ASTRO panel session on US rad onc labor market

[deleted18755]

Wait a minute ... Arkansas, West Virgina, East Carolina ... How many radiation oncologist does the rural south need? This is crazy!

Out of curiousity and for the record can anybody list the new programs started over the past few years and the ones that plan to start in the next year or two?

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[deleted18755]

Also great idea debtrising. It's sad that some random dude on an Internet forum can throw together a great plan like that on the fly while our brilliant, world renowned "leaders" sit idle!

 

[Sheldor]

Also great idea debtrising. It's sad that some random dude on an Internet forum can throw together a great plan like that on the fly while our brilliant, world renowned "leaders" sit idle!

That is a great idea, and I think having more fluid residency positions while capping the number of spots around 10ish is ultimately what is best for our field.

I will add that I know at least two medical students from the University of Arkansas who opted not to go into Rad Onc because they didn't want to have to move away from their families in Arkansas, even to Texas. Just remember, that not everyone is willing to move away from their home town/state for 5 years of training. I'm not saying this absolutely justifies UAMS getting a residency, but I do think its important to consider that not everyone places career so high on their list that they are willing to do absolutely anything to get there.

As for the need, there are maybe 20ish or so Rad Oncs in Arkansas, and there is definite need in more rural parts. Unfortunately, getting people to move to rural arkansas if they aren't from there is near impossible.

 

[deleted18755]

That is a great idea, and I think having more fluid residency positions while capping the number of spots around 10ish is ultimately what is best for our field.

I will add that I know at least two medical students from the University of Arkansas who opted not to go into Rad Onc because they didn't want to have to move away from their families in Arkansas, even to Texas. Just remember, that not everyone is willing to move away from their home town/state for 5 years of training. I'm not saying this absolutely justifies UAMS getting a residency, but I do think its important to consider that not everyone places career so high on their list that they are willing to do absolutely anything to get there.

As for the need, there are maybe 20ish or so Rad Oncs in Arkansas, and there is definite need in more rural parts. Unfortunately, getting people to move to rural arkansas if they aren't from there is near impossible.

If tens of thousands of our brave young men and women are willing to leave their families (often including pregnant wives and young children) for years at a time to literally risk their lives and die in every God forsaken corner of this planet to protect us I find it hard to imagine that two medical students from Arkansas wouldn't go to Texas for four years (unlike our soldiers they could obviously take their immediate family with them and come back several times a year for major holidays and vacations) then come back and "serve" their community of cancer patients for something like $400,00-$600,000/yr.

Oh what a sacrifice that would be!

Instead let's open a residency program in every small town in the rural south.

 

[Sheldor]

If tens of thousands of our brave young men and women are willing to leave their families (often including pregnant wives and young children) for years at a time to literally risk their lives and die in every God forsaken corner of this planet to protect us I find it hard to imagine that two medical students from Arkansas wouldn't go to Texas for four years (unlike our soldiers they could obviously take their immediate family with them and come back several times a year for major holidays and vacations) then come back and "serve" their community of cancer patients for something like $400,00-$600,000/yr.

Oh what a sacrifice that would be!

Not saying its right, just what I've seen

Rural states are a different beast, in my experience. I've moved 7 times over the last 10 years, not going to lie, it kind of sucks. Either way, the reality is that folks in those states sometimes consider not sacrificing 5% of their life living elsewhere if it means they could be nearly as happy going into Radiology or Medicine.

How do we come up with a solution that works long term? California has 38 million people and turns out what, 17-20 rad onc residents per year? Meanwhile Arkansas has 3 million and turns out 0? Should we proportion some set number of spots proportionally like the house of representatives? I don't know.

I don't know what the solution is, though I think the bigger problem is that NO ONE is willing to enforce a solution.

 

[Mandelin Rain]

If tens of thousands of our brave young men and women are willing to leave their families (often including pregnant wives and young children) for years at a time to literally risk their lives and die in every God forsaken corner of this planet to protect us I find it hard to imagine that two medical students from Arkansas wouldn't go to Texas for four years (unlike our soldiers they could obviously take their immediate family with them and come back several times a year for major holidays and vacations) then come back and "serve" their community of cancer patients for something like $400,00-$600,000/yr.

Oh what a sacrifice that would be!

Instead let's open a residency program in every small town in the rural south.

This is nonsense, because it can be applied to any choice in life.

