Advice needed...SurgOnc vs MedOnc

[MS42017]

Hi, I'm hoping to hear some advice/thoughts. I'm an MS4 planning on applying to GS this year. I'm on sub-I's right now and really enjoying them. I'm particularly interested in Surg Onc and breast. While I am enjoying myself I'm nervous that the hours of the residency are too much and too demanding for the next 5 years. A work-life balance is important to me, and I worry that I won't be happy.

What draws me to surg onc is the patient population which is why I am also considering MedOnc. I really liked both rotations during my 3rd year. I have decided on surgery up until now because I love being in the OR and I love the oncology procedures. That being said, I don't love all of general surgery. I think MedOnc might be a more balanced lifestyle, but it saddens me to never be in the OR again!

Can anyone comment on the differences in lifestyle as a resident and as an attending in the two fields? How different is the compensation? I'd appreciate any advice thanks.

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[ACSurgeon]

Hi, I'm hoping to hear some advice/thoughts. I'm an MS4 planning on applying to GS this year. I'm on sub-I's right now and really enjoying them. I'm particularly interested in Surg Onc and breast. While I am enjoying myself I'm nervous that the hours of the residency are too much and too demanding for the next 5 years. A work-life balance is important to me, and I worry that I won't be happy.

What draws me to surg onc is the patient population which is why I am also considering MedOnc. I really liked both rotations during my 3rd year. I have decided on surgery up until now because I love being in the OR and I love the oncology procedures. That being said, I don't love all of general surgery. I think MedOnc might be a more balanced lifestyle, but it saddens me to never be in the OR again!

Can anyone comment on the differences in lifestyle as a resident and as an attending in the two fields? How different is the compensation? I'd appreciate any advice thanks.

I'm usually the first to encourage people to go into surgery; not in your case.

Surg Onc is a lot of general surgery. The road to surg onc is not easy, the fellowship itself is brutal, and you have to be happy to "just be a general surgeon" if you apply Gen surg.

Your level of concern regarding the hours is a red flag.

Lifestyle is much more difficult through out and as an attending (unless you do pure breast).

Compensation shouldn't be a factor; both do really well.

If your post had more of "I love general surgery and willing to work really hard for 7-9 years but wondering if I can have some work-life balance", my response would have an entirely different tone

 

[deleted547339]

This seems fairly straightforward. Do you want to be a surgeon or an internist? Live for surgery? Be a surgeon. Like onc patients and path, do heme/onc.

Other than the fact that you treat cancer patients, the two specialties couldn't be further apart.

 

[Mr Krabs]

I also have this dilemma... though it's too early for me to start thinking of these things since clinical rotations still start the coming school year, but still I've always seen myself as being an oncologist of some sort. I do have questions about the application specifics though: what step scores would you guys recommend for Heme-Onc vs SurgOnc fellowship application?

 

[cpants]

Have you considered Rad Onc or Gyn Onc?

 

[Mr Krabs]

Have you considered Rad Onc or Gyn Onc?

hi! i can't really tell if this is directed to me or the OP but in case it's at me- for Rad Onc, I feel like I'm not stellar enough an applicant to even think of applying... although, I'm actually still currently preparing for Step1 so hopefully i do well enough to think about RadOnc...

For Gyn Onc, actually no... there's such a field? Wow, I'm not familiar with it. I always thought OB-Gyns just give cancer patients to IM Heme-Oncs

 

[Winged Scapula]

hi! i can't really tell if this is directed to me or the OP but in case it's at me- for Rad Onc, I feel like I'm not stellar enough an applicant to even think of applying... although, I'm actually still currently preparing for Step1 so hopefully i do well enough to think about RadOnc...

For Gyn Onc, actually no... there's such a field? Wow, I'm not familiar with it. I always thought OB-Gyns just give cancer patients to IM Heme-Oncs

Gyn Onc is a fellowship after OB/GYN. These guys are real surgeons and do some crazy things.

Gyn malignancies are surgically managed and most regular Ob/Gyns won't tackle them. Many of our Gyn Oncs also do the medical management, write for chemotherapy et Cetera.

 

[VisionaryTics]

I also have this dilemma... though it's too early for me to start thinking of these things since clinical rotations still start the coming school year, but still I've always seen myself as being an oncologist of some sort. I do have questions about the application specifics though: what step scores would you guys recommend for Heme-Onc vs SurgOnc fellowship application?

Don't think about whether you want to be an "oncologist" because the day to day of medical, surgical, and radiation oncologists is incredibly different.

Do you like to operate and just happen to like operating on cancer patients? Then maybe general surgery is a good idea. There are also surgical oncology fellowships in urology, ENT, orthopedics, neurosurgery, and ob/gyn. Colorectal surgeons and breast surgeons also do a ton of surgical oncology.

Do you like seeing patients in clinic, rounding, contemplating all the medical complexities of patients. maybe being in the lab or teaching a few days a week? Then probably medicine followed by heme/onc fellowship if you like doing all of the above on a cancer population.

