Urology vs Rad onc. Your views please

[DrDranzer]

Hey guys. I wanted your opinion on deciding between these 2 awesome fields. Always wanted to do something surgical and cancer related (initially did research gearing my app towards surgical oncology). Discovered Urology in 3rd year. Loved it. A close family member is a big wig Rad Onc. Tells me to do Rad onc, can still have a life+do interventional rad onc procedures +still dealing with cancer patients with a surgical mindset. He stresses on the lifestyle part. But from what I gathered, Urology isn't as bad a lifestyle for a surgical field (thoughts on Uro vs Surg onc /MIS? ). I'd really appreciate your thoughts and views, I would need to change the direction of my research in medical school appropriately. I got a 262 on step 1, previous MPH in biostatistics. Basically I'm leaning towards Uro, but now that I know a Rad onc Bigwig is family and telling me to join their side and they would help with that path, it is clouding my judgement. I guess I'm getting a FOMO for Rad Onc. I think the field is great, especially if I can get to do interventional procedures as well. I'd like to know about both of them from a future job security perspective as well. And how does Urology compare to Surg Onc/MIS in terms of job prospects, patients and satisfaction, intellectual and technical stimulation. Thanks!

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[anonperson]

Hey guys. I wanted your opinion on deciding between these 2 awesome fields. Always wanted to do something surgical and cancer related (initially did research gearing my app towards surgical oncology). Discovered Urology in 3rd year. Loved it. A close family member is a big wig Rad Onc. Tells me to do Rad onc, can still have a life+do interventional radiology onc procedures +still dealing with cancer patients with a surgical mindset. He stresses on the lifestyle part. But from what I gathered, Urology isn't as bad a lifestyle for a surgical field (thoughts on Uro vs Surg onc /MIS? ). I'd really appreciate your thoughts and views, I would need to change the direction of my research in medical school appropriately. I got a 262 on step 1, previous MPH in biostatistics. Basically I'm leaning towards Uro, but now that I know a Rad onc Bigwig is family and telling me to join their side and they would help with that path, it is clouding my judgement. I guess I'm getting a FOMO for Rad Onc. I think the field is great, esp if I cns do interventional procedures as well. I'd like to know about both of them from a future job security perspective as well. Thanks!

Radiation oncology isn't surgery. It is procedural but not surgery. You have to make that distinction in your mind because there is a difference between doing a open cystectomy for invasive bladder cancer (highly morbid, time consuming surgery) versus doing/planning radiation therapy for cancers. If you enjoy time in the OR than do urology with a focus on oncology. If not, think about radiation oncology.

Urology is the better career bet hands down. There is a shortage of urologists and a large number are projected to retire in the next 10 years which will exacerbate the problem.

No mid level encroachment. No real turf battles etc.

Even in desirable areas like Southern California, residents are getting great job offers.

Rad onc job market is not great. You can check out their board here. There is an oversupply of residents which is only getting worse. Unless your family member can guarantee you a job, you have to think about this. Nothing worse than working your a$$ off for over a decade and to have trouble getting a job you like.

If you are dead set on urologic oncology, more and more residents are doing fellowships (1 to 2 years) for training in the big whacks etc. If you just want to do robotic prostates, that's also an option at some health systems.

Nice thing is you can go through residency and still have a huge amount of flexibility. If you want to do oncology, that option is there. If more benign stuff, that is there as well.

Compensation for urology is also very strong. Their salaries are consistently on the higher end.

 

[DrDranzer]

Yeah I did read about the awful job market but they didn't talk about that, all they said was if you have the scores and research, they can make the process of getting a residency quite easy. From a job perspective you've given a great description of both of the fields!
I worked hard to get my scores, have a good work ethic, am not a pain to be with and enjoy helping my hands to heal by intervening tangibly, I feel at home in the OR. Again Urology seems like a good fit. I've been suggested ENT as well, but really have no idea about the day to day. But somehow the draw of GS and Surgical Onc/GS-->CT-->Thoracic Onc is strong too cos of the complexity of the cases and being a "well rounded doc". I don't mind busting my butt in residency to learn the craft but would hope I have somewhat of a controllable schedule as an attending, with adequate time for vacation and family and not burning out with constant call. Any Surgeons out there wish to chime in? Paging the veterans @Winged Scapula @SouthernSurgeon @ThoracicGuy @cpants @neutropeniaboy @VisionaryTics @Pir8DeacDoc @surgonc2017
@SLUser11 @MediCane2006 @balaguru

 

[imnamerican]

Some background on my experiences: I did a few years of clinical research in urology prior to med school, rotated as a 3rd year, had a bunch of OR time, and shadowed a bunch. I've done a year's worth of research in med school for rad onc and also finished an elective.

