What to do after residency if no job offers?

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You know I have been thinking about this oversupply issue and I think its not as lost a cause as we think. New residents coming into the field require two things. 1. Residency spots and 2. Med students interested in training. Obviously we have tried to address issue no.1 and its just not budging. However, we as residents have a powerful influence on No.2. By sharing our truthful difficult job search stories, and the stories of our colleagues with medical students who rotate through the dept, we can do these students and ourselves a favor by discouraging weak applicants who may be matching into lower tier programs from apply to rad onc. Furthermore, I encourage graduating PGY 5s to post their views on this website. Perhaps we can effect a grass roots change to limit the no. of entrants to our field.

"Discourage weak applicants who may be matching into lower tier programs." I LOL'd. Perhaps we should discourage the nerds who will match into higher tier programs since we know their personalities won't fit in private practice? As a potential employer in a highly desirable area, it's attitudes like this that have made me intentionally avoid applicants from higher tier programs.

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The desire of Rad Onc leadership is to increase the number of Rad Onc positions regardless of any factor other than the programs' own ability to train quality residents.

If the market is over-saturated so be it, they say. Eventually, discontent from PGY-5's will trickle down to MS-4's who are applying. Fewer people will apply, the number of graduating residents will decrease, and the problem will solve itself.
 
The desire of Rad Onc leadership is to increase the number of Rad Onc positions regardless of any factor other than the programs' own ability to train quality residents.

If the market is over-saturated so be it, they say. Eventually, discontent from PGY-5's will trickle down to MS-4's who are applying. Fewer people will apply, the number of graduating residents will decrease, and the problem will solve itself.

Nope, there will always be foriegn grads who would rather match radonc than not match at all. We need to discourage chairs fron expanding programs.
 
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Correct. I think their argument is invalid.

Agreed. The thing is, there's a delay between over-saturation and when you actually see the quality of applicant drop - because there's a 5-year residency program and lateral movement to another program in a different specialty is very hard in the current CMS GME system. It's not just oversaturation that will occur, it will also be the drop in high caliber applicants - people who are great academically with great personalities - as they decide to pursue other fields. It's going to happen in Rad Onc eventually, since expansion of programs is independent of current job market or economics (in fact RRC opinions for adding or expanding programs can't entertain economics). I was surprised when I found that out...
 
Does anyone actually have any data on unemployment of radiation oncologist and PGY-5s who can or cannot find a job after graduating residency?
 
A similar trend I found from an article back in 2011 in Canada. I wonder if they ever got things turned around...

A recent Canadian graduate told me that none of the graduates from 2014 found permanent employment in Canada. Apparently very few of the graduates over the last 3 years have a permanent position in Canada. Most have left the country.
 
For what it's worth, I've been in regular contact with a small cadre of PGY-5's graduating next year. Word is that there are plenty of jobs, many of them quite desirable. However, location remains a perennial problem. Also, the majority of jobs are employed and there are fewer and fewer "true" private practice positions (however, the good news is that starting salary and benefits are extremely robust). Finally, it seems that fewer RO docs are retiring.
 
For what it's worth, I've been in regular contact with a small cadre of PGY-5's graduating next year. Word is that there are plenty of jobs, many of them quite desirable. However, location remains a perennial problem. Also, the majority of jobs are employed and there are fewer and fewer "true" private practice positions (however, the good news is that starting salary and benefits are extremely robust). Finally, it seems that fewer RO docs are retiring.
I would agree with all of that.
 
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To the old people not retiring: youve had 30+ years raking it in. It is BS to stick around. The field has moved on, and you are left behind. Time to leave now.

I can't imagine how bad what you're going through sucks. But I don't think continuing this thread is going to help at all.

Please don't read this the wrong way. But this is a small field. You suggested you are from a top program. Well, this thread has generated a lot of chatter by applicants. Two separate students who rotated at a top program both thought they know who you are and named the same person on different occasions. I assure you I don't care and am not in the business of spreading rumors. They are probably wrong. Still, it's probably not a good idea to criticize senior members of the field.
 
I am also in touch with a large cadre of PGY-5's and the word is that there is a whole lot of nothing outside of some really undesirable places to live.

To the old people not retiring: youve had 30+ years raking it in. It is BS to stick around. The field has moved on, and you are left behind. Time to leave now.