I see you're still an M2. If you honestly had any real exposure to both specialties, I don't think you'd be having this debate. There is honestly very little overlap in the students who are interested in medicine and the students interested in surgery.

The OP's sentence "I would be saddened to never be in the OR again" is more realistically and commonly "I would shoot myself in the ****ing head if I ever had to do IM rounds or clinic again".

 

[Winged Scapula]

Don't think about whether you want to be an "oncologist" because the day to day of medical, surgical, and radiation oncologists is incredibly different.

Do you like to operate and just happ to like operating on cancer patients? Then maybe general surgery is a good idea. There are also surgical oncology fellowships in urology, ENT, orthopedics, neurosurgery, and ob/gyn. Colorectal surgeons and breast surgeons also do a ton of surgical oncology.

Do you like seeing patients in clinic, rounding, contemplating all the medical complexities of patients. maybe being in the lab or teaching a few days a week? Then probably medicine followed by heme/onc fellowship if you like doing all of the above on a cancer population.

I see you're still an M2. If you honestly had any real exposure to both specialties, I don't think you'd be having this debate. There is honestly very little overlap in the students who are interested in medicine and the students interested in surgery.

The OP's sentence "I would be saddened to never be in the OR again" is more realistically and commonly "I would shoot myself in the ****ing head if I ever had to do IM rounds or clinic again".

 

[Gate Closed]

I'm usually the first to encourage people to go into surgery; not in your case.

Surg Onc is a lot of general surgery. The road to surg onc is not easy, the fellowship itself is brutal, and you have to be happy to "just be a general surgeon" if you apply Gen surg.

Your level of concern regarding the hours is a red flag.

Lifestyle is much more difficult through out and as an attending (unless you do pure breast).

Compensation shouldn't be a factor; both do really well.

If your post had more of "I love general surgery and willing to work really hard for 7-9 years but wondering if I can have some work-life balance", my response would have an entirely different tone

I totally agree with this! Pursue surgery if and only if you cannot imagine yourself living without operating. Otherwise, you will just contribute to the high surgical attrition rate.

 

[Mr Krabs]

Don't think about whether you want to be an "oncologist" because the day to day of medical, surgical, and radiation oncologists is incredibly different.

Do you like to operate and just happen to like operating on cancer patients? Then maybe general surgery is a good idea. There are also surgical oncology fellowships in urology, ENT, orthopedics, neurosurgery, and ob/gyn. Colorectal surgeons and breast surgeons also do a ton of surgical oncology.

Do you like seeing patients in clinic, rounding, contemplating all the medical complexities of patients. maybe being in the lab or teaching a few days a week? Then probably medicine followed by heme/onc fellowship if you like doing all of the above on a cancer population.

I see you're still an M2. If you honestly had any real exposure to both specialties, I don't think you'd be having this debate. There is honestly very little overlap in the students who are interested in medicine and the students interested in surgery.

The OP's sentence "I would be saddened to never be in the OR again" is more realistically and commonly "I would shoot myself in the ****ing head if I ever had to do IM rounds or clinic again".

Solid advice thank you!

Gyn Onc is a fellowship after OB/GYN. These guys are real surgeons and do some crazy things.

Gyn malignancies are surgically managed and most regular Ob/Gyns won't tackle them. Many of our Gyn Oncs also do the medical management, write for chemotherapy et Cetera.

Ohh nice... Gyn Onc sounds interesting! Hopefully it clicks during rotations...

 

[mcworbust]

Ohh nice... Gyn Onc sounds interesting! Hopefully it clicks during rotations...

FYI, a month or so before your OB/Gyn rotation, contact the rotation coordinator (look it up or ask a friend who already rotated), say you're interested in OB/Gyn and would especially appreciate the opportunity to rotate with Gyn Onc if possible. I know at my school, the clinical rotations do whatever they can to accommodate your interests even if it's outside the normal curriculum but in the field, but you will have to feel it out. I know that I did not get significant Gyn Onc experience while others in my class likely did, but I never asked.

 

[tvelocity514]

I totally agree with this! Pursue surgery if and only if you cannot imagine yourself living without operating. Otherwise, you will just contribute to the high surgical attrition rate.

I understand where people are coming from when they say this, but I also think there are definitely people out there who enjoy both. I loved every single rotation except for psych and WCC on peds and I'm applying into surgery. My choice wasn't really a "would you rather cut than live" type of situation. I was happy on IM etc but I realized I was happiest on my surgery rotation- especially after being up for 36 hours and all i wanted to do was go back after a couple hours of sleep. There's also a lot of medicine in surgery that I was very surprised about when I did my gen surg rotation 3rd year and remember thinking "this is awesome - I get to think through all the medicine AND do surgery".