I ruled out urology and moved towards rad onc specifically because I realized during med school that I actually don't like procedures. To call rad onc procedures "interventional" in my opinion is a bit generous; outside of brachytherapy, which is a very small part of rad onc, you're not using your hands anywhere near the level of a surgeon. For that reason, if this is important to you, urology is a better choice.

I would also argue that in evaluating the lifestyle argument, I would put more weight on the opinion of recent grads than established physicians. For those who graduated in rad onc 5-10 years ago, their job market was great. Excellent options around the country, excellent compensation for a mostly outpatient job with minimal call. Nowadays, the market is clearly tightening to the point where the important question isn't necessarily whether you'll get into residency (which won't be a problem for you), but whether you'll get a job you want in a place you love. If location is important to you, rad onc might not be the answer.

There are some distinct positives in rad onc that cannot be taken away. Job is 8-5 for 4-5 days a week, still very reasonable compensation, very little call and inpatient responsibilities, and the patient population is tremendously rewarding. I hate the OR, so urology wasn't for me. If you can find a job in a place you like, rad onc is great. That said, I submit that the argument for rad onc is not as obvious as it might have been 5 years ago.

 

[dr zaius]

Urology PGY-4 here.

The most important decision you have to make is do you want to be a surgeon or not. Urology is an actual surgical field, and radiation oncology is absolutely not. Rad onc is a fascinating field with lots of opportunity for research, but if your aim is to get your hands "dirty" you will probably not be satisfied. Based on talking to the residents here as well as my classmates that went rad onc I would believe their lifestyle is probably better than ours. I mean, it has to be...right? At most places they don't have admitting privileges and there are very few rad onc emergencies. It's a very cerebral field though, with lots of cool physics, developing models, planning radiation treatments, etc. I think if you're looking to operate you might be disappointed.

Urology resident lifestyle sucks at most places. Depending on the set up you will push/exceed duty hours most weeks. This isn't the case for any of the attendings at my program. They have a decent lifestyle, know their family, make it to most events. It makes the journey seem worth it, and they are generally happy with their career decision. You can treat a lot of cancer in urology, and there is also a lot of room for research in urologic oncology. If you are interested in being an oncologic surgeon urology is a good choice- if you're OK just dealing with the GU tract aside from occasionally resecting some ileum to use as a conduit or neobladder. If you want to do it all from colons to gastric cancer surg onc may be a better fit.

The big question is still surgery vs not surgery. If you absolutely must be in the OR go for urology.

 

[ThoracicGuy]

Yeah I did read about the awful job market but they didn't talk about that, all they said was if you have the scores and research, they can make the process of getting a residency quite easy. From a job perspective you've given a great description of both of the fields!
I worked hard to get my scores, have a good work ethic, am not a pain to be with and enjoy helping my hands to heal by intervening tangibly, I feel at home in the OR. Again Urology seems like a good fit. I've been suggested ENT as well, but really have no idea about the day to day. But somehow the draw of GS and Surgical Onc/GS-->CT-->Thoracic Onc is strong too cos of the complexity of the cases and being a "well rounded doc". I don't mind busting my butt in residency to learn the craft but would hope I have somewhat of a controllable schedule as an attending, with adequate time for vacation and family and not burning out with constant call. Any Surgeons out there wish to chime in? Paging the veterans @Winged Scapula @SouthernSurgeon @ThoracicGuy @cpants @badasshairday @armybound @neutropeniaboy @mimelim @VisionaryTics @Pir8DeacDoc @Surg Onc Matched!

It all depends on where you end up working. I looked for solely general thoracic jobs and when I was job hunting, they were hard to find. Most of them wanted at least some cardiac and I didn't want that. What's out there now? Maybe it's swung again to the general thoracic side. I do have time with my family and I'm not in the hospital continuously.

