30-33 fractions. So you've got the consult, simulation, ~6 "on treatment visits"...you're seeing that patient at least 8 times over the course of 2-ish months. Now, with the preponderance of 5-fraction schemes ("APBI"), it's generally consult, simulation, and a single "on treatment visit". 3 interactions over ~2-3 weeks. Breast is one of the most common indications for radiotherapy and is "bread and butter" for many clinics. Don't let anyone over the age of 50 get all starry-eyed telling you about all the wonderful relationships they've formed with patients over the years. Those stories won't apply to your career.

"Lifestyle"

Ugh. Sure, maybe, for the boomers holding on to sweet gigs my generation will never see. Just like everyone else, we're plagued with documentation and prior auths. We've taken huge reimbursement hits over the last decade which means trying to see more patients (if that's even possible for a clinic) to make less money. My quality of life IS NOT what they showed you in the brochure. I'm on call all the time. Is it home call? Yes, absolutely. Does it mean my phone is on 24/7 and I can't go out of town without meticulous planning? Yup. Home call is such an insidious stressor, I only see it talked about fleetingly. Many RadOncs I know take call for a week (or even a month) at a time. I've watched people get really ground down "waiting for the other shoe to drop" all the time. "You get to take call from home, and it's not like patients call that much" is just...slopping several layers of lipstick on a pig.

Actually, for lifestyle: a huge problem is that med students are mostly exposed to academia, and academic attendings/residents. There's this tremendous misconception about which specialties have good and bad quality of life based on the RESIDENCY quality of life. Yes, RadOnc residency is generally easier than Neurosurgery. But residency is brief and artificial. Once you're actually practicing, all bets are off. I know Neurosurgeons with lifestyles that beat the brakes off mine.

The take home: the grass is always greener on the other side. Your brief experience with RadOnc, and the "talking points" rationale you gave - that's not reality. I would either stick with DR, or if you're set on switching...don't switch into a locked cabin on the water-logged Titanic.

 

[fiji128]

Not making a comment on weather you should change or not, but if you go to the acgme website you can view which programs currently do not a full resident complement. I’m sure any of those programs would take you in a second with your background.

 

[Radonc90]

- Switch to RO, life is too short to be miserable in rad.

 

[Clean7795]

What don't you like about your current specialty?

 

[RadRadRad]

- Switch to RO, life is too short to be miserable in rad.

I really enjoy being a radiation oncologist. But does anyone Really believe that the key to life happiness is being a RO….and that no other field can provide this?

 

[medgator]

- Switch to RO, life is too short to be miserable in rad.

I love RO but if the only place i would have a decent job would be Kearney NE or Evansville IN, i would seriously consider rads.

That being said, job and locums market is temporarily better this year in terms of geography but the vast majority are employed hospital gigs, whereas there are still plenty of private options in rads/IR which also happens to be more open geographically.

IR and mammo can provide pt contact as well

 

[deleted1111261]

I really enjoy being a radiation oncologist. But does anyone Really believe that the key to life happiness is being a RO….and that no other field can provide this?

Yes!!

This is it

It really doesn’t matter

Happy and unhappy people that I’ve met in medicine - rarely is the majority of their happiness based on their specialty selection. Happiness comes from within and from your relationships in your life.

Do either. I don’t think you will be happy or unhappy based on what you pick. Seriously.

 

[Doctorer]

- Switch to RO, life is too short to be miserable in rad.

I really enjoy being a radiation oncologist. But does anyone Really believe that the key to life happiness is being a RO….and that no other field can provide this?

This is what I wish I realized sooner in life, and why I hate comments like “only choose _____ if you can’t see yourself doing anything else.” There is almost no one that makes it in to medical school that conceivably couldn’t have been a psychiatrist/neurosurgeon/rheumatologist/lawyer/i-banker. Becoming a radiation oncologist isn’t going to turn an unhappy radiologist in to a happy one, while it may have the real effect of limiting your future geographic options.

 

[RickyScott]

This is what I wish I realized sooner in life, and why I hate comments like “only choose _____ if you can’t see yourself doing anything else.” There is almost no one that makes it in to medical school that conceivably couldn’t have been a psychiatrist/neurosurgeon/rheumatologist/lawyer/i-banker. Becoming a radiation oncologist isn’t going to turn an unhappy radiologist in to a happy one, while it may have the real effect of limiting your future geographic options.

Absolutely. “Pursue your passion” is an illusion. Humans can be passionate about many things. I don’t honestly believe that a high achieving radiation oncologist couldn’t be just as happy in one of the other specialties that were open to him/her. So again, why take existential career risks with radonc.

