Rad onc or internal med??

[Docmax__67]

If a newly graduated med schl student has to choose in between rad onc and IM which one should they prefer and why??

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[medgator]

IM (followed by specialty) all the way currently unless you have a real passion for rural based practice settings and oncology

 

[ROforbetterorworse]

Neither unless subspecializing after IM

Laws allowing NPs and PAs to act as PCPs is the future

 

[thecarbonionangle]

A huge problem with our field is we separated from DR, for reasons that made sense at the time. We do not have other training to fall back on to change jobs, make up income or save oneself from ruin and breadlines. Most fields have this basic skill. With declining compensation and demand, this leaves us cornered unable to do DR, or do systemic therapy. It is basically retrain or leave medicine altogether…

a derm path can do regular path. A pulm CCM can do HTN management. We cant do shiza. Many did a TY, some did a year of IM.

 

[medgator]

A huge problem with our field is we separated from DR, for reasons that made sense at the time. We do not have other training to fall back on to change jobs, make up income or save oneself from ruin and breadlines. Most fields have this basic skill. With declining compensation and demand, this leaves us cornered unable to do DR, or do systemic therapy. It is basically retrain or leave medicine altogether…

a derm path can do regulae path. A pulm CCM can do HTN management. We cant do shiza.

We can be great solid tumor oncologists in the right setting. I do not catfish and send as much business (or more) to medical oncology as I receive. The biggest problem now is we are creating too many of us.

 

[thecarbonionangle]

We can be great solid tumor oncologists in the right setting. I do not catfish and send as business (or more) much to medical oncology as I receive. The biggest problem now is we are creating too many of us.

I agree that we have the training and knowledge to be great onologists but we do not currently or ever will have the ability to be primary oncologists unless the path is created and im not aware of serious talks of doing this… i believe this might be our only saving grace. I hated DR, and i dont want to read films. I want to be an oncologist.

 

[medgator]

I agree that we have the training and knowledge to be great onologists but we do not currently or ever will have the ability to be primary oncologists unless the path is created and im not aware of serious talks of doing this…

Technically a heme onc can't be either. You seriously letting them treat your glottics, prostate and skin cancer cases, sista?

 

[DoctwoB]

Neither unless subspecializing after IM

Laws allowing NPs and PAs to act as PCPs is the future

Plenty of demand for PCPs. Easy to see a world in which MD PCPs pick and choose their patients while the NPs see the poorly insured. We get a lot of business from places who are glad to see us and not a PA/NP.

 

[RadOncDoc21]

Technically a heme onc can't be either. You seriously letting them treat your glottics, prostate and skin cancer cases, sista?

I’m in a system where the med oncs receive all the cancer patients and serve as the referral source for the community. Let’s just say it’s been damn near impossible for me to change the pattern. I’ve noticed that it takes new docs coming into the system to even have a chance to change the game.

 

[medgator]

I’m in a system where the med oncs receive all the cancer patients and serve as the referral source for the community. Let’s just say it’s been damn near impossible for me to change the pattern. I’ve noticed that it takes new docs coming into the system to have chance to change the game.

Key point. That's exactly how the practice i inherited was when i moved to town with 8 pts under treatment

 

[Ray D. Ayshun]

go away

 

[deleted1111261]

Key point. That's exactly how the practice i inherited was when i moved to town with 8 pts under treatment

What do you recommend that @RadOncDoc21 does to re-direct the flow through her/him?

 

[medgator]

What do you recommend that @RadOncDoc21 does to re-direct the flow through her/him?

Get to know him/her, be visible at tumor boards, learn the art of cross/reverse referrals back to your referrings, it's ok to see that new elective dx you get inpatient rather than turf and take the opportunity to build relationships in the hospital when you're starting out (honestly what's a med onc going to do if someone gets admitted for hemoptysis, bone pain etc). Arguably this is easier in a PP/independent setting but i think these principles can be done anywhere to some degree

Someone's gotta be doing pfts on every definitive lung pt before they see a single photon (best practice, at least from ACR). Pulmonologists derive revenue from their pft lab, similar to how we do from a Linac. Where do the ports/pegs/chemo go for lung/h&n pts? Just letting med onc handle everything? Med oncs don't speak h&n (oropharynx vs larynx vs np etc), they speak cisplatin vs (less often) cetuximab, and really don't have the same relationship with ENT that we do, so it's quite odd to me to see med onc getting h&n cases first, but I've seen it happen (getting dibs on a T1 glottic... Very strange).