 

[bannie22]

definitely not surg onc/mis lol

 

[DrDranzer]

definitely not surg onc/mis lol

Would you mind elaborating a bit? Especially the day to day, surgical cases and patient population in Uro vs SurgOnc ? I'm wondering why the comparison made you LOL!

 

[ThoracicGuy]

Would you mind elaborating a bit? Especially the day to day, surgical cases and patient population in Uro vs SurgOnc ? I'm wondering why the comparison made you LOL!

I wouldn't put much into his "advice". It's usually suspect, but then he is just a pre-podiatrist...

 

[cpants]

A couple of thoughts. Young urology attending here.

1. A lot of rad onc's hate urologists or have very negative feelings toward them. This is multifactorial -- mainly because a lot of urologists have opened radiation centers taking away their business and because they feel that a lot of the patients that have prostate surgery should be having radiation instead. Urologists are the gatekeepers for prostate cancer, and they don't like that they control the flow of prostate business. Check out the rad onc forum for multiple examples of this hostility. With that in mind, you may want to take your family member's advice with a grain of salt.

2. I especially say that because the rad onc job market is horrendous. A friend of mine had to do a fellowship just to find a job in the state (not big city) he wanted to practice in. They are totally oversaturated. Urologists without fellowship are getting high paying offers in basically any city in the country. Sure you will have to sacrifice something if you want to work in Manhattan/Boston, but that will still be an option with or without fellowship. The market is very very good. Unless you have a clear path toward joining your family member's rad onc practice on partnership track, I would be very cautious in thinking his connections will open any doors for you.

3. These fields are extremely different from each other in terms of pathology, the actual day-to-day work, the type of patients you will treat, call, etc. I would spend some time with people from both fields and figure out which field you like better. What do you want your day-to-day to look like? Do you want to do something highly procedural? Are you OK with treating a whole spectrum of benign disease as well as cancer? We can't answer these questions for you.

 

[DrDranzer]

A couple of thoughts. Young urology attending here.

1. A lot of rad onc's hate urologists or have very negative feelings toward them. This is multifactorial -- mainly because a lot of urologists have opened radiation centers taking away their business and because they feel that a lot of the patients that have prostate surgery should be having radiation instead. Urologists are the gatekeepers for prostate cancer, and they don't like that they control the flow of prostate business. Check out the rad onc forum for multiple examples of this hostility. With that in mind, you may want to take your family member's advice with a grain of salt.

2. I especially say that because the rad onc job market is horrendous. A friend of mine had to do a fellowship just to find a job in the state (not big city) he wanted to practice in. They are totally oversaturated. Urologists without fellowship are getting high paying offers in basically any city in the country. Sure you will have to sacrifice something if you want to work in Manhattan/Boston, but that will still be an option with or without fellowship. The market is very very good. Unless you have a clear path toward joining your family member's rad onc practice on partnership track, I would be very cautious in thinking his connections will open any doors for you.

3. These fields are extremely different from each other in terms of pathology, the actual day-to-day work, the type of patients you will treat, call, etc. I would spend some time with people from both fields and figure out which field you like better. What do you want your day-to-day to look like? Do you want to do something highly procedural? Are you OK with treating a whole spectrum of benign disease as well as cancer? We can't answer these questions for you.

Makes perfect sense. I wasn't aware at all about the prostate ca dynamics and resulting animosity. As I had said earlier, I'm experiencing a FOMO. I know I'm surgically minded (am reasonably smart+ have good hand eye coordination+ still firmly believe in the concept of going into medicine for what matters most at the end of the day, helping people..) The $, lifestyle and all the small stuff will come as you go along and was never the primary purpose in my case). I see these brilliant kids gunning for Rad onc at my school and would give their right kidney for a spot (rightly so, with all the hard work we medical students put in). That's why I respect this forum for all these 'on site' perspectives from seasoned folks from the trenches.

 

[cpants]

Well, I'm not sure money and especially lifestyle are the small stuff. These are important factors you should consider when you are making your choice. I'm not a believer in picking your specialty purely based on gut feelings and clinical interest. Most of us could be satisfied doing several different fields in medicine that share certain common features.

