re-training and re-boarding into medonc ... worth it or even practical?

[FreakFlag]

had these crazy thoughts after a few drinks last night...

would it be worth re-training and re-boarding into medical oncology... for the opportunity of greater geographic mobility while still pursuing the mission of fighting cancer?

would I have to retake Step 1, 2CK, 2CS, 3? what about the perfunctory med school dean's letter? my guess is that my dean's letter from last decade is outdated and would not be accepted.

if I matched into IM, could I start as a PGY-2... or would I need to repeat internship?

and to top it all off, is it statistically easier these days to match into radonc vs a well-regarded IM residency?


alas, the linac is my ball and chain...

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[xrt123]

You would start as a PGY2. The best thing to do is get a radonc job associated with a MedOnC group now and have them start a fellowship. PGY2 and 3 is all you need and then you could start practice as fellow. If you ignore hematology then you will have enough cancer knowledge for the clinical practice as a fellow except for leukemia. The PGY 2 and 3 is more than enough to get the IM background to handle the medical issues. It is an easy path and if you are real good you may be head of the FDA one day. Good luck!

 

[FreakFlag]

xrt123, very helpful post, wow. if I were still a PGY-5 right now looking for employment, i would seriously consider adding "PGY-2 IM residency" to my list of job prospects. other countries have "clinical oncologists" who are trained to give both radiation and systemic therapy.

so if no good radonc jobs as PGY-5, then reincarnating as a medicine PGY-2 surrounded by awesome co-residents in a cool city sounds way better than being banished to the land of no biryani a la "linac is my ball and chain." studying for radonc orals during a medicine PGY-2 might be challenging, but maybe some mutant novel COVID-21 ends up canceling oral boards that year anyway.

to top it all off, passing radonc MOC would be a piece of cake while studying for medonc boards.

 

[RadOncDoc21]

Not all places will consider your intern year as a true pgy1 position and you may have to repeat that year depending on the IM program.

 

[DoctwoB]

To me it sounds like leadership needs to appeal to the board of medical oncology. There is no law that one has to be boarded in medicine to be boarded in onc. Look at CCM, where you can enter from IM, EM, surgery, or anesthesia. Or pain medicine. Or hand surgery. Or sleep medicine. And so on. But it would require the blessing of the board and likely a separate pathway, (maybe 2 year fellowship with one year more medicine heavy and one more onc chemo heavy)

 

[Bearstronaut]

Pretty sure TYs aren't counted as PGY-1 for IM?

 

[StIGMA]

This is a reason to consider a real prelim medicine year, especially if done at a place with a legit medicine program

 

[FreakFlag]

This is a reason to consider a real prelim medicine year, especially if done at a place with a legit medicine program

solid strategy! wonder if we'll start seeing more MS-4s applying for prelim medicine PGY-1 spots for the 2021 match.

 

[medgator]

solid strategy! wonder if we'll start seeing more MS-4s applying for prelim medicine PGY-1 spots for the 2021 match.

Agree. Transitional is useless, so is a surgery internship in most cases

 

[scarbrtj]

Agree. Transitional is useless, so is a surgery internship in most cases

"Useless," real world practically, I agree. However, I did a surg internship. To this day, it was incredibly clinically helpful. Seeing APRs, LARs, lobectomies, prostatectomies, rotating in plastics, and... surg onc. I use that one isolated year at least a time or two each week. But this is romanticism. Do the straight medicine year!

 

[Ray D. Ayshun]

Transitional years are totally useless. Kinda like vacations are useless. Both, though, are more useful than talking about retraining as a med onc.

 

[medgator]

"Useless," real world practically, I agree. However, I did a surg internship. To this day, it was incredibly clinically helpful. Seeing APRs, LARs, lobectomies, prostatectomies, rotating in plastics, and... surg onc. I use that one isolated year at least a time or two each week. But this is romanticism. Do the straight medicine year!

You had a good year. A lot of prelim surgical interns never see an OR....