I found the job search a few years ago similarly frustrating. For the first time in 10+ years, merit seemed to be a small component of landing in a good spot. Boards scores, grades, recs, etc seemed to be less important than chance, networking/connections, etc. My advice is
a. find the best job that helps you springboard to your future desired location. (if academics, go to top notch academic center and sacrifice location...or do a fellowship). If private practice, consider academic job in the region of interest (watch out for non-compete in contract)
b. keep networking with people...peers from residency can be a valuable resource. Eventually a job you want will likely become available.


Would advise med students considering radonc to read this thread. If location is very important to you, I would urge you to think hard about pursuing radonc. It is becoming progressively more difficult to find a good job in a desirable location.
 
I can't imagine how bad what you're going through sucks. But I don't think continuing this thread is going to help at all.

Please don't read this the wrong way. But this is a small field. You suggested you are from a top program. Well, this thread has generated a lot of chatter by applicants. Two separate students who rotated at a top program both thought they know who you are and named the same person on different occasions. I assure you I don't care and am not in the business of spreading rumors. They are probably wrong. Still, it's probably not a good idea to criticize senior members of the field.

I would disagree with you on this one. It is OK to criticize senior members of the field if they're contributing to the future plight of the field by being selfish. Hopefully studentdoctor can help garner the attention of programs being selfish and indefinitely expanding their programs. I have yet to hear of one program that doesn't plan to expand.
 
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I would disagree with you on this one. It is OK to criticize senior members of the field if they're contributing to the future plight of the field by being selfish. Hopefully studentdoctor can help garner the attention of programs being selfish and indefinitely expanding their programs. I have yet to hear of one program that doesn't plan to expand.
I am probably in the minority on this board but I would bet that most programs that are expanding would not consider their actions selfish. I know that increases in resident complement at some programs have been motivated by a desire to provide trainees with additional time to devote to scholarly interests. These programs would claim that they are doing their part to ensure the scientific future of the specialty by developing the next generation of leaders. I can aver that some programs have intentionally reduced the size of their complement in the last decade, but of course the overall number is increasing.
 
I am probably in the minority on this board but I would bet that most programs that are expanding would not consider their actions selfish. I know that increases in resident complement at some programs have been motivated by a desire to provide trainees with additional time to devote to scholarly interests. These programs would claim that they are doing their part to ensure the scientific future of the specialty by developing the next generation of leaders. I can aver that some programs have intentionally reduced the size of their complement in the last decade, but of course the overall number is increasing.

What's sad is that the truth of the matter is this: They want cheap labor that can contour and see patients to write their notes (ie residents). It's almost laughable that some think they're doing it to advance the field.
 
Laughable? You shouldn't judge others motives without knowledge of the particulars. Furthermore you shouldn't project your own training experience (which sounds pathetic) on others.

Let's perform a thought experiment. A hypothetical program has 9 residents. The historical experience is that the residents spend 48 months in clinic and the scholarly output of residents is minimal.

This hypothetical program decides to increase the resident complement to 12. At any given time 9 residents are in clinic (performing cheap labor?/learning the trade) and 3 residents are free from clinical responsibilities to engage in scholarly activities. This means that at any given time some of the attending are uncovered.

As a result of this change the scholarly output of residents increases dramatically over 5 years and more than 2/3 graduating residents take academic positions when they complete training (compared with <15% historically). A majority of the costs of the of the additional residents is paid for from clinical revenues.

Selfish? Really?
 
Laughable? You shouldn't judge others motives without knowledge of the particulars. Furthermore you shouldn't project your own training experience (which sounds pathetic) on others.

Let's perform a thought experiment. A hypothetical program has 9 residents. The historical experience is that the residents spend 48 months in clinic and the scholarly output of residents is minimal.

This hypothetical program decides to increase the resident complement to 12. At any given time 9 residents are in clinic (performing cheap labor?/learning the trade) and 3 residents are free from clinical responsibilities to engage in scholarly activities. This means that at any given time some of the attending are uncovered.

As a result of this change the scholarly output of residents increases dramatically over 5 years and more than 2/3 graduating residents take academic positions when they complete training (compared with <15% historically). A majority of the costs of the of the additional residents is paid for from clinical revenues.

Selfish? Really?

I loved how you contradicted yourself and agreed with me in the previous post. You're essentially saying that the programs "need" to expand to keep the cheap labor running the clinics and can not give any academic time unless that cheap labor is running said clinic. Secondly you're judging my residency experience (which I assure you am very happy with), as we get the 1 year of research without all the clinics being covered by the cheap resident labor without you having any knowledge of it. You're either trying to expand your program with cheap labor or are blissfully ignorant of the realities of the field today.

