Question About Rad Onc

[SunnyS81]

Hi, this is my first time posting in the Rad Onc forum, although I've been reading all the posts for a few months.

Although I'm just an M1, I was interested in considering a career in radiation oncology if possible, however, I'm confused/concerned/worried about a few things, and I was hoping someone could answer my questions.

1) Why is it that some programs don't accept people for residency certain years? Someone posted that UNC didn't accept anyone last year I think, and I don't think Michigan accepted anyone this year either.

2) People have posted the number of a patients a person can expect to see over the course of the year on various threads for different programs. I understand that someone said you don't want to see too many patients because there is a lot of reading that you need to do during residency also. However, after you finish your residency, how busy do you think rad onc's are? Somone posted that Downstate has hospitals with 300 patients annually, which if you're the only rad onc in the hospital means that you see maybe 2 patients a day. Am I really off in my logic?

3) Why is it that Rad Onc is so competitive to go into. I think I know why derm, ortho, and the like are competitive, but I wasn't sure about rad onc.

I think that's all. I appreciate all responses.

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[Adawaal]

Sunny --

I'm currently an M4 in the application process, and I know there are a number of Rad Onc residents on here with much more knowledge than my two rotations have afforded me. However, I'm just sitting here watching football, so here goes...

1) Why is it that some programs don't accept people for residency certain years? Someone posted that UNC didn't accept anyone last year I think, and I don't think Michigan accepted anyone this year either.

Each program is alloted a finite number of resident slots. Rad Onc programs are very small (compared to say IM), with very few slots per program. Should a resident leave a program for whatever reason, a program may choose to just take one more the next year rather than try to fill that open slot mid-program. This is the reason Northwestern has no slot starting 2005. As a corollary, a program with LOTS of FABULOUS applicants one year can always offer a position more than they had planned by not taking one the following year. I've seen this happen as well. There are rarer circumstances that cause this to happen, but I think this is likely the most frequent reason.

2) People have posted the number of a patients a person can expect to see over the course of the year on various threads for different programs. I understand that someone said you don't want to see too many patients because there is a lot of reading that you need to do during residency also. However, after you finish your residency, how busy do you think rad onc's are? Somone posted that Downstate has hospitals with 300 patients annually, which if you're the only rad onc in the hospital means that you see maybe 2 patients a day. Am I really off in my logic?

Well, one has to keep in mind that a patient on conventional RT will come in five days a week for 4-6 weeks for radiation. The 300 patients (not a terrible number from what I've seen) quoted typically represents the number of NEW patients treated by a center each year. In addition to the 20-30 treatment visits for most patients, there are treatment planning sessions, consultations, and typically follow-up visits for a few years following completion of radiation. You can see how this quickly adds up to thousands of patient contacts per year for a program.

3) Why is it that Rad Onc is so competitive to go into. I think I know why derm, ortho, and the like are competitive, but I wasn't sure about rad onc.

I'm sure every applicant has his/her own reasons for choosing Rad Onc. It is considered to be one of the "lifestyle specialties" people are focking to these days, unfortunately. For me, though, Rad Onc has a unique combination of factors:
very interdisciplinary
cancer is the MOST evidence-based area of medicine
caring for cancer patients is very rewarding
lots of tres cool toys to play with
a real opportunity for research (and the time to do it)
therapies advancing probably faster than any other area of medicine
fewer concerns about insurance crap (precerts, etc.)
every patient is treated INDIVIDUALLY (unlike HTN, DM, CAD, etc.)
no daily rounds, hiking all over the hospital

Hope this was helpful. Maybe Steph and the other rockin' Rad Onc residents can expound further with their own thoughts....

 

[radonc]

about why radonc is so competitive.....
add on pretty good hours (probably 60 hours/week as a resident). plus, when you are done, the starting salaries are somewhere between 150-250K, based on private vs academics, location, etc, etc.

furthermore, radonc is a very multifaceted field...you can go into the OR to implant, you can spend time in the dark and look at films, then you also get to lay your hands on patients in clinics.

 

[Htowngsp]

The real reason it's seems unnaturaaly competitive is that there are so few slots. If only 250 people nationwide want to go into Rad Onc, then 1/3 don't match. Contrast that with IM where there are more spots than applicants by almost a 2:1 ration. Derm has the same scenario- If more than a handful of folks want in, it gets competitive fast. With ortho, my understanding is there are a lot of applicants for alot of spots.