Oh, you don't want to work in Salina, KS or Rhinelander, WI? You want to work on the east coast? Are you aware there are military soldiers positioned abroad? Suck it up buttercup! Pack a bag, and welcome to Salina.

Job problem solved.

If anything, the residency positions should be redistributed to more rural areas. The population of Philadelphia is 1.5 million. How many rad oncs does that city need?

 

[deleted18755]

This is nonsense, because it can be applied to any choice in life.

Oh, you don't want to work in Salina, KS or Rhinelander, WI? You want to work on the east coast? Are you aware there are military soldiers positioned abroad? Suck it up buttercup! Pack a bag, and welcome to Salina.

Job problem solved.

If anything, the residency positions should be redistributed to more rural areas. The population of Philadelphia is 1.5 million. How many rad oncs does that city need?

I disagree with your first point and think you are completely missing the point. These individuals are actually from the rural South and want to live in these places that the vast majority of us find so repulsive but where a lot of people live and need cancer care. Also, there is a big difference between a four year residency a state or two over from Arkansas in Texas and actually taking a permanent job and living forever in Salina or Rhinelander when you grew up in NYC or San Diego.

I don't understand why these individuals wouldn't just do the residency in the next state over then go back to Arkansas and take care of their community while honestly probably making more than their counterparts in big cities (not even adjusting for cost of living).

I do completely agree that residency positions should be redistributed but do you really think that the "leaders" in our field who practice in NYC, Boston, and Philly will give up their free labor/note-writters . . . I mean residents . . . to Arkansas even if it is clearly in the best interest of our profession and country? The last thing we need is a new program in ever undesirable area indefinitely pumping out 1-2 new grads a year (who will each work for the next 40+ years).

 

[OTN]

The Arkansas argument to support expansion is ridiculous. Are we using the job market to decide on residency expansion or not? The Arkansas argument seems to suggest we are, while we've heard on this board many times about how it would be unethical/illegal (I feel asinine even typing that out) to decrease residency spots due to job market concerns. Which is it? You can't have it both ways, where you use job market claims to expand but not to contract the residency pool.

If those who are looking for radoncs in Arkansas can't find them to employ/join their group, then they need to sweeten the deal until the job is taken. Costs are lower, reimbursement is similar, so both hospital and private groups are making PLENTY of money from cancer care...enough to where they would certainly be able to find someone to fill the position as you increase salary/pay. If someone from Arkansas can't stomach the thought of leaving the state even for a few short years for training...well I have zero sympathy for that. As we've said time and time before here, if you have specific geographic requirements (and staying in a small, rural state for your entire career certainly counts), radonc ain't for you. At all.

It makes no sense to add any residency positions to the field at this point, regardless of the reason, full stop.

 

[Mandelin Rain]

I disagree with your first point and think you are completely missing the point. These individuals are actually from the rural South and want to live in these places that the vast majority of us find so repulsive but where a lot of people live and need cancer care. Also, there is a big difference between a four year residency a state or two over from Arkansas in Texas and actually taking a permanent job and living forever in Salina or Rhinelander when you grew up in NYC or San Diego.

I don't understand why these individuals wouldn't just do the residency in the next state over then go back to Arkansas and take care of their community while honestly probably making more than their counterparts in big cities (not even adjusting for cost of living).

I do completely agree that residency positions should be redistributed but do you really think that the "leaders" in our field who practice in NYC, Boston, and Philly will give up their free labor/note-writters . . . I mean residents . . . to Arkansas even if it is clearly in the best interest of our profession and country? The last thing we need is a new program in ever undesirable area indefinitely pumping out 1-2 new grads a year (who will each work for the next 40+ years).

So you're good as long as you're not the one who has to move? But, my God think of the troops....

Anyway, I would not expand number of slots at all, and there is a big problem with redistribution. That being, the new chair of Arkansas is going to take the best applicants she can match, not the most likely to stay in Arkansas. As soon as those matched graduate, they too will be looking to move to San Francisco like everyone else.

 

[deleted18755]

So you're good as long as you're not the one who has to move? But, my God think of the troops....

Anyway, I would not expand number of slots at all, and there is a big problem with redistribution. That being, the new chair of Arkansas is going to take the best applicants she can match, not the most likely to stay in Arkansas. As soon as those matched graduate, they too will be looking to move to San Francisco like everyone else.

