ACRO Resident Webinar August 25, 2016| Residency Expansion: Facts and Myths

[deleted18755]

What a joke to think that resident's "slow down" attendings. Attendings peak into consults after I have already asked all the questions and jump right to business allowing them to avoid dealing with the non-sense; they sit in their offices approving films while I answer questions and do consents . They look at my contours and take bites here and there, mostly clinically irrelevant changes that make no difference after the expansion. You guys think I sit around waiting for these passionate well meaning attendings to throw me a bone and teach me something? I count the hours to finish the non-educational work and scut so I can actually go read/rot in a corner and hear my biological clock ticking. Let that sink in.

I honestly think that these attendings think that residents slow them down. It's a reflection of their arrogance and cluelessness. I'm sure there are attendings who haven't taken a patient from beginning to end in a decade (I don't just mean the consult note and volumes/plan review but all the little, often zero to minimally educational but incredibly time consuming and sometimes soul sucking, things that goes into patient care) but go around complaining how the resident is taking too long in a room or on the phone when in fact they are cobtouring a brachial plexus or LAD that the attending wouldn't bother or arguing with insurance companies while the attending is watching the olympics in his office.

Anyway, I know a lot of you don't want to hear it but at least for now there are good jobs, great staff, and wonderful patients in "undesirable" locations. It's not for everybody but there are many small towns and cities within a 2-3 hour drive of the biggest cities in the US (not necessarily rural Arkansas) that are nice places to live and raise a family. Please consider or at least don't automatically discount them. I would love to live in a larger city especially as my children get older but I will happily stay among my current community then work/live with these arrogant, manipulate, "sharks."

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[Gfunk6]

Just in case any of the current PGY-5's are finishing up and feel that they have not been sufficiently exposed to palliation for bone mets - http://careers.astro.org/jobs/84256...hips-in-brachytherapy-cns-and-palliative-care

This may seem elementary to some of us, but it would be unwise to squander an opportunity to learn 8 Gy x 1 with "internationally renowned faculty."

 

[Fpg1245]

Anyway, I know a lot of you don't want to hear it but at least for now there are good jobs, great staff, and wonderful patients in "undesirable" locations. It's not for everybody but there are many small towns and cities within a 2-3 hour drive of the biggest cities in the US (not necessarily rural Arkansas) that are nice places to live and raise a family. Please consider or at least don't automatically discount them. I would love to live in a larger city especially as my children get older but I will happily stay among my current community then work/live with these arrogant, manipulate, "sharks."[/QUOTE]

I'm not really that interested in the state of the field now but rather where it is headed in the next 3-5 years. In that time frame, they'll be plenty of new residency spots open and even the "undesirable locations" will also be unavailable to new grads as they'll as the market will be completely saturated. I'm happy that you were able to find a place to practice that you liked but some of us would like to have options (eg rural, suburban, urban) when we finally graduate without having to tack on another year or two of fellowship or worse.

 

[deleted18755]

Just in case any of the current PGY-5's are finishing up and feel that they have not been sufficiently exposed to palliation for bone mets - http://careers.astro.org/jobs/84256...hips-in-brachytherapy-cns-and-palliative-care

This may seem elementary to some of us, but it would be unwise to squander an opportunity to learn 8 Gy x 1 with "internationally renowned faculty."

At first I thought "well maybe this isn't THAT bad ... I can imagine somebody out there who had minimal brachytherapy and SRS exposure in residency for whatever reason and they can just put up with doing all the low RVU palliative cases the big wigs at Harvard don't want" but then I realized this is literally THREE seperate fellowships!!!

I can definitely see this being a red flag on somebody's CV that would make me think twice about hiring them. It could be explained away by somebody saying something like "my wife had one year of training left and I had to fill a year before we moved" or something like that but if anybody thinks that completing a one year fellowship in palliative RT is something to be proud of or that will get you ahead please realize it may lead your future employer to question your residency training, overall competence, and general decision making skills. It might actually help you get a job but by somebody who sees you as a fool who can be taken advantage of easily.

 

[seper]

joint center is doing that also?


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[ToasterThief]

So to add to the doom and gloom, is anyone else finding that the 2016/2017 academic job hunt is off to a worryingly slow start? For those of you who have gone through it, when do most of the ASTRO interviews come?

