Will I be competitive?

[14022]

I am at the end of the third year and have made a late decision to possibly go into Rad Onc. I think I have the stats to have a good shot of matching somewhere, but family and friends are very important to me and I want to be as close to Chicago as possible (prestige of program means very little, although I would like to go to a place with a strong peds exposure). Therefore, I was wondering if someone could give me an idea of whether I have a chance of competing with the crazy smart MD/phD's and studs from the Harvards and Hopkins of the world.

I go to an average medical school. I honored 2/3 of my basic science courses. 245 Step 1. Taking step 2 in July. Honored all third year core clerkships so far with >90th % an all shelves except one. Did cardiology research since first year. Primary author on manuscript of retrospective study that will be published in small peer-reviewed journal soon. Currently working on another cardio prospective study. I will probably be AOA by the time I graduate. I will find out next week if I am junior AOA. No other degrees (eg, MS, MPH, PHD) like may other of the studs who apply.

I set up my schedule to prepare for a career in peds cardio/nicu/hem-onc and set up away rotations for peds electives in Chicago. I recently started reading up on rad onc and realized that I may really enjoy it. I will be taking a 2 week elective in rad onc in July. If I like it and decide to go into it I will have to compeletly reorganize my schedule accordingly. I can try to set up away electives in Chicago, but I imagine it will be too late. I would consider applying to both rad onc and peds and just ranking chicago rad onc places at the top and then peds programs below it, but I would be applying to the same schools for both peds and rad onc (eg, northwestern, u chicago, loyola, rush) and would hate to have that backfire on me and just hurt my chances of matching into either of them if each specialty thought they were my back up plan. So I am really confused and do not know how to go about this. Are my chances good enough to warrant all the hassle? Any advice would be greatly appreciated.

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[stephew]

i think realistically, the chicago-only, peds and radonc criteria might need to be loosened a bit. Its just a hard field to get into now a days and if this is really what you want to practice, you may have to open the doors a bit wider. good luck.

 

[14022]

i think realistically, the chicago-only, peds and radonc criteria might need to be loosened a bit. Its just a hard field to get into now a days and if this is really what you want to practice, you may have to open the doors a bit wider. good luck.

I was just speaking in terms of my ideal situation, which I know is stringent. I want to be as close to chicago as possible, ie, midwest. There are a 15-20 programs within 5-6 hours of chicago, which is fine with me. My main concern is how late in the game it is and I am still trying to figure out what I want to do. Without rad onc research, away electives, other degrees (mph, phd, ms), is it even worth applying? Or will I just be overshadowed by all the other studs?

 

[doc05]

While I know nothing about radonc, I recommend you broaden your definition of "acceptable" location. After all, Chicago is in the center of the country and either coast is only a 2-3 hour flight away.

 

[pikachu]

It is late in the game, radiation oncology programs (like most other specialties) seem to appreciate people who are genuinely interested - genuine is often evinced by the length of time you've dedicated to the field. You will definitely need away electives and one at home if your school has a program. any research you've done is good, even if it's not oncology related - it shows you're interested in academics. It sounds like you are decent on paper, but you should show sincere interest in the field NOW. from my experience, it wasn't all about the numbers or the excess degrees (these sort of get your foot in the door), but about people who were really into radiation oncology and showed it.

 

[stephew]

i think you might consider audition rotations etc. like your sig by the way.

 

[jane]

I am in a similar situation and am thinking about all the same issues - whether I have a chance, whether a backup specialty will hurt me, whether it will be worth the "hassle". Anyway, what people have advised me to do is just set up away rotations in rad onc right now if you can - you can always change them if you change your mind. Good luck!

 

[Lady In Rad]

This is strictly from my own experience. I too found rad onc to be an interesting field but unfortunately it was late in the application season. I changed my entire senior schedule in April once I discovered rad onc. After rotations in rad onc and onc research, I was excited with the field. My final decision to apply only to rad onc was not made until September. Although I would not recommend this plan for anyone due to the incredible competitiveness of rad onc, this was my journey. I recently matched into the field last March. I would recommend like many others have posted is to determine you want it as early as possible, get as much rad onc experience, get the best board scores and grades, get to know as many people to write the best letters of rec, and do as much research in the field as you can. I did not match my first rad onc choice but I am extremely happy with the outcome.

Good Luck and follow your Goals!

 

[xrtdoc]

Your odds on being accepted are remarkably LOW if you don't apply. (although I can give case reports so they are not zero). I would forget about your peds requirement as many radonc training facilities can't get adequate patient numbers in PEDS, and the few that can are VERY competetive. Its easier to rotate as a resedent on elective to St. Judes than to math there. I would also apply to every radonc facility on the east coast and perhaps some in the west. Despite a preference for certain geographic locations, you should remember that radonc is only 1+4 years and afterward you can dictate where you want to work. This is delayed gratification.
Its your career.... don't let 3rd year depression ruin your chance of doning what you want.

 

[sirspamalot]

Aaaand 17 years later and anyone with a heartbeat can get into our specialty. Anyone wanna predict the next 17 year interval?

 

[medgator]

Aaaand 17 years later and anyone with a heartbeat can get into our specialty.