I actually trained in a city then moved back to my hometown (a place in the rust belt that people from places like Cleveland and Detroit look down upon and our claim to fame is it snows more than Buffalo!). It is difficult to recruit to places like this and then it's tough to stay when wives and families want out but there are a lot of decent people here. I would go to Rhinelander (I looked it up and the weather is nicer than where I am! or Salina to help the people there if I weren't in a similar place already and ... I'm an immigrant to this incredible country and if troops can go abroad to defend me I can go anywhere to care for patients).

As an aside, if anybody knows of a practice in Colorado or the mountain states in an "undesirable" or at least underserved area with good folks who could use my help (and that of my wife who is a med/onc but is happy to be a PCP for underserved as well) please let me know. We have never had a problem with anybody or fitting in but we are both first/second generation Indian immigrants and we have three young sons if that matters. Enough about me ...

Otherwise I agree with everything you said. I really doubt the new chair from Ohio is going to pass on top candidates in favor of local Arkansas folk and then of course those individuals will just go further saturate big cities and leave rural Arkansas in the dust.

 

[Sheldor]

The Arkansas argument to support expansion is ridiculous. Are we using the job market to decide on residency expansion or not? The Arkansas argument seems to suggest we are, while we've heard on this board many times about how it would be unethical/illegal (I feel asinine even typing that out) to decrease residency spots due to job market concerns. Which is it? You can't have it both ways, where you use job market claims to expand but not to contract the residency pool.

If those who are looking for radoncs in Arkansas can't find them to employ/join their group, then they need to sweeten the deal until the job is taken. Costs are lower, reimbursement is similar, so both hospital and private groups are making PLENTY of money from cancer care...enough to where they would certainly be able to find someone to fill the position as you increase salary/pay. If someone from Arkansas can't stomach the thought of leaving the state even for a few short years for training...well I have zero sympathy for that. As we've said time and time before here, if you have specific geographic requirements (and staying in a small, rural state for your entire career certainly counts), radonc ain't for you. At all.

It makes no sense to add any residency positions to the field at this point, regardless of the reason, full stop.

As to people's willingness to move, well, that is clearly a personal topic. I am of the opinion that 4 years is a significant period of life and that it is justifiable to not want to remove your children from their grandparents, or leave your life long home. Now, maybe its because I see young people dying all the time, but 4 years is not an insignificant portion of ones life. I almost didn't go into Rad Onc because of this but ultimately decided it was worth it. Do I have regrets? Sort of. My nieces and nephews are grown, I've missed births, I don't get to go to lunch every week with my brother and Dad, etc. These are real losses, and these are 4 years I won't get back. Now, In my case I had to move for medical school as well so its actually 9 years which makes the sting worse, but the point remains.

For the record, I agree with your conclusion. In fact, I think we need to reduce the number of residency positions back to the level they were at a few years ago. However, if "they" are going to approve expansions, I do think it is helpful to decide whether all new spots are truly equal.

 

[OTN]

As to people's willingness to move, well, that is clearly a personal topic. I am of the opinion that 4 years is a significant period of life and that it is justifiable to not want to remove your children from their grandparents, or leave your life long home. Now, maybe its because I see young people dying all the time, but 4 years is not an insignificant portion of ones life. I almost didn't go into Rad Onc because of this but ultimately decided it was worth it. Do I have regrets? Sort of. My nieces and nephews are grown, I've missed births, I don't get to go to lunch every week with my brother and Dad, etc. These are real losses, and these are 4 years I won't get back. Now, In my case I had to move for medical school as well so its actually 9 years which makes the sting worse, but the point remains.

For the record, I agree with your conclusion. In fact, I think we need to reduce the number of residency positions back to the level they were at a few years ago. However, if "they" are going to approve expansions, I do think it is helpful to decide whether all new spots are truly equal.

"Zero" sympathy was too harsh on my part. I certainly do understand that it's tough to move away from friends/family- Lord knows I've done it. It sounds like you knew just what to expect with a field like radonc going in, and that's all one could reasonably expect.

 

[canadianoutlaw]

I agree that the issue is more than just oversupply and that maldistribution is a huge component. I like the DebtRising idea, but just to play devils advocate here, it is still possible that these trainees do not move back to their rural roots at graduation. How do you ensure they return to practice in the undeserved locations? People will try to game the system to match in rad onc with empty promises during interviews, etc

A smart solution would be to team up with a larger center, you know like one of the ones in Texas, where the Arkansas institution and the Texas institution 'share' a spot every 2-3 years. They could specifically recruit to fill this spot from Arkanas or local regions- ie people who want to live there long term. The larger Texas institution would get an extra resident every 2-3 years; the requisite, essentially free labor to make their administration / senior docs happy, and this resident could then rotate through Arkanas for periods of time during residency as well to familiarize themselves with system and physicians. And, as pointed out previously, this resident would get superior training with a bigger and more diverse case load from the larger institution - all the while not being that terribly far from the state.

