Sure -
How long have you been in independent practice?
Longer than you.
Sure -
How long have you been in independent practice?
We're back to exactly what I was talking about earlier.Doing couple hours of contouring is not the same as being on call and doing bunch of surgeries
What environments have you practiced in?Longer than you.
What environments have you practiced in?
THISYou’re very busy. I work weekends sometimes too. MANY don’t.
I think it’s not intellectually honest to say rad onc doesn’t have a good QOL. Is it what it used to be when some were throwing a few wax drawings on and hitting the links? No. But the fact that it’s even possible to not be on site in the current environment or can leave work at 2 fares VERY favorably to many other fields. Can we be honest about this?
You’re very busy. I work weekends sometimes too. MANY don’t.
I think it’s not intellectually honest to say rad onc doesn’t have a good QOL. Is it what it used to be when some were throwing a few wax drawings on and hitting the links? No. But the fact that it’s even possible to not be on site in the current environment or can leave work at 2 fares VERY favorably to many other fields. Can we be honest about this?
You’re being too technical. In that case, no specialty should be called “lifestyle specialty”. I think we all know in medicine, it regard to specialties, when we talk about “lifestyle” we mean: good salary, not having to work weekends, not being on call so much, not so crazy workload when working. Rad Onc checks every single one of those.We're back to exactly what I was talking about earlier.
No one disagrees with your point here, in a vacuum.
But you have to be precise when defining "lifestyle". In RadOnc, you're basically always "on", as in, it's more like a salaried white collar job (except for the on-call part).
To be specific and avoid anecdotes: multiple groups within the hospital I practice in currently (surgeons, Radiology, etc) have variations of "2 weeks on, 2 weeks off".
When they're on, they're totally on. When they're off, they're totally off.
Literally one of the surgeons travels out of the country for several weeks per year, every year, without using any vacation time.
"Lifestyle" is a subjective experience.
Absolutely!Do you want to get to your point or is this 20 questions
There are pearls of wisdom nested within this strawman argument.In my job I do feel (and some of it is self inflicted) the feeling of always being ‘on’ and that is absolutely true about oncology related fields. However many of my friends don’t feel that way and feel totally fine being off as it is dependent on practice setup. The move to more employed jobs has eased this in my experience
But at the end of the day, rad onc has a good quality of life, period. We don’t need to act like it doesn’t.
I dont feel the need to act like a Martyr on this board at all times like some do.
I completely agree on all counts with this.I would place radonc in the middle of specialties when it comes to QOL. If you care about where you live, I would put it in the bottom half. Reasons:
1. No remote work
2. Worst ability to choose location of any specialty
3. "It's even possible to not be on site in the current environment" - not if you do any SBRT or brachytherapy
4. "Or can leave work at 2" - Other fields also have the ability to leave at 2 if the docs want. Not unique to radonc.
5. Less vacation than most other subspecialties (in my experience at least)
6. Usually, locums required if vacation taken, substantially increasing vacation expense
It's an easy residency, sure. However, one thing I didn't realize in training is that lots of other specialties which have hard residencies don't necessarily have difficult schedules as attendings. Neurosurgery is the classic example of this.
Also true that we don't work weekends (I don't work weekends at least, usually, unless I'm on call, and I'm confident my patient volumes and production numbers are very high) or take lots of call, but lots of other specialties have formed large enough groups to where call and weekend responsibilities are spread out really well. The amount of on-call and weekend work other specialties do is also something I overestimated in training.
Don't get me wrong: I like radonc as a discipline. I like being a radiation oncologist. But I don't think it's dishonest to say the QOL is negatively impacted by several factors which are innate to the discipline.
OTN -There are many things said there that I don’t disagree with regarding location, locums. I’m talking specifically about the day to day job.
Other specialities leaving at 2 means significantly less pay. Rad onc is uniquely high reimbursement where you can make a decent salary and still go home at 2 every day in many settings.