 

[drewdog1973]

If there is a way to petition for a fellowship somehow, that would be ideal. When you think about it, hem-onc is 1 year hem, 1 year onc, 1 year research. Say they can let you do an intensive inpatient medicine year + 1 year medical oncology (since a radiation oncologist would know fundamental oncologic principles).

This is all just fantasy, though.. not gonna happen.

 

[medgator]

If there is a way to petition for a fellowship somehow, that would be ideal. When you think about it, hem-onc is 1 year hem, 1 year onc, 1 year research. Say they can let you do an intensive inpatient medicine year + 1 year medical oncology (since a radiation oncologist would know fundamental oncologic principles).

This is all just fantasy, though.. not gonna happen.

Med onc starting to get as saturated as rad onc in certain locales with an increased reliance on mid-levels to help run things/supervise chemo etc

 

[elementaryschooleconomics]

When you think about it, hem-onc is 1 year hem, 1 year onc, 1 year research.

Once I found out about the actual structure of Heme/Onc fellowships, I was shocked. They get so little actual Oncology training compared to us (there are some programs that are 18 months clinical/18 months research as well).

In a specialty which allows the Holman pathway and requires an intern year, we have a ton of wasted potential. There is absolutely no reason there can't be a combined RadOnc/MedOnc pathway right now. You could Match into it straight out of med school:

1 intern year of general Internal Medicine (already exists, most of us do it anyway - TY/GenSurg/etc not allowed)
Holman-structured RadOnc (21 months elective, 27 months RadOnc)
In the elective time, something like 10 months general IM/11 months MedOnc

Culminating in ability to be board certified in RadOnc and Medical Oncology (Benign Heme not allowed)

I did a true IM intern year, and the majority of that time was on inpatient wards. My co-interns and I did the math: by the end of our intern year, we had comparable inpatient ward experience to mid-to-late year PGY2 medicine residents because of their outpatient and elective rotations. In studying for boards, I'm already spending a ton of energy and effort memorizing, down to the dose, chemo regimens and their side effects. I'm also expected to know workup and staging, even though I don't get to do it most of the time. While I'm expected to know basically all of Oncology for my own board certification, I'm not allowed to prescribe chemo/immunotherapy. On what planet does that make sense?

This will obviously never happen in my lifetime, so this is literally me daydreaming out loud. These walls we've erected in medicine are absurd - mostly time-based metrics, not merit-based. This was not always the case - even into the 90s people were graduating medical school early to start intern year (recognizing fluff/wasted time), and even this year some schools graduated kids early to help with COVID.

There's so much possibility that exists within the structure of the system we already have - we're just not able to utilize it.

 

[scarbrtj]

While I'm expected to know basically all of Oncology for my own board certification, I'm not allowed to prescribe chemo/immunotherapy. On what planet does that make sense?

The best argument.

 

[elementaryschooleconomics]

The best argument.

 

[randomname2018]

If I were a current PGY 2 or 3, I'd strongly consider transitioning out of Radiation Oncology entirely. If a PGY 4 or 5, I would be looking into other residencies in addition to the job market. Rad onc fellowships offer nothing beneficial as some have specifically stated you will not be hired after completion. In Rad Onc there is no plan B.

 

[blue.jay]

Medonc and radiotherapy is integrated in the UK, the way it should be.

Clinical oncology curriculum

Access the curricula documents and training pathways for clinical oncology.

www.gmc-uk.org

 

[blue.jay]

Med onc starting to get as saturated as rad onc in certain locales with an increased reliance on mid-levels to help run things/supervise chemo etc

Is it so @gutonc ? I often hear Hem-Onc peeps rave about their job market

 

[radiation]

had these crazy thoughts after a few drinks last night...

would it be worth re-training and re-boarding into medical oncology... for the opportunity of greater geographic mobility while still pursuing the mission of fighting cancer?

would I have to retake Step 1, 2CK, 2CS, 3? what about the perfunctory med school dean's letter? my guess is that my dean's letter from last decade is outdated and would not be accepted.

if I matched into IM, could I start as a PGY-2... or would I need to repeat internship?

and to top it all off, is it statistically easier these days to match into radonc vs a well-regarded IM residency?


alas, the linac is my ball and chain...

