Rads vs Rad Onc

[elektroshok]

I'm a third year. I've done clinic and had quite a bit of exposure to both fields but I have been having a hard time narrowing it down to one so I can start focusing on more research and whatnot in that field.

How did others end up deciding between two fields they liked equally but require different paths?

Thanks

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[cowme]

You couldn't be deciding between two more different fields. Rad onc is more similar to family practice than it is radiology on a day to day basis.

Rad onc is clinic every day from 8-5 with tons of patient interaction.

Radiology you sit in a dark room on a computer all day with minimal patient interaction.

 

[shark2000]

Agree with cowme.Nothing is similar between two fields other than the word rad in their name and incorrect perceived lifestyle of radiology by medical students.


Anyway, in summary:


Radiology: minimal patient contact, if you miss it do mammo. If you miss procedures do IR. Not an 8-5 job at all anymore. More and more places are going towards 24 hour final read. The basic of every hospital or urgent clinic that means more job opportunity, though ignore transient tight market now, but even now the market is better than rad onc.


Rad onc: major problem is that it is not the bread and butter of every community hospital. Also you are dependent on ONE modality and procedure. On the other hand it is a true 9-5 job. Lifestyle is great. Very good money now, possibly the best money/hour after Derm.


To me rad onc is boring and does not have any advantage pther than good pay and good hours that, may or may not be there. Seeing cancer patients everyday is horrible. I don't know how people do it.

 

[EeePC1005PR]

With rad onc you will be seeing palliative patients day in day out, cooking tumours semi-well. They seem particularly research / evidence based, and go deeper into physics, both of which would be fun.

But overall I just found normal radiology (diagnostic +/- IR +/- nuke med) broader, more flexible, less dependent on hospital, more definitive, more visually appealing, and have greater potential for advancement.

My personal struggle was between gen surg and radiology. In the end surgery was physically too tiring, and radiology had lots of machines which I loved, so radiology it was for me.

Good luck. At the end of day sounds a bit obvious, do what you like and can.

 

[samsoniter]

I know someone in radonc residency, they are being worked to the bone! Not sure if it is just a malignant program, but average day is 6am to at least 7pm, more often 10pm, throw in all the reading to be done and this sounds like no fun at all.....but on the plus side, the lifestyle is supposed to be great after training. On a personal note, I think dealing with terminally ill pts all day would wear me out emotionally. Radiology is a better fit for me because, to some degree, you can make it what you want- between IR, mammo, and DR there are plenty of options to find your own niche.
Caveat: I am only a resident, but feel the job market woes are probably being blown out of proportion to some degree, imaging is only going to increase and (hopefully) IR will continue to become more mainstream and not lose too much in the way of turf battles.
My advice: increase your exposure to both fields, shadow attendings and model your decision on their lives (not residents), and try to find that "aha" moment where you just can't get enough of what you are doing, this is the greatest feeling in med school!

 

[ar2388]

I know someone in radonc residency, they are being worked to the bone! Not sure if it is just a malignant program, but average day is 6am to at least 7pm, more often 10pm, throw in all the reading to be done and this sounds like no fun at all.....but on the plus side, the lifestyle is supposed to be great after training. On a personal note, I think dealing with terminally ill pts all day would wear me out emotionally. Radiology is a better fit for me because, to some degree, you can make it what you want- between IR, mammo, and DR there are plenty of options to find your own niche.
Caveat: I am only a resident, but feel the job market woes are probably being blown out of proportion to some degree, imaging is only going to increase and (hopefully) IR will continue to become more mainstream and not lose too much in the way of turf battles.
My advice: increase your exposure to both fields, shadow attendings and model your decision on their lives (not residents), and try to find that "aha" moment where you just can't get enough of what you are doing, this is the greatest feeling in med school!

That!!

 

[remote]

From a business standpoint, rad onc is a nightmare. Very poorly diversified field. If you read what senior rad oncs think about the macroeconomic trends, they describe the effect on their field as "disastrous." Keep in mind these are seniors in the field considered to be experts. They're right. Rad onc is not like rads or derm or even ophth. In the latter fields, you can pop one bubble and another will spring up to replace it...there's always a bull market in a well-diversified, innovative field.

how about urology vs. radiology vs. radiation oncology? any insights?

 

[shark2000]

how about urology vs. radiology vs. radiation oncology? any insights?

UROLOGY:

I myself hate urology. Once in a while in my pp, I have to do BE, give rectal contrast or do retrograde urethro/cyctogram/loopogram, and I really hate it. Overall, it is OK because it is only a small fraction of my practice.