 

[medicinewoman101]

So to add to the doom and gloom, is anyone else finding that the 2016/2017 academic job hunt is off to a worryingly slow start? For those of you who have gone through it, when do most of the ASTRO interviews come?

Astro interviews? Haha, no no that is a thing of the past. Sure there might be a few meetings set up at Astro sporadically. But that is incredibly few and far between now. Don't hold your breath for anything. Hiring now happens predominantly in jan and feb w interviews before that

 

[deleted18755]

I've been out of the loop for awhile but I still stay in contact with a bunch of residents who graduated in the past 2-3 years. One is living the dream, a few seem perfectly content, but three are miserable. Please be careful of the following when applying for "academic" jobs.

During the initial phone interview the chair talks about an academic position, after you get there for the interview he says "oh, by the way we just opened/acquired a satellite center and we need you to 'help out' until we find a 'community physician' to work there full time," you reluctantly agree* since you believe him but 1-1.5 year later after you bought a house and your kids just made friends/started school and you are still there in the middle of nowhere with 25-30 patients under treatment the chair says "I'm very disappointed in your lack of publications and academic productivity ... I think we should switch you from the academic to clinical track." Of note you still make an "academic" salary but you have the patient volume of a busy private practice.

At this point you are furious and feel betrayed/lied to but you remember that your contract precludes you from working within a 30 mile radius (of any site and the academic center has 3-5 "satellites" so you're not allowed to work anywhere within a 100 miles of your house) and your family is finally settling in after years of supporting you through med school and residency. You also realize that if you go someplace else this might/probably will happen again so you stay (2/3)** or talk to your friend Oldking and can't believe you are considering such a thing but decide to retreat to a small town in a big square state thousands of miles from where you grew up (1/3) and things are actually much better and not so bad there but for who knows how long.

I've followed along and watched helplessly as this happened to three of my close friends.

* "don't worry you'll have full resident coverage" might be used to entice you. At this point since you just finished residency and you are an academically oriented physician you think "it'll be tough to get any meaningful research done at this satellite site but at least I get to teach residents until I get back to the mother ship full time in a few months." Don't be surprised if when you actually get there, there are no residents rotation through, and when you ask about that the chair says "oh yeah, but don't worry we are expanding the residency program so you will have a resident soon."

** if this happens to you and you do have resident coverage please think back to when you were a resident and that fire you once had to actually teach and conduct research before all this greed and manipulation made you bitter and please do your best to teach him and don't turn in into a lazy and/or bitter jerk who says "I got screwed so I'll just let the crap slide on down to the resident."

 

[scarbrtj]

I was warned circa ~1997 that I would not be able to practice where I wanted to practice; wouldn't be able to "go back home" so to speak. Only gotten worse since that time. Pretty much, you finish a rad onc residency today, be prepared to move many, many states away from where you'd generally like to be. And expect a crap job to start. On top of that, the field is changing a lot. Much less autonomy, for example. And in general reimbursement has been steadily decreasing the past 10 years. That won't be changing. Medicine in general is sliding downward. The responsible approach, per specialty, would be to fight that slide as much as possible. Instead, it seems in rad onc we've vacillated between absolutely ignoring it and perpetuating it. How we as doctors lost control of this ship over the last 40-50 years is one of the most interesting stories ever. Right now, doctors don't look out for doctors; at best, surgeons look out for surgeons, dermatologists look out for dermatologists, etc. This sort of insularity has been a problem. It will not surprise me one bit if there's not some sort of unionization of physicians in the next few decades. If I could give advice to the youth, it would be: Medicine? No. Radiation oncology? Hell no. But I'm not jaded

 

[thecarbonionangle]

Just in case any of the current PGY-5's are finishing up and feel that they have not been sufficiently exposed to palliation for bone mets - http://careers.astro.org/jobs/84256...hips-in-brachytherapy-cns-and-palliative-care

This may seem elementary to some of us, but it would be unwise to squander an opportunity to learn 8 Gy x 1 with "internationally renowned faculty."

Well good to know the good folks at Harvard have our backs in this fellowship explosion mess. Why would we expect academics to be part of the solution when they stand to benefit so much from desperation in the coming years? People will be begging to catch the shade of these "internationally renowned faculty" doing their scut work just to have a job.