It really irks me when I run into Attendings who feel like they can't run their clinic without a resident. I'm just glad my institution established that can't be the case and that the Attendings need to be competent enough to run their own clinic.
 
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I found the job search a few years ago similarly frustrating. For the first time in 10+ years, merit seemed to be a small component of landing in a good spot. Boards scores, grades, recs, etc seemed to be less important than chance, networking/connections, etc. My advice is
a. find the best job that helps you springboard to your future desired location. (if academics, go to top notch academic center and sacrifice location...or do a fellowship). If private practice, consider academic job in the region of interest (watch out for non-compete in contract)
b. keep networking with people...peers from residency can be a valuable resource. Eventually a job you want will likely become available.


Would advise med students considering radonc to read this thread. If location is very important to you, I would urge you to think hard about pursuing radonc. It is becoming progressively more difficult to find a good job in a desirable location.

And the most important criterion merit-wise would be where you trained. I noticed this all-important factor was left out of your list. Are you saying Anderson and MKCC residents are being forced to take positions in flyover country? Would you suggest training in a location you want to be (e.g., go Cornell over Stanford if you're targeting the Northeast for jobs? I'm just trying to tease out how bad it is up there.
 
And the most important criterion merit-wise would be where you trained. I noticed this all-important factor was left out of your list. Are you saying Anderson and MKCC residents are being forced to take positions in flyover country? Would you suggest training in a location you want to be (e.g., go Cornell over Stanford if you're targeting the Northeast for jobs? I'm just trying to tease out how bad it is up there.
Honestly, for many PP positions, pedigree doesn't matter as much as it does in academics, Instead, you have the "3 A's"
 
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Can anyone tell me this - it seems that Rad Onc is different from many other fields in that foreign trained Rad Oncs can come here and do a one year fellowship and then get jobs as attendings.

It seems that in any other field of medicine, you have to come and do another entire residency?

Why does this loophole exist for Rad Onc?
 
Can anyone tell me this - it seems that Rad Onc is different from many other fields in that foreign trained Rad Oncs can come here and do a one year fellowship and then get jobs as attendings.

It seems that in any other field of medicine, you have to come and do another entire residency?

Why does this loophole exist for Rad Onc?
It also exists (existed?) for radiology. Not sure if that is the case any longer.
 
I loved how you contradicted yourself and agreed with me in the previous post. You're essentially saying that the programs "need" to expand to keep the cheap labor running the clinics and can not give any academic time unless that cheap labor is running said clinic. Secondly you're judging my residency experience (which I assure you am very happy with), as we get the 1 year of research without all the clinics being covered by the cheap resident labor without you having any knowledge of it. You're either trying to expand your program with cheap labor or are blissfully ignorant of the realities of the field today.

It really irks me when I run into Attendings who feel like they can't run their clinic without a resident. I'm just glad my institution established that can't be the case and that the Attendings need to be competent enough to run their own clinic.
 
You misunderstand the situation; perhaps I did not explain sufficiently. Overall patient numbers are going up. As a result the number of faculty is increasing. Resident case logs have actually decreased (because 25% of their time in training is now spent on scholarly pursuits WITHOUT clinical responsibilities). The increase in complement will result in more residents but the residents will be more competitive for an academic position when they finish (which is the explicit goal of the program).

I think you should be careful using the term competent when describing faculty members that presumably have passed the boards, but then again I am blissfully ignorant
 
And the most important criterion merit-wise would be where you trained. I noticed this all-important factor was left out of your list. Are you saying Anderson and MKCC residents are being forced to take positions in flyover country? Would you suggest training in a location you want to be (e.g., go Cornell over Stanford if you're targeting the Northeast for jobs? I'm just trying to tease out how bad it is up there.

I trained at a top 15 (if you believe in SDN rankings), not top 3 program. Not sure what things are like for MDACC, MSKCC, or Harvard grads

Medgator summed up things nicely. The post academic reality is that the 3As and other things that are unrelated to how you were evaluated for medical school and residency admission become extremely important in landing a job (and referrals in this job). I think understanding that you are being evaluated by a different set of criteria is important for your success, sanity, and self-critiquing.

My guess is that training in a region you are interested in is useful for subsequently landing an academic or private job in that area. Prestige has some importance too, so I guess it depends on how disparate the 2 programs are. I would choose top 3 over a better region. Not sure how much the prestige factor matters after that.
Go to a place with good clinical training and make sure its a good fit for your learning style and personality. Its hard to be successful if you're miserable.
Good luck.
 