 

[thecarbonionangle]

Let us be real here. Medicine is but A job. Many want to give it more meaning, “calling”, whatever but now this is just quixotic idealism that has been used to take advantage of us. We have a set of skills, which are valued by supply and demand. Currently there is too much supply and declining demand. The reality is residency sucks regardless. It is soulcrushing servitude in an often bad environment lacking collegiality. I know a minority absolutely loved their training so there is that too. The real question is where do you want your life to be when you are done:

1) do you want 600+ Starting in your city of choice with 12+ weeks vacation. Very high ceiling, high floor.
2) do you want 500k by 3-4 years out of practice if you are lucky, “anywhere”, low ceiling, high floor, 4-6 weeks vacation, just feel lucky you get A job with zero room to lateral.

Think very carefully about your choice. Life is too short. T’is true. The pursuit of happiness is a very important endeavor, but make sure you pick wisely considering what is important to you.

 

[questionmarker]

Not making a comment on weather you should change or not, but if you go to the acgme website you can view which programs currently do not a full resident complement. I’m sure any of those programs would take you in a second with your background.

Awesome! Do you happen to have a link? I've found multiple sites but not sure how official they are.

 

[deleted1111261]

WVU has a couple spots

 

[RickyScott]

Awesome! Do you happen to have a link? I've found multiple sites but not sure how official they are.

Columbia and Dartmouth as well- and they are Ivy League

 

[questionmarker]

Columbia and Dartmouth as well- and they are Ivy League

WVU has a couple spots

You guys are hilarious 💀

 

[questionmarker]

Even with the job market in dire straits, in the next decade or so will there be even less indications for radiation? The oversaturation is a major issue, but outside of that, is the modality headed in a specific direction?

 

[medgator]

Even with the job market in dire straits, in the next decade or so will there be even less indications for radiation? The oversaturation is a major issue, but outside of that, is the modality headed in a specific direction?

To a degree, sure, and then consider we have been training more grads the last decade based on no/faulty evidence

 

[elementaryschooleconomics]

Even with the job market in dire straits, in the next decade or so will there be even less indications for radiation? The oversaturation is a major issue, but outside of that, is the modality headed in a specific direction?

To try to predict that requires we assume nothing changes.

Obviously, "things" will change...but what direction? In the 1990s there was analogous concern over the job market. A new, very highly reimbursed radiotherapy technique became widely adopted (IMRT) in the early 2000s, and concerns evaporated. But it could have gone in a different direction - what if Gleevec (FDA approved 2001) had worked the same way on breast and prostate cancer?

That being said, there are a few things to consider:

The "silver tsunami", aka the increase in the aging/elderly population. Assuming the same cancer incidence, that alone would increase demand for RadOnc.

However, we can't assume the same incidence. After we dabbled with cutting back on PSA screening, data came out showing that probably wasn't a great idea. But just diagnosing more prostate cancer doesn't translate into more radiotherapy. There's active surveillance and robotic-assisted surgery for the low/intermediate risk guys. Even if they do get radiation, it's generally fewer fractions (aka less reimbursement). Functionally, that means RadOnc is still going to "see" less prostate cancer.

What about lung cancer? Well, now we have LDCT screening, catching lung cancer at an earlier stage. I've seen publications showing a 30-40% decrease in Stage III patients, and Stage III NSCLC is a "Top 5" indication for radiotherapy. Sure, that means we're seeing more SBRT - but only for the patients the surgeons choose to send to us. Until and unless SBRT becomes preferred over surgery for Stage I/II lung cancer, LDCT screening means that RadOnc "sees" less lung cancer.

Decreased smoking and the HPV vaccine? RadOnc "sees" less head and neck cancer.

A preponderance of data and guidelines recommending shorter treatment courses or omission for breast cancer? RadOnc "sees" less breast cancer.

I could go on, but those are the cancers which have historically had huge radiation indications: breast, prostate, head & neck, and lung.

I do think the aging population has increased the indications for palliative treatments, like bone mets. But even doing an "old school" 10-fraction regimen for metastatic lesions generates nowhere close to the reimbursement of a definitive lung or prostate regimen. I know a lot of my colleagues are busier than years past, and some think that means everything is going to be OK.

But just like the rest of life, quantity does not usually replace quality. In terms of reimbursement, I'd take 20 patients with Stage III lung cancer getting curative radiotherapy over 50 patients with bone mets getting palliative radiotherapy. I'm definitely going to feel busier with 50 patients, but the bean counters in fiscal aren't going to share my perception.

