Why is rad onc not more competitive?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Doing couple hours of contouring is not the same as being on call and doing bunch of surgeries
We're back to exactly what I was talking about earlier.

No one disagrees with your point here, in a vacuum.

But you have to be precise when defining "lifestyle". In RadOnc, you're basically always "on", as in, it's more like a salaried white collar job (except for the on-call part).

To be specific and avoid anecdotes: multiple groups within the hospital I practice in currently (surgeons, Radiology, etc) have variations of "2 weeks on, 2 weeks off".

When they're on, they're totally on. When they're off, they're totally off.

Literally one of the surgeons travels out of the country for several weeks per year, every year, without using any vacation time.

"Lifestyle" is a subjective experience.
 
Members don't see this ad :)
In my job I do feel (and some of it is self inflicted) the feeling of always being ‘on’ and that is absolutely true about oncology related fields. However many of my friends don’t feel that way and feel totally fine being off as it is dependent on practice setup. The move to more employed jobs has eased this in my experience

But at the end of the day, rad onc has a good quality of life, period. We don’t need to act like it doesn’t.

I dont feel the need to act like a Martyr on this board at all times like some do.

Isn’t it a common sentiment among many posters here that we love our jobs but the issue is that we worry about the future grads having the opportunity to have our job experiences?
 
  • Like
Reactions: 4 users
You’re very busy. I work weekends sometimes too. MANY don’t.

I think it’s not intellectually honest to say rad onc doesn’t have a good QOL. Is it what it used to be when some were throwing a few wax drawings on and hitting the links? No. But the fact that it’s even possible to not be on site in the current environment or can leave work at 2 fares VERY favorably to many other fields. Can we be honest about this?
THIS

It’s total ignorance to say there nothing wrong with the field. From trash ASTRO leadership, unnecesaary residency expansion all the way to thr boomer PP owners with their predatory “partnership track” offer … a lot can and must change/improve. However fearing away eager med students who like the field and can make those changes happen will only hurt the field even more. This is a field with GREAT potentials and only by having people who are passionate about it can we achieve those potentials. So let’s stop bashing Rad Onc and everyone who wants to get into this field and instead call out the issues and provide logical and practical solutions
 
You’re very busy. I work weekends sometimes too. MANY don’t.

I think it’s not intellectually honest to say rad onc doesn’t have a good QOL. Is it what it used to be when some were throwing a few wax drawings on and hitting the links? No. But the fact that it’s even possible to not be on site in the current environment or can leave work at 2 fares VERY favorably to many other fields. Can we be honest about this?

I would place radonc in the middle of specialties when it comes to QOL. If you care about where you live, I would put it in the bottom half. Reasons:

1. No remote work
2. Worst ability to choose location of any specialty
3. "It's even possible to not be on site in the current environment" - not if you do any SBRT or brachytherapy
4. "Or can leave work at 2" - Other fields also have the ability to leave at 2 if the docs want. Not unique to radonc.
5. Less vacation than most other subspecialties (in my experience at least)
6. Usually, locums required if vacation taken, substantially increasing vacation expense

It's an easy residency, sure. However, one thing I didn't realize in training is that lots of other specialties which have hard residencies don't necessarily have difficult schedules as attendings. Neurosurgery is the classic example of this.

Also true that we don't work weekends (I don't work weekends at least, usually, unless I'm on call, and I'm confident my patient volumes and production numbers are very high) or take lots of call, but lots of other specialties have formed large enough groups to where call and weekend responsibilities are spread out really well. The amount of on-call and weekend work other specialties do is also something I overestimated in training.

Don't get me wrong: I like radonc as a discipline. I like being a radiation oncologist. But I don't think it's dishonest to say the QOL is negatively impacted by several factors which are innate to the discipline.
 
  • Like
Reactions: 10 users
We're back to exactly what I was talking about earlier.

No one disagrees with your point here, in a vacuum.

But you have to be precise when defining "lifestyle". In RadOnc, you're basically always "on", as in, it's more like a salaried white collar job (except for the on-call part).

To be specific and avoid anecdotes: multiple groups within the hospital I practice in currently (surgeons, Radiology, etc) have variations of "2 weeks on, 2 weeks off".

When they're on, they're totally on. When they're off, they're totally off.

Literally one of the surgeons travels out of the country for several weeks per year, every year, without using any vacation time.

"Lifestyle" is a subjective experience.
You’re being too technical. In that case, no specialty should be called “lifestyle specialty”. I think we all know in medicine, it regard to specialties, when we talk about “lifestyle” we mean: good salary, not having to work weekends, not being on call so much, not so crazy workload when working. Rad Onc checks every single one of those.
 
  • Like
Reactions: 1 user
Do you want to get to your point or is this 20 questions
Absolutely!

As SDN is an anonymous forum, any of us can be what we claim to be, and it's easy to speak with authority on various topics where we lack the pertinent experience.