Steve Hahn and Ted Lawrence did med onc and rad onc training and both ended up doing rad onc. Don't know if any examples of the other way around, but would be interesting to hear their experiences with it

 

[sallyhasanidea]

Med onc starting to get as saturated as rad onc in certain locales with an increased reliance on mid-levels to help run things/supervise chemo etc

Can you expand more on this?

 

[medgator]

Can you expand more on this?

Not much more to expand on. In my area of practice, some of the med onc groups have stopped hiring new physicians and have been hiring NPs/extenders

 

[elementaryschooleconomics]

Not much more to expand on. In my area of practice, some of the med onc groups have stopped hiring new physicians and have been hiring NPs/extenders

It's all just a race to the bottom - we train too many residents, other fields have to contend with APPs...only the surgeons are safe...for now!

 

[whoknows2012]

Med onc starting to get as saturated as rad onc in certain locales with an increased reliance on mid-levels to help run things/supervise chemo etc

This statement is backed by zero evidence, sorry.

 

[whoknows2012]

Is it so @gutonc ? I often hear Hem-Onc peeps rave about their job market

Besides covid which put a little pressure on practices and hospital systems the job market has been pretty solid. Not sure where people in this thread are getting their information. I just went through the interviewing process in maybe the most competitive market in the country and while there weren’t 17 different lymphoma positions there was no shortage of good gigs (and high paying to boot)

 

[medgator]

This statement is backed by zero evidence, sorry.

Depends on where you are looking, hospital jobs are easier to find, but it's absolutely harder to find good PP partnership track jobs in certain competitive sunbelt locales, and there is definitely a shift to using more mid-levels in busy practices.

Think Texas oncology or FCS in Florida. Lately FCS has been looking for heme onc hospitalists

 

[whoknows2012]

Depends on where you are looking, hospital jobs are easier to find, but it's absolutely harder to find good PP partnership track jobs in certain competitive sunbelt locales, and there is definitely a shift to using more mid-levels in busy practices

I’m just telling you, I interviewed in one of the most competitive job markets in the country this year (Jan feb 2020) and the jobs were plentiful. To generalize on my end would be wrong except that I have direct experience of actually interviewing, talking with my colleagues from both in state and out, and actually being an oncologist.
To generalize that the market (that let’s be honest you don’t actually have any idea about) is bad because in some “competitive sunbelt locales” you’ve heard there were changes in hiring is disingenuous at best

in fairness you did qualify after the first statement that you were referring to your area of work but, come on, do you truly believe you know how the job market is for a field you don’t practice in bc of the experience you had in your limited geographical area?

 

[medgator]

I’m just telling you, I interviewed in one of the most competitive job markets in the country this year (Jan feb 2020) and the jobs were plentiful. To generalize on my end would be wrong except that I have direct experience of actually interviewing, talking with my colleagues from both in state and out, and actually being an oncologist.
To generalize that the market (that let’s be honest you don’t actually have any idea about) is bad because in some “competitive sunbelt locales” you’ve heard there were changes in hiring is disingenuous at best

in fairness you did qualify after the first statement that you were referring to your area of work but, come on, do you truly believe you know how the job market is for a field you don’t practice in bc of the experience you had in your limited geographical area?

Ok bro, have fun in Oklahoma. Yes we in rad Onc never talk to or interact with med oncs 🤣🤣

 

[whoknows2012]

Ok bro, have fun in Oklahoma. Yes we in rad Onc never talk to or interact with med oncs 🤣🤣

Will do!