Things come full circle nearly 25 years later... 50 years ago, same deal. History doesn't repeat but certainly can rhyme

 

[A_DeMichele]

Things come full circle nearly 25 years later... 50 years ago, same deal. History doesn't repeat but certainly can rhyme

specialized physicians responsible for therapeutic radiation only? doubt they will be needed in 50

 

[thesauce]

specialized physicians responsible for therapeutic radiation only? doubt they will be needed in 50

We need to do a better job of becoming the upfront cancer docs. I get so sick of seeing early stage lung and painful bony mets being seen by medonc first.

 

[NotMattSpraker]

We need to do a better job of becoming the upfront cancer docs. I get so sick of seeing early stage lung and painful bony mets being seen by medonc first.

This is an under appreciated problem. Ive now worked in 4 medical systems (academic, non-academic, rural) and consistently seen people way too late across all of them. Medical oncologists are happy to chemo people over and over while they sit there in pain.

 

[medgator]

We need to do a better job of becoming the upfront cancer docs. I get so sick of seeing early stage lung and painful bony mets being seen by medonc first.

Bone mets harder but it happens for me, usually inpatient though from the hospitalist or pcp.

If you are on good terms with your pulmonary folks there's no reason the early stage pts with poor pfts aren't a direct referral to your practice. Again this may be harder outside of a community setting if we are talking big academic/tertiary care center with accompanying politics.

Similarly you should be referring all of your definitive lungs to pulm for baseline pfts or other patients when they need lung biopsies... Enb ebus is far better for the patient in terms of ptx risk vs CT guided bx

 

[RickyScott]

Will I be competitive?

 

[forchinet121]

Wow that’s so crazy looking at this time capsule post, literally 10 years ago rad onc was like derm and now it’s become a wasteland, unreal how things change

 

[seper]

Maybe the 10 years of "peak RadOnc" was just a dead cat bounce

 

[Pointless]

I was reading this, laughing out loud, thinking it was a funny sarcasm post. Then I saw the date from 2007. Then I got kind of sad.

 

[medgator]

Wow that’s so crazy looking at this time capsule post, literally 10 years ago rad onc was like derm and now it’s become a wasteland, unreal how things change

If sdn existed in 1997 it would be the same wasteland we see today

 

[sirspamalot]

You must be fun at cocktail parties

 

[A_DeMichele]

If sdn existed in 1997 it would be the same wasteland we see today

I was at ARRO seminar in 2011, and they brought an old successful private practice dude to speak on how there were no RadOnc jobs whatsoever in his time... he said you see, life works out well sometimes

 

[Lamount]

I am an MSIII who is interested in rad onc.I have been a little disheartened reading the forums and was hoping for some advice.

I got 260+ on step I, will prob be AOA. I have a background/research in applicable basic science. And some non rad onc research during medical school. my institution doesn't have a rad onc residency and there isn't any research in rad onc here. I have applied to two away electives for next year (both top tier). I am going to attempt to do some rad onc research at my away electives, but i certainly can't depend on that happening. I am in a geographic region with many rad onc residency programs. It would be difficult for me to take a year off to do research because of family obligations. Is it likely I can match with these stats?

This is my first post on SDN, circa 2012. Wild.

 

[sirspamalot]

I 'member when I was a young resident, someone handed me a packet (yellow cover sheet) with Dr. Flanigan's summary of radonc private practice. It was truly doom and gloom. Average salary circa 1997 something like 116k. In 2004, having left the university at 100k, I earned 20x that for several years.. radonc has been very very very good for a very long time. If you can arbitrage yourself, you can still earn north of 750.

For new grads though, I think many won't ever see those #'s. And if flash or APM ever becomes reality.. look out below. Just give me another 5-7 years..

To those who want to master the 1099 lyfe, I do offer consulting on how to get up and running, feel free to PM me.

 

[forchinet121]

I 'member when I was a young resident, someone handed me a packet (yellow cover sheet) with Dr. Flanigan's summary of radonc private practice. It was truly doom and gloom. Average salary circa 1997 something like 116k. In 2004, having left the university at 100k, I earned 20x that for several years.. radonc has been very very very good for a very long time. If you can arbitrage yourself, you can still earn north of 750.

For new grads though, I think many won't ever see those #'s. And if flash or APM ever becomes reality.. look out below. Just give me another 5-7 years..

To those who want to master the 1099 lyfe, I do offer consulting on how to get up and running, feel free to PM me.

You earned 2 million dollars a year for several years?

 

[radoncftw]

You earned 2 million dollars a year for several years?

i have a relative who was a rad onc in the golden years. owned the machine. Made a killing. Also got divorced...so made a "killing - alimony".
Boomer still doing locums now

 

[Doctorer]

You earned 2 million dollars a year for several years?

Maybe if I do a few surveys…

 

[Fpg1245]

This is my first post on SDN, circa 2012. Wild.

Then you realized meritocracy is bull**** and that rad onc is probably one of the biggest hoaxes pulled in the last 15 years. Right up there with holistic medicine, the electric Ab machine, and psychic detectives.

