RadOnc have a good future?

[jgrady]

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Would anyone care to comment on where RadOnc is going as a field? Especially the future of RadOnc vs. Radiology?

I'm an MSII job shadowing a RadOnc that is actually suggesting Interventional Radiology as an alternative. The impression I get is that RadOnc is past it's peak and now treats fewer forms of cancer (not the 80% I heard previously) at such expense that field is at risk of shrinking due to lack of insurance coverage.

Radiology, from his perspective, is just taking off. Lots of new technology and modalities such that Rads now treat patients (not just diagnose) with many opportunities to specialize or shape your career as you see fit. He sees much less economic risk in Rads too.

I'm a former software geek and really love the idea of treating cancer patients with the latest technology, and hopefully contributing clinical findings to advance the field. But I'm starting to wonder...

Thanks for any input!

 

[stephew]

Would anyone care to comment on where RadOnc is going as a field? Especially the future of RadOnc vs. Radiology?

I'm an MSII job shadowing a RadOnc that is actually suggesting Interventional Radiology as an alternative. The impression I get is that RadOnc is past it's peak and now treats fewer forms of cancer (not the 80% I heard previously) at such expense that field is at risk of shrinking due to lack of insurance coverage.

Radiology, from his perspective, is just taking off. Lots of new technology and modalities such that Rads now treat patients (not just diagnose) with many opportunities to specialize or shape your career as you see fit. He sees much less economic risk in Rads too.

I'm a former software geek and really love the idea of treating cancer patients with the latest technology, and hopefully contributing clinical findings to advance the field. But I'm starting to wonder...

Thanks for any input!

Please see the FAQ for starters.

 

[fettucine]

This thread just made me smile (sarcastically). Aside from reading the faq, you should definately try to shadow a really good academic radiation oncologist in some medical school in your state (if your med school doesn't have a program of course). I can't believe a rad-onc would actually promote rads. Guaranteed that both were coming up from a down cycle just 6 years ago. Being somebody going into rad-onc my opinion is biased, but I have to completely disagree with the statement that I-rads will surpass Rad-onc. I won't give you a justification, which if you desire, just come to Denver this year for Astro and see why there is a 3 year wait list on machines, and why companies are spending billions of dollars making new machines, aside from the cutting edge research that will make you forget your wife. I think rad-onc is becoming such an exciting field with so much potential in the next 10 years that it gives me meth flashback from college thinking about it. If you can't squirm in your jeans (romantically of course) thinking about rad-onc, its potential, and the toys you will be playing with in the next five years, please go with rads, it truly will open doors for people who would die to be in this field. Bottom line is that both rad-onc and rads have become competitive, but the caliber of the candidates and there reason to be in the field is I believe vastly superior than in radiology, and I definately think that all these people see a great future in rad-onc.

Again its all my 2 cents, I haven't really polled any med students to arrive at these conclusions, just met about a dozen of them who had damn good reason to be in rad-onc this year, and probably deserved a spot in this years match, but were unsuccessful. Personaly I would bear with 3 years of medicine and then do hemeonc, unless they gave away a radiology spot AND a RED Limo ferrari with a backseat linac + 2 superbowl tickets. =)

-f8

 

[user_name]

I happen to have heard just the opposite of IR. I heard that it is not a sought after fellowship from rads anymore. This is directly from residents in training and private practice rad docs. They say cards and neurology are stenting everything themselves to the point that they lose all of the cool stuff and big bucks. They get stuck putting in PICC lines that the nurse can't get at the bedside and doing paracenteses that are loculated. The good endovascular is gobbled up by the docs that used to refer to IR, especially with neurology trying to become interventional. I also think regular radiologists without fellowship training are learning techniques in residency, so they don't need a separate IR guy. I know the hospital where I am doing my internship right now lets the residents get pretty involved in interventional techniques. Oh yeah, ortho is doing lots of former IR babies too like injected vertebral fractures with multiple fillers.
Rad Onc on the other hand will not be replaced by referring doctors taking over our "procedures." Mostly because nobody including HemeOnc knows what the heck we do. The only thing to replace us is a cure for cancer, which most really bright people seem to think is more than my career away.
Hope this helps.