But,
If you like Urology, it is a good gig and I disagree with the last poster.
And by liking I mean do not mind doing 20 rectal exams a day, then see tons of urethral discharge of STD daily, hemturia, bleeding, scrotal exams and ...

From business perspective, it is good. Prostate cancer, BPH and renal stones are some of the most common medical problems. Also if you like you can extend your practice to some subspecialized parts like Uro-oncology which is mostly renal cancers, renal transplant, congenital abnormalities/pediatrics urology and infertility. Also minor procedures like vasectomy and varicocele are pretty common.

Hours are really good after residency, much better than radiology. Barely you work nights or weekends.

RAD ONC:
The main problem is that it is single modality specialty. It may even vanish in 20 years, who knows. It is not the bread and butter of every community hospital. You can have a huge hospital without need for Rad Onc.

On the other hand radiology is really diverse and has become a fundamental part of each practice. Every hospital or urgent care clinic needs some kind of radiology support. These days, you barely can run a hospital without even an MRI. Also diversity it the key. Radiology has lost some turfs in the last 30 years without really impact on its economics. I don't say it is good, but for example we lost a lot of OB-US. But our US department is even busier than before. That is the beauty of field.

Despite what people may say here or on auntminnie, radiology as a field is more stable than people picture it. Yes, you may say there are relative surplus of radiologist, but in a long run radiology is a fundamental part of each and every medical practice. The main idea of teleradiolgy is the NEED for radiologist 24 hours. Unfortunately business people have abused it, but that is a different story. I can show you successful hospitals without 24 hour neurosurgery coverage, but barely you find a place without 24 hour radiology coverage. That says a lot.

 

[cowme]

urology is really a great gig. I forced myself to try to like it, but I just couldn't bring myself to. They have done an outstanding job of locking down their turf, to the point that some groups now get paid for radiation therapy (even if the rad onc is the one doing the treatment). They deal with some pretty important medical conditions (ED, infertility) and resect treatable cancers in the OR. And dear god, do they have cool toys.

Now that rads took a hit, they are probably the highest paid specialty left, but man, do they earn it. That residency is absolute hell for 6 years. No amount of guaranteed money could make me spend the peak years of my life doing something like that. I also think it'd be cool to be a marine, but no f-ing way I would ever go through the training

I will say, however, that they are likely next on the chopping block. If prostate cancer treatment continues to show no great data that it requires treatment, you can bet insurance companies will start to think twice about how much they reimburse for a TURP on a 95 year old man.

 

[dude1344]

I could launch into a detailed 10 page analysis, but the long and short of it is that radiology wins.

Care to elaborate?

 

[Asp]

For a specialty that is as research-driven as rad onc, you'd be surprised how little "Level 1" evidence there is for the efficacy of most of the things they do. I wouldn't be surprised if one the day the data comes in, and whoa, the field of radiation oncology gets a major downsize. Plus the day-to-day life is pretty much clinic erryday, erryday, with cancer patients, who are some of the worst patients, plus if you find the rare one you like they die on you -- bummer!

Radiology is the cornerstone of modern medical diagnosis. It offers the most patient independence, is the most intellectual field, pays among the best, and has the highest amount of vacation. Teleradiology offers something totally unique -- location independence! It is also the most ethical with little dependence on pharmaceutical industry or equipment vendors -- the field is pure, like a good line of cocaine.

tl;dr: Rad onc is "shiet." Radiology is "the shiet."

 

[Asp]

The only worthwhile surgical fields are lasik, retinal, mohs, oculoplastics and plastics (in about that order).

Mohs was super lucrative (think Central Park West / north Palo Alto / Coronado lucrative) before CMS crashed the party. Oh well! One of the few fields in the medicine that could make someone regret going into high finance.

 

[DrAwsome]

Mohs was super lucrative (think Central Park West / north Palo Alto / Coronado lucrative) before CMS crashed the party. Oh well! One of the few fields in the medicine that could make someone regret going into high finance.

You are absolutely right that Mohs was super lucrative, but with CMS cuts, it's now down to pretty much high end derm numbers. As far as rad onc, I think it's a fantastic field. Not only is it research heavy, but helping people beat cancer is awsome. I personally like clinic, it's not for everyone, but for those of us who enjoy it and like patient interaction, it's fantastic. Also, the lifestyle is awsome and the pay is not too shabby. Lastly from my understanding rads is having a number of issues now with the job market with grads can't find jobs, so that's a major problem, as well as with the CMS cuts, also another big problem. Although I would agree that rads is overall more stimulating and exciting than others.