In my job I do feel (and some of it is self inflicted) the feeling of always being ‘on’ and that is absolutely true about oncology related fields. However many of my friends don’t feel that way and feel totally fine being off as it is dependent on practice setup. The move to more employed jobs has eased this in my experience

But at the end of the day, rad onc has a good quality of life, period. We don’t need to act like it doesn’t.

I dont feel the need to act like a Martyr on this board at all times like some do.
There are pearls of wisdom nested within this strawman argument.

I can only speak for myself here: over the last 20 years I've worked in over a dozen hospitals in nearly as many different states. I've gone from being single to being married with kids, I've only been unable to connect with friends and family for years at a time, I've had family members die a thousand miles away and be the only one not at the funeral.

While we casually use the word "lifestyle" as if we're all talking about the same thing, it's an exclusively subjective definition. My personal definition of "good lifestyle" today is NOT what it was 10 years ago.

To cavalierly proclaim "RadOnc has a good quality of life, period" is an intense oversimplification that is a half-step away from a rationalization in a sunk-cost career.

And to be clear: I think RadOnc is great - for me. But my life is my own, and MANY flexibilities you get in other specialties are off-limits to us. These are not seen by med students or residents, so they become even more important to talk about.

Because, to be clear, I'm not actually talking with you guys, @UndecidedMS2 @drowsy12. I'm talking to the lurker M1 finding this thread in 2029.
 
  • Like
  • Haha
Reactions: 8 users
OTN -There are many things said there that I don’t disagree with regarding location, locums. I’m talking specifically about the day to day job.

Other specialities leaving at 2 means significantly less pay. Rad onc is uniquely high reimbursement where you can make a decent salary and still go home at 2 every day in many settings.

We may have different definitions of what we mean by quality of life of the job.
 
Last edited:
I would place radonc in the middle of specialties when it comes to QOL. If you care about where you live, I would put it in the bottom half. Reasons:

1. No remote work
2. Worst ability to choose location of any specialty
3. "It's even possible to not be on site in the current environment" - not if you do any SBRT or brachytherapy
4. "Or can leave work at 2" - Other fields also have the ability to leave at 2 if the docs want. Not unique to radonc.
5. Less vacation than most other subspecialties (in my experience at least)
6. Usually, locums required if vacation taken, substantially increasing vacation expense

It's an easy residency, sure. However, one thing I didn't realize in training is that lots of other specialties which have hard residencies don't necessarily have difficult schedules as attendings. Neurosurgery is the classic example of this.

Also true that we don't work weekends (I don't work weekends at least, usually, unless I'm on call, and I'm confident my patient volumes and production numbers are very high) or take lots of call, but lots of other specialties have formed large enough groups to where call and weekend responsibilities are spread out really well. The amount of on-call and weekend work other specialties do is also something I overestimated in training.

Don't get me wrong: I like radonc as a discipline. I like being a radiation oncologist. But I don't think it's dishonest to say the QOL is negatively impacted by several factors which are innate to the discipline.
I completely agree on all counts with this.

(with the slight disclaimer that @OTN might be in the top 1-2% in terms of raw wRVU production, and might actually be a cyborg)
 
  • Haha
  • Like
Reactions: 2 users
OTN -There are many things said there that I don’t disagree with regarding location, locums. I’m talking specifically about the day to day job.

Other specialities leaving at 2 means significantly less pay. Rad onc is uniquely high reimbursement where you can make a decent salary and still go home at 2 every day in many settings.

At least in my experience, whether it be in training, in my current practice, or in practices for which I have done locums work, I have never gone home at 2. I'm not saying it doesn't happen, but I don't think it's very common.
 
  • Like
Reactions: 2 users
THIS

It’s total ignorance to say there nothing wrong with the field. From trash ASTRO leadership, unnecesaary residency expansion all the way to thr boomer PP owners with their predatory “partnership track” offer … a lot can and must change/improve. However fearing away eager med students who like the field and can make those changes happen will only hurt the field even more. This is a field with GREAT potentials and only by having people who are passionate about it can we achieve those potentials. So let’s stop bashing Rad Onc and everyone who wants to get into this field and instead call out the issues and provide logical and practical solutions
So, is UndecidedMS2 like a Chairman in disguise, selling "the field?" Just a little sus...
 
Last edited:
  • Haha
  • Hmm
  • Like
Reactions: 7 users
Members don't see this ad :)
At least in my experience, whether it be in training, in my current practice, or in practices for which I have done locums work, I have never gone home at 2. I'm not saying it doesn't happen, but I don't think it's very common.

You’re also insanely busy, as you have shared quite often, so keep that in mind. Your quality of life on a day to day is probably top percentile of busy-ness
 
  • Like
Reactions: 1 users
I wish. But I don’t mind getting involved and be the change i so loudly preach
Are you just preaching a change of rad onc “exposure.” You would really have to be a low energy person to have interest in rad onc and then complain of lack of exposure. Happiness comes from within.
 