 

[DebtRising]

I agree that the issue is more than just oversupply and that maldistribution is a huge component. I like the DebtRising idea, but just to play devils advocate here, it is still possible that these trainees do not move back to their rural roots at graduation. How do you ensure they return to practice in the undeserved locations? People will try to game the system to match in rad onc with empty promises during interviews, etc

This can be tackled in a few ways. Tying tuition reimbursement to number of years in the state - having the annual contract be dependent on location post training. If I learned anything from looking into these things, residency management is much more like the wild west then a well regulated system, and very few lawsuits seeking clarification of labor practices and contract limitations have ever been brought (disclosure: I am not a lawyer).

The counter argument to your point was already mentioned as well - there is no guarantee the AR residents are going to stay in AR. Is the chair really going to pick local candidates every year? Not only is that doubtful, its impossible based on the demographics. Same for W. VA with UPMC not too far away, and same with the new Carolina place.

I don't know the right way forward - if that is a good idea we should try and find a way to advocate for it. Personally I am afraid of being blacklisted - Wash U did not seem to paint a nice picture with their own former resident who just merely questioned the supply of labor, and he brought it up after finding employment elsewhere. I have wrote to ARRO, and will do so again. On a micro-level I have made sure this information and the employment search of past residents is available to prospective students. Not in a 'sky is falling' manner I post on here (I firmly believe the sky has already fallen on this issue and the repercussions will be long lasting - already over supplied and rising with lag time to true effect!!)- I just point them to the new employment projections, I point to how many new true faculty my institution has hired versus satellite-only positions / length of employment of senior docs, how quickly residents spots have expanded and change in ratio of applicants to slots to near parity, what happened when similar trends occurred in radiology and let them make their own conclusions. None of that is done with malice because I don't know everything that occurs in the labor market, but certainly there are enough objective data points there that are worth sharing.

Edit - Thought of it after posting. Maybe that's the best someone in my position can do - put together the objective evidence of oversupply / worsening market and try and get it pubished, even if informally on SDN as a sticky titled 'Not to be rude, but here is why you might not be able to find the job you think for the next 15 years.."

 

[Sheldor]

"Zero" sympathy was too harsh on my part. I certainly do understand that it's tough to move away from friends/family- Lord knows I've done it. It sounds like you knew just what to expect with a field like radonc going in, and that's all one could reasonably expect.

I may have came across as overly fatalistic as well, so I apologize for that. I just wanted to speak up for people with spouses/kids where the decision is not as simple as "its just four years."

 

[deleted18755]

I hereby nominate "debtrising" for the next president of ASTRO!

 

[BobbyHeenan]

Chirag Shah - the initial author of the Red Journal article outlining the concern over residency expansion has been proven correct on every.single.point so far moving forward:

1. We don't have an under supply problem and we actually might have an over supply issue
2. We have a distribution issue (hard to recruit to rural places)
3. Graduating more residents will not solve #2; we've been doing that and these issues are still there

To recruit to rural places you give incentives: pay them more, offer debt relief, tie a residency expansion to a guarantee (with financial penalties) to serve in a rural area, etc. Primary care and visa/immigrant programs have used these strategies in the past. I personally had a state issued student loan that was 100% forgivable if I did primary care in certain counties within that state. If I didn't do primary care, then I owed it in full with a higher interest rate than standard.

The other solution to rural centers is to allow mid levels or med oncs to "supervise" on certain days. Not for CT sims, SBRT, HDR, etc though. This opens up a slippery slope, but people do this now and slide underneath some gray areas in Medicare rules. There are some rural exemptions in place, but the threshhold for meeting them is pretty high. I'm personally not a huge fan of this, but to me it's better than programs continuing to pop up. The reality is that it's very hard to get a full time rad onc to live in a rural area and bill professional fees only if the linac is only treating 15-20/day. If financially the hospital or whomever cannot sweeten the pot, then less days worked is another way.

In my mind you start with those measures, you don't simply just continue to churn out residents.