Long story short, I'm just saying that everyone is different and for some it's not "do you love cutting or could you love ANYTHING else or else you will cause the attrition rate to increase". I definitely am not discounting anything said above as that is true for the majority of people. I just wanted to give others food for thought that sometimes you like both and other things should be part of the decision.


Edit: just wanted to clarify- I also had more cons in medicine than surgery when I made a pro/con list - eg the length of rounds really did suck haha (compared to surgery) and I wanted them to go faster. I still liked thinking through everything though.

To op- Ultimately, no one can tell you what to go into. You need to really think back to how you felt doing the procedures and time spent during the day and figure out what you liked the most. Try hard to be honest with yourself in regards to which you were happiest doing. Which would you rather get calls in the middle of the night about and take care of? Would you rather do immediate surgical treatments on patients or 90%+ medical management with treatments? The patient base has some similarities but also remember you can't do surgery on everyone but a lot of medical oncologists do try chemo on almost everyone (I'm biased so disregard that last statement).

Also, make sure to assess your personality. I got along with surgeons really well and always wanted to see operations and talk with them. I realized a lot of the medicine guys would end up talking about when they were off next or non-work stuff a lot and I wasn't a fan of that. Some people are more focused on time off than work though and I think you should take that into consideration (obviously there's some of each in every profession though).

Sent from my iPhone using SDN mobile ap

 

[Gate Closed]

I understand where people are coming from when they say this, but I also think there are definitely people out there who enjoy both. I loved every single rotation except for psych and WCC on peds and I'm applying into surgery. My choice wasn't really a "would you rather cut than live" type of situation. I was happy on IM etc but I realized I was happiest on my surgery rotation- especially after being up for 36 hours and all i wanted to do was go back after a couple hours of sleep. There's also a lot of medicine in surgery that I was very surprised about when I did my gen surg rotation 3rd year so I honestly was like "this is awesome - I get to think through all the medicine stuff AND do surgery".

Long story short, I'm just saying that everyone is different and for some it's not "do you love cutting or could you love ANYTHING else or else you will cause the attrition rate to increase". I definitely am not discounting anything said above as that is true for the majority of people. I just wanted to give others food for thought that sometimes you like both and other things should be part of the decision.

Yes, there are people who enjoy both. However, if you do enjoy something besides surgery, why would you opt to compromise in terms of lifestyle (unless of course you do breast in the end)?

 

[Gate Closed]

I understand where people are coming from when they say this, but I also think there are definitely people out there who enjoy both. I loved every single rotation except for psych and WCC on peds and I'm applying into surgery. My choice wasn't really a "would you rather cut than live" type of situation. I was happy on IM etc but I realized I was happiest on my surgery rotation- especially after being up for 36 hours and all i wanted to do was go back after a couple hours of sleep. There's also a lot of medicine in surgery that I was very surprised about when I did my gen surg rotation 3rd year and remember thinking "this is awesome - I get to think through all the medicine AND do surgery".

Long story short, I'm just saying that everyone is different and for some it's not "do you love cutting or could you love ANYTHING else or else you will cause the attrition rate to increase". I definitely am not discounting anything said above as that is true for the majority of people. I just wanted to give others food for thought that sometimes you like both and other things should be part of the decision.


Edit: just wanted to clarify- I also had more cons in medicine than surgery when I made a pro/con list - eg the length of rounds really did suck haha (compared to surgery) and I wanted them to go faster. I still liked thinking through everything though.

To op- Ultimately, no one can tell you what to go into. You need to really think back to how you felt doing the procedures and time spent during the day and figure out what you liked the most. Try hard to be honest with yourself in regards to which you were happiest doing. Which would you rather get calls in the middle of the night about and take care of? Would you rather do immediate surgical treatments on patients or 90%+ medical management with treatments? The patient base has some similarities but also remember you can't do surgery on everyone but a lot of medical oncologists do try chemo on almost everyone (I'm biased so disregard that last statement).

Also, make sure to assess your personality. I got along with surgeons really well and always wanted to see operations and talk with them. I realized a lot of the medicine guys would end up talking about when they were off next or non-work stuff a lot and I wasn't a fan of that. Some people are more focused on time off than work though and I think you should take that into consideration (obviously there's some of each in every profession though).

Sent from my iPhone using SDN mobile ap

Just saw your edit. Your perspective is in fact very different than the OP's. You are clearly more "surgically-oriented". The way the OP describes things is not even remotely convincing that 5 years in trauma/transplant/SICU/etc would be tolerable for him/her.

 

[tvelocity514]

Just saw your edit. Your perspective is in fact very different than the OP's. You are clearly more "surgically-oriented". The way the OP describes things in not even remotely convincing that 5 years in trauma/transplant/SICU/etc would be tolerable for him/her.