So, is UndecidedMS2 like a Chairman in disguise, selling "the field?" Just a little sus...THIS
It’s total ignorance to say there nothing wrong with the field. From trash ASTRO leadership, unnecesaary residency expansion all the way to thr boomer PP owners with their predatory “partnership track” offer … a lot can and must change/improve. However fearing away eager med students who like the field and can make those changes happen will only hurt the field even more. This is a field with GREAT potentials and only by having people who are passionate about it can we achieve those potentials. So let’s stop bashing Rad Onc and everyone who wants to get into this field and instead call out the issues and provide logical and practical solutions
At least in my experience, whether it be in training, in my current practice, or in practices for which I have done locums work, I have never gone home at 2. I'm not saying it doesn't happen, but I don't think it's very common.
I wish. But I don’t mind getting involved and be the change i so loudly preachSo, is UndecidedMS2 like a Chairman in disguise? 'Cause, I think you just channeled the past 3 ASTRO presidents.
Are you just preaching a change of rad onc “exposure.” You would really have to be a low energy person to have interest in rad onc and then complain of lack of exposure. Happiness comes from within.I wish. But I don’t mind getting involved and be the change i so loudly preach
But at the end of the day, rad onc has a good quality of life, period. We don’t need to act like it doesn’t.
I dont feel the need to act like a Martyr on this board at all times like some do.
After 4 years (sometime in mid 2030s), it will be so easy to find a new job in a large metro.A quote about a plan from Mike Tyson comes to mind
To expand on that, I think one of OPs responses discussed how radiation planning isn't terribly stressful. Firstly of course, is the point that I thought that as well until I realized I'd have to actually see the hn patients I planned in followup. Residency and attending life are different. Otherwise, it's worth reiterating that radiation planning is hardly what most of us spend the majority of our time doing. Beyond posting on sdn, I spend time dealing with getting things done correctly and in a timely manner in a smaller, less efficient medical system. Going further into this would involve the ability to write like ese. Suffice it to say, it's stressful.To be clear OP, you can make more money in better locations in many other specialties. Radiology and anesthesia were not competitive when I was in medical school, but both specialties are now superior to rad onc for location and pay. The competitive half of ROAD, ophtho and derm, are way better for new grads than rad onc. There’s also many surgical and IM specialties that are appealing and IM residency in particular has become less demanding even in the last few years.
Location and QOL are strongly linked and it’s hard to appreciate that when you’re a poor med student like I was, when you’ll be happy to have time to go running outside or watch a movie at AMC. If I had twice the workload but could be in a big city desirable location, no doubt my QOL and personal happiness would go up.
Good luck regardless of what you choose. Your reasoning’s not wrong, you just may be overestimating the pay and to some degree the QOL of rad onc versus other specialties, as an attending.
Bro, this is definitely a you decision. When I'm not on call (which is most of the time), I'm not doing Rad Onc stuff. Rad Onc call is less of an issue than non-RO call, let's be real.If you think you ain't working weekends in RadOnc
You're gonna have a bad time
Hahaha this is true.Bro, this is definitely a you decision. When I'm not on call (which is most of the time), I'm not doing Rad Onc stuff. Rad Onc call is less of an issue than non-RO call, let's be real.
We can talk about how being chained to the machine and all that. And not being able to go out of town if in a small group. But the decisions to work at a place that has only ONE doctor on site (with no arrangements for call coverage with supporting hospitals) is a you decision.
All work and no play makes ESE a dull boy
From ChappelleWhile I don’t get called in the middle of the night and rarely on weekends, I’m on call 24/7 and even when I’m on vacation with a locums doctor I get calls from referring docs and I have to do planning and contouring. I grind each day from about 7-430 with no lunch break and I live in a rural location. The lifestyle is not bad, but it’s not great.
Honestly great idea for anyone marrying with hugely disparate incomes......
I'm drafting a letter to the ACGME that anyone who applies to Match in RadOnc should automatically be forced to meet with an attorney who specializes in prenups!
(kidding, kidding...sort of)
My plan is to go somewhere that pays alot (ideally over $600k) for 4-5 years no matter how middle of nowhere it is. Hopefully i can payoff my loans and save up a good chunk then move to a desireable location with lower pay. I’m a single guy so I can see how that might now be ideal for other people especially those with families and such.
