So you want to be a radiation oncologist. You want to be the doctor who cures cancer once and for all.
Let’s debunk the public perception myths and give it to you straight. This is the reality of radiation oncology.
Welcome to our next installment in So You Want to Be. In this series, we highlight a particular medical specialty help you decide whether or not it’s a good fit for you. Find the other So You Want to Be guides here on the Med School Insiders website as well as our YouTube playlist.
What Is Radiation Oncology?
Radiation oncology is a medical specialty focused on the use of ionizing radiation to treat cancer as well as some benign conditions. Radiation oncologists design and deliver targeted radiation therapy to eradicate tumors while minimizing damage to surrounding healthy tissue.
Radiation oncology uses highly precise, high-energy X-rays to treat many different types of cancer. Think of it as a specialized tool that destroys cancer cells while protecting the healthy parts of the body as much as possible. It’s often one part of a larger cancer treatment plan, working alongside surgery and chemotherapy.
Practice Settings and Physician Implications
Radiation oncologists can practice in an academic, community, or hybrid setting.
In academic settings, radiation oncologists balance their clinical duties with research, teaching residents and fellows, and attending conferences. Although they do treat common cancers like prostate, breast, and lung, they often see rare or complex cases that have been referred to them from community practice settings.
Specialists in radiation oncology typically focus on one or two disease areas of the body. For example, there are many academic physicians who may only treat breast cancer or concentrate exclusively on lung cancer.
Pediatric and central nervous system, or CNS, cases are often more heavily referred to academic or specialized centers, though this can vary by state and city depending on practice and referral patterns.
Academic physicians often have more varied schedules due to the research and teaching time that is involved, which makes the academic path demanding. Despite this, the compensation is typically lower than in community or private practice settings, though for many, this is offset by the prestige and research opportunities.
In community practice, radiation oncologists focus mainly on clinical care with an emphasis on efficient, direct, and high-quality patient care. Their patient population is broader and often skews more toward common cancers like prostate, breast, and lung.
Community physicians enjoy more predictable schedules and have a heavier clinical focus with direct patient care, though on-call duties still apply, and emergencies, like spinal cord compression, may still arise. While their schedules are more routine, they can have long clinical hours, typically with little to no teaching or research involved.
Community practice requires efficiency and adaptability due to a broader case mix, a predominantly clinical focus, and, for some physicians, additional duties as a partner in a private practice setting.
Compensation is usually higher than academic practice on average.
Hybrid practice offers a balance between academic prestige and community-oriented care. Physicians blend clinical care with limited academic or research responsibilities, and compensation typically falls between academic and community levels.
Hybrid physicians can still experience moderate variability but benefit from a fairly regular clinic schedule.
Cancer Types
Radiation oncologists treat a wide range of cancers, from head and neck to breast to prostate to CNS to lung to gastrointestinal to pediatric and more.
Prostate and breast cancer are two of the most common cancer types, which means they’re more protocol-driven and have standardized treatment paths.
CNS and pediatric oncology tend to be more subspecialized and require multidisciplinary approaches and frequent imaging.
Gynecologic and head and neck cancers often involve more complex planning due to nearby critical structures. These cancers also require significant management of side effects and symptoms due to the sensitive areas involved, needing a multidisciplinary team of therapists, nurses, nutritionists, counselors, and physicians.
Treatment Approach
There are two treatment approaches radiation oncologists take: curative treatment and palliative treatment.
Curative treatment involves a structured treatment regimen with higher doses of radiation, often over several weeks, with the goal of eradicating cancer while sparing healthy tissue. This requires detailed treatment planning, close collaboration with medical physicists, and regular imaging to ensure precision.
The patient population includes younger or healthier patients who are candidates for definitive therapy. Curative treatment tends to involve more follow-up care to monitor for recurrence or long-term side effects.
Palliative treatment involves shorter treatment regimens focused on symptom relief rather than long-term survival.
Candidates for palliative treatment are patients with multiple myeloma, cancers causing symptomatic pain in multiple areas of the body, late-stage cancer patients and those with very poor performance status, or those with metastatic disease.
Palliative treatment generally involves less intense planning but more emotional challenges since the patients are terminally ill.
Technology-Based Approaches
Radiation oncologists use a number of technology-based approaches to treatment.
There’s external beam radiation, or EBRT, which involves techniques like intensity-modulated radiation therapy, or IMRT, and proton therapy, which require advanced equipment and multidisciplinary teams.
These are more technically demanding and require careful coordination with dosimetrists and physicists. They’re used to treat cancers in difficult-to-access areas, like head and neck and CNS.
There is also internal radiation, also known as brachytherapy, which involves implanting radioactive materials near the tumor site. This requires procedural skills and can be time-intensive. It’s most often used to treat prostate and cervical cancer, though intra-operative brachytherapy is an option for some other disease types.
Brachytherapy may involve more after-hours care due to an increased risk of bleeding and infection.
Misconceptions About Radiation Oncology
Now, let’s clear up some major misconceptions about radiation oncology.
First off, many people believe it’s all about technology, but this is far from the case. While technology does play a critical role, patient care and decision-making are equally as important.
It’s also not only for cancer. Though rare, radiation oncology also treats benign conditions like trigeminal neuralgia and keloids.
Finally, while many assume the profession is dangerous because physicians work with radiation, advanced techniques have made it safe and highly targeted for patients and healthcare workers.