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You misunderstand the situation; perhaps I did not explain sufficiently. Overall patient numbers are going up. As a result the number of faculty is increasing. Resident case logs have actually decreased (because 25% of their time in training is now spent on scholarly pursuits WITHOUT clinical responsibilities). The increase in complement will result in more residents but the residents will be more competitive for an academic position when they finish (which is the explicit goal of the program).

I think you should be careful using the term competent when describing faculty members that presumably have passed the boards, but then again I am blissfully ignorant

It's still beyond me how increasing the number of residents at your program will make them more competitive in the job search. If your program would like to give more research time to your residents, have fewer attendings be covered by a resident, as opposed to accepting and graduating more residents. So now instead of competing with 1 other resident they'd be competing with 2 for the same jobs. I understand that you're a program director and it's really part of your job description to try to expand the program, but don't stand oblivious to the fact that you're doing it to the detriment of the field by creating an oversupply. Just look at a field like pathology or radiology where their graduates need to complete 2 fellowships to obtain any permanent position or Canadian radonc graduates who are leaving their country to find jobs.

Also if you really believe that all those who passed their boards are truly competent physicians, you need to meet more board certified radoncs (the older generation of which didn't even have to pass boards). The lack of competence of some board certified radiation oncologists truly amazes me at times.
 
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It's still beyond me how increasing the number of residents at your program will make them more competitive in the job search. If your program would like to give more research time to your residents, have fewer attendings be covered by a resident, as opposed to accepting and graduating more residents. So now instead of competing with 1 other resident they'd be competing with 2 for the same jobs. I understand that you're a program director and it's really part of your job description to try to expand the program, but don't stand oblivious to the fact that you're doing it to the detriment of the field by creating an oversupply. Just look at a field like pathology or radiology where their graduates need to complete 2 fellowships to obtain any permanent position or Canadian radonc graduates who are leaving their country to find jobs.

Also if you really believe that all those who passed their boards are truly competent physicians, you need to meet more board certified radoncs (the older generation of which didn't even have to pass boards). The lack of competence of some board certified radiation oncologists truly amazes me at times.

I don't think that we will agree on the issue of oversupply/increasing the number of residents. I am more sanguine about the future prospects. There are many variables in play (health care reform, hospital hiring doctors, aging population, changing fractionation patterns that effect linac utilization) that make it difficult to project future workforce needs.

On the second point I was trying to highlight that competence might not be the best word to describe attending physicians who depend on residents to run their service (not a statement on the larger population of BC radiation oncologist). From your latest post I am beginning to wonder whether that is the case. Is it your claim that board-certified attending physicians are truly incompetent and only by the wizardry of residents can quality care be provided? If that is the point you are making than I stand corrected. I thought that you meant that the demands of the service were so great that an additional person was required to get the work done in which case competence may not be the appropriate term.
 
Another major area of concern not directly related to the #grads is that bundled billing is coming to radonc. I think starting Jan 1st, 2015, IGRT will be bundled into IMRT. The things that we used to bill for separately including CT sims, technical planning, dose calculations etc will all be bundled into 1 package for simple, moderate, complex planning and treatment delivery.

This is clearly aimed at decrease reimbursements to radoncs. Frankly we in radonc have been lucky in that these changes have already been implemented in many other specialties including inpatient medicine, medonc, nephrology/dialysis etc. Given that per physician billing is going to come down (no more 500 bucks for daily prostate CBCTs), I think more centers are going to demand extra RVU's out of their current attendings than trying to hire new graduates.

There are a lot of factors coming together and I feel like none of them are positive for the radonc job market in the next few years...
 
The 3As are important in any job. If job offers are not coming you should do some soul searching about how you project yourself in emails, phone calls and interviews. If you come across as bitter or entitled that is going to hurt you. If you project an aura that all senior rad oncs must retire to accommodate more intelligent and more competent new grads no one is going to want you to join their practice.
 
There is obviously a lot of negativity on this thread, so I will share my experience to offer a differing viewpoint so that people aren't lead to believe that there are no jobs available...there is hope.

My co-chief resident and I have both signed contracts to join great groups and have received multiple job offers. No, the jobs are not in NYC or the Bay Area, but they are in locations that we are both incredibly excited about and feel fortunate to be moving to. I will reiterate two things that I think to be pertinent to the junior residents who will be looking for jobs in the years to come:

1. If you have a desired geographic location, contact the groups in that region early (mid-PGY-4 year or so) to let them know that you are interested. Similar to the comments in Terry Wall's handout, you could arrange an informal visit to meet the partners, learn more about the group, etc. This obviously not only expresses, but also demonstrates, how serious you are about potentially joining their group.