From reading the OP's post, I would recommend medical oncology as surg-onc is definitely not a lifestyle friendly field - nor is the training to get there. However, I think it's up to the OP to determine if him/her being "saddened he/she will never be in the OR again" will be worth doing vs. having a better lifestyle balance. Personally when I read his/her post, I would have advised the OP to lean towards medicine however there is always a lot that isn't said in a post. As I said originally, my previous post was not to discredit or deny what you said originally, but to increase awareness for any other students that find this thread in the future that it isn't just a cut vs not cut mentality for everyone and it is ok. They will ultimately determine which makes them the happiest.

 

[mcworbust]

I understand where people are coming from when they say this, but I also think there are definitely people out there who enjoy both. I loved every single rotation except for psych and WCC on peds and I'm applying into surgery. My choice wasn't really a "would you rather cut than live" type of situation. I was happy on IM etc but I realized I was happiest on my surgery rotation- especially after being up for 36 hours and all i wanted to do was go back after a couple hours of sleep. There's also a lot of medicine in surgery that I was very surprised about when I did my gen surg rotation 3rd year and remember thinking "this is awesome - I get to think through all the medicine AND do surgery".

Long story short, I'm just saying that everyone is different and for some it's not "do you love cutting or could you love ANYTHING else or else you will cause the attrition rate to increase". I definitely am not discounting anything said above as that is true for the majority of people. I just wanted to give others food for thought that sometimes you like both and other things should be part of the decision.


Edit: just wanted to clarify- I also had more cons in medicine than surgery when I made a pro/con list - eg the length of rounds really did suck haha (compared to surgery) and I wanted them to go faster. I still liked thinking through everything though.

To op- Ultimately, no one can tell you what to go into. You need to really think back to how you felt doing the procedures and time spent during the day and figure out what you liked the most. Try hard to be honest with yourself in regards to which you were happiest doing. Which would you rather get calls in the middle of the night about and take care of? Would you rather do immediate surgical treatments on patients or 90%+ medical management with treatments? The patient base has some similarities but also remember you can't do surgery on everyone but a lot of medical oncologists do try chemo on almost everyone (I'm biased so disregard that last statement).

Also, make sure to assess your personality.

*****I got along with surgeons really well and always wanted to see operations and talk with them. I realized a lot of the medicine guys would end up talking about when they were off next or non-work stuff a lot and I wasn't a fan of that. *****

Some people are more focused on time off than work though and I think you should take that into consideration (obviously there's some of each in every profession though).

Sent from my iPhone using SDN mobile ap

I totally felt the same way about getting along w/ surgeons and being slightly annoyed on medicine when talking on and on about when they're off next. I also loved all my rotations like you (however I loved psych, but agree with you that WCC suck).

I loved and was great at surgery but didn't pursue it cuz of a physical limitation - just curious, what non surgical specialties did you enjoy working with/were close to surgery personality without the surgery? Thx

 

[Mr Krabs]

FYI, a month or so before your OB/Gyn rotation, contact the rotation coordinator (look it up or ask a friend who already rotated), say you're interested in OB/Gyn and would especially appreciate the opportunity to rotate with Gyn Onc if possible. I know at my school, the clinical rotations do whatever they can to accommodate your interests even if it's outside the normal curriculum but in the field, but you will have to feel it out. I know that I did not get significant Gyn Onc experience while others in my class likely did, but I never asked.

Niceee, I didn't know we could do this. Thought only those with like, prior connections could ask for specific rotation experiences... thanks!

 

[mcworbust]

Niceee, I didn't know we could do this. Thought only those with like, prior connections could ask for specific rotation experiences... thanks!

From what I've gathered, the rotation/education coordinators and the physician in charge of the rotation have the primary job of making sure students are doing what they need to do to get the competency in that rotation and also to make sure they meet whatever benchmarks are set for the rotation by either their department or by the school. However, since you're paying for the rotation with your tuition, as long as the cool things you're interested in in the field you're rotating in don't interfere with you reaching the level of competency they've set for students on the rotation (and don't interfere w/ other students' experiences), you should absolutely be able to ask. Now since these activities may be "extra", they can always say no (especially if the area you're interested in usually doesn't have students), but I look at this as part of what you're paying your school for and therefore paying them to do. At my school I've found that the coordinators/rotation directors have bent over backward to accommodate interests in the field as they are also selling their field/specialty somewhat, and like to cultivate interest in that field. Have fun with it!

 

[Mr Krabs]

From what I've gathered, the rotation/education coordinators and the physician in charge of the rotation have the primary job of making sure students are doing what they need to do to get the competency in that rotation and also to make sure they meet whatever benchmarks are set for the rotation by either their department or by the school. However, since you're paying for the rotation with your tuition, as long as the cool things you're interested in in the field you're rotating in don't interfere with you reaching the level of competency they've set for students on the rotation (and don't interfere w/ other students' experiences), you should absolutely be able to ask. Now since these activities may be "extra", they can always say no (especially if the area you're interested in usually doesn't have students), but I look at this as part of what you're paying your school for and therefore paying them to do. At my school I've found that the coordinators/rotation directors have bent over backward to accommodate interests in the field as they are also selling their field/specialty somewhat, and like to cultivate interest in that field. Have fun with it!