However I think the whole "under supply" thing was a red herring. Like others mentioned above, the powers that be initially loved to tout that as a reason for expansion. Now that it's been debunked they don't mention it and instead are hiding behind it being "legally tenuous" to limit expansion. The goal posts have moved, and in a direction that absolutely hurts young residents.

 

[seper]

Eventually there will be way too many grads, and rural spots will get filled.

 

[medgator]

Eventually there will be way too many grads, and rural spots will get filled.

Not until it's pretty much wrecked the urban/suburban market.

 

[OTN]

Not until it's pretty much wrecked the urban/suburban market.

Hospitals will take advantage of the glut of radoncs to depress salaries, that's for sure, but private practice groups, as long as they're good and don't screw over new grads, shouldn't see much of a change in income. As we all know, you can't just go "hang a shingle" as a newly-minted radiation oncologist, so we're not going to see increased competition on its own, but only via expansion from other groups and hospitals. Given the large capital outlay for a radonc department, the salary of a radonc isn't going to be the deciding factor in whether or not a new center will be built.

I just can't see how a bunch of radoncs looking for work will really change the dynamics of most markets. Unfortunately, this does mean the potential for unemployment for new grads. Personally, I would favor an immediate halting of all residency program expansion (sorry Arkansas) and a 5-10% reduction in residency positions over the next few years. I find the lack of concern/ability to do the right thing on the part of ASTRO leadership to be abhorrent, and certain docs in particular the forefront of this should feel ashamed.

 

[Neuronix]

Hospitals will take advantage of the glut of radoncs to depress salaries, that's for sure, but private practice groups, as long as they're good and don't screw over new grads

I chuckled. After interviewing with all three types of groups (academic, private hospital owned, private physician owned), I don't think greed is specific to a practice environment. Not that they're all bad of course, but there are certainly exploitative private physician groups out there.

 

[medgator]

Hospitals will take advantage of the glut of radoncs to depress salaries, that's for sure, but private practice groups, as long as they're good and don't screw over new grads, shouldn't see much of a change in income. As we all know, you can't just go "hang a shingle" as a newly-minted radiation oncologist, so we're not going to see increased competition on its own, but only via expansion from other groups and hospitals. Given the large capital outlay for a radonc department, the salary of a radonc isn't going to be the deciding factor in whether or not a new center will be built.

I just can't see how a bunch of radoncs looking for work will really change the dynamics of most markets. Unfortunately, this does mean the potential for unemployment for new grads. Personally, I would favor an immediate halting of all residency program expansion (sorry Arkansas) and a 5-10% reduction in residency positions over the next few years. I find the lack of concern/ability to do the right thing on the part of ASTRO leadership to be abhorrent, and certain docs in particular the forefront of this should feel ashamed.

I meant that in reference to the job market for new grads. They will pretty much be left with hospitals and shady pp groups who can take advantage of this supply/demand imbalance. That's basically already happening in some desirable urban markets

 

[OTN]

I chuckled. After interviewing with all three types of groups (academic, private hospital owned, private physician owned), I don't think greed is specific to a practice environment. Not that they're all bad of course, but there are certainly exploitative private physician groups out there.

Oh I very much agree with this. There are some good private practice groups which still remain, but the "hire and fire" guys will have a field day with all the available grads.

 

[medicinewoman101]

My whole life has been upended by rad onc. I'm in a good place but not the place that I need. I will probably leave the field at some point soon but holy cow 7-8 years of your life is not worth many undertakings. Could certainly have found a way to be happy in Pathology and live where I wanted. If you are looking at getting into rad onc you should think very long and hard. And if you have to think very long and hard you probably shouldn't do it.

I actually trained in a city then moved back to my hometown (a place in the rust belt that people from places like Cleveland and Detroit look down upon and our claim to fame is it snows more than Buffalo!). It is difficult to recruit to places like this and then it's tough to stay when wives and families want out but there are a lot of decent people here. I would go to Rhinelander (I looked it up and the weather is nicer than where I am! or Salina to help the people there if I weren't in a similar place already and ... I'm an immigrant to this incredible country and if troops can go abroad to defend me I can go anywhere to care for patients).

As an aside, if anybody knows of a practice in Colorado or the mountain states in an "undesirable" or at least underserved area with good folks who could use my help (and that of my wife who is a med/onc but is happy to be a PCP for underserved as well) please let me know. We have never had a problem with anybody or fitting in but we are both first/second generation Indian immigrants and we have three young sons if that matters. Enough about me ...