  • Like
Reactions: 1 user
But at the end of the day, rad onc has a good quality of life, period. We don’t need to act like it doesn’t.

I dont feel the need to act like a Martyr on this board at all times like some do.

Agree. It is a great QoL in medicine, not so great compared to the rest of the world.

Im no martyr, but my QoL sucked at my first job. It's not universally good, and many people have a lot less control than you might.

As reimbursement tightens and people get settled after the big COVID job explosion, how do you think QoL will change for most?

Remember that virtually everyone is projecting that RVU/physician will go up over time. Unlike many types of physicians, is no real physical cap on how many RVUs you can carry as an RO.

Healthcare is not a place where people spend a lot of money to make sure departments are well staffed with happy, well rested physicians.

I would not be so naive to think that QoL is great today and that will not change.

I would not be so naive to forget that we are unique among physicians with few if any exits from the clinic if things start to burn.
 
  • Like
Reactions: 7 users
@NMS - I absolutely agree. I have many posts about my concern about the change in QOL for future rad onc.
 
  • Like
Reactions: 1 user
To be clear OP, you can make more money in better locations in many other specialties. Radiology and anesthesia were not competitive when I was in medical school, but both specialties are now superior to rad onc for location and pay. The competitive half of ROAD, ophtho and derm, are way better for new grads than rad onc. There’s also many surgical and IM specialties that are appealing and IM residency in particular has become less demanding even in the last few years.

Location and QOL are strongly linked and it’s hard to appreciate that when you’re a poor med student like I was, when you’ll be happy to have time to go running outside or watch a movie at AMC. If I had twice the workload but could be in a big city desirable location, no doubt my QOL and personal happiness would go up.

Good luck regardless of what you choose. Your reasoning’s not wrong, you just may be overestimating the pay and to some degree the QOL of rad onc versus other specialties, as an attending.
 
  • Like
Reactions: 5 users
To be clear OP, you can make more money in better locations in many other specialties. Radiology and anesthesia were not competitive when I was in medical school, but both specialties are now superior to rad onc for location and pay. The competitive half of ROAD, ophtho and derm, are way better for new grads than rad onc. There’s also many surgical and IM specialties that are appealing and IM residency in particular has become less demanding even in the last few years.

Location and QOL are strongly linked and it’s hard to appreciate that when you’re a poor med student like I was, when you’ll be happy to have time to go running outside or watch a movie at AMC. If I had twice the workload but could be in a big city desirable location, no doubt my QOL and personal happiness would go up.

Good luck regardless of what you choose. Your reasoning’s not wrong, you just may be overestimating the pay and to some degree the QOL of rad onc versus other specialties, as an attending.
To expand on that, I think one of OPs responses discussed how radiation planning isn't terribly stressful. Firstly of course, is the point that I thought that as well until I realized I'd have to actually see the hn patients I planned in followup. Residency and attending life are different. Otherwise, it's worth reiterating that radiation planning is hardly what most of us spend the majority of our time doing. Beyond posting on sdn, I spend time dealing with getting things done correctly and in a timely manner in a smaller, less efficient medical system. Going further into this would involve the ability to write like ese. Suffice it to say, it's stressful.
 
  • Like
Reactions: 2 users
While I don’t get called in the middle of the night and rarely on weekends, I’m on call 24/7 and even when I’m on vacation with a locums doctor I get calls from referring docs and I have to do planning and contouring. I grind each day from about 7-430 with no lunch break and I live in a rural location. The lifestyle is not bad, but it’s not great.
 
  • Like
Reactions: 5 users
If you think you ain't working weekends in RadOnc

You're gonna have a bad time
Bro, this is definitely a you decision. When I'm not on call (which is most of the time), I'm not doing Rad Onc stuff. Rad Onc call is less of an issue than non-RO call, let's be real.

We can talk about how being chained to the machine and all that. And not being able to go out of town if in a small group. But the decisions to work at a place that has only ONE doctor on site (with no arrangements for call coverage with supporting hospitals) is a you decision.

All work and no play makes ESE a dull boy
 
  • Haha
  • Like
Reactions: 2 users
Bro, this is definitely a you decision. When I'm not on call (which is most of the time), I'm not doing Rad Onc stuff. Rad Onc call is less of an issue than non-RO call, let's be real.

We can talk about how being chained to the machine and all that. And not being able to go out of town if in a small group. But the decisions to work at a place that has only ONE doctor on site (with no arrangements for call coverage with supporting hospitals) is a you decision.

All work and no play makes ESE a dull boy
Hahaha this is true.

I do want to really ram home my point that I don't think this is a dichotomy: I don't mean to say that just because I won't endorse RadOnc as a "great lifestyle" does it mean I believe it has a "bad lifestyle".