 

[Ray D. Ayshun]

I’m just telling you, I interviewed in one of the most competitive job markets in the country this year (Jan feb 2020) and the jobs were plentiful. To generalize on my end would be wrong except that I have direct experience of actually interviewing, talking with my colleagues from both in state and out, and actually being an oncologist.
To generalize that the market (that let’s be honest you don’t actually have any idea about) is bad because in some “competitive sunbelt locales” you’ve heard there were changes in hiring is disingenuous at best

in fairness you did qualify after the first statement that you were referring to your area of work but, come on, do you truly believe you know how the job market is for a field you don’t practice in bc of the experience you had in your limited geographical area?

medgator specified in the first post as well

 

[whoknows2012]

medgator specified in the first post as well

Ah ok in that case, forget my whole post! 🤦‍♂️
( obviously being sarcastic, my comments are just as relevant despite missing three words in the first post)

is the job market that bad for rad Onc?

 

[medgator]

Ah ok in that case, forget my whole post! 🤦‍♂️

is the job market that bad for rad Onc?

Doubling residency slots and while simultaneously reducing radiation fractions/courses isn't good for a job market. More convenient and less costly radiation is absolutely better for society though

 

[Ray D. Ayshun]

Ah ok in that case, forget my whole post! 🤦‍♂️

is the job market that bad for rad Onc?

Yes, as bad as medonc in certain locales, I hear.

If you're worried about us fronting on med onc, read how every thread where a medstudent asks what to do, the response is, medonc.

 

[whoknows2012]

Yes, as bad as medonc in certain locales, I hear.

👏

 

[Chartreuse Wombat]

Since we are oversimplifying...simple thought experiment..

The indications for medical oncology "interventions" relative to radiation oncology "interventions" in the last 5 years...

Increased, decreased?

If you must care for oncology patients (which is enormously rewarding)....choose wisely

 

[RadOncDoc21]

Since we are oversimplifying...simple thought experiment..

The indications for medical oncology "interventions" relative to radiation oncology "interventions" in the last 5 years...

Increased, decreased?

If you must care for oncology patients (which is enormously rewarding)....choose wisely

I feel like a used car salesman in my tumor boards.

 

[elementaryschooleconomics]

I feel like a used car salesman in my tumor boards.

 

[xrt123]

Ah ok in that case, forget my whole post! 🤦‍♂️
( obviously being sarcastic, my comments are just as relevant despite missing three words in the first post)

is the job market that bad for rad Onc?

Did you get offers for technical buy in? If so then its not as bad as I thought. Many of us live in CON or COPN states where you have no option to set up practice and state governments dictate where and when radiation therapy is given. Many of the surveys assess salaries at the low end at the time of graduation and never take into account ownership of practice. The drop in technical ownership amongst radoncs is not clearly discussed anywhere but has a relatively dramatic effect on the job market but also your job stability and power to take care of patients. Food for thought.

 

[whoknows2012]

Did you get offers for technical buy in? If so then its not as bad as I thought. Many of us live in CON or COPN states where you have no option to set up practice and state governments dictate where and when radiation therapy is given. Many of the surveys assess salaries at the low end at the time of graduation and never take into account ownership of practice. The drop in technical ownership amongst radoncs is not clearly discussed anywhere but has a relatively dramatic effect on the job market but also your job stability and power to take care of patients. Food for thought.

the offer I had for partner was 3 years (quite a substantial salary, ~425k) then buy in 2 yrs if interested in partner track) salary lessened for those two years obviously) then full partner track salary thereafter

 

[xrt123]

Sweet, sign that and by the time you are a partner you can hire salary only Radoncs in 5 years to do the keep those linacs humming.

 

[whoknows2012]

Sweet, sign that and by the time you are a partner you can hire salary only Radoncs in 5 years to do the keep those linacs humming.

Haha I took the nearly 50% reduced academic salary. 🤷‍♂️

 

[Neuronix]

I only ever found $250k-$350k starting with a max potential in the $450k range private or academics in rad onc after a national search. Given no pay cut I just went into academics .

