Brutal Honesty Required

[clueless1]

Hey all...I've recently found this forum, and it's absolutely a great resource with plenty of people that are willing to lend their knowledge and expertise for the benefit of us up-and-comers. I wanted to say "thanks" in advance for your input. Which I am relying on because:

I need people here to be brutally, ridiculously, knock-me-down honest to this post. I'm a 3rd year, and I recently was told by one of my residents that they think rad onc would be a good field for me (undergrad chemistry major, strong physics/math background, interest in using that background in my career), so I've started shadowing a rad onc and I think I really like it. But before I go any further, it should be noted that the guy who advised me to look into the field was a fairly strong student who graduated from a top 10 medical school who failed to match into rad onc. I've also heard that the un-matched rate for rad onc is through the roof - worse than almost any other specialty!

So my question is: before I start getting serious and doing electives, etc., I need to know if I have a snowball's chance in Ecuador of actually matching somewhere in rad onc one year from now. I have a 219 USMLE step 1 (I realize that's low for rad onc - will I even get interviews with that?), average med school, average med student, 2 prior research experiences with oncologists (I am also thinking of doing heme-onc), and I have another research elective lined up (maybe in rad onc if I think I have a chance). Is this enough to match anywhere? Furthermore, since I want to do research and teaching as part of my career, will this be enough to even get serious consideration from university programs? Does anyone know of anyone that was interviewed or seriously considered anywhere with similar numbers? Will audition electives do me any good whatsoever?

Again, thanks in advance for any input. As you may all remember, this is an extremely stressful time for me. No need to apologize for discouragingly negative replies (if that's what your opinion is) - the more brutally honest, the better. If you estimate my chances as 0.01%, let me know so I don't end up not matched and in career limbo like my resident!

Take care, all.

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[radonc]

here is what i think is most important when you apply to radiation oncology.

1. letters of recommendation
with just 80-100 people graduating each year, getting a rec from someone famous means a lot. in most fields, just having a great letter means something. but in this field, just cuz its small, throwing a name around means alot. ive had about 20 interviews, and only 1 or 2 PEOPLE from over 80 MD's i interviewed with didnt mention my letter.

2. research / publications
having publications means a lot. having publications in radiation oncology means a hell of a lot more. showing that you put time, effort, and dedication to a project from start to finish shows exactly what i wrote.

3. med school
people dont want to admit it but everything is regional. all my interviews were on the east coast cuz my med school was in the mid atlantic. i had 1 or 2 in the mid west, but the rest ranged from boston to miami. having a radiation dept at your medschool is important too. having a residency program is even better. going to a top medschool helps as well.

4. usmle scores
higher scores are better, nuff said. however, having #1, 2, and 3 can make up for a low score.

5. extra curricular activities - these days, the young rad onc attendings are much more well rounded than before. they actually have interest, hobbies, and activities outside of the field. you have to show that you can fit in.

6. undergrad university - harvard means more than a local college

7. deans letter - everyone knows it bullshiot

just go for it. it took me 2 rounds to get a spot, but i did it. the second time around, it is harder, but your a year wiser having gone through it the first time. dont look back, just apply and see what happens. medicine (IM) is always there waiting for you.

these are just my 2 cents, after 2 years of interviewing (example of my interviews : florida, g-town, vandy, cleveland clinic, wake) and finally matching

 

[jdog]

radonc,
now that you've matched, do you mind sharing your stats (step1/2, aoa, rank) and what you felt helped the most this second time around (e.g. change of recs, prelim choice, research, etc.)? thanks for your posts. i'm just curious.

 

[oscar]

What radonc posted is definitely true and applying for residency is definitely a multifaceted endeavor. But, if you don't mind, trying to interpret the spirit and intention of your original post, I think you want a bottom line type assessment of your chances, so here it goes. Please keep in mind though that this is not coming from someone in the know and is speaking solely on common sense, conversations with people on the other side, and people who have been through the process already. I don't want anybody here to think that I'm supposed to be an authority. I only give this opinion because it sounds like you want to hear what are YOUR chances given YOUR statistics that you presented.

Assuming you are just an average student as you say with an average CV and nothing particularly standing out, I would say you really have to bank on 2 things: 1) get to know someone pretty famous in the field pretty well if you don't already so that he or she can write a glowing letter that will stand out. Especially when you get a recommendation from someone that you know personally, that can go a long way. 2) get into some good research. With someone well known would be good, but I would say since you already have past experience in an oncology-related field, try to develop that more and turn it into something really solid. We all know you can't get much done in a 1 month block except maybe some chart review that may or may not even get written up. But if you can continue previous work and even get published or at least submit or present something, that would be the best thing for you, even if the person you work for is totally unknown. To show sincere interest through a significant piece of work will go far. Of course, take care of the basic stuff and try to bring up your Step 2 as best you can.

Best case scenario, I'd say if you can do those 2 things above, you could get interviews at quality programs (5-10) with maybe 1 to 3 elite ones, depending on your connections.

Worst case, if you don't and you keep things status quo, my guess is you'd get 3-6 interviews from lower tier programs with one or 2 from a good but not elite program.