. But by all means, find a life partner and live someplace you feel fulfilled in. That is the most important thing in life. I have spent years in misery moving around because you have to in this field and leaving blown up relationships behind.
I can only speak for myself here: over the last 20 years I've worked in over a dozen hospitals in nearly as many different states. I've gone from being single to being married with kids, I've only been unable to connect with friends and family for years at a time, I've had family members die a thousand miles away and be the only one not at the funeral.
Sure -
How long have you been in independent practice?
Agree. Usually only happening if I'm out part of the week and having to catch up with sims, contouring, plan review/approval etcYeah, if you're working a lot on the weekend; I think that's probably a you thing.
I do feel for the guys in solo practice who are essentially on call 24/7, but again, that's a decision.
Right - I am solo hahaha (part of a group but...eh this setup is weird and I wouldn't generalize a lot of it)Yeah, if you're working a lot on the weekend; I think that's probably a you thing.
I do feel for the guys in solo practice who are essentially on call 24/7, but again, that's a decision.
When a rad onc gets up past 35 or 40 or so on beam, having a routine Saturday work session (can do it from home, but office makes more sense, imho) becomes almost mandatory.It's uncommon to have dedicated contouring time, and nights/weekends are sometimes the only option. This is a common phenomenon in medicine, it's "Pajama Rounds".
When a rad onc gets up past 35 or 40 or so on beam, having a routine Saturday work session (can do it from home, but office makes more sense, imho) becomes almost mandatory.
However for all practical purposes no rad onc routinely has 35-40+ on beam anymore.
i agree with you.Right - I am solo hahaha (part of a group but...eh this setup is weird and I wouldn't generalize a lot of it)
You guys are running to the other end of the spectrum with this, it's not "zero weekend work" and "48 hour shift in the hospital", that's not what I'm saying.
My point is the traditional messaging around RadOnc and weekends is misleading to medical students, if you phrase it as "you don't work weekends".
Do we have full, regular clinic days on the weekend? Not that I've seen, no.
Where I started getting irritated with this was back in "the old days" where RadOnc was sold to MD-PhDs like me as "the best" option for a research career. It does sound like that, at first.
But as has been talked about to death here...or used to be, in the Golden Era...many people interested in academic track jobs were given an "80/20" package of "you have dedicated research time on weekdays from 6PM-10PM and all day Saturday and Sunday!"
It also seems really common to have the "on-call Monday to Monday" schedule. I actually once tried to figure this out - was there a common "on call" model in this country. While the institutions with residency programs do seem to stick with the one week at a time arrangement, I've learned that EVERYTHING exists out here, from zero call to 24/7/365.
In the end, I just want people interested in this career who hear "no weekend work" to not be blindsided by the more nuanced truth:
1) If you want to have a productive academic career, your research time will be weekends.
2) It's uncommon to have dedicated contouring time, and nights/weekends are sometimes the only option. This is a common phenomenon in medicine, it's "Pajama Rounds".
3) While many of us think "home call" is easier than hospital call (myself included), it means you can't really go anywhere or commit 100% to things on nights and weekends. Is your kid having a birthday party on Saturday at 1PM? Ah darn, cord compression page at 12:30PM. Spouse spontaneously suggests camping with friends at a park ~4 hours away? Ah can't, on call.
AGAIN, I'm not claiming it's a "bad lifestyle". It's average. Many of these problems exist in most/all specialties. It's why people are bailing left and right.
I think trying to paint RadOnc as some amazing lifestyle is setting future students/residents up for disappointment. It's just about individual preferences, and some people prefer "shift work" (be it by the day or by the week), so when you're off, you're OFF.
Again, again - not a bad lifestyle. Just not Eden.
When a rad onc gets up past 35 or 40 or so on beam, having a routine Saturday work session (can do it from home, but office makes more sense, imho) becomes almost mandatory.
However for all practical purposes no rad onc routinely has 35-40+ on beam anymore.
Exactly my experience.
When I get that busy (rarely now, but I do hit those numbers maybe one month a year), I end up catching up on the weekends from home. It is what it is.