At least I managed to finagle my way into some reasonable protected time after a lot of after hours/weekend/vacation research work. Dunno if it will last. Didn't get my region of choice, and probably never will, but at least I'm not rural nowhere I guess.

 

[RadOncDoc21]

I only ever found $250k-$350k starting with a max potential in the $450k range private or academics in rad onc after a national search. Given no pay cut I just went into academics . At least I managed to finagle my way into some reasonable protected time after a lot of after hours/weekend/vacation research work. Dunno if it will last.

That sounds about right coming straight out of residency. I don’t know much more about the academic pathway but I was offered pretty much the same.

 

[Neuronix]

That sounds about right coming straight out of residency. I don’t know much more about the academic pathway but I was offered pretty much the same.

Conversely, the med onc fellows were getting $600k offers out of fellowship with their choice of location. They had recruiters and practices calling them starting their first year of fellowship. The fellowship programs in my area try to sign them on a year before they graduate to keep them out of the hands of private practice. I know people who left here and now make nearly or even over $1M/year in my urban area. Oh well, life ain't fair.

 

[StIGMA]

I only ever found $250k-$350k starting with a max potential in the $450k range private or academics in rad onc after a national search. Given no pay cut I just went into academics .

At least I managed to finagle my way into some reasonable protected time after a lot of after hours/weekend/vacation research work. Dunno if it will last. Didn't get my region of choice, and probably never will, but at least I'm not rural nowhere I guess.

I've seen starting offers at/close to that 'max potential' range at academic centers for new grads. I don't think it's typical but it's out there. MDACC starts near 390K base for instance.

My home institution is close to that... while they most recently hired heme/onc attendings as instructor at half what the new radonc faculty were offered. Really depends on current market, where you want to be, career goals. If you are inflexible in your goals/location things may be tough.

Those heme/onc numbers are nuts but I'm very doubtful that is sustainable.

 

[medgator]

Conversely, the med onc fellows were getting $600k offers out of fellowship with their choice of location. They had recruiters and practices calling them starting their first year of fellowship. The fellowship programs in my area try to sign them on a year before they graduate to keep them out of the hands of private practice. I know people who left here and now make nearly or even over $1M/year in my urban area. Oh well, life ain't fair.

Have seen that as well in the big independent heme onc groups with ancillary ownership. What's happening now is that they are hiring more extenders lately and less physicians.....

 

[Mandelin Rain]

I only ever found $250k-$350k starting with a max potential in the $450k range private or academics in rad onc after a national search. Given no pay cut I just went into academics .

Hmmm....

It depends where you look, but there are certainly non-academic jobs in the nation with higher reimbursement upside (probably 25-50% higher i.e. 600-700k). I think the days of million+ dollar technical ownership are close to over though.

 

[medgator]

Hmmm....

It depends where you look, but there are certainly non-academic jobs in the nation with higher reimbursement upside (probably 25-50% higher i.e. 600-700k). I think the days of million+ dollar technical ownership are close to over though.

Yup. Just stay away from competitive coastal markets (and maybe Austin and Atlanta).

 

[deleted941485]

To me it sounds like leadership needs to appeal to the board of medical oncology. There is no law that one has to be boarded in medicine to be boarded in onc. Look at CCM, where you can enter from IM, EM, surgery, or anesthesia. Or pain medicine. Or hand surgery. Or sleep medicine. And so on. But it would require the blessing of the board and likely a separate pathway, (maybe 2 year fellowship with one year more medicine heavy and one more onc chemo heavy)

Appeal? Try getting on their hands an knees and offering their dignity in exchange for the privilage of pushing 100-200K systemic agents. But I dont have an ego I'd do it if they offered a reasonable pathway for it. What does MedOnc get out of all this? Seriously if they are going to offer us a chance to learn their trade would it not be fair to at least allow them to learn ours? Do get me wrng I really think its a good idea but I mean our value propositon here is what exactly? We can talk about how this benefits patient blah blah blah...but why should a MedOnc board care?