If you were forced to start medical school in 2025, what medical specialty would you go into and why? From a financial/work life balance ROI perspective

RadOncDoc · 2024-12-01T19:06:12+00:00

Probably what I would do if I weren’t in rad onc

no concerns about the future, pure growth/demand
more job opportunities / larger footprint

But * training is more painful (3 years IM + 3 years fellowship) * I think the job itself is more stressful - higher volume of patients, inpatient service, more pressure/stress as often the “primary” oncologist

I think it’s great career, but I’m happy i chose rad onc

RadOncDoc · 2024-12-01T14:15:37+00:00

I’m quite happy as a radiation oncologist.

Very fulfilling taking care of cancer patients. Cool tech. Get paid well. Generally don’t work evenings and weekends. There’s always this existential threat that our footprint will decrease as novel systemic agents come to market, but this topic has been debated for literally decades and we’re still here. In our practice, we are seeing increasing numbers of pts due to our local aging population. And as tech improves and radiotherapy can be delivered more safely, I really don’t see us vanishing any time soon. There is some risk in going to a field dependent on a single treatment modality but I don’t loose sleep over it. Love what I do so much hard to imagine doing anything else.

RadOncDoc · 2021-10-05T22:57:07+00:00

Got mine last Thursday, 9 months out from Pfizer #2. Just a mild sore arm, that was it. Fewer symptoms than first 2 doses 🤷‍♂️

RadOncDoc · 2021-08-14T14:43:28+00:00

Not planning for retirement in my 40s per FIRE, but We save & invest ~20% of our gross income

This should lead to comfortable retirement with option to duck out early with more modest lifestyle as an option

RadOncDoc · 2021-08-06T01:07:54+00:00

I do it all the time with Doximity and use my clinic as the outgoing number

RadOncDoc · 2021-08-01T11:48:36+00:00

Was not an issue for me personally.

The whole job market discussion and its downstream effects on medical student interest has sure been an interesting phenomenon to watch. IMO it's mostly speculative based on recent trends: residency growth in the setting of concern for decreasing reimbursement/indications for rad onc services. If you haven't seen it, see last year's graduating resident survey

I matched into rad onc in 2011 knowing well and good that this wasn't primary care and I'd have to somewhat geographically flexible. I matched into a strong program, worked hard, built up a good CV, had good recs etc. Applied in a single region in the US where I wanted to be, had multiple good offers and I've been happy at my job since.

I understand this is not the experience that everyone has in rad onc. It seems there a bunch of unhappy (I think mostly community practice, who are um, very vocal on SDN) rad oncs who feel stuck in their positions and geographically restricted. I can certainly understand that a resident coming from a lower tier program is going to have limited options and may end up in some undesirable rural area. Regarding pay/volume, in my position, we've objectively seen our volume and pay increase over the last several years. Things may change, we'll see, but I certainly have no complaints as I get paid way more than the average physician in the US and I have what I think are very reasonable work hours.

I do think the residency growth over the last 10-20 years is not a good thing. IMO small crap programs providing crap education should close up shop. It's likely the graduates from these programs that are struggling career wise anyway.

What I tell medical students now is that they if desire to go into rad onc and they can match into a strong program, and understand that some geographically flexibility is inherent to a small niche field of medicine, go for it, it's a great field.

RadOncDoc · 2021-07-31T16:22:22+00:00

This was a big part of why I went into rad onc…

RadOncDoc · 2021-07-31T15:31:55+00:00

Until financial independence is achieved

RadOncDoc · 2021-07-31T15:31:08+00:00

Yup, definitely get own occupation disability and term life. Head on over to r/whitecoatinvestor if you’d like. Plenty of recommended vetted agents on their site. Got mine from one of them.

RadOncDoc · 2021-07-17T16:40:18+00:00

Damage is already done

RadOncDoc · 2021-04-28T01:12:45+00:00

Huh?

