It's funny that ApacheIndian makes a series of false declarations about rad-onc and then goes on to say that "smart medical students" should know better than to make decisions based on limited info.
So let's go through some of the misconceptions of his post:
(1) Front lines of patient contact:
Hardly the front lines. Nearly every patient comes in with a tissue diagnosis, imaging, and relevant work-up. Internists do the bulk of the initial diagnosis and medical/surgical oncologists dot most of the i's and cross most of the t's. Radiation oncologists focus mainly on treatment and its response. This is very nice. We briefly "check-in" with the patients once a week while on treatment (usually six weeks total). With stereotactic radiosurgery, we only have to see them once or twice. If a patient gets unstable, we just send to the ED, call a code, etc. Then medical or surgical oncology takes over from there and deals with all the acute issues.
ApacheIndian hates patients and that is fine. I prefer hanging out with people and shooting the breeze over coffee, which is also fine. There is no right answer.
(2) Dealing with death and all it's 5 stages all the time (no cure for cancer last time I checked)
Wow - someone should alert the Times that all the cancer patients who were considered cured still have disease. Man, Lance Armstrong's going to be pissed.
Anyways, the statement is just ******ed given that most patients are treated for cure while in the radiation world. Once a patient becomes truly terminal, the role of the rad-onc is generally limited to some palliation. The really touchy-feely stuff that ApacheIndian despises usually falls on the medical oncologists as they are the wielders of salvage chemotherapy or alternatively the palliative care team if the patient chooses hospice.
(3) Must read journals for life
Well, you gotta at least read guidelines from time to time. But after all, radiologists had to learn CT after the era of plain films, then MRI after CT etc. This is a part of any career in medicine.
(4) Know one thing very well --> cancer
True! (good for you, Apache, you got one right!) But keep in mind that radiologists get dizzy looking at an EKG, orthopods can't adjust thyroid medication, etc. Every career in medicine is limited by specialization and division of labor. Duh.
(5) need large pop to support this gig
Cancer is the second leading cause of death and there is a shortage of radiation oncologists; this is unfortunate but true. Plus, karma seems to always be on the look-out for new cancer patients.
(6) clinic, clinic, clinic, notes, charts, look at images for targeting tumor
Yes, we have clinic; great observation, Apache--I've asked my assistant to get you a cookie.
Radonc clinic is much milder than most clinics in medicine. Appointments are long (upwards of an hour), number of patients is fewer, and there is very little negotiation of therapy (patients either consent or they don't). If you take away all the higher ideals of medicine (as Apache likes to do) and focus solely on money-to-work ratio, then nothing beats the pace of radiation oncology. IMRT, for instance, is the second-highest paying procedure in all of medicine, right below a specific neurosurgery that I can't remember off the top of my head. Of course, I happen to like the higher ideals of medicine, but then again, I believe in an after-life and being judged by some higher authority for your works and all that.
Also, as it happens, my brother-in-law is a radiologist and makes a lot of money doing it. But he also spends every day at work plugged into his station reading studies at a brutal pace. It's an assembly line job that just happens to pay a tremendous amount. And like any assembly line job, he complains of boredom, alienation, burn-out, etc. But don't take my word for it -- go to auntminnie.com and play around on the general radiology forums. Pretty soon you start getting this picture of unsatisfied middle aged men in emotional crises. Unrelated but interesting note: They tend to have this weird inferiority complex when it comes to cardiologists and an altogether unhealthy obsession with reimbursement (but really, don't take my word for it -- read for yourself). Overall a hilarious way to spend an hour. Radiologists in academics seem to be a happier breed though.
(7) "In general rad oncs tend to be dweeby metrosexual types who like reading journals on the john every morning (like their less competitive onc brethren) Rads by contrast are more type A money & lifestyle fast-laners who appreciate the good life."
When I was going through medical school, my home institution's radiology program lost a couple of residents in one year. One went to work for industry ("radiology is too boring"), and the other transferred to ortho ("radiology is too boring and I miss actually doing something productive/creative with my life"). But wait!, you mean not everyone falls in crazy love with radiology like Apache?!?; but he's so smart and experienced – I mean he's like a resident and everything!!! He's definitely not one of those metrosexual dweebs in rad-onc!!! (btw, metrosexual? really? 2003 called and wants its word back.)
And finally, some practical advantages to radiation oncology, when specifically compared to radiology.
1) Malpractice practically a non-issue
2) Turf battles generally a non-issue (neurosurgeons and urologists have toyed with radiation but in the end they've almost all have partnered with radiation oncologists to fill that part of the practice. Very different than, say, cardiologists who just take radiology turf without asking permission, to the constant and annoying whining of radiologists).
3) Outsourcing a non-issue (one of the nice things about the whole seeing patients in clinic thing)
4) Pace is generally slower (see above)
5) Only about 100 trained a year so you tend to be on the right side of the supply-demand curve; easy to work 4 days a week with lots of vacation if you're into that sort of thing
6) Hardly ever have to interact with ED personnel (my personal favorite)
7) Medicare cuts lately have been focused on rads, resulting in them turning up the pace of the assembly line; admittedly, rad-onc is probably somewhat vulnerable too
8) For what it's worth, never have to think twice about calling yourself a "doctor" or oncologist
9) Below-the-radar field so all the overcompensating, cluster 2 personalities tend to go to radiology (or ortho or plastics), which is nice
10) Finally, the long vacation, high salary jobs are abundant, but for some reason rad onc doesn't do the whole internet job posting thing, not sure why
So to summarize, if medicare cuts, outsourcing, helpless loss of turf, the constant threat of lawsuits, and bizarre overcompensation in your colleagues get your motor revin, then go for rads. Otherwise if you're like the rest of us, do rad-onc. Of course, you have to match first so there's that.
Finally, I was going to let this go but I can't resist calling Apache out on this: Radiologists are "fast-laners"?!?!
--hahahahahahaBWAHAHAHAhahahahahaha. If you want to be a fast-laner, work in banking, entertainment, politics, corporate law, etc where you deal with power, sex, and money, not a job where you are a salaried worker calling infiltrates on chest x-rays and mindlessly describing the handiwork of orthopods. And forget about running the hospital as a CEO, etc with a radiology license. Bottom line is any douche accountant or dentist can make some bank, buy nice toys, and impress a hottie from time to time; doesn't make him a fast-laner (and they all know it in the back of their heads--see auntminnie). My dad is a hedge fund manager and basically thinks it's really cute when my brother-in-law acts like he's a baller after working like a cog in a machine all day to make a small percentage of his salary (which he makes mostly by sitting back and drinking coffee). Don't get me wrong, radiology is a solid job and a good salary, but "fast-lane", give me a f*cking break, poser.
In all seriousness though, it all comes down to patients. Both are great jobs, particularly in this economic climate. If you like patients, do rad-onc. If you don't, do rads. When all the posturing is put aside, it's really as simple as that.
