I think this is a great topic. I wanted to put a few objective data points here to give the foundation on why there is so much negativity from certain parts of our community on this issue. All of these are found in other threats.
1. Radiation oncology demand:
Supply and Demand for Radiation Oncology in the United States: Updated Projections for 2015 to 2025.
http://www.ncbi.nlm.nih.gov/pubmed/27209499
This is a revision to a model published in 2014. I am going to copy and paste part of the abstract (we all have the full article, abstracts are free to view and thus can be posted)
"Between 2015 and 2025, the annual total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 19%, from 490,000 to 580,000. Assuming a graduating resident class size of 200, the number of FTE physicians is expected to increase by 27%, from 3903 to 4965.
In comparison with prior projections, the new projected demand for radiation therapy in 2020 dropped by 24,000 cases (a 4% relative decline). This decrease is attributable to an overall reduction in the use of radiation to treat cancer, from 28% of all newly diagnosed cancers in the prior projections down to 26% for the new projections.
By contrast, the new projected supply of radiation oncologists in 2020 increased by 275 FTEs in comparison with the prior projection for 2020 (a 7% relative increase), attributable to rising residency class sizes."
In other words - due solely to residency expansion and based on a now rescinded model we are already training more radiation oncologists than are needed.
A potential argument could be that the tide will turn - radiation services will expand. In this current climate where we are the de-factor enemy (we being physicians), and the studies that show that oncologic care is superior in the US are either picked apart or not discussed (while those discussing absolute mortality numbers are held up as fact... which is insane when the correct metric should be cause-specific mortality rates), I submit there is almost no chance radiation services will increase.
2. The job market circa 2014
Employment After Radiation Oncology Residency: A Survey of the Class of 2014
http://www.ncbi.nlm.nih.gov/pubmed/26194674
Employment information was found for 163 / 167 graduates but only 60% responded to survey
Some very sobering stats
128 slots in 2006 -> 200 2015
33% found no job openings in there geographic area of interest
Of those who found a job, 16% wanted academic practice but could not find a position
7/97 of respondents could not find a job (7% could not find a job!!!)**
**All of these results are freely available when I google/pull up the article on my smart phone on a personal device that does not have red journal subscription typed in. If this is an error and they should not be shared to those people who do not have a red journal subscription please let me know. I say this only because there is no listed abstract on pubmed. But I would not post if I could not obtain this information freely at this time.
This is data from 2014. Let that sink in. Again, a potential argument is that a snapshot in time does not give a full picture of employment. I counter that argument with the fact that massive medicare changes are supposedly coming, of which there seems to be little advanced notice, and uncertainty in payment is unlikely to foster healthy hiring in the future.
3. At least some in the field, outside those of us who joined this field when ASTRO had the old model and 'Demand is expected to increase!!!!' plastered on their website, are becoming aware of this and seem to actually care about residents.
The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation
http://www.redjournal.org/article/S0360-3016(16)30289-9/abstract
"
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors and entrenched professional groups. Policymakers must recognize that the number of practicing radiation oncologists is a poor surrogate for clinical capacity.
There is likely to be significant opportunity to augment capacity without increasing the number of radiation oncologists by improving clinic efficiency and offering targeted incentives for geographic redistribution"
Thank you for taking the time to write this Dr. Falit. I truly feel that the senior physicians in this field could care less about the labor market, much like what happened with radiology (ie: Oh I care about my residents... but if you're residents can't find a job that's not a concern for me).
4. Fellowships, which are not accredited, required, or seem to truly advance knowledge (outside a TRUE proton or pediatric situation) are expanding.
The ARRO fellowship directory is attached to this post
21 fellowships. 21!!
Some of the descriptions don't even have a clear focus of interest, leaving it up to the applicant (though I do submit, this is an ARRO accrued list and not official material from the program).
There is a lymphoma fellowship at MSKCC. Are there really residency programs where Hodgkin's lymphoma is not taught well? The website also lists lymphoma and myeloma... not sites with a lot of complexity on our side. Everyone at MSKCC may be smarter and more accomplished than I am, though I will put my work ethic against anyone's. But with that said, how is that defensible? It is either an implicit acknowledgment that there are deficient training programs in our country, or a play to get people desperate for NYC into a pseudo-job at below market rates. And I don't mean to pick on MSKCC.... their fellowship page was just the first search result when I googled.
5. Medicine is in decline. We are being told to accept lower reimbursement, see more patients, jump through more hoops from government mandates and private insurance companies, and a large part of the population wants a 'public option' insurance type pushed. Yet none of these people are offering to pay our student loans or cost of education (as is done in all the countries with said policies), lower our paper work / administrative time, or offer meaningful tort reform (less relevant to our field unless we really examine follow up imaging ordering). That is a whole other discussion but I doubt anyone here would argue my premise - we are the enemies (whole field / health costs), we have no unified voice, and there is a good chance things will get worse.
Basically, as we pump out more graduates that our specific field and society doesn't need, we are adding more weight to a ship that overall is sinking, and may be sinking quickly.
I would even argue that this will not reduce costs or salaries - but more radiation services will be offered to justify positions. Every bone met will be treated, every lung nodule will be SBRT'd, every prostatectomy path with EPE will be radiated (for some reason referrals at this point seem to never get held up....
.
6. This is a catastrophic setup, and this just happened in radiology.
To make it even better... we keep expanding! I forget which - did Arkansas just come online? What about W. Va? How can anyone justify opening new residencies in this environment? There should be a hybrid solution, targeting areas of need (like I posted before a hybrid position between Arkansas and a Texas program, or between W. Va and UPMC where a slot is created and shared to recruit someone to these 'underserved' areas and the resident rotates at both places before accepting a position in geographic region X... absolutely would offer superior clinical training without creating a new slot in perpetuity AND would attract people who are interested in being in region X at the outset). But as reimbursements fall, it is hard to cut back on a very cheap and very flexible labor source.
I wish I was more senior and involved in health policy, but I am not. What I can do is post the few objective data points there are to show how bad things are, and posit a few arguments that I doubt anyone can fully refute to make the point clear. This is where the negativity about the job market comes from. And this is why anyone who is seriously considering entering this field needs to investigate this further, as much as they can, because it is not a given you will have a job. It wasn't in 2014.