Will definitely be checking out all onc fields out when i can including GynOnc... thanks!

 

[vhawk]

Gyn Onc is actually a pretty cool specialty, you get to do big whacks, you get to have a lot more of a touchy feely relationship with your patients, and presumably most gyn oncs do some sort of other gyn or OB stuff as well which helps balance out what can be a depressing relentless field of surgical oncology. I get to occasionally do a gallbladder or hernia which helps keep me sane but I can imagine occasionally delivering a baby or whatever would be even better.

 

[Mr Krabs]

Gyn Onc is actually a pretty cool specialty, you get to do big whacks, you get to have a lot more of a touchy feely relationship with your patients, and presumably most gyn oncs do some sort of other gyn or OB stuff as well which helps balance out what can be a depressing relentless field of surgical oncology. I get to occasionally do a gallbladder or hernia which helps keep me sane but I can imagine occasionally delivering a baby or whatever would be even better.

Yeahhhh plus I wanna go into onc for personal reasons... one of my loved ones passed away when i was still in high school due to cancer and i saw how much she suffered... I want to honor her memory by going into a career that let's me take "revenge" on what killed her (yeah, it sounds silly but that's why i'm into Onc in general ) so lifestyle doesn't really matter much to me. plus the other operations that get done by GynOncs sound interesting too! Just hope i'm the right fit...

 

[Winged Scapula]

Gyn Onc is actually a pretty cool specialty, you get to do big whacks, you get to have a lot more of a touchy feely relationship with your patients, and presumably most gyn oncs do some sort of other gyn or OB stuff as well which helps balance out what can be a depressing relentless field of surgical oncology. I get to occasionally do a gallbladder or hernia which helps keep me sane but I can imagine occasionally delivering a baby or whatever would be even better.

None of our Gyn Oncs here do general gyn or OB but they do do prophylactic surgery for mutation carriers which I know they enjoy; I also like to do benign masses in young women or the prophylactic surgeries as well. Helps keep the relentless cancer bad vibes at bay.

 

[Fab5Hill33]

If you're exploring fields related to onc - whether its for a future career, or just to learn what treatments are out there - I would recommend doing an interventional radiology rotation. Interventional oncology (IO) is a big part if IR nowadays. There are some IRs who devote their entire practice to IO and perform procedures like radioembolization, chemoembolization, microwave ablation, cryoablation, etc.

Will definitely be checking out all onc fields out when i can including GynOnc... thanks!

 

[CTFellowMD]

I would just like to point out that unless you land at a major cancer center as faculty after fellowship (This is even more difficult than getting into residency/fellowship FYI), most surgical oncologists function as general surgeons. They usually pick a specific subset of general surgery (IE: foregut, hepatobiliary, colorectal, etc) and focus on that area. This includes not only treating oncology patients, but also doing routine general surgery procedures (cholecystectomies, hernias, etc) and also taking general surgery call. If you think you are going to go into surgical oncology and then just do whipples every day, you are sorely mistaken.

It makes no sense to me that someone would have trouble deciding between Surg Onc and Heme/Onc. I can understand enjoying working with the patient population, but these are drastically different fields.

 

[Winged Scapula]

I would just like to point out that unless you land at a major cancer center as faculty after fellowship (This is even more difficult than getting into residency/fellowship FYI), most surgical oncologists function as general surgeons. They usually pick a specific subset of general surgery (IE: foregut, hepatobiliary, colorectal, etc) and focus on that area. This includes not only treating oncology patients, but also doing routine general surgery procedures (cholecystectomies, hernias, etc) and also taking general surgery call. If you think you are going to go into surgical oncology and then just do whipples every day, you are sorely mistaken.

It makes no sense to me that someone would have trouble deciding between Surg Onc and Heme/Onc. I can understand enjoying working with the patient population, but these are drastically different fields.

Depends on your practice environment. None of our local hospitals require GS call anymore for sub specialists; you can take it if you want, but there are enough GS practitioners who want it, that its generally not a problem, We don't have a lot of PP Surgical Oncologists here but those we do have don't seem to be doing much true general surgery.

I do think it would be hard, outside of academics, to come out into PP and be "the melanoma guy" or "the thyroid guy" and make a living.

 

[Mr Krabs]

If you're exploring fields related to onc - whether its for a future career, or just to learn what treatments are out there - I would recommend doing an interventional radiology rotation. Interventional oncology (IO) is a big part if IR nowadays. There are some IRs who devote their entire practice to IO and perform procedures like radioembolization, chemoembolization, microwave ablation, cryoablation, etc.

Will be exploring this one too! Though I think I would also want to be able to be able to prescribe chemo/immunotherapy like Gyn Onc... do radiologists prescribe drugs? Even Interventional ones?