 

[RickyScott]

To try to predict that requires we assume nothing changes.

Obviously, "things" will change...but what direction? In the 1990s there was analogous concern over the job market. A new, very highly reimbursed radiotherapy technique became widely adopted (IMRT) in the early 2000s, and concerns evaporated. But it could have gone in a different direction - what if Gleevec (FDA approved 2001) had worked the same way on breast and prostate cancer?

That being said, there are a few things to consider:

The "silver tsunami", aka the increase in the aging/elderly population. Assuming the same cancer incidence, that alone would increase demand for RadOnc.

However, we can't assume the same incidence. After we dabbled with cutting back on PSA screening, data came out showing that probably wasn't a great idea. But just diagnosing more prostate cancer doesn't translate into more radiotherapy. There's active surveillance and robotic-assisted surgery for the low/intermediate risk guys. Even if they do get radiation, it's generally fewer fractions (aka less reimbursement). Functionally, that means RadOnc is still going to "see" less prostate cancer.

What about lung cancer? Well, now we have LDCT screening, catching lung cancer at an earlier stage. I've seen publications showing a 30-40% decrease in Stage III patients, and Stage III NSCLC is a "Top 5" indication for radiotherapy. Sure, that means we're seeing more SBRT - but only for the patients the surgeons choose to send to us. Until and unless SBRT becomes preferred over surgery for Stage I/II lung cancer, LDCT screening means that RadOnc "sees" less lung cancer.

Decreased smoking and the HPV vaccine? RadOnc "sees" less head and neck cancer.

A preponderance of data and guidelines recommending shorter treatment courses or omission for breast cancer? RadOnc "sees" less breast cancer.

I could go on, but those are the cancers which have historically had huge radiation indications: breast, prostate, head & neck, and lung.

I do think the aging population has increased the indications for palliative treatments, like bone mets. But even doing an "old school" 10-fraction regimen for metastatic lesions generates nowhere close to the reimbursement of a definitive lung or prostate regimen. I know a lot of my colleagues are busier than years past, and some think that means everything is going to be OK.

But just like the rest of life, quantity does not usually replace quality. In terms of reimbursement, I'd take 20 patients with Stage III lung cancer getting curative radiotherapy over 50 patients with bone mets getting palliative radiotherapy. I'm definitely going to feel busier with 50 patients, but the bean counters in fiscal aren't going to share my perception.

I would add that baby boomer/silver tsunami will pass by the mid 2030s. (Born 1945-55) Smoking rates started to plummet in the late 80s, early 90s, but there will be 30-40 year lag following large downturn in smoking for smoking related cancers to truly plummett. Biomarkers/ctdna/better selection will allow us to forego a lot of adjuvant xrt. 10 years from now, we may be treating a fraction of the early breasts.

Forego Radiotherapy for Women With Low-Risk Luminal A Breast Cancer?

Study shows 5-year local recurrence rate of 2.3% with lumpectomy and endocrine therapy alone

www.medpagetoday.com

Lastly, the unknown unkowns- will a couple doses of pluvicto knock out localized prostate cancer? (Trials have already started).

Cancers common in residency/first years of practice, but much rarer 10 years later : stomach, hodgkins, cervical, seminoma, myeloma,pancreas.

 

[questionmarker]

Gotcha. I do remember hearing about IMRT working as the perfect deus ex machina, so to speak.

Pluvicto, Xofigo? Are those all prescribed by NM? We have a combined DR/NM pathway. The only thing is I feel like clinical nucs is relegated only to high end academic centers, not community hospitals but I could definitely be wrong. Not sure if an analogous pathway exists for RO/NM.

 

[RickyScott]

Gotcha. I do remember hearing about IMRT working as the perfect deus ex machina, so to speak.

Pluvicto, Xofigo? Are those all prescribed by NM? We have a combined DR/NM pathway. The only thing is I feel like clinical nucs is relegated only to high end academic centers, not community hospitals but I could definitely be wrong. Not sure if an analogous pathway exists for RO/NM.

In vast majority hospitals, pluvicto is part of nm, but even if it wasn’t, it’s reimbursement is terrible.

 

[maxxor]

In vast majority hospitals, pluvicto is part of nm, but even if it wasn’t, it’s reimbursement is terrible.

Even on the technical side after doing some more due diligence, it’s really bad.

Like. We even are half questioning lutathera right now and we are a mega academic 340b place.