Again, @OTN nailed it - I would consider it "average".

The thing that will occasionally make my personal barometer tip a little bit less than average (but still not "bad") is the common inflexibility of transitioning jobs within the same geography.

I can promise everyone that if you move too many times, especially as you start to have kids, the stress on your family and your marriage is incalculable.

I consider this "lifestyle", too.

While I've been able to pull things out of the fire, many have not.

I'm drafting a letter to the ACGME that anyone who applies to Match in RadOnc should automatically be forced to meet with an attorney who specializes in prenups!

(kidding, kidding...sort of)
 
  • Like
  • Haha
Reactions: 5 users
While I don’t get called in the middle of the night and rarely on weekends, I’m on call 24/7 and even when I’m on vacation with a locums doctor I get calls from referring docs and I have to do planning and contouring. I grind each day from about 7-430 with no lunch break and I live in a rural location. The lifestyle is not bad, but it’s not great.
From Chappelle

"Nobody’s life is perfect.

No matter what it looks like from the outside, you don’t know what the ****’s going on inside.

I have a great life, but it’s not a perfect life, but it’s good. It’s…

My ****’s like an above ground pool.

You ever seen one of them?

[shrugs shoulders]

It’s a pool..."
 
  • Like
  • Haha
Reactions: 2 users
.

I'm drafting a letter to the ACGME that anyone who applies to Match in RadOnc should automatically be forced to meet with an attorney who specializes in prenups!

(kidding, kidding...sort of)
Honestly great idea for anyone marrying with hugely disparate incomes.....
 
  • Like
Reactions: 1 users
My plan is to go somewhere that pays alot (ideally over $600k) for 4-5 years no matter how middle of nowhere it is. Hopefully i can payoff my loans and save up a good chunk then move to a desireable location with lower pay. I’m a single guy so I can see how that might now be ideal for other people especially those with families and such.

Please don't do this. You can PM if you need more information about why this is a horrible idea. You should be able to make 500k at a hospital in most reasonably populated areas. Yes, you can probably get 700-800k to live in a rural square state with a 3 hour drive to a major airport. The difference in QOL is not worth 200k pre-tax for 4-5 years. Post-tax you're talking about a little over 100k extra per year. This is not going to meaningfully move your QOL. There is not much you won't be able to afford on 500k/year that you can on 700k/year. If so, then you are living paycheck to paycheck on a high end lifestyle and Dave Ramsey will be by shortly to slap you in the face.

There is a number where doing what you propose can make sense for some people. And it is way, way higher than 700k.

To clarify the above post, yes an excellent lifestyle is possible in RadOnc. I produced over 15k/wRVU and almost never worked on the weekend and often didn't come in on Friday. I have an even better lifestyle now at lower volume.

Will this apply to you? Who knows. The mass boomer extinction is going to affect anybody in training at some point in their careers in all fields, and this is something they need to account for. Pay off your loans early and save aggressively living well below your means. But by all means, find a life partner and live someplace you feel fulfilled in. That is the most important thing in life. I have spent years in misery moving around because you have to in this field and leaving blown up relationships behind. You can make 500k in so, so many other fields and there is no reason you can't retire wealthy on this income if you make even semi-reasonable financial decisions early on.
 
  • Like
  • Love
Reactions: 7 users
. But by all means, find a life partner and live someplace you feel fulfilled in. That is the most important thing in life. I have spent years in misery moving around because you have to in this field and leaving blown up relationships behind.

Meme Reaction GIF by Robert E Blackmon
 
  • Like
Reactions: 1 users
I can only speak for myself here: over the last 20 years I've worked in over a dozen hospitals in nearly as many different states. I've gone from being single to being married with kids, I've only been unable to connect with friends and family for years at a time, I've had family members die a thousand miles away and be the only one not at the funeral.

This is the bigger issue compared to the nights and weekends question.

You absolutely can find a job in BFE working 9-3 4 days a week.
But your family lives 2000 miles away with 3 connecting flights and $1k for a round trip ticket with 10 hours of travel time each way.
Your spouse is relegated to a career of selling stuff on etsy.
Your town of 15,000 people has 3 restaurants, maybe a softball league you can join. The main activities are drinking and going to church.
If something goes bad at work (and it will), you'll have to move another 1000 miles to who knows where to find something comparable during a job search process that's going to take 6 months minimum.
So you're at work only 24 hours a week making 700k per year. That's great!
What are you going to do with the other 85% of your life not at work? Pick up more shifts? Oh, yeah, you can't do that in this field.
 
  • Like
Reactions: 3 users
Sure -

How long have you been in independent practice?

Been in practice now over a decade. My weekend call consists of coming in to see one consult, maybe 1 out of every 3 or 4 calls? We treat on the weekend maybe once a year?

