Medical School - PreclinicalResidency & Beyond

Spotlight Series – Radiation Oncology

Learn about Radiation Oncology from a resident's perspective!

Dr. X (the resident wished to remain anonymous) is a fourth-year resident in radiation oncology.

Why did you choose your specialty?

Radiation oncologists get a lot of time to get to know their patients while also getting a good amount of time to spend deeply involved with their colleagues in the pure discussion of medicine/science.

There is less “House of God” style “BS” in terms of the production mill of admitting and discharging patients.

I argue a lot with people and thus since most radiation oncologists work relatively autonomously, this job may provide me with a job where I won’t be fired or constantly offending people.

I majored in chemistry/pharmacology. I went to medical school, which arguably gives you a doctorate in some sort of “Biology.” Finally, I have finished the coursework for PhD level particle physics as part of my residency. Now I have what I consider a relatively complete education in each branch of science.

I get to build very deep relationships with my patients.

The problems are often very complex and enjoyable for me to spend sometimes hours considering various solutions.

If you went back to the 1700s and told people that there was this way of putting them inside a room and pressing a button and they wouldn’t experience any pain or discomfort and then several weeks later their cancer burden would be gone, they would’ve probably accused you of some sort of trickery or perhaps some sort of “magic.”  But this (albeit oversimplified) is the reality of my profession. It’s modern day “magic.” Whenever I am skeptical of something in the world, it reminds me that I perhaps should broaden my mind.

After reviewing the literature for a large majority of the most common medical conditions in medical school, I came to the conclusion that the probability that the treatment benefit exceeded the probability of harms in the treatment of many conditions (such as the common cold, for instance) is likely weighted towards harms. Given that you take an oath to “Do no harm” as a physician, I wasn’t sure I could fulfill my oath as a general internist, and I felt my conscience would be burdened by this. The advantage of an oncologist is that almost all conditions an oncologist is responsible for treating is expected to progress to death if untreated. As such, offering any treatment, almost independent of the side effects, does appear to have a positive therapeutic index and thus this job probabilistically makes me feel better.

How would you describe your specialty?

There appears to be two distinct phenotypes of radiation oncologist. Type 1: Smart, nerdy and often times socially awkward. We spend a lot of time working with physicists. Type 2: Three-piece suit, full windsor tie, MBA, loves to network. Our specialty has gone through a large change over the past two generations because it used to be one of the least competitive specialties (a fellowship after radiology), and now it is one of the most competitive residencies.

What kinds of medical students tend to be attracted to your specialty?

Medical students who are very driven to complete research and are lifestyle driven for the most part. There is a substantial cohort of radiation oncology residents who are very interested in business as well. Many would emphasize a personal connection to a friend or family member with the diagnosis of cancer; however, statistically this certainly must be true for almost all residents in any specialty so probably not a very useful criterion to point out.

What do you like the most about your specialty and why so?

I get a lot of time with each of my patients and feel as though I can truly address each and every concern of each patient. I also get to work with medical physicists every day and am constantly learning. I’m not sure if this will wear off over time as I get more experience.

What do you like the least about your specialty and why so?

The sadness I feel when my patients experience bad outcomes, which is often times inevitable in many cases I see. I also have to work with highly egotistical people, although this may be true of every specialty as this perhaps is a common personality trait of those in medicine.

Learn More: Podcast Episode 24: Specialty Spotlight: Psychiatry

What do you find the most challenging about your specialty and why so?

The multidisciplinary nature of the work I do. On one dimension, I have to employ information from the basics of particle physics to how it interacts with biology. On another dimension, I need to understand clinical oncology and the details of trial design and get a deeper understanding of published literature than the simple conclusions from the abstract or UpToDate. On yet another dimension, I am challenged with explaining these very intricate concepts to people who have very little basis for an understanding of these concepts: my patients. Finally, I work very closely with almost every surgical subspecialty (thoracic surgeons, ENT, plastics, etc.) and so must be quite familiar with their fields and the details of their literature as well as medical oncologists who often times think quite differently than physicians in radiation oncology.

What’s the most interesting case you’ve seen or thing you’ve done in residency?

The best parts of my residency truthfully have been the perspective some of my patients have given me on life. One woman who has a life expectancy of several weeks, perhaps who I have become quite close with within the past week, was telling me how being on death’s door has changed her. I remember she offered me one of her cookies that one of her neighbors had brought by. As we shared a cookie, she expressed to me how she had spent the past two years fighting with various chemotherapy regimens and experimental protocols and failed to just spend 10 minutes simply enjoying the small things in life. Few of us have truly had to deal with our mortality, but from my observation in others it truly changes you. Perhaps part of my job has given me a great deal of perspective. It has allowed me to share in the greatest happiness people report in their life (being cured of cancer). It’s allowed me to see people struggle in great strength if only for their spouses’ sake, even when they confide to me once their family leaves the room that they wish they could just give up. It’s taught me a type of courage that I never thought I could have: to stand up for those who are disenfranchised in ways written about in no history book. I have seen the greatest strength of people surely enduring what must be some of the greatest pains a human can experience forgoing their pain medications in order to be lucid enough to help their equally sick spouse. The most interesting thing certainly has been the honor of getting to know my patients and the perspective hearing their experiences both with cancer and their life has given me.

Read More: A Day In the Life of an OB-GYN

What’s your advice for premeds in terms of making the most of their college academics, extracurriculars and social life?

Everyone talks about “balance.” I would perhaps ask you to consider that the best reward is finding academics/your job a reward in itself which is almost by definition an “unbalanced” philosophy. This seems to me to be true of all of my friends who have really found a passion for their specialty at my stage in training. Unfortunately, for the most part, this is a bit of a personal risk because adopting a strategy such as this, namely an “all in” strategy, can make you quite dissatisfied if things do not work out as planned. And unfortunately, apart from what many people might believe, much more of out fate is stochastic than is under our control. Or at least that would be my take on the situation.

What’s your advice for medical school applicants in terms of figuring out where to apply, writing personal statements and/or secondary essays, getting letters of recommendation, interviewing and/or anything else?

I don’t believe I was particularly successful in this aspect of my application process, so I’m not sure my advice would be very helpful. My philosophy is one of honesty. I would just say try your best to be honest and talk from the heart. You should think of the situation as an opportunity to find yourself amongst like-minded people who carry a similar philosophy of life. Many of us try to go to schools based on a reputation; but if you’re honest you might just find a place which is excited about you may select you and other like-minded people, and you may find great friends and relationships at that institution.

Ziggy Yoediono MD

Dr. Yoediono was a Duke University pre-major advisor, and an adcom member for Duke University School of Medicine, the University of Rochester School of Medicine and the Harvard Longwood Psychiatry Residency Program. Today, he is an Associate Director of Advising at MedSchoolCoach.

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