There is almost no common ground between rad onc and urology, aside from treating prostate cancer patients as a small portion of your practice in either field. The fact that you are choosing between these two tells me you have not really spent enough time figuring out what it is you like and the factors that are important to you. If you were going between rad onc and med onc or between urology and ENT -- that would make a lot more sense.

 

[DrDranzer]

Now that you put it that way, I'm pretty sure I want to be in the OR and a surgeon with an interest in oncology Rad onc was purely a FOMO. I agree with what you wrote about how we could consider doing quite a few gigs in medicine especially after narrowing it down to surgical vs non surgical hence, lifestyle and compensation do become the important differentiators. On that note, how does Urology compare with Surgical Oncology and ENT? I know the path to Surg Onc would be more painful from a financial and time perspective, but I actually would not mind doing a General Surgery residency because as I've observed and been told, ANY surgical residency involves keeping your nose to the grindstone, for which I am ready. I do have a fair idea about the procedures involved in Uro, ENT, Surg Onc/Thoracic onc. But I would need your views on comparing them using the following variables: Lifestyle as an attending, patient outcomes (proportion of cancer can you actually cure, do the pathologies treated by surg onc inherently lend themselves to causing burnout compared to those by Uro/ENT?), overall attending morale, job prospects (already been educated about Uro on that) and compensation. Thanks again!

 

[ThoracicGuy]

Now that you put it that way, I'm pretty sure I want to be in the OR and a surgeon with an interest in oncology Rad onc was purely a FOMO. I agree with what you wrote about how we could consider doing quite a few gigs in medicine especially after narrowing it down to surgical vs non surgical hence, lifestyle and compensation do become the important differentiators. On that note, how does Urology compare with Surgical Oncology and ENT? I know the path to Surg Onc would be more painful from a financial and time perspective, but I actually would not mind doing a General Surgery residency because as I've observed and been told, ANY surgical residency involves keeping your nose to the grindstone, for which I am ready. I do have a fair idea about the procedures involved in Uro, ENT, Surg Onc/Thoracic onc. But I'd need your views on comparing them using the following variables: Lifestyle as an attending, patient outcomes (proportion of cancer can you actually cure, do the pathologies treated by surg onc inherently lend themselves to causing burnout compared to those by Uro/ENT), overall attending morale, job prospects (already been educated about Uro on that) and compensation. Thanks again!

Best lifestyle and patient outcomes is probably Urology. ENT is probably second.

 

[evilbooyaa]

Rad Onc resident here. If you want to do surgery, do Urology. If you don't, do Rad Onc, out of the two options you've mentioned.

The 'procedures' within Rad Onc are minimal. Essentially nothing involving a Bovie or a scalpel. Pretty much the most invasive we get is with needles. You can be a dedicated brachytherapy specialist, but it's going to be small OR procedures once in a while, without any big surgeries.

A couple of thoughts. Young urology attending here.

1. A lot of rad onc's hate urologists or have very negative feelings toward them. This is multifactorial -- mainly because a lot of urologists have opened radiation centers taking away their business and because they feel that a lot of the patients that have prostate surgery should be having radiation instead. Urologists are the gatekeepers for prostate cancer, and they don't like that they control the flow of prostate business. Check out the rad onc forum for multiple examples of this hostility. With that in mind, you may want to take your family member's advice with a grain of salt.

2. I especially say that because the rad onc job market is horrendous. A friend of mine had to do a fellowship just to find a job in the state (not big city) he wanted to practice in. They are totally oversaturated. Urologists without fellowship are getting high paying offers in basically any city in the country. Sure you will have to sacrifice something if you want to work in Manhattan/Boston, but that will still be an option with or without fellowship. The market is very very good. Unless you have a clear path toward joining your family member's rad onc practice on partnership track, I would be very cautious in thinking his connections will open any doors for you.

3. These fields are extremely different from each other in terms of pathology, the actual day-to-day work, the type of patients you will treat, call, etc. I would spend some time with people from both fields and figure out which field you like better. What do you want your day-to-day to look like? Do you want to do something highly procedural? Are you OK with treating a whole spectrum of benign disease as well as cancer? We can't answer these questions for you.