 

[medgator]

Even on the technical side after doing some more due diligence, it’s really bad.

Like. We even are half questioning lutathera right now and we are a mega academic 340b place.

Med onc style margins but unlike immunotherapy, giving lutathera (and even pluvicto afaik since it is basically the same thing except for mCRPC) requires giving multiple infusions including an antiemetic and renal protective amino acids before the actual radiopharmaceutical infusion is given. Ties up physics and the nuc med tech for quite a bit, so much higher labor costs

I'd rather give opdivo over that, honestly, at least from a logistical perspective

 

[maxxor]

Med onc style margins but unlike immunotherapy, giving lutathera (and even pluvicto afaik since it is basically the same thing except for mCRPC) requires giving multiple infusions including an antiemetic and renal protective amino acids before the actual radiopharmaceutical infusion is given. Ties up physics and the nuc med tech for quite a bit, so much higher labor costs

I'd rather give opdivo over that, honestly, at least from a logistical perspective

The latest drama is realizing that radiopharm therapy is subject to pass through nonsense. After pass through expires, lutathera is subject to a 20% patient copay. That’s 10k a cycle just for the drug.

I’m currently trying to figure out if billing even realized they needed to charge the copay….🤷🏻‍♂️

 

[RickyScott]

Med onc style margins but unlike immunotherapy, giving lutathera (and even pluvicto afaik since it is basically the same thing except for mCRPC) requires giving multiple infusions including an antiemetic and renal protective amino acids before the actual radiopharmaceutical infusion is given. Ties up physics and the nuc med tech for quite a bit, so much higher labor costs

I'd rather give opdivo over that, honestly, at least from a logistical

The latest drama is realizing that radiopharm therapy is subject to pass through nonsense. After pass through expires, lutathera is subject to a 20% patient copay. That’s 10k a cycle just for the drug.

I’m currently trying to figure out if billing even realized they needed to charge the copay….🤷🏻‍♂️

Instituition has to front the cost and then reimbursed 60+ days later by insurance. Heard of neighboring institution that got denied despite pre-approval.

 

[maxxor]

Instituition has to front the cost and then reimbursed 60+ days later by insurance. Heard of neighboring institution that got denied despite pre-approval.

Yeah it’s way worse than chemo. If patient no shows, no biggie, give it to someone else or at another time.

Radiopharm? No show? Better hope the company gives you some credit….

 

[medgator]

Yeah it’s way worse than chemo. If patient no shows, no biggie, give it to someone else or at another time.

Radiopharm? No show? Better hope the company gives you some credit….

Huge point there. Immunotherapy can be used for the next patient, has a plethora of indications etc

 

[elementaryschooleconomics]

Cancers common in residency/first years of practice, but much rarer 10 years later : stomach, hodgkins, cervical, seminoma, myeloma,pancreas.

Good point. Anyone who claims any of this is hyperbole only needs to look at seminoma and Hodgkins from 1980-today. I still have never treated a seminoma, and am probably in rare company when I can say I've treated 2 Hodgkins patients in 2022.

 

[deleted1111261]

I Hodgkin’d in 2022

 

[DukeNukem]

Happiness comes from within and from your relationships in your life.

Do either. I don’t think you will be happy or unhappy based on what you pick. Seriously.

Happiness comes from your relationships? Pick radiology.

What happened to me can easily happen to you.

I have a family. My wife and I tried hard to end up in one specific REGION of the country, with a clear bias towards and ties to two cities. I couldn't even get an INTERVIEW in that REGION as a resident. I applied to every job within 100 miles of those cities--nothing. So I applied all over the country and got offers in two random locations. I picked the one that wasn't an academic satellite in a frigid cold location six months of the year. It turned out they lied to me about so much about the job. My wife HATED it in the location where I took my job for many reasons, far from family, poor job opportunities in her area, etc. So as I'm applying to 100+ new jobs as a first, second, and third year attending, being well underpaid as a radiation oncologist in a malignant department, my wife threatens to leave me and take the kids. During that time I was looking desperately and applying to anything I could find, I got maybe one interview a year on average.

I was between radiation oncology and radiology, and I view not picking radiology is the biggest mistake of my life. Don't throw away your opportunity to go where you want and flexibility to jump ship if you end up in the wrong job.

 

[RadOncDoc21]

Yes!!

This is it

It really doesn’t matter

Happy and unhappy people that I’ve met in medicine - rarely is the majority of their happiness based on their specialty selection. Happiness comes from within and from your relationships in your life.