How to Become a Radiation Oncologist
Radiation oncologists are typically analytical thinkers who are detail-oriented and comfortable with technology. They’re often academically inclined and enjoy research, which also translates to more research experience.
To become a radiation oncologist, after four years of medical school, you’ll participate in a five-year residency.
There are no alternative pathways, which means you’ll need to know early on that it’s the ideal path for you.
In terms of residency competitiveness, radiation oncology is right in the middle of the pack, currently sitting between med/peds and PM&R. Our Specialty Competitiveness Index factors in Step 2 CK score, match rate, research items, AOA status, and top 40 NIH funding.
Your Step 2 CK score is the most critical hard metric for applying to residency. The average Step 2 CK score for radiation oncology is 252, which is right in midrange compared to other specialties.
The average number of research items for successful applicants is 15.9, which is on the higher end, with only the top five most competitive specialties having a higher average number of research items.
Year after year, radiation oncology continues to have a high number of research items for successful residency applicants. If you’re considering a career in radiation oncology, it’s essential that you prioritize research as soon as possible to be a competitive applicant.
Most people find research slow, frustrating, and painful, and that’s how I felt at first, too. I can tell you from experience that it does get easier. As you expose yourself to research, put in the reps, and dive into the difficult tasks, you’ll get more and more used to it, and you may even start enjoying it.
Shortcut this tedious process using the proven systems outlined in the Med School Insiders Ultimate Research Course for premed and medical students. The course includes advanced tactics you won’t find anywhere else since we innovated them.
It outlines the exact processes Dr. Shaun Andersen, Dr. Deepal Patel, and I used to each crank out more than 60 research items before graduating from medical school. By adopting these tactics, you can also earn dozens of publications, boost your application, and do so in record time.
Skip the painful learning curve, publish more, enjoy the process, and make a real impact on your radiation oncology application.
Subspecialties within Radiation Oncology
While many radiation oncologists practice as generalists, fellowships are becoming more common, particularly in academic centers.
Radiation oncologists can choose to further subspecialize with proton therapy. This fellowship offers advanced training in particle therapy, which is effective against tumors that have not metastasized or tumors near critical areas like the brain, as well as for reducing the potential risk of secondary cancers from radiation therapy in pediatric cancer patients.
There is also brachytherapy, which involves placing radioactive implants like capsules, seeds, or wires directly into or near a tumor to damage the DNA of cancer cells while minimizing damage to nearby tissue. Brachytherapy is commonly used to treat cancers of the eye, prostate, and cervix, though it can also treat cancers of the brain, rectum, breast, skin, and more.
Pediatric radiation oncology is focused on treating childhood cancers, and head and neck oncology offers high specialization in complex cases. Physicians specializing in head and neck oncology will work closely with a Clinical Nurse Specialist, dietician, and other healthcare providers in order to help manage symptoms for patients.
Each subspecialization is usually a year in length after the five-year standard residency training in radiation oncology.
What You’ll Love About Radiation Oncology
There’s a lot to love about radiation oncology.
Radiation oncologists get to form meaningful, collaborative, and long-term relationships with an incredibly diverse patient population. They also get to participate in a field that’s constantly evolving with new technology and treatments. Radiation oncology is unique in that it balances direct patient care with technology and research.
Radiation oncologists have a predictable schedule, with few emergencies and typically no overnight call. Most physicians work 40 to 50 hours a week, focusing mostly on prostate, breast, lung, and head and neck cancers in the community setting, but there is a lot of room for variety.
The compensation is also excellent. Radiation oncology is the sixth highest-paying of all medical specialties, with the average radiation oncologist earning nearly $570,000 a year.
What You Won’t Love About Radiation Oncology
Of course, radiation oncology is not for everyone.
Treating terminally ill cancer patients and speaking regularly with their family members is undeniably emotionally taxing. In many cases, you’ll have treated the patient for quite a while and developed a strong bond with them. Over time, the compounding of these losses can lead to burnout.
The future of the field is also in question. Advances in systemic therapies and personalized medicine may impact patient volume in the future, and shifting healthcare policies and declining reimbursement rates create financial uncertainty. While there are valid concerns, and future trends are difficult to predict, multiple analyses have shown stability of the job market for radiation oncologists for at least the next few years.
Should You Become a Radiation Oncologist?
So, should you become a radiation oncologist?
If you have strong analytical and problem solving skills, are comfortable with technology and data, and are interested in building long-term relationships with your patients, radiation oncology might be for you. But you must have excellent, empathetic communication skills for counseling patients and their families.
It’s also important to enjoy being on the cutting edge of medicine and keeping up with the latest medical literature.
If work-life balance is important to you, radiation oncology won’t make you choose between your work and your family. It also offers excellent compensation compared to the number of hours worked, unlike many high-paying surgical specialties.
It’s a rewarding field for those who enjoy blending cutting-edge technology with compassionate patient care.
Med School Insiders has helped more than 11,000 premeds and medical students succeed in pursuing their ideal career paths through our 1-on-1 services. Our team of physicians were top of their class, attended their dream medical schools, and matched into the nation’s top residency programs.
Many of them, including myself, earned merit-based scholarships that covered the cost of medical school tuition, which means we didn’t leave medical school with hundreds of thousands of dollars of debt. Through our proven methods, we can show you how to do the same.
Special thanks to radiation oncologist Dr. Mihailo Miljanic for being the expert contributor for this guide. Feel free to contact him to learn more about the field.
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