Of course, this is totally one insignificant person's opinion, but it's the kind of thing I would want people to say to me if I asked them your question with personal stats, so that's how I'm trying to answer you. Hope you don't mind.

 

[digimon]

Get a PhD.

Just kidding.

I'll let you know how things turn out for me, but i agree with the above statements. In addition, i'd like to add that i was asked at a few places about my experience with radiation oncology, in terms of broad exposure to the field, and understanding of some of the key issues. i did 3 rotations, which were all very different, that gave me a good feel for much of what goes on. for example--get some hands-on experience--observe t/o's, prostate seed implants, coronary brachy, HDR/LDR, IORT, etc. Get some exposure to the different types of treatment planning--different software, imrt plans, 3-d conformal, and just plain ct-sim/mets/palliation, gamma knife/cyber knife, stereotactics. get a feel for the physics--dvh's, how a linear accelerator works, basic dosimetry. try to get a basic understanding of radiobiology, how radiation works, and some of the things people are working on to enhance radiation effects. get a good feel for the different types of patients you're gonna see--consults, on-treatment, follow-ups. #1 is to make sure radonc is for you.

but to get the interview, i agree that you have to get outstanding reccs, particularly from academic people in the field. the bigger the name, the better. and research is key. there is a shortage of academic radoncs, and they want to train people who are sincerely interested in staying academic. you can show this by solid research participation. with these things, you can definitely overcome your board score. you'll get screened at some places, but generally, from what i've experienced, they take a look at your whole package. you did well, and i'm sure you're capable of being a radonc, just be committed and prepare for the worst.

 

[clueless1]

Great feedback!!! Thanks a ton for your honesty radonc, oscar, and digimon - it is really appreciated. As someone just getting their feet wet in my options, it is great to have people that know something about the field level with me and just "put it out there" in terms of what matching requires. I definitely will take your advice to heart. Thanks for not holding back! As I said in the original subject post, it was brutal honesty I was looking for. It's just so hard to get because people are so nice on average!!! I never thought that I'd be complaining about that...

Any more feedback from anyone would be welcomed. Also, do any of you guys know of heresay/word-of-mouth cut-off numbers for interviews at places?

Again, the contributions have been invaluable. Thanks to all for your input!

 

[Finally M3]

This is actually oscar. I'm borrowing someone else's account right now so that's not my name that appears above.

Anyway, like I said in the subject, don't get too hung up on the USMLE thing. While it's true that rad onc has become very competitive these past few years, it's not the traditional kind of competitive that you would think of with ENT or ortho or something where 250 and AOA are prereqs. The wild card that everyone can play in rad onc is the research and connections angle. I think this field is unique in that those things can offset a lower USMLE, so giving you cutoffs may not be as useful since they aren't hard and fast rules, except maybe at some of the top notch places.

Even then, I heard from someone who interviewed at UPenn I think who said one of the interviewers left splayed open the board scores of the other applicants that day and they weren't all extraordinarily high, ranging from 225-250, which encourages me. I don't fault him for looking either, cause if it was me, and all it took was a shift of the eye to the paper, I'd have probably done the same.

Anyway, the point is, if you really want an answer to your question, why don't you just use the numbers for say ophtho or ENT since there aren't any published ones for rad onc? They're pretty top notch and if you can qualify for those fields, you can certainly qualify in rad onc. The caveat here though is that since you can move yourself up on the list with your lab work and letters, so too can others, so one should definitely not sit on one's laurels thinking they have it made with high scores and AOA. Okay, enough rambling...

 

[clueless1]

I'll keep that in mind...Quick question: what do you guys think about taking Step 2 of the USMLE prior to application? Have you found that programs prefer/require it, or does it even matter? I'm trying to figure out my 4th year schedule as we speak, and wanted to know if I should account for having to take Step 2 early in the year...

 

[Spyder]

I would take step II in the fall of your 4th year, sept. or oct.
Most residencies, not just Rad/Onc would like to have your
scores prior to their match list. I know of even some primary
care types that lost out on spots because their step II scores
weren't back and the program didn't want to take a risk on
them. It didn't used to be this way, but in recent years, this
is the trend. If you do well on step II, it can help your efforts
asssuming you do well. Step II isn't that hard, and I think that
the sooner in your 4th year you take them the easier it is. It's
mostly diagnosis type stuff and it is related to all the fields, i.e.
surg, ob/gyn, im, peds, and the closer you are to those rotations
the easier it is. My 2 cents. Also, after you finish, the sooner
you take step 3 the better. It is more management and
treatement issues, but is also comprehensive with respect to
all the specialties. The sooner you take it, the fresher those
issues are. I am doing a prelimary year in medicine and the
folks taking this test as a pgy3 don't remember much ob/gyn,
peds, or surgery. I took it in december as a pgy1 and did
better than most of those guys, even though they know
medicine much better. And I only had to study about an hour
and a half, skimming over some ob/gyn and peds. My advice is
don't wait, just take it.

 

[-=[BJIC]=-]

Yes, this subject sounds interesting, indeed.