 

[OTN]

You earned 2 million dollars a year for several years?

$2,000,000 in 2004 → 2024 | Inflation Calculator

The 2.51% inflation rate means $2,000,000 in 2004 is equivalent to $3,285,611.43 today. This inflation calculator uses the official US consumer price index published by the Department of Labor.

www.in2013dollars.com

 

[sirspamalot]

Shazam. It was a good run.. all pro fees, no machine ownage. I made them 5x that easily.

 

[forchinet121]

Shazam. It was a good run.. all pro fees, no machine ownage. I made them 5x that easily.

Are you saying you made more than 2 mil per year for many years? What’s your net worth now and are you still working?

 

[Gfunk6]

My retired partner owned a center with full tech and pro back in the heyday of IMRT. No prior auth, no denials, maximum revenue and (relatively) low staff and machine costs. He drove a silver Ferrari America and retired before the **** hit the fan - the ultimate boomer fantasy really.

 

[forchinet121]

My retired partner owned a center with full tech and pro back in the heyday of IMRT. No prior auth, no denials, maximum revenue and (relatively) low staff and machine costs. He drove a silver Ferrari F60 America and retired before the **** hit the fan - the ultimate boomer fantasy really.

How much was he making at his peak?

 

[RickyScott]

My retired partner owned a center with full tech and pro back in the heyday of IMRT. No prior auth, no denials, maximum revenue and (relatively) low staff and machine costs. He drove a silver Ferrari Americana and retired before the **** hit the fan - the ultimate boomer fantasy really.

Mike steinberg probably made tens of millions selling a bunch of practices and then somehow landed 1 mill + yr gig at ucla (to pay the property tax on his west la estate)

 

[Gfunk6]

How much was he making at his peak?

Not sure because he went to part time status and relinquished his partnership before I became a partner so there was no transparency for me. However he retired in Palo Alto . . .

 

[forchinet121]

Not sure because he went to part time status and relinquished his partnership before I became a partner so there was no transparency for me. However he retired in Palo Alto . . .

Crazy stuff

 

[Fpg1245]

My retired partner owned a center with full tech and pro back in the heyday of IMRT. No prior auth, no denials, maximum revenue and (relatively) low staff and machine costs. He drove a silver Ferrari America and retired before the **** hit the fan - the ultimate boomer fantasy really.

All while talking about the merits of hard work and how his grandparents came here with show strings in their pockets and look at me now…nauseating

 

[communitydoc13]

summary of radonc private practice. It was truly doom and gloom

I was in residency in late 00s early 10s. When I started, residents were often offered jobs at primary site, and some were leaving for lucrative PP gigs after a few years. We would have several PP alumni come and give morning talks/case rounds. These were universally good.

By the time I finished, chair had put an end to this. He clearly did not want further positive interaction with PP and the messaging was clear that PP represented something less than what the program was hoping to produce in their graduates. With the exception of the recent young hires, the faculty did not pick up the slack and could be asked only for rare presentations, which were often below the standard of the PP docs.

Meanwhile, match selection was appalling. Stellar med studs with clear goals to become clinical docs were ranked far below aspiring (that's what they were selling at least) physician scientists and policy wonks.

There are so many reasons why radonc is no longer competitive. Many are intrinsic to the field and the direction of scientific oncology progress. But academic leadership expedited the change with the peculiar way they responded to the glut of talent and interest as well as the massive dollars they were generating. In the end, they created a false dichotomy with community radiation oncology.

If the academics had only kept their footprint small, kept training spots roughly where they were circa 2007, and been happy when their clinically oriented graduates took personally lucrative (but high value for community) jobs in private practice, radonc would still be among the most competitive fields in the country today (although not indefinitely).

That being said, competitiveness does not matter much for quality.

 

[Reaganite]

Mike steinberg probably made tens of millions selling a bunch of practices and then somehow landed 1 mill + yr gig at ucla (to pay the property tax on his west la estate)

Ah, those old private practices of his...Word is as soon as he sold, UCLA built a center right across the street from his West LA office and subsequently put his old partners out of business. A few years later, a hospital pulled a very lucrative PSA from a private doctor who used to be part of that group and gave it to UCLA. Provider apparently was immediately hit with a 50% pay cut and ended up leaving shortly after. Have heard some other stories you would have to get me drunk at ASTRO to pry out of me.

 

[sirspamalot]

Are you saying you made more than 2 mil per year for many years? What’s your net worth now and are you still working?

Averaged close to 2M for 4 years during the golden era. Made some mistakes, and 2008 was unkind. I'm comfortable, but I lived well back then a lifetime ago.. and continue to support my family now.. so.. I'm gonna keep cranking for another 5-7 years or so then maybe part time.

 

[medgator]

Averaged close to 2M for 4 years during the golden era. Made some mistakes, and 2008 was unkind. I'm comfortable, but I lived well back then a lifetime ago.. and continue to support my family now.. so.. I'm gonna keep cranking for another 5-7 years or so then maybe part time.

What's your magic number? Seems like you should have been able to amass 8 figures pretty easy at this point

 

[sirspamalot]

It ain't easy but I've made good progress.