Do either. I don’t think you will be happy or unhappy based on what you pick. Seriously.

Very zen type of response… it even me me feel good about myself for only like 5 seconds but I’ll take it.

 

[medgator]

Happiness comes from your relationships? Pick radiology.

What happened to me can easily happen to you.

I have a family. My wife and I tried hard to end up in one specific REGION of the country, with a clear bias towards and ties to two cities. I couldn't even get an INTERVIEW in that REGION as a resident. I applied to every job within 100 miles of those cities--nothing. So I applied all over the country and got offers in two random locations. I picked the one that wasn't an academic satellite in a frigid cold location six months of the year. It turned out they lied to me about so much about the job. My wife HATED it in the location where I took my job for many reasons, far from family, poor job opportunities in her area, etc. So as I'm applying to 100+ new jobs as a first, second, and third year attending, being well underpaid as a radiation oncologist in a malignant department, my wife threatens to leave me and take the kids. During that time I was looking desperately and applying to anything I could find, I got maybe one interview a year on average.

I was between radiation oncology and radiology, and I view not picking radiology is the biggest mistake of my life. Don't throw away your opportunity to go where you want and flexibility to jump ship if you end up in the wrong job.

@questionmarker I've seen this happen before with other professional couples where one was an RO. Something to think about if that applies to you

 

[elementaryschooleconomics]

Happiness comes from your relationships? Pick radiology.

What happened to me can easily happen to you.

I have a family. My wife and I tried hard to end up in one specific REGION of the country, with a clear bias towards and ties to two cities. I couldn't even get an INTERVIEW in that REGION as a resident. I applied to every job within 100 miles of those cities--nothing. So I applied all over the country and got offers in two random locations. I picked the one that wasn't an academic satellite in a frigid cold location six months of the year. It turned out they lied to me about so much about the job. My wife HATED it in the location where I took my job for many reasons, far from family, poor job opportunities in her area, etc. So as I'm applying to 100+ new jobs as a first, second, and third year attending, being well underpaid as a radiation oncologist in a malignant department, my wife threatens to leave me and take the kids. During that time I was looking desperately and applying to anything I could find, I got maybe one interview a year on average.

I was between radiation oncology and radiology, and I view not picking radiology is the biggest mistake of my life. Don't throw away your opportunity to go where you want and flexibility to jump ship if you end up in the wrong job.

I know a lot of students will read this post and think it doesn't apply to them.

This is one of the problems with medical training, in that it's at least a decade of time invested and most of us start the process as...well, kids. Personally, I was 18-years-old when I really committed to becoming a doctor. I wasn't married, I didn't have children.

When I graduated undergrad and started medical school, I was dating my future spouse, but still - not married. No kids.

I cruised SDN during M1/M2 while thinking about potential specialties I wanted to pursue. I read posts warning about the geographic restrictions of RadOnc (this was 15 years ago, so just regular warnings that apply to any small market job). At the time, I didn't really care about geography. My hometown is nowhere near a medical school, and the few that were within a 2-hour drive were "reach" schools for me. I knew from the start that becoming a doctor meant I would have to leave the area for a long time. I had mentally committed to that path.

Well, the years dragged on, and I did eventually engage in that pesky spouse business, making offspring, missing family funerals because of distance and/or work obligations. The guilt from the choices I made because of medicine will be with me for the rest of my life.

So I started to care about geography. And caring about geography is what pushed me over the edge to my "SDN career". Because the "leadership" of this field likes to talk about "low unemployment rate" or whatever BS statistics they choose to craft their narrative.

But a statistic isn't me, isn't you, isn't @DukeNukem, isn't our spouses or our children. When I hear "unemployment is low" from some gray-haired guy who graduated medical school before I was born, all I can hear is "low does not equal zero".

Even a single unemployed Radiation Oncologist is tragic. That's someone who sacrificed time and money to go to undergrad and graduate, go to medical school and graduate, go to residency and graduate...invest at least 13 years of their youth and go hundreds of thousands of dollars in debt to arrive at the same place they could have been had they decided to drop out of high school and live in a tent.

But there's no stat for @DukeNukem's story. By our current available metrics, that's actually a success story. While it almost cost everything...he's employed! RadOnc is great. Hallelujah!

 

[RickyScott]

I know a lot of students will read this post and think it doesn't apply to them.

This is one of the problems with medical training, in that it's at least a decade of time invested and most of us start the process as...well, kids. Personally, I was 18-years-old when I really committed to becoming a doctor. I wasn't married, I didn't have children.