I'm not sure what you've done in your practice to get to a point where you're consistently working weekends but that sounds like more the outlier than the rule. I agree with the post above about intellectual dishonesty in trying to paint rad onc as a hard QOL field. Whatever else it is or isn't, it is definitely NOT a hard lifestyle field. Let's be honest with the med students about labor issues, geography etc... let us not get carried away though. Still a great field (for now).
 
  • Like
Reactions: 8 users
Yeah, if you're working a lot on the weekend; I think that's probably a you thing.

I do feel for the guys in solo practice who are essentially on call 24/7, but again, that's a decision.
 
  • Like
Reactions: 1 users
Yeah, if you're working a lot on the weekend; I think that's probably a you thing.

I do feel for the guys in solo practice who are essentially on call 24/7, but again, that's a decision.
Agree. Usually only happening if I'm out part of the week and having to catch up with sims, contouring, plan review/approval etc
 
  • Like
Reactions: 1 user
Yeah, if you're working a lot on the weekend; I think that's probably a you thing.

I do feel for the guys in solo practice who are essentially on call 24/7, but again, that's a decision.
Right - I am solo hahaha (part of a group but...eh this setup is weird and I wouldn't generalize a lot of it)

You guys are running to the other end of the spectrum with this, it's not "zero weekend work" and "48 hour shift in the hospital", that's not what I'm saying.

My point is the traditional messaging around RadOnc and weekends is misleading to medical students, if you phrase it as "you don't work weekends".

Do we have full, regular clinic days on the weekend? Not that I've seen, no.

Where I started getting irritated with this was back in "the old days" where RadOnc was sold to MD-PhDs like me as "the best" option for a research career. It does sound like that, at first.

But as has been talked about to death here...or used to be, in the Golden Era...many people interested in academic track jobs were given an "80/20" package of "you have dedicated research time on weekdays from 6PM-10PM and all day Saturday and Sunday!"

It also seems really common to have the "on-call Monday to Monday" schedule. I actually once tried to figure this out - was there a common "on call" model in this country. While the institutions with residency programs do seem to stick with the one week at a time arrangement, I've learned that EVERYTHING exists out here, from zero call to 24/7/365.

In the end, I just want people interested in this career who hear "no weekend work" to not be blindsided by the more nuanced truth:

1) If you want to have a productive academic career, your research time will be weekends.
2) It's uncommon to have dedicated contouring time, and nights/weekends are sometimes the only option. This is a common phenomenon in medicine, it's "Pajama Rounds".
3) While many of us think "home call" is easier than hospital call (myself included), it means you can't really go anywhere or commit 100% to things on nights and weekends. Is your kid having a birthday party on Saturday at 1PM? Ah darn, cord compression page at 12:30PM. Spouse spontaneously suggests camping with friends at a park ~4 hours away? Ah can't, on call.

AGAIN, I'm not claiming it's a "bad lifestyle". It's average. Many of these problems exist in most/all specialties. It's why people are bailing left and right.

I think trying to paint RadOnc as some amazing lifestyle is setting future students/residents up for disappointment. It's just about individual preferences, and some people prefer "shift work" (be it by the day or by the week), so when you're off, you're OFF.

Again, again - not a bad lifestyle. Just not Eden.
 
  • Like
Reactions: 2 users
It's uncommon to have dedicated contouring time, and nights/weekends are sometimes the only option. This is a common phenomenon in medicine, it's "Pajama Rounds".
When a rad onc gets up past 35 or 40 or so on beam, having a routine Saturday work session (can do it from home, but office makes more sense, imho) becomes almost mandatory.

However for all practical purposes no rad onc routinely has 35-40+ on beam anymore. ;)
 
  • Like
  • Wow
Reactions: 4 users
in a lot of these locales you won't have to work on the weekends. You also won't do other things on the weekends, like go out to eat, visit art districts, hike, smile...
 
  • Haha
  • Like
Reactions: 8 users
When a rad onc gets up past 35 or 40 or so on beam, having a routine Saturday work session (can do it from home, but office makes more sense, imho) becomes almost mandatory.

However for all practical purposes no rad onc routinely has 35-40+ on beam anymore. ;)

Exactly my experience.

When I get that busy (rarely now, but I do hit those numbers maybe one month a year), I end up catching up on the weekends from home. It is what it is.

I think an under-rated "lifestyle" impediment is inpatient consults/volume. A lot of that depends on hospitalist/med onc (especially if the med onc service is ran by NP's) culture. But throwing inpatients on top of a busy outpatient clinic can throw a wrench in things.
 
  • Like
Reactions: 5 users
Right - I am solo hahaha (part of a group but...eh this setup is weird and I wouldn't generalize a lot of it)

You guys are running to the other end of the spectrum with this, it's not "zero weekend work" and "48 hour shift in the hospital", that's not what I'm saying.