1. Urorads is, IMO, a frank violation of the Stark law that isn't being enforced. Referring your own patient for radiation at the center you own, in a climate where self-referral is deemed illegal. While at the same time, Rad Oncs don't seem to be able to even own the Linac anymore. I don't have any personal experience with these places, but it's a frustrating model from a Rad Onc perspective.

However, more than that, Rad oncs seem to feel that some Urologists, even in academic centers, but especially those out in the community, see prostate cancer as a nail, and robotic prostatectomy as a hammer. Sure, some of them are on active surveillance, but if the patient is getting treatment, then they're best off with a RALP. Even when the best predictors of SV invasion or ECE are incredibly high. Referral to Rad Onc for prostate cancer only as a secondary treatment in the medically inoperable. No multidisciplinary discussion about whether the patient with MRI evidence of ECE should really be put through a surgery or whether he should get RT +/- hormones. No discussion about the very real possibility of bimodal or trimodality treatment at some point if you start with RALP, so we see patients with cT3b disease at diagnosis, with positive margins on RALP, surprised that they're having PSA recurrence at 1 year out from surgery.



2. Fully agreed. The leaders of our field have 0 care about the future of the field across the country as the number of residency spots continues to expand with worsening job markets across the board. The issue with Rad Onc doesn't seem to be the residency anymore, but getting the attending job that you want. I'm sure most are still happy, but given the rise in crap, non-educational, Rad Onc 'fellowships' recently there are certainly people willing to fill them in bigger cities.

3. Agreed, as stated above.

 

[cpants]

Rad Onc resident here. If you want to do surgery, do Urology. If you don't, do Rad Onc, out of the two options you've mentioned.

The 'procedures' within Rad Onc are minimal. Essentially nothing involving a Bovie or a scalpel. Pretty much the most invasive we get is with needles. You can be a dedicated brachytherapy specialist, but it's going to be small OR procedures once in a while, without any big surgeries.



1. Urorads is, IMO, a frank violation of the Stark law that isn't being enforced. Referring your own patient for radiation at the center you own, in a climate where self-referral is deemed illegal. While at the same time, Rad Oncs don't seem to be able to even own the Linac anymore. I don't have any personal experience with these places, but it's a frustrating model from a Rad Onc perspective.

However, more than that, Rad oncs seem to feel that some Urologists, even in academic centers, but especially those out in the community, see prostate cancer as a nail, and robotic prostatectomy as a hammer. Sure, some of them are on active surveillance, but if the patient is getting treatment, then they're best off with a RALP. Even when the best predictors of SV invasion or ECE are incredibly high. Referral to Rad Onc for prostate cancer only as a secondary treatment in the medically inoperable. No multidisciplinary discussion about whether the patient with MRI evidence of ECE should really be put through a surgery or whether he should get RT +/- hormones. No discussion about the very real possibility of bimodal or trimodality treatment at some point if you start with RALP, so we see patients with cT3b disease at diagnosis, with positive margins on RALP, surprised that they're having PSA recurrence at 1 year out from surgery.



2. Fully agreed. The leaders of our field have 0 care about the future of the field across the country as the number of residency spots continues to expand with worsening job markets across the board. The issue with Rad Onc doesn't seem to be the residency anymore, but getting the attending job that you want. I'm sure most are still happy, but given the rise in crap, non-educational, Rad Onc 'fellowships' recently there are certainly people willing to fill them in bigger cities.

3. Agreed, as stated above.

Agree that there has been some bad behavior by urologists. Most of us don't practice that way, however. I also agree that it is ethically questionable to own and refer to your own radation center. Again, this scenario is the exception to the rule in urology. Most urologists do not own facilities like this, and in fact, we are as a field becoming increasingly hospital-employed. The clinical benefit of RALP is a discussion for another thread, but the tendency is for us to want to use our hammer and you to want to use your hammer. The problem for you is that we see all the nails before you do. That said, in my practice most newly diagnosed patients get AS, EBRT next most common, and RALP least common treatment. We do participate in multidisciplinary tumor boards and have a quite friendly relationship with the local radiation oncologists. You seeing the patients first just probably isn't going to happen ever, unless you start doing prostate biopsies, seeing elevated psa and prostate nodule consults (be careful what you wish for), and convince the primary care docs that you should be the point of care for elevated PSA (unlikely). Also, those who live in glass houses should not cast stones. There have been plenty of questionable practices in the rad onc world as well.