 

[ThoracicGuy]

Will be exploring this one too! Though I think I would also want to be able to be able to prescribe chemo/immunotherapy like Gyn Onc... do radiologists prescribe drugs? Even Interventional ones?

No. And unless you are in a specialized center, as an IR doc you'd be unlikely to only do oncologic type procedures.

 

[CTFellowMD]

Depends on your practice environment. None of our local hospitals require GS call anymore for sub specialists; you can take it if you want, but there are enough GS practitioners who want it, that its generally not a problem, We don't have a lot of PP Surgical Oncologists here but those we do have don't seem to be doing much true general surgery.

I do think it would be hard, outside of academics, to come out into PP and be "the melanoma guy" or "the thyroid guy" and make a living.

That's actually good to hear (for the sake of some of my friends). It's definitely region and hospital specific, but I know several people who have been disappointed with their first attending jobs after surg onc fellowship due to the amount of "basic" gen surg required.

I guess my point for the op is that Surgical Oncology is a general surgery speciality. You are not an Oncologist that sometimes also operates. Heme/onc and Surg onc are extremely different, so choosing Surg Onc if you don't love (or at least enjoy) general surgery as a whole is a bad idea.

 

[Fab5Hill33]

While it's true you're unlikely to do only oncology procedures at a non-academic center, interventional oncology can be a significant component of your IR practice. If you want to do invasive procedures, opportunity to treat cancer patients, and a balanced lifestyle it's worth considering. It's not surgery, but it's also much more procedurally involved than anything in med-onc or rad-onc.

FWIW, I'm in private practice and I prescribe/order chemo agents for my chemoembolization procedures, and I order yttrium-90 for my radioembolization procedures. I attend weekly tumor board and work closely with the surgeons, oncologists, and radiation oncologists in planning therapy for our patients.

No. And unless you are in a specialized center, as an IR doc you'd be unlikely to only do oncologic type procedures.

 

[ThoracicGuy]

While it's true you're unlikely to do only oncology procedures at a non-academic center, interventional oncology can be a significant component of your IR practice. If you want to do invasive procedures, opportunity to treat cancer patients, and a balanced lifestyle it's worth considering. It's not surgery, but it's also much more procedurally involved than anything in med-onc or rad-onc.

FWIW, I'm in private practice and I prescribe/order chemo agents for my chemoembolization procedures, and I order yttrium-90 for my radioembolization procedures. I attend weekly tumor board and work closely with the surgeons, oncologists, and radiation oncologists in planning therapy for our patients.

Sure, you order the agents you use during the procedure, but you aren't managing ongoing chemotherapy like Medical Oncology.

 

[MediCane2006]

I echo the comments of those who just think these two fields are so WILDLY different I can't imaging being torn between them once the OP actually does rotations.

I loved both my medicine and surgery rotations. On medicine, I enjoyed the challenge of putting together diagnoses on medicine...and I got along reasonably well with the majority of the residents. I like the intellectual challenge of studying all the obscure differential diagnoses for rounds. Rounds overall, though, SUCKED. The procedures were awful (paracentesis? gross). And I always felt like I was drowning in the futility of it all.

On surgery, I was OBSESSED. I crammed anatomy like crazy before cases, because there was this intense pressure to know the answer on the rare occasion that the attending actually acknowledged you and asked you a question. I figured out the rounds hierarchy quick, and making sure my intern was prepped for morning rounds with all the info got me out of bed even on mornings I wanted to sleep in. I would find myself hanging around the trauma bay even after my day was done, hoping a big trauma would come in (or one of the trauma residents would be bored and offer to teach me a procedure). Even though overnight call sucked, I always felt like I was a fellow soldier with the residents who were also going sleep-deprived to do complex cases in the middle of the night (and I credit my surgery residents in that they always made me feel included, even in the middle of a late-night trauma). Reading/studying never felt like work because I was so excited to know the answer in a case.

I say all this not to say that I was some kind of surgical protege (I wasn't), but that when you actually rotate through these specialties, if you like surgery you will KNOW IT. And that will carry you through the years of misery that it takes to make a surgeon. If you like oncology patients and think you'll miss the OR, you will do medicine and you will never, ever look back.

 

[dr zaius]

While it's true you're unlikely to do only oncology procedures at a non-academic center, interventional oncology can be a significant component of your IR practice. If you want to do invasive procedures, opportunity to treat cancer patients, and a balanced lifestyle it's worth considering. It's not surgery, but it's also much more procedurally involved than anything in med-onc or rad-onc.

FWIW, I'm in private practice and I prescribe/order chemo agents for my chemoembolization procedures, and I order yttrium-90 for my radioembolization procedures. I attend weekly tumor board and work closely with the surgeons, oncologists, and radiation oncologists in planning therapy for our patients.

And you certainly aren't admitting them when they come in with a complication.