My point is the traditional messaging around RadOnc and weekends is misleading to medical students, if you phrase it as "you don't work weekends".

Do we have full, regular clinic days on the weekend? Not that I've seen, no.

Where I started getting irritated with this was back in "the old days" where RadOnc was sold to MD-PhDs like me as "the best" option for a research career. It does sound like that, at first.

But as has been talked about to death here...or used to be, in the Golden Era...many people interested in academic track jobs were given an "80/20" package of "you have dedicated research time on weekdays from 6PM-10PM and all day Saturday and Sunday!"

It also seems really common to have the "on-call Monday to Monday" schedule. I actually once tried to figure this out - was there a common "on call" model in this country. While the institutions with residency programs do seem to stick with the one week at a time arrangement, I've learned that EVERYTHING exists out here, from zero call to 24/7/365.

In the end, I just want people interested in this career who hear "no weekend work" to not be blindsided by the more nuanced truth:

1) If you want to have a productive academic career, your research time will be weekends.
2) It's uncommon to have dedicated contouring time, and nights/weekends are sometimes the only option. This is a common phenomenon in medicine, it's "Pajama Rounds".
3) While many of us think "home call" is easier than hospital call (myself included), it means you can't really go anywhere or commit 100% to things on nights and weekends. Is your kid having a birthday party on Saturday at 1PM? Ah darn, cord compression page at 12:30PM. Spouse spontaneously suggests camping with friends at a park ~4 hours away? Ah can't, on call.

AGAIN, I'm not claiming it's a "bad lifestyle". It's average. Many of these problems exist in most/all specialties. It's why people are bailing left and right.

I think trying to paint RadOnc as some amazing lifestyle is setting future students/residents up for disappointment. It's just about individual preferences, and some people prefer "shift work" (be it by the day or by the week), so when you're off, you're OFF.

Again, again - not a bad lifestyle. Just not Eden.
i agree with you.
the clinic schedule itself is manageable 7-5 pm for those that are busier, but what many people don't understand including therapists, nurses, that even work in my department, is that contouring/treatment planning takes a decent amount of time and at least in the 2 places I have practiced is not something that is scheduled. In residency, this was what "academic days" was for. In the community, I don't have days with nothing on my schedule. You have to find time to squeeze it in. I don't take a "lunch" and often come in early or stay a little later to try to get it done while at work. It is much much easier to write a consult note or follow-up at note on my couch then to try to contour a H&N case from home.
 
  • Like
Reactions: 7 users
There is obviously a lot of variability in Rad Onc jobs/practice settings.
I know other docs who work more limited hours and are much less busy than I am and able to do everything while at work and take 1 hour lunch. Some centers don't even treat after hours/weekends, so really not much "call" to be had as patients need to be transferred to higher level of care.

I think one of the other issues with our job is that we are outpatient doctors with a patient base/panel of our own. This type of work is a grind.
The shift work model is much more attractive to me.
I have friends in rads/gas. They work shifts, sometimes overnight or weekend, but have twice as much vacation and have the option to pick up extra shifts and make more $$.
My wife is an ER doc and she works 3 shifts per week and thats it. She never writes notes from home or has to deal with continuity of care.
 
  • Like
Reactions: 1 users
When a rad onc gets up past 35 or 40 or so on beam, having a routine Saturday work session (can do it from home, but office makes more sense, imho) becomes almost mandatory.

However for all practical purposes no rad onc routinely has 35-40+ on beam anymore. ;)
Exactly my experience.

When I get that busy (rarely now, but I do hit those numbers maybe one month a year), I end up catching up on the weekends from home. It is what it is.

I think an under-rated "lifestyle" impediment is inpatient consults/volume. A lot of that depends on hospitalist/med onc (especially if the med onc service is ran by NP's) culture. But throwing inpatients on top of a busy outpatient clinic can throw a wrench in things.
i agree with you.
the clinic schedule itself is manageable 7-5 pm for those that are busier, but what many people don't understand including therapists, nurses, that even work in my department, is that contouring/treatment planning takes a decent amount of time and at least in the 2 places I have practiced is not something that is scheduled. In residency, this was what "academic days" was for. In the community, I don't have days with nothing on my schedule. You have to find time to squeeze it in. I don't take a "lunch" and often come in early or stay a little later to try to get it done while at work. It is much much easier to write a consult note or follow-up at note on my couch then to try to contour a H&N case from home.
All this, precisely.

Is it a 2AM page while you're sleeping in the call room to come to the OR for an emergent incarcerated hernia surgery?

Nope.

There is obviously a lot of variability in Rad Onc jobs/practice settings.
I know other docs who work more limited hours and are much less busy than I am and able to do everything while at work and take 1 hour lunch. Some centers don't even treat after hours/weekends, so really not much "call" to be had as patients need to be transferred to higher level of care.