Hope the job market improves for you guys. Our shortage of urologists is just as manufactured as your excess of rad oncs is. The powers that be have kept residency slots to a minimum.

 

[evilbooyaa]

Agree that there has been some bad behavior by urologists. Most of us don't practice that way, however. I also agree that it is ethically questionable to own and refer to your own radation center. Again, this scenario is the exception to the rule in urology. Most urologists do not own facilities like this, and in fact, we are as a field becoming increasingly hospital-employed. The clinical benefit of RALP is a discussion for another thread, but the tendency is for us to want to use our hammer and you to want to use your hammer. The problem for you is that we see all the nails before you do. That said, in my practice most newly diagnosed patients get AS, EBRT next most common, and RALP least common treatment. We do participate in multidisciplinary tumor boards and have a quite friendly relationship with the local radiation oncologists. You seeing the patients first just probably isn't going to happen ever, unless you start doing prostate biopsies, seeing elevated psa and prostate nodule consults (be careful what you wish for), and convince the primary care docs that you should be the point of care for elevated PSA (unlikely). Also, those who live in glass houses should not cast stones. There have been plenty of questionable practices in the rad onc world as well.

I fully agree that there is some bad behavior by Rad Oncs as well. I didn't mean to paint all urologists with that broad brush. My issue is when the Urologist does the job of the Radiation Oncologist by discussing radiation. Closed door discussion that I would literally pay money to know what they say. No desire to see the patients first. I believe that a prostate cancer patient, if not going on active surveillance, should meet with a Urologist and Rad Onc prior to any definitive treatment. That is certainly not the case at my institution. I would send a stage I lung cancer for thoracic surgery consultation.

You're probably one of the reasonable ones, I'm just continually frustrated that the academic institution I am at has minimal reasonable discussion between Urology and Rad Onc about prostate cancer patients. Only patients who make it to RO for definitive treatment are those who Urology isn't comfortable operating on, or patients who have researched their own way online and demand a Rad Onc consult prior to surgery. I'm a resident so can't do a whole lot about it.

 

[dr zaius]

Everyone who is diagnosed in our clinic goes to the multi-disciplinary clinic with a urologic oncologist, radiation oncologist, uro andrologist (erectile dysfunction expert), and social worker. The patient meets with us independently and then we get together and discuss the patient towards the end of the day (yes, it's a day long process). It's a really good system that provides the patient with the information needed to make a decision they are comfortable with. We also talk to each other and if one feels that a patient can benefit more from surgery or radiation that is hashed out.

For instance we had a patient recently with a single > or = 8 core and a smattering of gleason 3+3=6. The rad oncs were concerned they would end up over treating this patient and thought he might be better served with surgery. Collaboration comes a bit easier for us, I reckon, as no one is paid based on number of treatments/procedures.

The thing I like the most about urology is that you deal with a lot of cancer (cure rates for testis cancer are extremely high, prostates can be rewarding, kidney cancer can be as well, bladder is...bladder), but you also have the opportunity to treat a lot of benign diseases. Kidney stones, BPH, urethral strictures...a lot of these patients do not require a fellowship trained urologist. You can tailor your practice to your liking. There is a wide spectrum of practice in urology, and I'm not sure if that's present in surg onc (obviously please correct me if I'm wrong about this). If you want to do a uro onc fellowship and do primarily the big surgeries with a small amount of quick cases you can do that. If you want to be a general urologist you can still do prostates and kidneys, referring out complex stuff like familial cancer syndromes. There is a lot of variability in practice. The job market is good right now, and the AUA isn't massively increasing residency spots to cause that to change.

 

[Buzz Me]

It all depends on where you end up working. I looked for solely general thoracic jobs and when I was job hunting, they were hard to find. Most of them wanted at least some cardiac and I didn't want that. What's out there now? Maybe it's swung again to the general thoracic side. I do have time with my family and I'm not in the hospital continuously.

I lucked out and have been able to tailor my practice into what I enjoy - which is mainly thoracic oncology. Some ECMO and occasional bypass for big whacks, but no cardiac call.