When I graduated undergrad and started medical school, I was dating my future spouse, but still - not married. No kids.

I cruised SDN during M1/M2 while thinking about potential specialties I wanted to pursue. I read posts warning about the geographic restrictions of RadOnc (this was 15 years ago, so just regular warnings that apply to any small market job). At the time, I didn't really care about geography. My hometown is nowhere near a medical school, and the few that were within a 2-hour drive were "reach" schools for me. I knew from the start that becoming a doctor meant I would have to leave the area for a long time. I had mentally committed to that path.

Well, the years dragged on, and I did eventually engage in that pesky spouse business, making offspring, missing family funerals because of distance and/or work obligations. The guilt from the choices I made because of medicine will be with me for the rest of my life.

So I started to care about geography. And caring about geography is what pushed me over the edge to my "SDN career". Because the "leadership" of this field likes to talk about "low unemployment rate" or whatever BS statistics they choose to craft their narrative.

But a statistic isn't me, isn't you, isn't @DukeNukem, isn't our spouses or our children. When I hear "unemployment is low" from some gray-haired guy who graduated medical school before I was born, all I can hear is "low does not equal zero".

Even a single unemployed Radiation Oncologist is tragic. That's someone who sacrificed time and money to go to undergrad and graduate, go to medical school and graduate, go to residency and graduate...invest at least 13 years of their youth and go hundreds of thousands of dollars in debt to arrive at the same place they could have been had they decided to drop out of high school and live in a tent.

But there's no stat for @DukeNukem's story. By our current available metrics, that's actually a success story. While it almost cost everything...he's employed! RadOnc is great. Hallelujah!

We all knew some malignant AF medstudents. And naturally, many of them want to be chair. Medstudents and residents think they have reached the finish line when they find a job. Rude awakening. Having little lateral mobility/leverage leads to a malignant workplace- they can always find pretexts to make your life hell and you put up with it because you can’t move your family 1000 miles. Availability of lateral jobs forces departments to behave themselves, and when they disappear you could be in for a world of pain.

She’s probably a chair now in nyc

 

[bigman1]

Very zen type of response… it even me me feel good about myself for only like 5 seconds but I’ll take it.

I strongly disagree. Being in a specialty like medical oncology would make me miserable. I would not be able to live with myself morally. Radiation Oncology is a part of our identity and brings many of us a profound meaning in life, similar to one who has absorbed the meaning of the perennial philosophy and the like.

 

[RickyScott]

I strongly disagree. Being in a specialty like medical oncology would make me miserable. I would not be able to live with myself morally. Radiation Oncology is a part of our identity and brings many of us a profound meaning in life, similar to one who has absorbed the meaning of the perennial philosophy and the like.

Hard to tell if this sarcasm.

 

[bigman1]

Hard to tell if this sarcasm.

Last sentence is some sarcasm but the first two is the truth. Have you ever sat in on medical oncology clinic? I have no idea how these guys go to sleep at night,

 

[evilbooyaa]

I strongly disagree. Being in a specialty like medical oncology would make me miserable. I would not be able to live with myself morally. Radiation Oncology is a part of our identity and brings many of us a profound meaning in life, similar to one who has absorbed the meaning of the perennial philosophy and the like.

????

I mean yeah I prefer RO patient population compared to the multitude of patients MO have to see on the (rare) days they're in clinic... but not living with yourself morally? What does that mean?

 

[TheWallnerus]

Good point. Anyone who claims any of this is hyperbole only needs to look at seminoma and Hodgkins from 1980-today. I still have never treated a seminoma, and am probably in rare company when I can say I've treated 2 Hodgkins patients in 2022.

Do you know how much f***in time we spent in residency on ... balls. I really wish I had that time back. Was writing on ball wall from then the writing to be seen on all our future walls?!
1) phIII trial: big field dog leg vs small field PA only... CONCLUSION: SMALL FIELD JUST AS GOOD
2) phIII trial: 30 Gy vs 20 Gy .... CONCLUSION: 20 Gy JUST AS GOOD
3) phIII trial: RT vs chemo .... CONCLUSION: CHEMO PROB BETTER

 

[TheWallnerus]

I strongly disagree. Being in a specialty like medical oncology would make me miserable. I would not be able to live with myself morally.

May not be able to live w/ yourself morally but you could live with yourself and all the fat royalties?!

 

[maxxor]

May not be able to live w/ yourself morally but you could live with yourself and all the fat royalties?!

Speaking of royalties, I know of 1 radonc who’s side gig is writing scripts for TV shows.