RadOnc vs Rads

[Fireboy]

---

Members do not see this ad.

Hi guys,

I'm approaching my M4 year and debating between these radonc and rads. Yes, I know that these are substantially different fields. Nonetheless, the unique aspects of each field attract me.

I am attracted to Rads because it strikes me as an extremely intellectual and cerebral specialty... one that requires an integrative knowledge of many pathological processes. The option of doing very cool interventional procedures is a plus. Additionally, it is a very technologically driven field, which I find quite appealing, and it offers a very flexible lifestyle. Drawbacks, from my perspective are the lack of follow through on the diagnostic process... perhaps this leads to decreased satisfaction? Also, I have heard that the push to read more and more films given declining reimbursements can sometimes make one's daily schedule into a "factory grind."

I'm interested in radonc b/c it is one of the most integrative fields in medicine... combining a spatially located approach to a circumscribed disease process, physics, molecular adjuncts to radiation, imaging & technology, and lots of collaboration with colleagues. Plus, I find the field of oncology itself attractive, as I believe that end of life issues are too often swept under the rug in our society... the patient population is one that i find very gratifying to serve. Developing profound patient relationships is a major plus... Drawbacks, from my perspective, would include less geographic flexibility(??), perhaps less intellectual stimulation b/c of the lack of a diagnostic process(??), the politics that are necessarily involved in a very small field, and perhaps less flexibility than rads in terms of time available to spend with one's family (??), which is quite important to me.

I would very much appreciate any thoughtful comments on the pros and cons of each field in relation to the other (in general, or in response to my comments specifically).

Thanks a lot guys!!

 

[deleted4401]

I think you've evaluated the two fields, well enough. I think the only things incorrect would be the flexibility/family life. Rad-onc offers a flexible lifestyle and plenty of people work part time or 80/20. Don't worry about that.

I think the major issue is the most obvious issue. Would you prefer to work with patients or not? If you really don't like patient care, then rad-onc just doesn't fit. There is a lot of patient contact - consults, on-treatment visits, follow-ups, procedures, and phone calls. It's not quite primary care, but you are definitely seeing patients constantly. Dx is a doctor's doctor - a doctor (not a patient) is requesting a study and interpretation from you. And you provide that service to the doctor. Sure it's patient related, but at the end of they day you most likely will never see, touch, or talk to the patient.

It's interesting how radiologists claim their field is so 'cerebral'. I really think that is a phrase they've used and repeated, and now it's just something people say without thinking about. All fields are intellectually stimulating if you are sharp enough to realize you'll never know it all. There is always a new problem, a new twist in presentation, a difference in histology or pathology, distorted anatomy, whatever, and if you are intellectually curious, you will be stimulated in any specialty. Except in orthopedics ... kidding.

-S

 

[IRISH22]

"the patient population is one that i find very gratifying to serve..."

I think you hit the nail on the head with that one. This is honestly a large part of the reason that I went into oncology. I found that onc patients truly listen to what you have to say and care about their health more than perhaps anyone else. They desperately want to get well, and you want the same for them. That is one of the most (surprisingly) gratifying concepts in medicine.

The rest of your thoughts seem right on too me. Rads is a "cerebral" field. To be a good rad you have to be very smart (i think). But as Sim pointed out, it really boils down to one big issue: patients or images of patients? Dont listen to what the rad residents tell you about how they get to do CT guided biopsies, etc. Thats like hearing a surgeon tell you that he gets 10 hours of patient contact a day. If they are asleep or you have a needle in your hand, you really arent paying attention to what they say.

good luck.

 

[gerido]

Here's a link to it.
http://forums.studentdoctor.net/showthread.php?t=494893&highlight=radiation

I too, was in your position, deciding between the two based on an underlying interest in technology. Ultimately, I decided to go the radiology route. Below are MY reasons.

Radiation Oncology: The thing that attracted me to Rad Onc is the opporturnity to work with patients and still be "doctor." When when they can't cure the patient, they can a least offer palliative treatment. The lifestyle is decent, and the salary is nice. The cons of Rad Onc for me is how depressing Rad Onc could be, especially if you are close with your patient. While Rad oncologist closely follows the literature, I feel like they are RCTs quoting technologist, following evidence based guidelines to treat, or not treat. In clinical situations where no RTCs are available, they often opted to treat unless there are contraindications (which there are very few... b/c nothing is worst than cancer). There is little creativity or decision making outside of the RTCs and considerations for contraindications. Even the planning is mostly done by dosimetrist, to be recheck by physicists and approved by rad oncologists. All patients have already been worked up and diagnosed.. Frankly, 90% of the information you need to make decisions is already in the chart. This is not to say that they do isn't complicated or demand a lot of training.. but I feel like it's a hyperspecialized field, far removed from traditional medicine, mostly memorizing a lot of RCTs and following an algorithm.

Radiology: Most attrative about radiology is the flexibility it offers. I've met docs who mostly work from home. No matter how much volume increased rad experience, their job will unlikely be as busy as most clinician's job. Most radiologist I've met (at least in academia) have a remarkable knowledge of pathophysiology and able to come up with a broad differential and offering a very accurate diagnosis. The salary is excellent (maybe overpaid?) and the flexibility allows rads to have a good lifestyle.

I was initially very concern about outsourcing, but after talking to multiple attendings/residents... this is not likely to happen, at least not anytime soon and to any meaningful degree. Our medico-legal system simply make nearly impossible and the quick pace of technology evolution makes it difficult to impliment. New technology maintain the high reimbursetments. The cons, in my opinion, is that radiologists are technologist, more so than rad oncs. It's all about pattern recognition and memory recall. Because of this, anyone with a good memory and a fast set of eyes have so much earning potential in rad. At the end of the day, I feel like radiology is simply just a job.

There are of course, remarkable differences you have to consider. 1) do you want to see patients (not just any patients, but cancer patients, all demands some sort of emotional support, many who realistically will succumb to their disease). 2) Do you want to diagnose or treat? 3) Do you want work with and/or rely on others (nurses, surgeons/med onc, physicists, dosimetrist, techs) or work mostly by yourself during the work day.

I talked to a lot of residents/attendings on both field. For rad, ultimately, many accept that radiology is a job, one that they want to do well and know impact patient care. They tend to focus on family, hobbies, etc for "happiness" and "fulfillment." I get mixed feelings about this with rad oncs, many see it as a job who does not want to bring it home. But many also find it extremely fulfilling to work with cancer patients.

While many quote the "exciting technology" in both field, in reality, you are a clinician or a reader at the end of the day.. You hardly work with the machines.. the only time you're near it is to supervise the tech/support.. you don't contribute to its development unless you're in academia.. and regardless of how much development there are, you are likely to be doing the same thing over and over again, approving/fixing treatments & seeing patients in clinic, or reading images. One thing I would recommend is that if you don't like having personal conversations with patients and is not a "people person," stay away from Rad Onc.. I've met some sh*tty rad oncs with no personality or ability to communicate appropriately with patients. If you have a poor work ethics or unreliable, stay away from Rad.. b/c I see some pretty sh*tty rads making their colleages carry their load due to intentional slowness or simply just taking off.

Ultimately, I chose the flexibility of rad over the algorithm nature of rad oncs. These are all my own personal opinion based on my own limited experience, take it with a grain of salt. Someone suggested to me to imagine myself, 15 years from now, and think about which field would make be miserable/unhappy... and make the decision based on this.