 

[DrDranzer]

How are the job prospects of Thoracic only gigs? What would the future hold, especially in light of decreasing rates of smoking due to better education of risks in the general public and millennials? How do your patients do, are you constantly stressed about a complication/ how often do you question your role in the treatment of their cancer leading to burnout/frustration? I've had personal experience with an aggressive malignancy in the family and the consequent effects on the us all, both the positive and negative. I'm asking about the majority of the patients in your practice. Lastly, does your lifestyle mirror that of a surgical oncologist/urologist and how is the compensation compared to both? Thank you

 

[DrDranzer]

How are the job prospects of Thoracic only gigs? What would the future hold, especially in light of decreasing rates of smoking due to better education of risks in the general public and millennials? How do your patients do, are you constantly stressed about a complication/ how often do you question your role in the treatment of their cancer leading to burnout/frustration? I've had personal experience with an aggressive malignancy in the family and the consequent effects on the us all, both the positive and negative. I'm asking about the majority of the patients in your practice. Lastly, does your lifestyle mirror that of a surgical oncologist/urologist and how is the compensation compared to both? Thank you

I lucked out and have been able to tailor my practice into what I enjoy - which is mainly thoracic oncology. Some ECMO and occasional bypass for big whacks, but no cardiac call.

I lucked out and have been able to tailor my practice into what I enjoy - which is mainly thoracic oncology. Some ECMO and occasional bypass for big whacks, but no cardiac call.

Are you in PP? How is Thoracic Onc in Academics vs the community?

 

[ConfusedChemist]

So if you're relative wasn't in rads...would you even be considering it?

If the only reason is that someone told you to consider it, well you could find that for any specialty. Have you done any shadowing/rotations in rads?

 

[DrDranzer]

So if you're relative wasn't in rads...would you even be considering it?

If the only reason is that someone told you to consider it, well you could find that for any specialty. Have you done any shadowing/rotations in rads?

I have not rotated in Rad Onc yet, but I have collaborated on research with Rad Oncs. Before medical school, hadn't exactly shadowed but was part of the 'cancer family' and visited rad oncs and other members of the team. As I said I was initially bent on surgical oncology till I stumbled upon Urology. Rad Onc was a small blip on my radar till I actually came to know it's competitive for having a good lifestyle and can be rewarding. Also, that I'm fortunate to personally know someone prominent in the field and I have the research and scores to get in. You can call it 'Grass is greener on the other side/FOMO'. But now as I've had all the good folks of Rad Onc here tell me to not do rad onc expecting to have a practice focused on major interventions, since they would only form a small part of the day to day, I'm gravitating back to the OR, where I felt I belonged initially.

 

[DrDranzer]

I have actually not rotated in Rad Onc yet, but I have collaborated on research with Rad Oncs. Before medical school, didn't exactly shadow but was part of the 'cancer family' and visited rad oncs and other members of the team. As I said I was initially bent on surgical oncology till I discovered Urology. Rad Onc was a small blip on my radar till I actually came to know it's competitive for having a good lifestyle and can be rewarding. Also, that I'm fortunate to personally know someone prominent in the field and I have the research and scores to get in. You can call it 'Grass is greener on the other side/FOMO'. But now as I've had all the good folks of Rad Onc here tell me to not do rad onc expecting to do a practice focused on major interventions, as they would only form a small part of the day to day, I'm gravitating back to the OR, where I felt I initially belonged.

 

[DrDranzer]

Forgive me for the multiple reply quotes, I'm still getting a hang of actually posting and conversing in this forum for a change!

 

[Dr.LeoSpaceman]

As someone headed to surg onc, I can tell you that compared to the other surgical specialties you list it doesn't compare well.

First off, though, you will need to define what part of "surg onc" you are interested in. I would argue that the comment about surg onc not being as broad as urology isn't accurate. A surgical oncologist may deal with breast, endocrine, skin/soft tissue, GI and HPB malignancies. Few (if any) will manage all of those, and will instead choose to focus on a subset. And since they are all general surgeons by training, many will have some element of traditional general surgery. Whether that is general surgical issues in oncology patients, or true general surgery call can vary depending on the job.