 

[clueless1]

What about Plan B's? In other words, I think I'm at least as likely as the next guy to NOT match if I decide to apply into Rad Onc programs, and given that highly likely scenario (seeing as how Rad Onc is probably the most competitive field out there, from what I hear), what should I do with myself during the year following graduation? More specifically, what should I do during that year that would make me more competitive the following year if I apply again?

Feedback has been great, by the way. Thanks to all!

 

[oscar]

3 words:

Reeee search... Period

Anything related to oncology is adequate.

 

[jasmine125]

I thought I would take a quick break from Step 2 studying to give you some encouragement. I'm a 4th year that just suffered through the mid-evil torture process of the match and in Rad-Onc no less. Somehow I matched, I don't know how, I don't even care, but I matched. ..here are my stats:

1. NO research: last time I stepped foot in a lab was sometime in undergrad and it was in neurology.

2. no research, hence, NO publications

3. totally average boards scores, I don't even think they were as high as 219

4. my med school has a honors/high sat/sat/unsat grading scheme. . . me: preclinical years-sat/highsat; clinical years-honors/highsat

5. no step 2 scores when i applied

6. didn't decide on rad-onc until sometime in 3rd year

7. not even close to AOA status

8. most ppl thought i was crazy for applying esp w/o any backup plan (i would have just reapplied)

9. i go to one of the state schools in NY

10. I applied to 30 programs, got rejected from 27 INCLUDING my own freakin' school where I busted my butt during my rotation, did a kick ass presentation and got honors. . .who knew this year he wanted only MD/PhDs? I did get some excellent LORs though.

11. best decision of my life hands down: AWAY ELECTIVES. . .I am convinced that's what did it. if there is only one piece of advice i can give anyone interested in RAO, do AS MANY electives as you can at programs you are truly interested in. . .and then work like u've never worked before.

I did a total of 3 RAO electives in 4th year(1home, 2away). it got to the point where my dean told me she thought that "frankly" 3 was "too much." I didn't listen to her. I only used LORs from my home rotations and didn't ask the places i visited for any, it was too late into the year.
sorry, this is getting really long. So my point is, if u want RAO, just go for it, head on, plow through everything/everyone that discourages you. I managed to match into a very competitive/IV league program and I believed until match day that I was the exact candidate highly competitive programs laughed at. . .and yes, this is one of programs I visited. I shocked my school, the RAO dept at my school, my classmates and most of all myself. U HAVE to show personality and a strong work ethic with a genuine interst in patients and learning, high numbers certainly help, but it doesnt take a genius to be a radiation oncologist, everyone knows that. during my electives i worked extremely hard, showed tenacity, a good sense of humor. I demonstrated that I can handle the rigors of the field by being aggressive but not annoying and tackled a pretty large/complicated topic for my presentation and went all out with it. When i first set foot into the department, the 1st day of my visiting elecive, 2 other students were just finishing, another one was starting with me and another started while us 2 were already there. . .i laughed to myself and wanted to kill myself for picking RAO.

I did ALOT ALOT ALOT of follow up with this particular program: personalized thank you cards to each attending after my elective, i sent in grades from other home electives(surg-onc, radiology) as they came in with a short letter on the its significance as it pertains to RAO, thank u's again after the interview to each interviewer(total of 8), and finally another follow up letter to the big guys(chair, PD, medical director) after i finshed all interviews "reaffirming my keen interest" in early february.

so anyway, that's my story, i understand this might have just been a lucky fluke for me, but I hope it helps even a little. . .grades are good, but certainly not the deciding factor.

 

[scaredapplicant]

hey jasmine,

i think i met you at one of the NY school interviews in NYC. we rode on the subway back together.... remember me??? email me at [email protected] ... Congrats on matching.

fc

 

[gilbertfletcher]

i did not match at a program where i did an away rotation at despite getting honors for the month and getting great feedback from the chairman and pd. i ranked this program 1, but ended up matching at #5 of 13. turns out to be a better "match" in retrospect. have confidence, and go for it! if i can match, anyone can

btw, anyone know who matched at WashU?

 

[Spyder]

Just as an add-on to gilbertfletcher's post. I also didn't match
at the program I did an away rotation at, also with great
feedback from the program. However, I think there is a lot
of discussion between PDs in the field and I feel pretty sure
that my match was based in some way on communication
between the PD of the program I rotated with and the PD of
the program I matched at. Interestingly, the other person
that matched at my future program came from the school I
rotated at as well. I can't verify that this was the case and
am prone to conspiracy theories, but that is the only way
I can explain the situation. This was last year incidently.
So, I start my rad/onc in about 2 months, but I can't imagine
that this year or next would be any different.

 

[clueless1]

jasmine - thanks a ton for your encouragement! I have been hearing a lot of horror stories, which makes your success story a lot more encouraging...Not that I want the rosy outlook - on the contrary, hence the title of this thread. But, once in a while, it can't hurt to hear someone who's honest and successful! Congrats on matching. I hope I can lend moral support to my compatriots once I'm in your shoes! I will take your away elective message to heart - I'm in the process now of trying to do as many as possible. Great feedback, all - keep it coming!!!