Dual Certification in Nucs (pp marketability?)

[vernhart]

I've heard very mixed things on nuc med marketability (I know alone it's poor but I mean as dual cert in DR residency). Some say very marketable to DR pp groups and some say only good for academics.

If planning on still doing fellowship, will doing the 16 month dual certification pathway be worth it?

Greatest concerns are
1. whether pp groups actively look for and hire based on nuc sub-specialization and
2. whether the opportunity cost of a mini-fellowship/other electives is worth it

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[Dave1980]

nucs is not a useful fellowship. It's just not that hard to read nucs and it's a fairly rare modality.

mini fellowhsip in pet/ct would be useful

 

[guytakingboards]

nucs is not a useful fellowship. It's just not that hard to read nucs and it's a fairly rare modality.

mini fellowhsip in pet/ct would be useful

I work in a large sub-spec group and they've had as much trouble recruiting a nucs/general guy over the years as any other position. There just aren't a ton of people getting DR/NM training, much less going into PP.

NM is one of the faster evolving specialties right now and if medium to large PP groups want to offer the latest in radiotracers and theranostics, then they're gonna need a more recent grad familiar with all of it. Anecdotally my group has brought in 2 DR/NM guys in the last two years, one of which did the 16-mo pathway.

I think it depends on the size of PP group. DR/NM is likely not that useful for a smaller group where people need to be generalists.

 

[maxxor]

nucs is not a useful fellowship. It's just not that hard to read nucs and it's a fairly rare modality.

mini fellowhsip in pet/ct would be useful

Pet is considered a part of modern nucs training.

I’m dual boarded. The fellowship is marketable if they need someone to handle the operations side of the protocols or they want to set up a theragnostics program rather than cede it to RadOnc (Ga/Cu & Lu DOTA, or PSMA + Lu PSMA). Others will come. FES has been approved and perhaps FAPI will the new FDG.

The bigger problem is that unless the group is big enough, you often up in a position where the other members of the group think they are “good enough” at reading PET that they don’t need a nucs guy, or the Nucs guy keeps getting put on body / general rotations. Or they keep piling work on the nucs rotation because “they aren’t reading enough”.

Many of these have been my own person experience. I left that group after they tried to sell to PE and failed…

 

[SeisK]

Pet is considered a part of modern nucs training.

I’m dual boarded. The fellowship is marketable if they need someone to handle the operations side of the protocols or they want to set up a theragnostics program rather than cede it to RadOnc (Ga/Cu & Lu DOTA, or PSMA + Lu PSMA). Others will come. FES has been approved and perhaps FAPI will the new FDG.

The bigger problem is that unless the group is big enough, you often up in a position where the other members of the group think they are “good enough” at reading PET that they don’t need a nucs guy, or the Nucs guy keeps getting put on body / general rotations. Or they keep piling work on the nucs rotation because “they aren’t reading enough”.

Many of these have been my own person experience. I left that group after they tried to sell to PE and failed…

Are many groups ceding theranostics to radonc?

 

[maxxor]

Are many groups ceding theranostics to radonc?

I can only speak to my local area, but a decent number of RadOnc are trying everything they can to push into other areas cuz their job market is bad.

I know of a couple private RadOnc groups doing Xofigo. I know of one trying to start a Lutathera program. A lot will try to do Lu-PSMA when that becomes available.

 

[SeisK]

I can only speak to my local area, but a decent number of RadOnc are trying everything they can to push into other areas cuz their job market is bad.

I know of a couple private RadOnc groups doing Xofigo. I know of one trying to start a Lutathera program. A lot will try to do Lu-PSMA when that becomes available.

Nucs needs to advertise itself as “the handlers” of theranostics and to expand rapidly.

 

[Dave1980]

Why would anyone but med onc administer those radioactive drugs? I mean...they order it...it's like chemo only radioactive

 

[SeisK]

Why would anyone but med onc administer those radioactive drugs? I mean...they order it...it's like chemo only radioactive

There are imaging features under investigation as to who gets what and (soon) how much of it. This is dosimetry, It’s rooted in complex imaging features that a medonc isn’t really qualified to answer.

plus you have to have the facilities to handle it which a medonc clinic simply doesn’t have.
Authorization to administer the agents, etc.

 

[maxxor]

Why would anyone but med onc administer those radioactive drugs? I mean...they order it...it's like chemo only radioactive

I'm academic now, but we see all the patients in consult for enteral/parenteral radiotherapy referrals. It's not that different a model from IR or RadOnc.

Endocrine refers the Thyroid patients. We assess the living situation, make sure they can follow the radiation safety precautions, coordinate with the facility RSO (or serve as the RSO), explain the process, handle the NRC paperwork, and be the AU.

Similar process for Lutathera. We also help coordinate the actual administration. I've done lutathera in an outpatient infusion center and in a hospital room which is technically outpatient. You need space, shielding, an amino acid infusion, and other stuff. We are doing trials with role of post-treatment SPECT emissions to see if the dosing should change. We are also looking at Ac225 DOTA as potential next gen as its an alpha emitter.

Xofigo and Lu PSMA are less overhead complexity but similar eligibility stuff needs to be done.

 

[GadRads]

I'm academic now, but we see all the patients in consult for enteral/parenteral radiotherapy referrals. It's not that different a model from IR or RadOnc.

Endocrine refers the Thyroid patients. We assess the living situation, make sure they can follow the radiation safety precautions, coordinate with the facility RSO (or serve as the RSO), explain the process, handle the NRC paperwork, and be the AU.

Similar process for Lutathera. We also help coordinate the actual administration. I've done lutathera in an outpatient infusion center and in a hospital room which is technically outpatient. You need space, shielding, an amino acid infusion, and other stuff. We are doing trials with role of post-treatment SPECT emissions to see if the dosing should change. We are also looking at Ac225 DOTA as potential next gen as its an alpha emitter.

Xofigo and Lu PSMA are less overhead complexity but similar eligibility stuff needs to be done.

In your academic practice, do you do only nucs, or nucs and general radiology? Was the transition from private practice to academic radiology easily doable since you were applying outside of academia?

 

[maxxor]

In your academic practice, do you do only nucs, or nucs and general radiology? Was the transition from private practice to academic radiology easily doable since you were applying outside of academia?

In your academic practice, do you do only nucs, or nucs and general radiology? Was the transition from private practice to academic radiology easily doable since you were applying outside of academia?

Nucs only.

I moonlight for the community sites and read abdominal/msk outpatient stuff and ER work for extra money. I’ll do that probably until my loans are paid off.