2. In my experience, pedigree matters both for academics and private practice. Can top institutions produce sub-par Radiation Oncologists and "lesser" institutions produce great Radiation Oncologists? Absolutely. However, the name recognition "is what it is", especially if you have a desire to obtain a position that is not in a part of the country where you are training.

Therefore, if a group has come to know a resident physician who is someone that they can see fitting in well within their group, expresses a strong desire to live in the area, has demonstrated to the Chair and Program Director that he/she will be an excellent Radiation Oncologist (i.e. comments from professional references) and comes from a great program, why not offer him/her the position? All of the boxes have been checked and they run the risk of losing the candidate if they don't offer the job to him/her. The two job offers that I received were as above and were never posted publicly prior to their being offered to me.

I know looking for a job can be extremely stressful, so hang in there. Best of luck to all of you in your search for a job.
 
The plans for expansion are openly mentioned in interviews. Everyone seems to have plans to take more and more. It's a little scary.
 
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This might be a dumb question, but what are 3 A's?
 
I don't think that we will agree on the issue of oversupply/increasing the number of residents. I am more sanguine about the future prospects. There are many variables in play (health care reform, hospital hiring doctors, aging population, changing fractionation patterns that effect linac utilization) that make it difficult to project future workforce needs.

On the second point I was trying to highlight that competence might not be the best word to describe attending physicians who depend on residents to run their service (not a statement on the larger population of BC radiation oncologist). From your latest post I am beginning to wonder whether that is the case. Is it your claim that board-certified attending physicians are truly incompetent and only by the wizardry of residents can quality care be provided? If that is the point you are making than I stand corrected. I thought that you meant that the demands of the service were so great that an additional person was required to get the work done in which case competence may not be the appropriate term.

Unfortunately most of the parameters that are changing: hypofractionation, decrease in smoking habits, a move towards chemotherapy as opposed to radiation (for lymphoma, gastrointestinal, and ovarian cancer for example) would cause for a decrease and not an increase in the numbers for radiation oncologists needed. What's happening now is that the smaller centers are folding (due to increased reimbursements for hospital based and larger cancer centers compared to the smaller free-standing centers) hence the patient complements go up for the larger center (while simultaneously decreasing for the smaller centers). Subsequently a PD like yourself will have the increasing numbers at your individual center as the reason to increase the resident complement (without any regard to the need for more radoncs in the field as a whole) leading to future graduates without necessarily future jobs. This will drive the field to become undesirable to the best an brightest (which it was until most recently) due to lack of employment upon graduation (just look at Radiology). I just plead with you to not ignore these facts and at least bring them up in the next meeting you have with other PDs at ASTRO. My center for example has decided against an increase resident complement (despite having the numbers for atleast 8 more, due to this very fact. We just have attendings go uncovered or hire midlevels to help out said attendings.
 
the increasing numbers at your individual center as the reason to increase the resident complement (without any regard to the need for more radoncs in the field as a whole) leading to future graduates without necessarily future jobs.

So more patients are being treated at academic centers and the increased workload is being compensated for largely by increasing resident complement instead of hiring on more attendings? I.e., fewer PP jobs, more residents graduating each year, and stagnant demand at academic centers? That's a pretty ugly scenario for grads in the near future if true.
 
So more patients are being treated at academic centers and the increased workload is being compensated for largely by increasing resident complement instead of hiring on more attendings? I.e., fewer PP jobs, more residents graduating each year, and stagnant demand at academic centers? That's a pretty ugly scenario for grads in the near future if true.

Ugly but no evidence to support it is true. Yes many pp are being absorbed by academic centers but is there resident coverage at these satellites ?
 
Ugly but no evidence to support it is true. Yes many pp are being absorbed by academic centers but is there resident coverage at these satellites ?

My impression has been that academic centers are expanding their compliment of mostly clinical attendings, often at satellites. Some programs do try to expand their residencies to cover these attendings. My experience has been that most attendings do want resident coverage. It varies a bit how hard the program is willing to push for expansion and how willing the program is to limit its residents academic time. Since it's easier to just force your residents to work harder and residents have no power, there are plenty of situations where residents are being pulled in increasingly many directions.