I think one of the other issues with our job is that we are outpatient doctors with a patient base/panel of our own. This type of work is a grind.
The shift work model is much more attractive to me.
I have friends in rads/gas. They work shifts, sometimes overnight or weekend, but have twice as much vacation and have the option to pick up extra shifts and make more $$.
My wife is an ER doc and she works 3 shifts per week and thats it. She never writes notes from home or has to deal with continuity of care.
Bingo.

This is the stuff worth talking about. Because when I was a med student, all I heard about was "RADONC IS A GREAT LIFESTYLE NEVER WORK WEEKENDS" blah blah blah.

The truth is always more nuanced. But med students, residents, and "academic lifer" attendings don't get exposed to the insanely wide variability of jobs across the country.

Average lifestyle!

in a lot of these locales you won't have to work on the weekends. You also won't do other things on the weekends, like go out to eat, visit art districts, hike, smile...
.........that uh.......that joke has an acid burn of truth to it......

Clearly, I'm someone who is happy with just an internet connection. But where I live, the only DoorDash you can get is McDonald's, and if you want to watch a movie in theaters, you gotta drive north for awhile...
 
  • Like
Reactions: 2 users
in a lot of these locales you won't have to work on the weekends. You also won't do other things on the weekends, like go out to eat, visit art districts, hike, smile...

Just fly in and out on your private plane, whats the problem?

Don't you have one?
 
  • Haha
  • Like
Reactions: 8 users
I'm fine with the lifestyle day to day. I work from home all the time. Documentation is the bear (some of this is my fault....just have never moved on from academic style documentation). I am with my family every weekend.

The lifestyle issue regarding radonc is overwhelmingly related to the inability to choose where you are going to work and the remarkable difficulty switching jobs within a region.

Also, I think it was a problem that we were getting derm candidates in radonc back in the golden era. This can be a peculiar person...typically overwhelmingly qualified academically, often with accolades, but goal oriented towards some sort of money/lifestyle end goal alone. This is not the substrate of the best docs for a field addressing a disease as desperate as CA. It actually doesn't feel bad to have to work hard when you believe that it is high value to your patients.

I want good people to continue to populate the field, and I am sure that they are presently.

My biggest complaint is that more than 10 years into community practice, I am overwhelmingly drawn to progressive aspects of oncology outside of radonc. The standard of care is overwhelmingly being changed through personalized medicine, genomic characterization of cancer and targeted systemic therapy. I am only involved with these aspects of cancer care as medical director and a participant in tumor boards. I just do not find incremental changes in conformality very interesting. I am very skeptical regarding the broad applicability and clinical significance of ion based therapy. Our trade journal speaks for itself.

I do like being a primary decision maker regarding cancer treatment strategy. This is not the typical radonc role. (FWIW, I play much more of this role in my community practice than the notable academic leaders that I witnessed at major academic centers, most of whom emphasized getting along with other departments while playing a secondary role clinically).

So for @UndecidedMS2, if any of the following applies to you...I strongly encourage the radonc field.

1. You are a true academic superstar (This does not mean AOA at a good med school or even a super solid MD/PhD. This means Tim Chan/Max Diehn level) and plan a career in academic molecular oncology without rounding on inpatients.

2. You are a true physics nerd who happens to be a doc. This can mean a true believer in ions with a plan to go academic. This can be the type of person that gleefully geeks out on physics based dosimetric research or imaging. This can mean an aspiring brachy jock.

3. You really are happy with the idea of serving the community as a cancer doc, likely away from your home town or a major metro, and making good money without much call. You will be a downstream doc and must come to terms with this. Your career flexibility will be dwarfed by your colleagues.

Not sure that we need many more generally smart, academically ambitious types without discrete hard science/physics research plans. We've got plenty of those to last 30 years. We do not need many more statistical analysis of the optimal duration of lupron.
 
  • Like
  • Love
Reactions: 6 users
I have always felt that nurses and ESPECIALLY therapists have no understanding of the work we do after hours. They have this culture that they must start at a certain time, treat through lunch if it means they can get out early. Because you know only them have a life. They think we just see patients and go home shortly after. There is a lot of work after hours. As a rotating student you might not get the full picture. i have friends who have a busy call weekend every time they are on call. I know people who do not take any call at all.
 
  • Like
  • Love
Reactions: 9 users
‘Also, I think it was a problem that we were getting derm candidates in radonc back in the golden era. This can be a peculiar person...typically overwhelmingly qualified academically, often with accolades, but goal oriented towards some sort of money/lifestyle end goal alone. This is not the substrate of the best docs for a field addressing a disease as desperate as CA. It actually doesn't feel bad to have to work hard when you believe that it is high value to your patients.’


I know exactly what you mean and hundred percent agree. There are some people that were highly annoying that matched into rad onc similar time as me, who thought they had grifted the system and found the best deal in medicine (a total free lunch) and were shocked and disappointed when they actually had to do some work.
 