 

[Gfunk6]

So I know this is a Radiology forum and you guys are high on the specialty, I get it.

But why all the hate and mis-information towards your buddies in the Radiation Oncology field?

Damn.

 

[Gfunk6]

Haha...no hate my friend...just dispassionate analysis. What misinformation? (honest question)

Just some serious hyperbole going on in this thread. For instance . . .

major problem is that it is not the bread and butter of every community hospital.

How is this a problem unless you want to work in a rural area? Linear accelerators (and cyclotrons that produce protons) are very expensive pieces of equipment with very high capital costs both in terms of purchase and maintenance. However they are money-makers for the hospital. Just like Radiology always runs in the black, Rad Onc allows hospitals to run IM, peds, and EM programs (which are obviously vital) at a loss.

From a business standpoint, rad onc is a nightmare. Very poorly diversified field.

Only poorly diversified for those who do not understand it. Yes all of our machines machines use radiation in some capacity, so do yours. Does that make your field "poorly diversified?" Obviously not, because although all diagnostic radiology equipment operates in the electromagnetic spectrum there are separate and unique clinical indications for each modality (MRI, CT, plain films, nuclear imaging, etc.).

In Rad Onc we similarly have diversified forms of treatment. Also, like interventional cards did to CT surgery we are replacing formerly definitive surgical procedures with stereotactic radiosurgery.

For a specialty that is as research-driven as rad onc, you'd be surprised how little "Level 1" evidence there is for the efficacy of most of the things they do.

This is so off base that I don't even know where to begin.

For Radiology, I could make stupid, ill-informed comments like,

"Yeah the Radiology job market is awesome. I guess that's why you have a 63 page thread about how residents can't find jobs anywhere."

*or*

"Great job with Nighthawk telerads you guys. You are digging your own graves just like Anesthesiology did with the CRNAs."

Obviously, there's a lot of hyperbole in both of those statements. So while I appreciate you guys are excited about Radiology (why would you have gone into it otherwise!), I think your comments about Rad Onc are, to put it mildly, over the top.

 

[cowme]

don't misquote me! All I said was that your field was mostly clinic, and very different from rads.

 

[EeePC1005PR]

how about urology vs. radiology vs. radiation oncology? any insights?

Urology is surgery of renal tract and prostate. It's probably one of the less stressful branches of surgery (compared to cardiothoracic, neural, orthopaedic and general surgery).
Procedures are generally non-emergent.
Even if emergent, is usually organ threatening rather than immediately life threatening.
There are big long cases still eg. nephrectomy, cystectomy, cancer debulking. People can get pretty damn sick and need high level baby sitting.

There are some pretty cool tools to play with but they are limited to urogenital stuff and just in my opinion radiology has way cooler gadgets big or small.

Urologists are generally pretty cool and humorous people. It's quite an unique specialty you just need to try it out for a rotation and should be pretty clear whether it's for you or not. I thoroughly enjoyed my urology term because of its people, not the science of the specialty itself.

 

[Asp]

For Radiology, I could make stupid, ill-informed comments like,

"Yeah the Radiology job market is awesome. I guess that's why you have a 63 page thread about how residents can't find jobs anywhere."

*or*

"Great job with Nighthawk telerads you guys. You are digging your own graves just like Anesthesiology did with the CRNAs."

Obviously, there's a lot of hyperbole in both of those statements. So while I appreciate you guys are excited about Radiology (why would you have gone into it otherwise!), I think your comments about Rad Onc are, to put it mildly, over the top.

Well I wouldn't say those statements are hyperbole. They are pretty much the two biggest problems facing radiology today. Other problems are turf wars and modality maturity.

Still, radiology at present is the surer long-term bet. This isn't to say rad onc doesn't beat the living pulp out of outpatient IM -- it does.

 

[neo87]

My brother is a rads resident and I start radonc next year so we have this back-and-forth every so often --

As other posters have said, if you like clinical practice of oncology + imaging / physics explore rad onc

If you like diagnostic imaging and hate clinic ( or like IR) --> radiology

As an aside, it may seem like small community hospitals don't have rad onc, but many are scrambling to build facilities now, for the reasons that Gfunk mentioned. The mid sized community hospital I'm doing TY at has a pretty large department, including a gamma knife and proton center under construction.