 

[Fab5Hill33]

I admit my own patients when there are issues with any of my procedures. Not sure why you think I wouldn't. Patients with severe post-embo syndrome, bleeding complications, etc. I admit all of them.

 

[deleted547339]

I admit my own patients when there are issues with any of my procedures. Not sure why you think I wouldn't. Patients with severe post-embo syndrome, bleeding complications, etc. I admit all of them.

Can't tell if you're serious....

The last conversation I had with IR was explaining that I don't need a CBC to diagnose hemorrhagic shock. The massive transfusion protocol activation was enough for me to think the patient needed embolization.....

 

[LucidSplash]

I admit my own patients when there are issues with any of my procedures. Not sure why you think I wouldn't. Patients with severe post-embo syndrome, bleeding complications, etc. I admit all of them.

If you do, I applaud that. But I have to say that is the first time I have ever heard of IR admitting a patient in any hospital I've worked at and I suspect others here have the same experience. Additionally most of us have had the pleasure of managing complications from IR procedures when IR can't/won't.

 

[Winged Scapula]

When I was in training, IR would "admit" their patients when there was a post procedure complication and in some cases, prior to procedures.

Our issue was that no radiologist had enough recent inpatient experience (only internship) to know how to manage patients. Even simple things like patients diet, activity orders, putting them on home meds seemed to be forgotten; since either IM or surgery would be consulted (usually at the request of the nursing staff), it seemed a heck of a lot easier for them just to be on our service since we would have to double and triple check their orders. Current residents here tell me its no different now.

So let's clarify the difference between "admit" and "manage".

 

[deleted547339]

When I was in training, IR would "admit" their patients when there was a post procedure complication and in some cases, prior to procedures.

Our issue was that no radiologist had enough recent inpatient experience (only internship) to know how to manage patients. Even simple things like patients diet, activity orders, putting them on home meds seemed to be forgotten; since either IM or surgery would be consulted (usually at the request of the nursing staff), it seemed a heck of a lot easier for them just to be on our service since we would have to double and triple check their orders. Current residents here tell me its no different now.

So let's clarify the difference between "admit" and "manage".

Yea. I'm pretty sure that IR can admit where I'm a fellow. But that just seems crazy to me. I respect radiologists for what they do, but they only did 1 year of clinical medicine.

 

[Winged Scapula]

Yea. I'm pretty sure that IR can admit where I'm a fellow. But that just seems crazy to me. I respect radiologists for what they do, but they only did 1 year of clinical medicine.

I believe that's the issue that everyone has.

No one is disrespecting radiologists but we all remember how clueless we were as interns, and to admit and manage med-surg issues without the training (or anyone senior with it ) seems ridiculous.

 

[Light at end of tunnel]

Dang y'all, why y'all beatin up on Radiology.

Show some love.

 

[Fab5Hill33]

A large proportion of any IR practice is based on managing surgical complications. Whether it's postop abscess drainage, ureteral or biliary ductal injury, postop thromboembolic disease, internal bleeding postop, etc. I bail out my surgical colleagues multiple times a day.

You might want to think twice before criticizing the colleagues who bail you out. If you've been around the block, you know damn well it does goes both ways.

For the record, I contributed to this thread only to offer a possible solution to the med-onc vs surg-onc career debate. Not to disparage surgery.

If you do, I applaud that. But I have to say that is the first time I have ever heard of IR admitting a patient in any hospital I've worked at and I suspect others here have the same experience. Additionally most of us have had the pleasure of managing complications from IR procedures when IR can't/won't.

 

[LucidSplash]

Dang y'all, why y'all beatin up on Radiology.

Show some love.

Look I'm getting a little annoyed with you. You're a medical student and you should really be doing more listening than talking at this point in your career, both IRL and in the surgery-specific forum.

No one is "beating up" on radiology. But radiology doesn't admit or know how to take care of patients. No one is casting shade on them for that. It's just a fact of life. And IR at most places frequently doesn't manage their own complications. That's a little more divisive as you can imagine.

 

[Fab5Hill33]

Let's be frank, even surgery will very commonly consult medicine to manage insulin orders and other "medical issues." As well they should. They have bigger issues to deal with. And so do other specialties (like IR).

Moreover, you don't need a surgical training to manage simple admission orders. Hospitalists, physician assistants and nurse practitioners regularly take on this role in many practices. My residents do the same.

So to clarify, yes we both admit and manage our patients in IR.

When I was in training, IR would "admit" their patients when there was a post procedure complication and in some cases, prior to procedures.

Our issue was that no radiologist had enough recent inpatient experience (only internship) to know how to manage patients. Even simple things like patients diet, activity orders, putting them on home meds seemed to be forgotten; since either IM or surgery would be consulted (usually at the request of the nursing staff), it seemed a heck of a lot easier for them just to be on our service since we would have to double and triple check their orders. Current residents here tell me its no different now.

So let's clarify the difference between "admit" and "manage".