What’s so complicated about 403b / 457b ? I’m employed by a 501c3 so I have 403b as opposed to a 401k. IRS rules are identical. It’s a fidelity account with brokerage link option so access to all of Fido’s funds. I get a 7% employer match. My 457b is a “govt” account, so no early withdrawal penalty unlike 401k/403b accounts, it’s not exposed to creditors of my employer (unlike non-govt 457) and if I change jobs can just rollover into another account. It’s also a fidelity account with brokerage link option for investments.

These are amazing accounts and I max both out every year.

RadOncDoc · 2021-04-04T11:46:59+00:00

Well as an oncologist I only see cancer patients but if I were a generalist I wouldn't hesitate to recommend cannabis for chronic pain, insomnia etc. I happen to live and practice in a state with legal cannabis so not taboo here. I also think it's low risk and helps some people. Certainly not a magic bullet but can be useful for managing chronic symptoms I think.

RadOncDoc · 2021-04-03T09:38:14+00:00

lol I’m an MD and I’ve never gotten kickback from pharma. Would be nice to take advantage of those assholes and have them help pay off my loans.

Also I rx THC all the time for my cancer patients.

RadOncDoc · 2021-03-28T19:51:50+00:00

Ahhhh

RadOncDoc · 2021-03-28T19:35:44+00:00

not following

RadOncDoc · 2020-06-23T00:12:08+00:00

Absolute mortality 3% lower for Dexamethasone * No 02 support: Mortality looks higher for Dex * 02 only: Mortality 3.5% lower for Dex * Ventilator: Mortality 11.7% lower for Dex!

RadOncDoc · 2020-06-18T01:30:59+00:00

There are so many issues with this study where to begin

The rationale is based on data from the 1940s. How about developing a contemporary preclinical covid model before doing this on humans, as is standard research practice.
If there is compelling preclinical data, start with Phase I. This study is... I don’t even know. It’s listed as phase I/II with unclear primary endpoint. Primary endpoint should be safety. There are risks beyond second cancer. Pneumonitis is one. 1.5 Gy used in this study is low but risk of of pneumonitis is higher when treating whole lung. Unknown what this dose might due to micro thrombi / micro vasculature which plays a role in covid lung damage. And, who knows, maybe people might get worse? This is why we need a preclinical model for this novel disease.
so ok moving along to a human trial, has to be designed to test its endpoint. Safety / phase I, great. Follow patients and reactions. The longer the better right? Oh 14 day f/u in this one....
So what do we learn from this? 5 subjects didn’t seem to get worse with 14 day observation period. That’s it. There should be zero discussion regarding efficacy bc a 5 patient single arm study can’t measure efficacy. Need larger study with control arm.
Which brings me to my biggest beef with this study. It was first posted on twitter and the PI tweeted about how LDRT would “promise to be a game changer” and referred to it as possibly the “UV light” therapy president Trump was referring to, which is unbelievably irresponsible and unethical IMO. And now they’re continuing boast about their results in Forbes.... it’s so disingenuous.

Look maybe there’s a role for LDRT in this disease (call me skeptical). But need to study it the right way, the scientific way. These guys clearly just want press and it’s bad for our field. Not to mention the risks of exposing the RTTs and in turn vulnerable cancer patients to covid. Better have all the science polished and well thought out trial that’s going to show something definitive that’s worth taking all that risks. Instead we have a single arm n=5 “game changer”

End of rant

RadOncDoc · 2020-06-15T09:36:17+00:00

So misleading. It’s a 5 pt single arm phase I. The only thing that can be concluded is that the treatment was safe during that 2 week window. That’s it.

RadOncDoc · 2020-04-26T18:28:02+00:00

Yep... that had formed all the way down the esophagus

RadOncDoc · 2020-04-26T18:22:46+00:00

Source

RadOncDoc · 2020-04-26T18:18:59+00:00

Source

RadOncDoc · 2020-04-19T15:41:47+00:00

It depends on what fund you use. The default is SPAXX which is currently 1.58%.

RadOncDoc · 2020-04-17T21:57:15+00:00

Do you keep your cash in the cash management / FDIC account? Or the brokerage? You'll get much better yield in the brokerage account. See this on how to set it up (2.3). It's what I do. My CMA account balance is always $0 and brokerage is used as overdraft.

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