Otherwise I agree with everything you said. I really doubt the new chair from Ohio is going to pass on top candidates in favor of local Arkansas folk and then of course those individuals will just go further saturate big cities and leave rural Arkansas in the dust.

 

[Gfunk6]

My whole life has been upended by rad onc. I'm in a good place but not the place that I need. I will probably leave the field at some point soon but holy cow 7-8 years of your life is not worth many undertakings. Could certainly have found a way to be happy in Pathology and live where I wanted. If you are looking at getting into rad onc you should think very long and hard. And if you have to think very long and hard you probably shouldn't do it.

Have to say I've had the precise opposite experience in every way. Ideal location, decent income, wonderful partners and most important of all AUTONOMY. Since we are dealing with extremes, figured I would share the other side of the spectrum.


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[medgator]

Have to say I've had the precise opposite experience in every way. Ideal location, decent income, wonderful partners and most important of all AUTONOMY. Since we are dealing with extremes, figured I would share the other side of the spectrum.


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Same here, very happy with my job/location/practice setup. Again, we're both out a few years here, not newly minted grads.

I do think astro and the academic community has done a disservice by expanding slots for those looking for solid pp/independent jobs NOW. We had a partner retirement last year. She was really the least busy out of all of us and instead of bringing someone on, we're all working a little harder....

 

[Mandelin Rain]

Have to say I've had the precise opposite experience in every way. Ideal location, decent income, wonderful partners and most important of all AUTONOMY. Since we are dealing with extremes, figured I would share the other side of the spectrum.


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Agreed. I'm with you, and am not too far from the job hunt. It's definitely not as bad for everyone as it's made out here. There are opportunities for a great job in all practice models. If your search is very narrow, however, you probably won't find them.

 

[radiaterMike]

Word on the street is that labor market and residency positions are on the agenda for the next SCAROP meeting. Being out of the loop on the job market I wonder if there is any data on this. I.e. how many positions are filled from unadvertised positions. I would assume that the chairs would appreciate the residents experience in the job hunt. If the struggles are real I would expect them to address it.


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[radiation]

Anybody attend?

 

[xrthopeful]

Yeah I mean all the graduates I know this year had no trouble finding jobs they liked.

The real frustrations voiced here are that this could be a real problem in the future if you pay attention to the numbers, which it seems like the ivory tower types have historically ignored. I am hopeful that because people always seem to be talking about this stuff now that there will be changes.

First step is stopping Arkansas, West Virginia, and East Carolina dead in their tracks with their plans to open residency programs.

It's too late with University of Tennessee, they've just started one.

 

[mpdoc2]

Yeah I mean all the graduates I know this year had no trouble finding jobs they liked.

The real frustrations voiced here are that this could be a real problem in the future if you pay attention to the numbers, which it seems like the ivory tower types have historically ignored. I am hopeful that because people always seem to be talking about this stuff now that there will be changes.

First step is stopping Arkansas, West Virginia, and East Carolina dead in their tracks with their plans to open residency programs.

It's too late with University of Tennessee, they've just started one.

Funny, all the graduates I know had trouble findings jobs they liked.

 

[medgator]

Funny, all the graduates I know had trouble findings jobs they liked.

These anecdotes are just that. If all 1-3 of your senior residents are willing to be geographically flexible and they end up with jobs they are happy with, that has no bearing on the decision and subsequent effects of increasing the number of rad onc residency spots 50% in 10 years.

Certain locales have become competitive the last few years to get good, if any, jobs and this will only exacerbate with the ongoing trends in residency expansion

 

[radiaterMike]

This really is not a new problem. If you talk to people who have been in the field 10, 20 and even 30+ years, many will say that they are where they are at (or were at) because that was the job that was available when they graduated. The question is how much of a problem is it, and to what extent will expanding residency positions affect the problem. Will adding spots in Arkansas really affect the demand for a swanky Manhattan job ? Probably not. Are residents forced to take jobs in practices with questionable scruples (i.e. keep new hires for a few years and not offer partnership because a new crop of cheap labor is coming). Probably. If so, is this a greater problem because of increased workforce and lower demand ? I don’t know the answers to these questions- but to enact change, these questions will need to be answered. All graduating residents not getting their ideal location and ideal job right out of residency is not enough to enact change because no change is going to correct that. You are not entitled to everything you want in life if other people want the same things. One thing residents can do is to work hard in residency and to start networking very early in their career to make connections in the practice(s) he/she wants. More residents are doing this, which is why many jobs are filled without advertising on the ASTRO web site. Those that aren’t doing this think the sky is falling. Maybe it is, but the data needs to show it is before anyone is going to make a change.