 

[LucidSplash]

A large proportion of any IR practice is based on managing surgical complications. Whether it's postop abscess drainage, ureteral or biliary ductal injury, postop thromboembolic disease, internal bleeding postop, etc. I bail out my surgical colleagues multiple times a day.

You might want to think twice before criticizing the colleagues who bail you out. If you've been around the block, you know damn well it does goes both ways.

For the record, I contributed to this thread only to offer a possible solution to the med-onc vs surg-onc career debate. Not to disparage surgery.

I'm not being critical, I'm simply describing practice as I have witnessed it. Again, I applauded you for managing your patients as you say you do. I wasn't being sarcastic. I think of IR as colleagues and most times we work quite collegeally for the benefit of the patients. But we have all had situations where IR burns us by refusing to manage things they are able to manage, mostly because of time of night. When I've asked IR to help it's because it's for the benefit of the patient, better than an open surgery. I don't mind working together with IR when that is not the case and if you're an IR doc who manages their own complications when it's in the best interest of the patient for you to do so, then you have my respect. But to pretend you have colleagues who don't do that is ridiculous.

 

[Winged Scapula]

Let's be frank, even surgery will very commonly consult medicine to manage insulin orders and other "medical issues." As well they should. They have bigger issues to deal with. And so do other specialties (like IR).

Moreover, you don't need a surgical training to manage simple admission orders. Hospitalists, physician assistants and nurse practitioners regularly take on this role in many practices. My residents do the same.

So to clarify, yes we both admit and manage our patients in IR.

Please be assured that not all of your IR colleagues know how nor deign to manage "medical issues" and very very many GS programs and physicians do their own. While you and your residents may do so and feel confident that you are doing it well, there are many others who do not and patients are potentially endangered.

Let's get back to the OP's question which is med one vs surg onc.

 

[Fab5Hill33]

Med student or not, your response was way out of proportion to his comment. You may want to take a step back and cool down.

Not to mention that your facts are incorrect.

Look I'm getting a little annoyed with you. You're a medical student and you should really be doing more listening than taking at this point in your career, both IRL and in the surgery-specific forum.

No one is "beating up" on radiology. But radiology doesn't admit or know how to take care of patients. No one is casting shade on them for that. It's just a fact of life. And IR at most places frequently doesn't manage their own complications. That's a little more divisive as you can imagine.

 

[LucidSplash]

Med student or not, your response was way out of proportion to his comment. You may want to take a step back and cool down.

Not to mention that your facts are incorrect.

My response was in proportion to the sum total of that individuals posts over the recent weeks. If it was one comment, I would agree with you. But that is not the case.

And I do happen to believe my facts are correct. This is a surgery forum and discussing things that are common experiences among surgeons isn't "beating up" on anyone. The dialogue here regarding IR has been pretty respectful.

 

[Light at end of tunnel]

Look I'm getting a little annoyed with you. You're a medical student and you should really be doing more listening than talking at this point in your career, both IRL and in the surgery-specific forum.

No one is "beating up" on radiology. But radiology doesn't admit or know how to take care of patients. No one is casting shade on them for that. It's just a fact of life. And IR at most places frequently doesn't manage their own complications. That's a little more divisive as you can imagine.

Well, you're welcome to ignore my comments. It's your right to be annoyed, but its also my right to continue to offer my input.

 

[LucidSplash]

Well, you're welcome to ignore my comments. It's your right to be annoyed, but its also my right to continue to offer my input.

Its your choice. But your comments haven't really contributed much to the conversation because you have little experience in the areas you are commenting on. And the comments themselves are more "peanut gallery" type rather than substantive. There are Med students who post here who are taken seriously by the regular surgery members because they heed the adage of two ears/one mouth use proportionally. You may do as you wish, but you're not likely to get the reception you want.

And if you want to discuss that more you're welcome to PM me. I'll heed WS request to get back to the original topic of the thread.

 

[Fab5Hill33]

I understand your frustration. And I will admit there are some bad "old-school" IRs out there that aren't living up to the current standard. But you also have to understand that lazy doctors exist in all specialties, and it's not fair to generalize.

As good as the surgeons are where I work, I can name numerous instances where I've been asked to perform a procedure because the patient "is not a surgical candidate," which is oftentimes code for "I don't want to touch this trainwreck." So, it goes both ways.

I'm not being critical, I'm simply describing practice as I have witnessed it. Again, I applauded you for managing your patients as you say you do. I wasn't being sarcastic. I think of IR as colleagues and most times we work quite collegeally for the benefit of the patients. But we have all had situations where IR burns us by refusing to manage things they are able to manage, mostly because of time of night. When I've asked IR to help it's because it's for the benefit of the patient, better than an open surgery. I don't mind working together with IR when that is not the case and if you're an IR doc who manages their own complications when it's in the best interest of the patient for you to do so, then you have my respect. But to pretend you have colleagues who don't do that is ridiculous.