Oscar, great to read your thoughts on the all of this (your analysis is so much more eloquent than mine). To answer your first question, I was basing my analysis on the strength of the residency program, which I was loosely basing on the following criteria in no particular order (although it was more of a gestalt, than a no holds barred US News and World Report in depth spreadsheet analysis):
1. Quality of clinical training
2. Quality of didactics/ learning the rad onc literature (closely related to #1 above)
3. Research experience/opportunities
4. Current overall strength of the rad onc department (not necessarily related to the residency program); For example, I consider Sloan to be #1 or #2 in terms of strength of the department. The technology is simply amazing, research by attendings is top notch, clinical care of patients is second to none, no other institution is as well respected by the public. In short, this is the type of place I would take my mother, father, spouse, etc. if they needed XRT. Yet, I don?t think their residency training is in the top two for the reasons discussed in my earlier post.
5. Reputation of the department (closely related to #4 above, but still distinct); for example Stanford has a great reputation within the field of rad onc, but I think that its current strength (#4 above) is well below its reputation (i.e. it is living on past glory).
6. Ability to get a top job in private practice
7. Ability to get a top job in academics
8. Quality of fellow residents
9. Lifestyle as a resident
10. Technology of the program
A word on location; I tried to avoid including this in the analysis. I know that it matters, but this is something each applicant can decide on how to factor into his or her individual situation. Some people just have to be on the coast, and would never consider MD Anderson, U Michigan, or Wash U. Others are from the Midwest, and prefer to return home for residency. Otherwise, I think most people would agree with the above criteria and the direction in which they should go (i.e. higher quality training vs. lower quality training). Individual variation is most likely to be found on how one would weigh the above factors. This is a very individual decision.
UCSF: I agree that it should be in the top 10. I ranked it at #5 based mainly on the following factors (weighted in descending order):
1. Reputation
2. Ability to get a top job in academics
3. Ability to get a top job in private practice
4. Current Strength of the department
5. Quality of fellow residents
6. Lifestyle
Where it really deserves to be ranked, I possess no universal truth that gives me insight into that. I do know that you can certainly find individuals who feel this is the strongest rad onc department in the country. I personally disagree with that. After visiting both Sloan and MD Anderson, UCSF is just not at the same level in terms of departmental strength, let alone the quality of the residency. None of this really matters in the end. What does matter is the following, at UCSF expect to do a great deal of learning on your own and being taught by other residents because formal didactics are poor and training in clinic from faculty is well below average. I agree they have junior faculty that would like to teach and change things, but they don?t have the power or the time to change things on their own. The problems start at the top and work their way down from there. This is only compounded by an ineffectual residency program director. Additionally as you correctly pointed out, their patient load is light, and I would argue that it is too light. Yet at the end of residency, this program will pay big dividends when one looks to find a job in either private practice or academics because it undoubtedly has a top 5 reputation (probably top 3) in the realm of rad onc. Residents will do great on the boards in spite of the program and not because of it since they take some of the strongest applicants each year. I don?t know with any certainty, but I imagine that UCSF is one of the top 3 most competitive rad onc residencies year in and year out.
Stanford:
Everything you said about this place is true. I have heard some of the negative things about this program as well, yet I still think it deserves to be ranked somewhere from #6 to #9. I would argue that Stanford can claim to have three big names: Hoppe (lymphoma), Donaldson (peds/lymphoma), Hancock (lymphoma). Obviously, Hoppe is the most well known, but Donaldson is very well known and respected too. Having her calling to find you a job is going to carry a great deal of weight at the end of residency. Hancock may not make the rad onc all-star team, but he would get votes on some ballots. Unfortunately, they are all big names in areas that most applicants could care less about. There was a time when Stanford was the top rad onc department in the country. Yes, this was during our parents? youth, but that reputation has never gone away entirely. This institution is one of the birthplaces of rad onc in the US. It has also produced a great number of chairmen. I honestly believe that Stanford is one of the top 4 programs for getting a job in academics. First off, you have 11 or 12 months of dedicated research time. One can buff up their CV prior to applying for a job in academics. Secondly, in the world of academics Stanford, UCSF, Harvard, and Sloan are like one giant program. There is a great deal of lateral flow of graduates from one residency into an attending position at another. Yes, you can get a job at one of these places if you go elsewhere, but the majority of faculty at each of these places is a graduate from one of these four places. Just look at Sloan, the entire attending staff comes from mainly these four programs. Additionally, all of these programs are very close-knit in that the faculty knows one another quite well. This has been one several arguments used by faculty (but not residents, who would rank MD Anderson way above Stanford) at my program to discourage fourth-year medical students from ranking MD Anderson above these four programs. You can count the number of MD Anderson graduates at these four places on one hand, and I believe on just one finger if memory serves me correctly. I do think that all things being equal a Stanford grad has a better chance than a MD Anderson or U Michigan grad at getting a job at one of the elite programs. Whether this is just or not, I can?t speak to that. I do believe that there is some truth in the above, which is based on my rad onc experiences ( I spent several years in rad onc prior to applying, I have attended ASTRO several times, and I know faculty and residents at many different programs). I can honestly say that at my home institution, graduates from a rad onc residency at one of these elite four programs are held in higher regard than graduates from other programs.
U Michigan: I agree with you 100% about this place. Their residents take nearly as much call during their PGY-2 year as MD Anderson residents take over four years. Yet, I do have great respect for their residency program. I think their residents are well trained when they come out, but they could certainly use more brachy. Not that I have attended that many ASTRO?s, but U Michigan has been as prominent as any program there. In my humble opinion, I consider this department one of the current leaders in rad onc along with Harvard, MD Anderson, UCSF, Stanford, and Sloan. These programs dominate or at least seem to be the best represented at ASTRO in terms of presentations, faculty involved with refresher courses, panels, etc. That has just been my impression and most likely is flawed as I have never sat down and calculated this directly from the ASTRO program guide. Yet, after thumbing through the program guide just now, these six places have a presence at ASTRO that is a level above the rest of rad onc (Although Harvard, MD Anderson, and Sloan have a greater presence than U Mich, Stanford, UCSF).
University of Washington (the one in Seattle for those keeping track):
I have no firsthand knowledge of the program because they only interviewed on one day last year. I heard they crammed 20+ applicants into that one day though. Does anyone know the story with the brachy there? I thought the great brachy experience stemmed from the University of Washington?s close relationship with the large private practice but very academic group in the Northwest. I may suffer my East Coast bias, but I would not place UW in my top 10. I think around 15 is a fair assessment. In my neck of the woods, this program just does not come up very often in rad onc related conversations. I would say a place like U Penn, Thomas Jefferson, ?Mayo garners more respect in rad onc circles or I least in the circles in which I travel. I have also heard others talk about the Seattle Prostate Group (or whatever the actually name of the big brachy group is in the state of Washington) as a separate entity from UW. Although the details elude me, the big brachy group in the Northwest is a world leader in brachy and is very well respected. I honestly don?t know much about UW, so I don?t want to be unfair. For those of you who know something about UW, please post.