 

[Krukenberg]

http://news.cision.com/american-soc...for-sustained-increases-to-cancer-re,c2017525

ASTRO priority #4 is explicitly about training more doctors, and presumably in astro's case more rad oncs


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[canadianoutlaw]

http://news.cision.com/american-soc...for-sustained-increases-to-cancer-re,c2017525

ASTRO priority #4 is explicitly about training more doctors, and presumably in astro's case more rad oncs


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I was at Advocacy Day and when this was discussed, the emphasis was more about preserving existing Medicare funding for graduate medical education as a whole, for the "House of Medicine", and less about increasing the number of radiation oncologists in training. The current cap on Medicare support for GME was imposed by the Balanced Budget Act of 1997 and the president’s FY 2017 Budget proposes to reduce the indirect medical education (IME) adjustment by 10 percent beginning in FY 2017. This would cut funding to teaching hospitals by nearly $18 billion over 10 years. Many programs struggle paying their current residents. I think this is attempting to address a bigger question: how are residents going to get paid? But I agree, this is a slippery slope for rad onc with our potential impending oversupply of radiation oncologists. But I'm sure current and future residents would like to continue to get paid.

More here from the AAMC:
https://www.aamc.org/download/300736/data/trainingtomorrowsdoctorstodayact.pdf

 

[Mandelin Rain]

Funny how these things go.

Most recent (past week) ASTRO advertised jobs include....

Baltimore
Toronto
Palo Alto (SF)
Royal Oak (Detroit)
St. Louis
Washington DC
NYC
Little Rock
NYC (Columbia needs a junior faculty after a presumably failed attempt at filling that ridiculous fellowship)

Jobs in civilization exist.

 

[canadianoutlaw]

Funny how these things go.

Most recent (past week) ASTRO advertised jobs include....

Baltimore
Toronto
Palo Alto (SF)
Royal Oak (Detroit)
St. Louis
Washington DC
NYC
Little Rock
NYC (Columbia needs a junior faculty after a presumably failed attempt at filling that ridiculous fellowship)

Jobs in civilization exist.

I think I also saw two jobs posted in Boston recently as well

 

[Mandelin Rain]

As a lesson to current residents... great jobs open up every year around this time. It's so late in the game that most every one else has already signed and you become in hotter demand. Perhaps that's changed recently if people are struggling to find jobs, but I know a few people who signed late and landed jobs they love. Keep the faith.

 

[ramsesthenice]

As a lesson to current residents... great jobs open up every year around this time. It's so late in the game that most every one else has already signed and you become in hotter demand. Perhaps that's changed recently if people are struggling to find jobs, but I know a few people who signed late and landed jobs they love.

I can tell you that an academic center in a highly desirable big east coast city (tri-state area) is currently looking for someone who is graduating this year. I interviewed with them for a job to start next year and they told me this week plans changed and they want to try to fill it this year. Sucks for me but it proves that they are out there...

 

[medgator]

Funny how these things go.

Most recent (past week) ASTRO advertised jobs include....

Baltimore
Toronto
Palo Alto (SF)
Royal Oak (Detroit)
St. Louis
Washington DC
NYC
Little Rock
NYC (Columbia needs a junior faculty after a presumably failed attempt at filling that ridiculous fellowship)

Jobs in civilization exist.

Most of those are academic positions to be fair. It's been mentioned before and it's worth mentioning again, the good pp jobs in semi desirable/desirable locations aren't posted on the astro site. Also, there literally hasn't been a decent FL or Carolinas job posted in months, academic or otherwise

 

[canadianoutlaw]

Most of those are academic positions to be fair. It's been mentioned before and it's worth mentioning again, the good pp jobs in semi desirable/desirable locations aren't posted on the astro site. Also, there literally hasn't been a decent FL or Carolinas job posted in months, academic or otherwise

UNC, Duke, Wake Forest and SERO have all hired recently. They may not have been posted on ASTRO

 

[ramsesthenice]

Most of those are academic positions to be fair. It's been mentioned before and it's worth mentioning again, the good pp jobs in semi desirable/desirable locations aren't posted on the astro site. Also, there literally hasn't been a decent FL or Carolinas job posted in months, academic or otherwise

None of them are posted (academic or otherwise). This one wasn't either. The good ones almost never are. But you know that. I'm pretty sure you have told me that before. The job I was looking at was brought to my attention by my PD through a friend.