Also, Rad Onc is attractive to alot of folks I know in residency because it is very "scientific" ( that is if you like physics, there are physics areas to explore. Like molecular biology- try radiobiology, etc, etc, ) without sacrificing real patient care as part of the career.

 

[SunnyS81]

Thanks for your responses and keep them coming.

One other thing.....that I forgot to post....

I've noticed when people contrast programs they talk about the different technologies available at each place. I was just thinking to myself, aren't rad onc's limited by the technology available to them? Like if you go to a top 5 program, you probably won't have a problem, but even if you became an attending at a place like Penn, isn't it a problem that you are restricted by the available resources. I may be nieve but this seems to be where the hospital is the limiting factor and not neccessarily the physician and his/her knowledge. And if you ever had an interest in going into private practice, how many community hospitals have this type of technology?

Thanks again, as I'm learning a lot from you all.

 

[stephew]

ive heard people (interestingly, usually from derm, where it seems very important to hang onto the kudos of "Most competitive") often say rad onc is "artificially competitive" because there aren't so many spots compared to IM. Very true. However the real answer is a little most subtle- rad onc used to ALWAYS have free spots. Why did it change? The money and hours didnt change.

My unsubstantiated answer is that we've finally produced our first gen of doctors who not only like technology but who have grown up with it (computers in the home etc). So what used to be the field of only those more inclined to engineering and somesuch, now is open in appeal to many.

With regard to sunny's comment:

Originally posted by SunnyS81
I was just thinking to myself, aren't rad onc's limited by the technology available to them? Like if you go to a top 5 program, you probably won't have a problem, but even if you became an attending at a place like Penn, isn't it a problem that you are restricted by the available resources.

Actually the "best" or more properly "newest" technology isn't always at the top 10 places. U wisc has the best Ive seen and probaly isnt in most people top list (but should be).

But you are right in that yes, you can only play with the toys you have. So that's part of the decision you make come time to get out in the real world after residency. But basic residency training will make it relatively easy to pick up techniques that you may not have trained on (i.e. tomotherapy). Community centers often dont have all the hot toys, but some are very well equipped.
Steph

 

[argg]

About the 300+ patients...
As Adawaal said, I was referring to the number of new patients presenting for evaluation and treatment in the department at each hospital. Most of these people will get several weeks of external beam, some will go for implants in the OR, a few will get both. And again, like Adawaal said, they all need initial visits for evaluation, for set-up and sim, then on-treatment visits, and follow-up visits for months to years after treatment. It does wind up making you very busy, especially if there are only one or two residents around.

As far as competition in the field, I would second everything said above but I would also add something else. I think the increasing competitiveness is partly because med school gunners are gunners even when it comes to specialty selection. There are people out there that choose their specialty just to prove they can get into the field. Rad onc has become very attractive the last few years as just that kind of proving ground.

You can see it all around the other boards. People are flaming each other constantly about what field is most competitive. People want to know their field is tougher to get into and more 'worthy' of respect than any other.

 

[Ligament]

I wonder if the salary is what makes rad onc so attractive. A buddy of mine doing rad onc at U of Chicago claims he will be making 750k-1Million within 3 years of graduation. Is this the case for all rad onc docs? this is some serious cash!

 

[Htowngsp]

That salary is way high- here in Houston we have three or four guys who are making that kind of money, but they are running huge operations or doing back to back brachy all day. The average I've heard bounced around here for right out of residency is $150-250K depending on what city.

(Oh, and by these figures, I mean net pretax income- I know a mid career Rad Onc in Dallas grossing 3 mil, but after equipment costs, overhead, physics staff, techs, malpractice, etc. he sees $400k pretax, which beomes 255ish post-tax).

 

[stephew]

Ligament, I accidently clicked on "Edit" to your post when I meant only to reply.I think Ive restored it to its original. Please check.

In reply, your buddy is thinking of a private practice somewhere that is less popular if he's seriously thinking of that money in "3-5 years". Some go into it merely for this: one individual i know repeatedly (and stupidly) would tell anyone who would listen he was going into medicine "for the money and the women". Knowing him I know why he would have to. But for the rest of us, we actually love the field, the patients, the good we can do, the intellectual adventure. The money makes for a good lifestyle.

 

[radonc]

what i tell people is:

if i wanted to make a lot of money, i would have gone into investment banking. i could have made 80K +bonuses out of college, already been an associate making 150+ after 3 years and finished my mba right now. then at age 32, (age i am gonna be when i finish radonc) i would be at a hedge fund or some VC firm right now pulling down a hell of a lot more.

instead, i gave up 10 years of earning potential to be 150K in debt, making between 35-45 K. i wont be making money till im 32! and even then itll be 150-200.