  • Like
  • Haha
Reactions: 2 users
I have always felt that nurses and ESPECIALLY therapists have no understanding of the work we do after hours. They have this culture that they must start at a certain time, treat through lunch if it means they can get out early. Because you know only them have a life. They think we just see patients and go home shortly after. There is a lot of work after hours. As a rotating student you might not get the full picture. i have friends who have a busy call weekend every time they are on call. I know people who do not take any call at all.
This drives me nuts.

At this point, I suspect they must learn this in therapist school. Maybe it's a requirement for licensure.

My favorite tactic if I catch even a whiff of passive aggressiveness in this direction:

"Hey can you check the timestamp on when I completed that Care Path item?"

Buys me another 3-6 months before, like goldfish, they forget and we have to do the dance all over again.
 
  • Like
  • Haha
  • Love
Reactions: 7 users
‘Also, I think it was a problem that we were getting derm candidates in radonc back in the golden era. This can be a peculiar person...typically overwhelmingly qualified academically, often with accolades, but goal oriented towards some sort of money/lifestyle end goal alone. This is not the substrate of the best docs for a field addressing a disease as desperate as CA. It actually doesn't feel bad to have to work hard when you believe that it is high value to your patients.’


I know exactly what you mean and hundred percent agree. There are some people that were highly annoying that matched into rad onc similar time as me, who thought they had grifted the system and found the best deal in medicine (a total free lunch) and were shocked and disappointed when they actually had to do some work.

I competed against these people to get in the field as a math/physics guy. PDs wore average step 1 scores around like Rolexes for status symbols. It’s all they cared about. Step 1 scores have nothing to do with your abilities to be a good rad onc. It’s a test of memorization ability. 3 dimensional geospatial and mathematical skills are far more relevant for this field. These are not evaluated in any meaningful way in resident selection. Would you rather have someone who used to design airplanes with a 210 step 1 or someone who has been a professional test taker their whole lives and can’t put together an ikea product but has a 270 step 1? They would take the latter, every single time. I’m sure we have all worked with rad oncs like this. Huge failure on the academics in this field for filling classes with people who should have been doling out steroid creams and doing cosmetic procedures 2 days a week.

There should be a rad onc specific competency test. Our own version of the MCAT or the SAT. What would this object look like rotated 270 degrees and mirrored? A B C or D? A 4 cm sphere loses 10% of its volume, approximately what is the new diameter? A colony of 1 billion cells repopulates at X rate, how many daily halvings would be required to reduce it to 100 cells? Etc. Of course DEI folks would freak as competency tests don’t count for lived experiences or whatever.
 
Last edited:
  • Like
Reactions: 5 users
I found you a picture of someone taking the rad Onc competency test.

 
  • Like
  • Haha
Reactions: 1 users
To be clear OP, you can make more money in better locations in many other specialties. Radiology and anesthesia were not competitive when I was in medical school, but both specialties are now superior to rad onc for location and pay. The competitive half of ROAD, ophtho and derm, are way better for new grads than rad onc. There’s also many surgical and IM specialties that are appealing and IM residency in particular has become less demanding even in the last few years.

Location and QOL are strongly linked and it’s hard to appreciate that when you’re a poor med student like I was, when you’ll be happy to have time to go running outside or watch a movie at AMC. If I had twice the workload but could be in a big city desirable location, no doubt my QOL and personal happiness would go up.

Good luck regardless of what you choose. Your reasoning’s not wrong, you just may be overestimating the pay and to some degree the QOL of rad onc versus other specialties, as an attending.
What are the appealing IM subspecialties in your opinion? GI and med onc? I feel like everyone on this forum trashes on IM
 
I hear what you're saying re: med school perceptions vs reality but, as I think you noted, that is going to be true in any specialty. Once I got into practice and realized that you can never, truly leave work at work, that it follows you everywhere, I didn't come to the conclusion that I was deceived... its simply the reality that you can't appreciate when you're not embroiled in it. It's why, despite having what I have to believe is one of the best QOL setups in medicine, I still plan to retire much earlier than the traditional age. It's tough work if you do it right.

Still would rather be doing what I'm doing than anything else in medicine.
 
  • Like
Reactions: 4 users
1. You are a true academic superstar (This does not mean AOA at a good med school or even a super solid MD/PhD. This means Tim Chan/Max Diehn level) and plan a career in academic molecular oncology without rounding on inpatients.

Tim Chan/Max Diehn and a couple other folks are amazing, but I wonder if they would’ve had equally or more amazing academic careers in medical oncology.

The academics who publish on nomograms, machine learning, big data on Lupron duration using retrospective studies, those rad oncs probably would be PI’s of phase 3 trials and heads of phase I/II centers if they’d gone into med onc.
 
  • Like
Reactions: 1 users
Top