 

[medgator]

UNC, Duke, Wake Forest and SERO have all hired recently. They may not have been posted on ASTRO

My point exactly. I don't recall any of those jobs being posted on the astro site. They didn't have to resort to that as there were probably lots of internal candidates and/or candidates who hustled and made pp connections early

 

[Krukenberg]

http://careers.astro.org/jobs/8053670/radiation-oncologist-practice-opportunity-in-hendersonville-nc

What's the deal with "fellowship in radiation oncology preferred"?


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[medgator]

http://careers.astro.org/jobs/8053670/radiation-oncologist-practice-opportunity-in-hendersonville-nc

What's the deal with "fellowship in radiation oncology preferred"?


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Starting to sound like the radiology job market

 

[RadOncDoc21]

http://careers.astro.org/jobs/8053670/radiation-oncologist-practice-opportunity-in-hendersonville-nc

What's the deal with "fellowship in radiation oncology preferred"?


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I think it's more of a mistake on the recruiter. During my job search I spoke with recruiters/head hunters who thought radiation oncology was something you go into after a prior residency such as internal medicine, etc. It's not just physicians who don't know anything about our field.

 

[canadianoutlaw]

I think it's more of a mistake on the recruiter. During my job search I spoke with recruiters/head hunters who thought radiation oncology was something you go into after a prior residency such as internal medicine, etc. It's not just physicians who don't know anything about our field.

agreed. i find it highly unlikely (impossible?) a center in rural NC would care about a rad onc fellowship. In residency I was often called a "fellow" by support staff, and sometimes even by non-rad onc attendings, who just didn't know better

 

[thesauce]

agreed. i find it highly unlikely (impossible?) a center in rural NC would care about a rad onc fellowship. In residency I was often called a "fellow" by support staff, and sometimes even by non-rad onc attendings, who just didn't know better

Yeah - just recently I had another attending ask me where I did my fellowship. I said that I didn't do one and he stood there incredulously. I tried explaining it 3 or 4 times and finally gave up. It's bizarre because it hasn't been a subspecialty of radiology since before either of us was born

 

[madewell]

A friend who is an academic professor at an esteemed east coast institution asked me how long my fellowship would last. While we need to stop the increase of residency positions if possible, it's unlikely to affect the vast majority of us. The people training at those places are likely to get inferior clinical training + not be as strong academically. You should still be able to get more desirable jobs, but can't complain if they take pp jobs at locations you don't want. The problem from my perspective is how much we rely on medical oncologists, despite having longer oncology training and most likely seeing more patients than they do. Anyone with cancer that can/have been treated by radiation oncology should see a radiation oncologist without a referral. After all, we are oncologists.

 

[thecarbonionangle]

That probably will not change unless we merge with med onc. It is so engrained in the internal medicine mind set to consult/refer to med onc even though the patient just needs radiation for "coordination of care". For example if a rad onc patient shows up in the ER and is admitted, often the ER calls the med onc service for admission and advice. Unless rad onc is willing to go to the ER and admit at 3am and take care of that patient the current system will not change. Any takers?

Many are too hard headed to see that we are ONCOLOGISTS. This is mostly due to the internal medicine mind set as well. Med onc is often referred to as "oncology" in the internal medicine world and when rad onc is brought up I think people hear "RADIATION oncology", or in other words "radiation doctors". They don't make the connection to realize that med oncs are "chemotherapy doctors". The root of this problem is traced back to medical education. Rad oncs rarely lecture medical students and a rad onc rotation is not a part of the curriculum. Somehow psych and neurology are? Then when these students start internal medicine residency, they don't rotate with rad onc either. Overall this creates the generally held belief that rad onc is "easy" and you are hardly involved in patient care. Many think we are radiologists. It is only until they are med onc fellows when they rotate with rad onc for a month in some places. By then it is too late, and nobody knows what rad onc does. People think we just press a button and "nuke" the patient without ever seeing them. It is funny now that I am close to finishing my intern year, people are starting to stay things like "are you ready to be chilling and not see patients?". People have no idea what we do, even at the senior attending level.