Decision-making is slightly different if you know you want a breast or endocrine practice upfront. There are dedicated (1 year) fellowships for these, and I doubt many people would say slogging through the process of getting into and completing a complex general surgical oncology fellowship makes any sense if those are your interests. Same goes for colorectal, where there is certainly a nice mix of oncology and benign stuff. @SLUser11 and @wingedscapula are certainly the ones to ask regarding job market, compensation, etc. for colorectal and breast, respectively...but they've also posted the same info inother threads which I'm sure you can find.

So what do you end up doing if you go into surg onc? Based on what I've seen, it's dominated by people who are interested in HPB, sarcoma, and "complex" GI oncology. These people may also accept other elements of surg onc (as above) or general surgery to fill out their practice early in their career while they build a practice. So say this is what you want: assume that the pathway to completing fellowship is going to be minimum of 9 years (5 years residency + 2 years research 2 years fellowship). You might be able to get it down to 1 year of research if things line up right, but you would need a confluence of factors to ensure productivity. And competitiveness for spots is still seemingly going up, which adds a layer of uncertainty into the equation.

I let the others who have recently finished (or are in) fellowship to comment on the job market. But I can tell you that it's not what I would call robust, particularly if your goal is to end up in an academic setting. After that, lifestyle, compensation, etc. are all going to depend on what your practice looks like. As for having patients that do well, that's going to depend on which population you treat. If you have a HIPEC and/or HPB-heavy practice, your patients are going to do poorly from a disease-specific standpoint. But surgical oncologists treating thyroid cancer, breast cancer, melanoma and colon cancer are going to have many patients that do "well".

 

[evilbooyaa]

Everyone who is diagnosed in our clinic goes to the multi-disciplinary clinic with a urologic oncologist, radiation oncologist, uro andrologist (erectile dysfunction expert), and social worker. The patient meets with us independently and then we get together and discuss the patient towards the end of the day (yes, it's a day long process). It's a really good system that provides the patient with the information needed to make a decision they are comfortable with. We also talk to each other and if one feels that a patient can benefit more from surgery or radiation that is hashed out.

For instance we had a patient recently with a single > or = 8 core and a smattering of gleason 3+3=6. The rad oncs were concerned they would end up over treating this patient and thought he might be better served with surgery. Collaboration comes a bit easier for us, I reckon, as no one is paid based on number of treatments/procedures.

Kudos to your hospital group. That sounds like a great system.

 

[DrfluffyMD]

No desire to see the patients first.

Coming from the prospective of an IR, who has many of our procedure and turf taken away, if you aren't willing to see the patient clinically and offer a self-contained management package to PCP, the chance is that people will continue to take away your procedures if they are lucrative.

And about radonc, the residency spot expanded by 50-60% or something ridiculous. I heard job in good geographic regions are very difficult to comeby. If I were you and I want to do procedures, I would not want to do radonc.

I was in a similar shoe when I was a med student and I chose radiology for lifestyle. Unfortunately, reading images bored me to no end. I prefer a 7am to 9pm surgical day to a 9am to 5pm reading day with 2 hours of lunch break.

Choose wisely.if you are meant to be a surgeon, don't talk yourself out of the OR.

 

[RadOncDoc21]

Rad Onc baby, unless you like seeing penises (sp?) all day!

 

[DrfluffyMD]

Rad Onc baby, unless you like seeing penises (sp?) all day!

Some people are into that sort of thing.

 

[RadOncDoc21]

Some people are into that sort of thing.

Lol, to each his or her own I guess!

 

[Buzz Me]

How are the job prospects of Thoracic only gigs? What would the future hold, especially in light of decreasing rates of smoking due to better education of risks in the general public and millennials? How do your patients do, are you constantly stressed about a complication/ how often do you question your role in the treatment of their cancer leading to burnout/frustration? I've had personal experience with an aggressive malignancy in the family and the consequent effects on the us all, both the positive and negative. I'm asking about the majority of the patients in your practice. Lastly, does your lifestyle mirror that of a surgical oncologist/urologist and how is the compensation compared to both? Thank you

I'm confused. Exactly which part of the body are you interested in? Not much in common between thoracic and urology.

Are you an M3? M4? What were your thoughts on your General Surgery rotation?