I've been in practice less than 10 years and have a job I really like and I make good money in a city I find to be desirable enough.
Still, I feel like my expectations (informed almost solely by my academic department) as a 3rd year med student committing to go all in on rad onc have largely been unmet. I fully expected to be making high 6 figures and to provide a highly in-demand service to patients. The first ASTRO I attended was incredible. Lavish parties everywhere. Industry people bending over backward to get in your good graces. Job hunting residents were being sought out, seemingly by everyone. All the academic types looked happy. The dream-like promises seemed to check out. The reality today... ain't quite that. No regrets whatsoever, but another halving of reality vs expectations would be a tough pill to swallow.
I agree with this right here. There was unrealistic expectations, partially on our side thinking "we are top medical students going into one of the most difficult residencies [at that time] and we will be respected by all our colleagues." Eh wrong! We respect those in our field, but those outside, especially from the old school days do not.
Hear me out though... is it undeserved? In medicine, we are grouped by what we can do.
Do we do inpatient medicine? No
Are we good at managing basic medical problems (CV triage, electrolyte problems, ID stuff, etc)? No
Do we work weekends, night floats, or daily morning rounds? No
What we do is kill cancer with radiation, understand oncology, and run clinical trials. Unfortunately, we have medical oncology, surgical oncology (including ENT, uro, etc.) colleagues who understand oncology and run clinical trials, but they also do inpatient medicine, general medicine, nights, call, weekends, etc.
In the field, we are unique by virtue of what we offer that no one else does. I try to talk med onc trials with some of my colleagues and I expect them to say naively "Oh, wow I'm impressed by your comprehensive knowledge about cancer." When I tell them we have chemo questions on our boards I expected "Wow, that is so impressive." But you know what I got? Some say "Why? We will take care of the chemo." Now that's not my whole experience, I've had other colleagues who appreciate rad oncs breadth of knowledge and I do get direct referrals from pulm (this took about 5 years, weekly lung tumor board, CT screening talks, etc.) but that had to be EARNED not on tests, but with real life interactions. We cannot rest on our med school laurels, we have to show we can produce.
My respect goes to Cliff Robinson doing cardiac ablation (giving new indications for XRT), David Raben (he worked at a drug company for a year and wants rad onc to start giving drugs), Drew Moghanaki (bringing SABR to the lung to the forefront and being a formidable force against surgeons), and of course Weichselbaum and Hellman for coming up with a new paradigm (oligomets).
Long story short: On another post I recommended a 6 year IM/Rad Onc residency.
[Edit: Although it would bring rad onc more respect to have IM certification. I understand that would wreck havoc on current rad oncs by possibly being out competed and more importantly, not sure medicine or society needs rad oncs who can do all that other stuff...]
. I think that's really the point of Ramses "I wish the place would burn down". When your chair tells you "We need some help at the satellite, you can make the 2 hour trek out there one day a week", you'd wish it would burn down too so you didn't spend 4h in a car every Tuesday
www.prnewswire.com
rbsevolution.com
) that the major deviation last year with the test was in the makeup of people that validate the questions. The gist of it is that when questions are added to the bank, there is a room of people who validate the questions and give a score to the question relating how easy/hard it is and whether they think it's in the scope that a radiation oncologist should know. Typically there is some low level of year-to-year turnover with that group (e.g. maybe 10% new people per year), but that year apparently it was an abnormally large turnover in the question validation core. So that's why the test changed so much apparently -- because so many new people were making the choice on what topics were appropriate and the level of detail needed to know. Anecdotally, I've heard that last year's test was more biased towards cancer bio than rad bio (?), which may reflect that radiation biology as a research/training field has contracted and there are WAAAAAY more general cancer biologists than radiation biologists.