 

[stephew]

i never understand why people think its A versus B. Its as if the word fragment "rad" is involved somehow things are interchangable. Frankly, radonc has more threat from neurosurgeons and urologists who -in some places- dominate the radonc relevant procedures in the area. This isn't good for patients in my experience (any more than me doing the surgery before implementing a brachy device) nor is it reflective of wisdom on radoncs part. But that is a tangent. Interventional rads and radiology and radonc dont overlap much more than med and surgery or any two fields you care to examine. Saying medonc will take over rad onc is just not realistically possible. Can a med onc learn radonc? Sure in the same way I can learn medonc. Degrees are just formal training and quality assurence. But anyone can learn more about anything and get better with expereince. But the fields are so different they just don't overlap in a day to day way at all. Same with IR and radiology. Its 5 years of training for a reaon, folks. But it probably takes being in radonc (or rads or IR) to know this, so it requires some patience on our part to address the misconceptions.

 

[jgrady]

Thanks for the responses. Btw, the I had read the FAQ and it did not address the future of RadOnc from a professional or treatment expense standpoint. I still have to wonder if the number of procedures RadOncs handle today will decrease because:

1) In some cases the treatment is curative for just 1-2% of cases or is palliative at great expense to the insurance companies.

2) The newer technologies sound like they will be pushing the already sky high cost of RadOnc (e.g. to cover basic linacs costing $2 million including dosimetry software and maintenance).

caveat: this RadOnc that is hot in Rads (and Cards & GI btw) is convinced that we are going to a socialized medical system, which is probably a source of the pessimism.

In any case, RadOnc is a very cool field. I was able to observe dosimetry planning from beginning to end on a new brain tumor patient today and then help set-up the patient and blocks for some XRT. While breaking the news to the patient was sobering, the experience was incredible.

fettucine, I will have to see if I can get to ASTRO. That would be really good. I don't have an academic RadOnc program close, so I'm only exposed to clinical. As for HemeOnc, I still have to do my homework...

 

[stephew]

1) In some cases the treatment is curative for just 1-2% of cases or is palliative at great expense to the insurance companies.

about 40-60% is curative. Palliation is expensive? I think once you practice medicine you'll see that there is no way around palliation. American society will not ok letting people remain in pain, and palliative RT is a hell of a lot cheaper than constant meds, and certainly no more expesnive that other interventional palliative procedures. Once youre in the real world of medical care you will see this is a nonissue. Palliation is one of the most important points of ALL medicine which is why the vast majority of health care dollars goes to the last 6 mos of life.

2) The newer technologies sound like they will be pushing the already sky high cost of RadOnc (e.g. to cover basic linacs costing $2 million including dosimetry software and maintenance).

As opposed to what other field? ITs all expensive when its new. We'ld have to shut down radiology, anesthesiology, surgery etc if we wouldnt let procedures expand. But lets say its a mad world and that happened? Fine, use the conventional stuff.

caveat: this RadOnc that is hot in Rads (and Cards & GI btw) is convinced that we are going to a socialized medical system, which is probably a source of the pessimism.

I dont understand the above sentence but the socialized medcine thing- yeah yeah, just like in 1992. Sort of the chicken little view which has been hanging around forever, But listen, even if we had socialized medicine, they dont poke a pin in radonc and say "yep this is what we're gonna cut out". It effects across the board. Including btw radiology, IR, surgery, etc. In short im not quite sure why your doomsday senario only seems to hit radonc hard. Take for example radiology. You'd say bye bye to the newly expanded PET reimbusements, MRI, CT, the list goes on.

 

[jgrady]

Thanks Stephew, helps to get multiple perspectives.

 

[stephew]

Thanks Stephew, helps to get multiple perspectives.

i agree that's a wise thing to do. good luck.