I doubt that residents really impact the number of attendings hired, though they may lower the number of other staff. I think this is especially true of midlevels, but also nurses, and possibly people like our departmental outside record gatherer.

Consider doing a fellowship?

After talking to a number of fellows, I'm very sour on this idea. It doesn't seem like it effects your job prospects much, if at all, and just puts you back into the job market the following year. If you want a specific job, there is no guarantee that it will materialize. The exception is if a program promises they will hire you after the fellowship.

It might work for internationals trying to get US jobs. If the job market gets really bad it might be your only option for employment though. I'm sure some programs will salivate at the idea of having more fellows.
 
My impression has been that academic centers are expanding their compliment of mostly clinical attendings, often at satellites. Some programs do try to expand their residencies to cover these attendings. My experience has been that most attendings do want resident coverage. It varies a bit how hard the program is willing to push for expansion and how willing the program is to limit its residents academic time. Since it's easier to just force your residents to work harder and residents have no power, there are plenty of situations where residents are being pulled in increasingly many directions.

I doubt that residents really impact the number of attendings hired, though they may lower the number of other staff. I think this is especially true of midlevels, but also nurses, and possibly people like our departmental outside record gatherer.

Again - what is the evidence for this ? If this is true for what programs (and for what satellites) is this true.
 
Again - what is the evidence for this ? If this is true for what programs (and for what satellites) is this true.

I have none. Hence the liberal use of phrases like "my impression" or "my experience".

Further, I'm certainly not going to identify specific programs on a public forum like this.
 
After tAalking to a number of fellows, I'm very sour on this idea. It doesn't seem like it effects your job prospects much, if at all, and just puts you back into the job market the following year. If you want a specific job, there is no guarantee that it will materialize. The exception is if a program promises they will hire you after the fellowship.

It might work for internationals trying to get US jobs. If the job market gets really bad it might be your only option for employment though. I'm sure some programs will salivate at the idea of having more fellows.
Agreed. Fellowships seem to only really help in certain academics positions, particularly in situations where your program was weak in a given area. The timing thing can't be understated though.... I know someone who did a fellowship for a year because of the tough job market in a certain locale and the following year, the market up opened there.
 
I know someone who did a fellowship for a year because of the tough job market in a certain locale and the following year, the market up opened there.

True. I've seen it go both ways--some have gotten the jobs they wanted and others have not. I know one person who did a fellowship and remains unemployed within rad onc because of location restrictions. I know another who did a well-regarded fellowship in a particular subspecialty area and couldn't get a job in that subspecialty anywhere in the USA. They couldn't even stay in academics as they'd hoped and had to take a job in essentially a private practice general position.

Having seen these things first-hand, I'd be very concerned about putting the job search off a year when the market gets tighter every year...
 
I just went on the ASTRO job search website and did a quick search. Only about 20 posts right now for attending radiation oncologists and at least two seemed to be working for a dermatology group as "dermo-rads" Obviously there are unadvertised positions out there particularly in highly competitive areas. In comparison, there are what 150 or so residents graduating this year and probably a least a dozen or more fellows who are looking for jobs added to the number of attendings who might be looking to switch. What is frustrating is that even with these numbers, our leadership wants to increase the number of training slots.... we might very well be headed into a future where a fellowship becomes necessity after residency, not for learning but for jobs
 
I just went on the ASTRO job search website and did a quick search. Only about 20 posts right now for attending radiation oncologists and at least two seemed to be working for a dermatology group as "dermo-rads" Obviously there are unadvertised positions out there particularly in highly competitive areas. In comparison, there are what 150 or so residents graduating this year and probably a least a dozen or more fellows who are looking for jobs added to the number of attendings who might be looking to switch. What is frustrating is that even with these numbers, our leadership wants to increase the number of training slots.... we might very well be headed into a future where a fellowship becomes necessity after residency, not for learning but for jobs

Not an entirely fair considering how early astro was this year. Probably a lot more in early September
 
I just went on the ASTRO job search website and did a quick search. Only about 20 posts right now for attending radiation oncologists and at least two seemed to be working for a dermatology group as "dermo-rads" Obviously there are unadvertised positions out there particularly in highly competitive areas. In comparison, there are what 150 or so residents graduating this year and probably a least a dozen or more fellows who are looking for jobs added to the number of attendings who might be looking to switch. What is frustrating is that even with these numbers, our leadership wants to increase the number of training slots.... we might very well be headed into a future where a fellowship becomes necessity after residency, not for learning but for jobs
Sounds like radiology.
 
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