 

[Adawaal]

It could be worse, radonc. You could be like me and on the Rad Onc interview trail as a 32-year-old....

Oh well.... time to go soak the dentures....

 

[stephew]

Adawaal- just put them under the beam for a few MUs and that'll do ya.
steph

 

[SunnyS81]

Two more things that have spurred ideas while studying:

1) With the wide range of incomes posted (150k-3mil), what is a legitimate amount that a person can expect once they are established in private practice? (since that usually pays more...that should be the higher end). Is anyone well informed on this? I seem to be finding that people widely ranging numbers from different sources when looking for incomes, and all the survey's I've looked at have a very small sample size. (I don't remember what rad onc's are surveyed to make).

2) My pathology professor started med school in 1951. Which means penicilen started being prescribed when he was an undergrad. Keeping in mind that was only 55 years ago (and many would say the beginning of modern medicine), do you think it is feasible that amazing treatments (I hesitate saying cures) for cancer will exist within our life times? What would happen to all the med-onc's, rad-onc's, and surg-oncs? Just something my mind wandered to while bored in a lecture about stem cells. I was just thinking, with billions of dollars being pored into research every year, I'd feel like a chump if that happened as a practicing onc early in my career (20 years from now would put me in my early 40's).

I'd love to hear answers to both....

 

[radonc]

sunny,

does is really matter if you make 150 or 300 or 500K? you are gonna be well off, no matter what. making money is compounded by a ton of different factors...location, practice size, # of patients, malpractice insurance to name a few.... and by the time you finish radonc, the amount one gets paid will be totally different! just remember, if you work hard and if you are good at what you do, you will be just fine.

radonc

 

[SunnyS81]

The reason i asked was because i was curious. In my mind, i would expect in $200-400k range. i was shocked by the $500k+ claims (my initial response was"holy **** that's a lot"). Also, my adivsor as an undergrad was a rad onc research faculty member, and when i asked why it is so competitive, she said, "Because there's a lot of money in it." I wanted to know if the statement was true or not. Additionally, I know med onc's make in the $300k range, so i was wondering how rad-onc's compared. And for the record, I think income does matter to a small extent in considering a career. As our counselor (an EM doc) told us, "Most people would be happy in several fields, not just one." So if there are people considering rad onc, it might be a piece of information that pursuades or disuades someone from going into the field. Much like deciding where you went for undergrad, med school, and residency, I'm sure the small things counted (I know they did for me).

I'm sure what I said runs contrary to all the beliefs on SDN who want to keep it hush-hush. Just like the amount of hours a person can expect should be known (i've met general surgeons who have claimed 40-50 hours weeks........which I find hard to believe), and demand, outlook, etc.

 

[Htowngsp]

What's funny is how the way a field looks as you enter may be different over the course of your career. For instance, when my brother, an opthamologist, entered residency when it was super-competitive, LASIK was brand new, and glaucoma was reimbursed the way IMRT is now. Now, 10 years out, a bunch of ophthamologists who entered the specialty for the cash realize they hate the field and aren't making the astronomical salaries expected in the "gold rush days of the past". To some degree, prognostication about how much radoncs will make when sunny enters the field in 9 years are just guesses at best. All it takes is a single alteration in billing practices (i.e. "bundling" of IMRT by medicaid reimbursement). Or for an example : ten years ago PET wasn't reimbursed either, and now nuc med can clear many benjamins.

(I must stop - when I noticed on a rotation that, as a former business major, a presentation of billing minutiae at a local cancer center during morning conference was putting everyone but me to sleep, I realized I am an Uber-dork).

In closing, though I appreciate this thread, I wish we had more threads on econnomics affect the science of rad onc. For instance, why as it we saw such a huge interest in oncologic PET and IMRT only after thaey were reimbursable? Here in H-town, Baylor had IMRT for nearly five years before anyone else around wanted one- coincidentally when they were able to make huge technical fees of treatments everyboy wants IMRT. I'm curious if there are instances where the economics of the field may hinder the patients best interest. Just a thought.

 

[radonc]

you are gonna be a doctor and be in the top 1% of income in the united states. does 300 or 500k really matter? its not that $$$ issues are hush hush but there are many confounding variables that affect income. academic vs private, rural vs urban practice, # of hours a week you work, # of patients you see, etc, etc. thats why talking about $$$ at your stage in life isnt very practical.