I think an under-rated "lifestyle" impediment is inpatient consults/volume. A lot of that depends on hospitalist/med onc (especially if the med onc service is ran by NP's) culture. But throwing inpatients on top of a busy outpatient clinic can throw a wrench in things.
All this, precisely.i agree with you.
the clinic schedule itself is manageable 7-5 pm for those that are busier, but what many people don't understand including therapists, nurses, that even work in my department, is that contouring/treatment planning takes a decent amount of time and at least in the 2 places I have practiced is not something that is scheduled. In residency, this was what "academic days" was for. In the community, I don't have days with nothing on my schedule. You have to find time to squeeze it in. I don't take a "lunch" and often come in early or stay a little later to try to get it done while at work. It is much much easier to write a consult note or follow-up at note on my couch then to try to contour a H&N case from home.
Bingo.There is obviously a lot of variability in Rad Onc jobs/practice settings.
I know other docs who work more limited hours and are much less busy than I am and able to do everything while at work and take 1 hour lunch. Some centers don't even treat after hours/weekends, so really not much "call" to be had as patients need to be transferred to higher level of care.
I think one of the other issues with our job is that we are outpatient doctors with a patient base/panel of our own. This type of work is a grind.
The shift work model is much more attractive to me.
I have friends in rads/gas. They work shifts, sometimes overnight or weekend, but have twice as much vacation and have the option to pick up extra shifts and make more $$.
My wife is an ER doc and she works 3 shifts per week and thats it. She never writes notes from home or has to deal with continuity of care.
.........that uh.......that joke has an acid burn of truth to it......in a lot of these locales you won't have to work on the weekends. You also won't do other things on the weekends, like go out to eat, visit art districts, hike, smile...
in a lot of these locales you won't have to work on the weekends. You also won't do other things on the weekends, like go out to eat, visit art districts, hike, smile...
This drives me nuts.I have always felt that nurses and ESPECIALLY therapists have no understanding of the work we do after hours. They have this culture that they must start at a certain time, treat through lunch if it means they can get out early. Because you know only them have a life. They think we just see patients and go home shortly after. There is a lot of work after hours. As a rotating student you might not get the full picture. i have friends who have a busy call weekend every time they are on call. I know people who do not take any call at all.
‘Also, I think it was a problem that we were getting derm candidates in radonc back in the golden era. This can be a peculiar person...typically overwhelmingly qualified academically, often with accolades, but goal oriented towards some sort of money/lifestyle end goal alone. This is not the substrate of the best docs for a field addressing a disease as desperate as CA. It actually doesn't feel bad to have to work hard when you believe that it is high value to your patients.’
I know exactly what you mean and hundred percent agree. There are some people that were highly annoying that matched into rad onc similar time as me, who thought they had grifted the system and found the best deal in medicine (a total free lunch) and were shocked and disappointed when they actually had to do some work.
What are the appealing IM subspecialties in your opinion? GI and med onc? I feel like everyone on this forum trashes on IMTo be clear OP, you can make more money in better locations in many other specialties. Radiology and anesthesia were not competitive when I was in medical school, but both specialties are now superior to rad onc for location and pay. The competitive half of ROAD, ophtho and derm, are way better for new grads than rad onc. There’s also many surgical and IM specialties that are appealing and IM residency in particular has become less demanding even in the last few years.
Location and QOL are strongly linked and it’s hard to appreciate that when you’re a poor med student like I was, when you’ll be happy to have time to go running outside or watch a movie at AMC. If I had twice the workload but could be in a big city desirable location, no doubt my QOL and personal happiness would go up.
Good luck regardless of what you choose. Your reasoning’s not wrong, you just may be overestimating the pay and to some degree the QOL of rad onc versus other specialties, as an attending.
1. You are a true academic superstar (This does not mean AOA at a good med school or even a super solid MD/PhD. This means Tim Chan/Max Diehn level) and plan a career in academic molecular oncology without rounding on inpatients.
Why?Tim Chan/Max Diehn and a couple other folks are amazing, but I wonder if they would’ve had equally or more amazing academic careers in medical oncology.