 

[TheWallnerus]

If a newly graduated med schl student has to choose in between rad onc and IM which one should they prefer and why??

This is like “As a newly sexually actively person, if I had to choose between women or men which one should I prefer and why.”

Search your heart. I bet you know the answer already.

 

[Ray D. Ayshun]

This is like “As a newly sexually actively person, if I had to choose between women or men which one should I prefer and why.”

Search your heart. I bet you know the answer already.

I think I said that more succinctly.

 

[Docmax__67]

This is like “As a newly sexually actively person, if I had to choose between women or men which one should I prefer and why.”

Search your heart. I bet you know the answer already.

I'm pretty much interested in cardiology and oncology..but I wanna settle a bit early. So I thought it would be good if i get a suggestion from u ppl that's it.!

 

[RickyScott]

Just because you choose radonc doesn’t mean you will be practicing it. We are one black swan event (ctc dna ruling out 80 % of adjuvant xrt across numerous disease sites w/in 10 years) from actual bread lines.

 

[Docmax__67]

Just because you choose radonc doesn’t mean you will be practicing it. We are one black swan event (ctc dna ruling out adjuvant xrt across numerous disease sites w/in 10 years) from actual bread lines.

What do you mean..like there won't be any future for radonc??

 

[medgator]

What do you mean..like there won't be any future for radonc??

There will be a future for 50-70% of us probably. Like i said, what do you think happens when there is true demand for 120/year and academic centers around the country are collectively graduating 200/year?

 

[RickyScott]

What do you mean..like there won't be any future for radonc??

Radonc will be part of cancer for foreseeable future, but that does t mean today’s medstudents will be part of it.

 

[Docmax__67]

Radonc will be part of cancer for foreseeable future, but that does t mean today’s medstudents will be part of it.

will AI take over our roles ??

 

[elementaryschooleconomics]

will AI take over our roles ??

I would be surprised if AI would completely take over our jobs in our lifetime. Beyond the technology, you can't underestimate how valuable the human connection is to most patients - you can be a terrible doctor, on the medical side, but if patients like and trust you, you'll likely have a long career.

However, AI (and other technology) is already augmenting our jobs, and will likely consume a larger and larger role.

Radiation therapy for cancer isn't going anywhere, but the downward pressure for producing Radiation Oncologists just gets worse and worse. Seemingly every "development" in the field in the last 5-10 years which ostensibly benefits patients doesn't simultaneously mean an increase in manpower needs. It appears to be the exact opposite, in fact: hypofractionation, omission, machine learning, etc means an individual doc can treat more patients than they could 20 years ago...yet we're producing far more RadOncs then we were 20 years ago.

It objectively makes no sense. Just another classic tale of boomers kicking the ladder down behind them, as they decry these concerns as "magical thinking from anonymous internet trolls".

 

[RickyScott]

will AI take over our roles ??

No, as of now ai is largely sh—t is very unimpressive. Think watson.

 

[deleted1111261]

If a newly graduated med schl student has to choose in between rad onc and IM which one should they prefer and why??

Forgetting the job market woes, if you’re talking non speciality IM, these are incredibly different fields. “Do you want a hamburger or a chair?”

One is entirely therapeutic and the other is mostly diagnostic. One offers variety of disease states and body systems and one is just oncology. One is mostly chronic disease and the other has often life threatening. One offers flexibility of inpatient or outpatient or mix, the other is essentially outpatient only.

I don’t know what to tell you. Very different. The major difference will be flexibility- you’ll be tied to a linac, as my buddy The Todd says.