Right now, much of the energy of this forum is being put into dissuading medical students into joining an amazing and rewarding field due to issues with job placement and geographic restrictions. I understand the sentiment, it is rooted in good intention, but I do think it is really only focusing on the supply side of supply/demand economics (and ignores other fundamental issues in the field).
Fellowships on this board have been lambasted in the past, with good reason. Most do not add anything beyond what a normal training program should be preparing residents to do as they currently only focus on areas that are already commonly used in the general rad onc practice (SRS, SBRT, palliative care). However, to me, it would be much easier to enact fellowship reform vs. coordinated residency contraction, and would be a better long-term investment in the field. This is something the large centers making decisions can more easily acquiesce to, helps them, and doesn’t force a huge amount of restructuring. Like many posters have already pointed out, the job market is distressed NOW, so any residency program adjustments will take 5 years to see changes.
What we really need are fellowships that allow expert utilization of an underutilized radiation modality. This would be beneficial in a number of ways: 1) it would decrease the glut of applicants competing in the same job markets 2) potentially increase overall utilization of radiation therapy services. We should really have bona-fide board-certified fellowships in the following areas:
Obviously, it doesn’t need to be said but I’ll say it anyway: SRS/SBRT fellowships should be abolished. Palliative fellowships should only be true board-certified ones and not just the inpatient rad onc service (integrated and equivalent to standard palliative care fellowships).
Fellowships on this board have been lambasted in the past, with good reason. Most do not add anything beyond what a normal training program should be preparing residents to do as they currently only focus on areas that are already commonly used in the general rad onc practice (SRS, SBRT, palliative care). However, to me, it would be much easier to enact fellowship reform vs. coordinated residency contraction, and would be a better long-term investment in the field. This is something the large centers making decisions can more easily acquiesce to, helps them, and doesn’t force a huge amount of restructuring. Like many posters have already pointed out, the job market is distressed NOW, so any residency program adjustments will take 5 years to see changes.
What we really need are fellowships that allow expert utilization of an underutilized radiation modality. This would be beneficial in a number of ways: 1) it would decrease the glut of applicants competing in the same job markets 2) potentially increase overall utilization of radiation therapy services. We should really have bona-fide board-certified fellowships in the following areas:
- Radiopharmaceuticals/Nuc med – this is the big one to me. For the life of me I can’t understand why we basically gave away a huge modality. Y90 and I131 is basically the domain of nuc meds and endocrinologists (and even only IR in some states). We now have 2 new agents that prolong OS for multiple cancers (Radium and Lu). There are more coming. There is basically zero advocacy on trying to keep this a rad onc modality because it reimburses poorly. This is a self-fulfilling prophecy though because the billing is tied to the advocacy behind it. When you are able to really put the weight of lobbying and specialty advocacy around a life-prolonging treatment, the billing can be tremendous (see CART cells, Novocure). Most residents get very poor training in this, and a fellowship is certainly justifiable
- Brachytherapy – brachy use is going down to the detriment of the field. Time and time again we show that you cant replace brachy with external beam A Phase II Trial of Stereotactic Ablative Radiotherapy as a Boost for Locally Advanced Cervical Cancer. - PubMed - NCBI . Brachy is going to become much, much more attractive once bundled payments hits. We should be embracing this and pumping out as many brachytherapists as possible.
- Cardiac SABR – this is a niche field right now with really only a handful places doing it with any real rigor. WashU is really doing a huge favor to the field by making cardiology equal partners in this and doing rigorous prospective trials. This is a potential gamechanger if we can get enough centers doing this.
- Peds – for obvious reasons
Obviously, it doesn’t need to be said but I’ll say it anyway: SRS/SBRT fellowships should be abolished. Palliative fellowships should only be true board-certified ones and not just the inpatient rad onc service (integrated and equivalent to standard palliative care fellowships).