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Italy...
1773749310926.png
 
There is nothing on the open sourced google docs spread sheet as of now in terms of the SOAP.
 
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From the spread sheet apparently the University of Virginia program got shut down in 2024-25. "Reminder: do not go to UVA Rad Onc. They plan to reopen within 1-2 years after suddenly closing the program which forced residents to find positions outside of the match. We almost lost our careers because of their actions for which they have no remorse. David Penberthy (former PD) and James Larner (chair) are the root causes of the program's closure, and were directly mentioned in the ACGME citation letter which resulted in the program initially being placed on probation, as they created a truly malignant workplace culture. Their actions are closely followed by those of Chris Luminais and Kara Romano (both former APDs) who held virtually no regard for resident experience or well-being despite being fairly recent grads. The faculty ultimately decided to close the program instead of addressing numerous issues to ensure the viability and success of the program, viewing us as a "bad batch of residents" instead of a new group with unique educational needs. The experience of medical students and even residents from other specialties were optimized over ours. We were treated as second class citizens by the faculty and other members of the department, and our goal is to ensure no one here has such an experience. Until there is new leadership and new faculty, the department will not change and we encourage you to seek training elsewhere."
 
What a coincidence that the "bad batch of residents" excuse goes back all the way to when RadOnc was getting literally the best medical school graduates from the entire country. Is it true now? Maybe, I don't know.

It's almost like some academic centers don't want to teach but want free labor...
 
fiji128 said:
From the spread sheet apparently the University of Virginia program got shut down in 2024-25. "Reminder: do not go to UVA Rad Onc. They plan to reopen within 1-2 years after suddenly closing the program which forced residents to find positions outside of the match. We almost lost our careers because of their actions for which they have no remorse. David Penberthy (former PD) and James Larner (chair) are the root causes of the program's closure, and were directly mentioned in the ACGME citation letter which resulted in the program initially being placed on probation, as they created a truly malignant workplace culture. Their actions are closely followed by those of Chris Luminais and Kara Romano (both former APDs) who held virtually no regard for resident experience or well-being despite being fairly recent grads. The faculty ultimately decided to close the program instead of addressing numerous issues to ensure the viability and success of the program, viewing us as a "bad batch of residents" instead of a new group with unique educational needs. The experience of medical students and even residents from other specialties were optimized over ours. We were treated as second class citizens by the faculty and other members of the department, and our goal is to ensure no one here has such an experience. Until there is new leadership and new faculty, the department will not change and we encourage you to seek training elsewhere."
Click to expand...
The residency shutdown rate in rad onc has to be one of the highest of any specialty
 
metallica81788 said:
What a coincidence that the "bad batch of residents" excuse goes back all the way to when RadOnc was getting literally the best medical school graduates from the entire country. Is it true now? Maybe, I don't know.

It's almost like some academic centers don't want to teach but want free labor...
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I think it’s even more inane than that. “I am a rad onc at university. I must have a residency program or I’m not as important as the other rad oncs.”
 
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WildRivers said:
Yeah, when I spoke to that Italian urologist he had told me that nobody wants to do radonc in Italy. It's dying over there. He has no one really to collaborate with.
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I appreciate all the work you've done for the field, but he is gaslighting you (and sadly you and others are just accepting it on this point because of beef you have with American rad onc leadership rightfully so).. Yes there are few residents over there, but there are plenty of people he could have collaborated with. Rad onc is pretty strong in Italy, particularly GU rad onc.
 
MegaVoltagePhoton said:
I appreciate all the work you've done for the field, but he is gaslighting you (and sadly you and others are just accepting it on this point because of beef you have with American rad onc leadership rightfully so).. Yes there are few residents over there, but there are plenty of people he could have collaborated with. Rad onc is pretty strong in Italy, particularly GU rad onc.
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Oh a few old ones are on the paper. I just mean in general, he doesn't have youthful / energetic new radoncs to work with. One thing we have is that - I have found residents in radonc to be really great over the course of my career.

Did you listen to our episode? Thank you if you did. I did get him to concede that he was delivering misinformation. I don't think anyone else was able to do that. I also think I did a pretty good job highlighting where he went wrong. Where else do you think he gaslit me?

My beef is with people being jerks. It's happened a lot to me. I think we can be assertive and prove our points without being embarrassing. It's just ideas, no one is talking about their mommas. Part of my disappearance has been due to ASTRO's difficulty in challenging my ideas rather then going after me personally. Have tried to turn over a new leaf and get more involved. I applied for Advocacy Day on behalf of my group and of course their policy people need to have a Zoom call with me to make sure I'm "in alignment". I don't think any other radonc has to jump through this kind of hoop. I certainly can improve my interactions with people, but that organization is extremely brittle.
 
JustAdocInBox said:
Am I reading this correctly that Italy has 171 rad onc fellowship slots for a country of 60 million? No surprise that most positions go unfilled.
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I believe these are the openings per year.

So, in 2016, they opened 107 new spots and 96 doctors fillied those spots.
Bearing in mind that usually training takes about 5 years, this likely means around 600 residents in radiation oncology back then.

I don't think that's a very odd number.
 
Word on the street is 5 positions went unfilled Monday.

Alleged list:
Arkansas
Indiana
Jefferson
Montefiore x2
 
TodoBien24 said:
Word on the street is 5 positions went unfilled Monday.

Alleged list:
Arkansas
Indiana
Jefferson
Montefiore x2
Click to expand...
Montefiore is decent, but I guess the other nyc programs are better. Jeff has always had such nasty faculty.Not sure how they ever matched.
 
Jefferson is on the didn’t match every year basically. Maybe they got one this year.

Seems like a horrific dept! But perhaps they filled this year
 
The spread sheet today says, referencing Discord:

Arkansas
Mississippi
Montefiore x 2
Jefferson
Indiana

Last cycle 2024-25, apparently only Stony Brook was in the SOAP.

2023-24 cycle:
Texas Galveston
Kentucky
Arkansas
Alabama
Jefferson
Kaiser LA
Wayne State
Dartmouth

2022-23 cycle:
Alabama
Mayo AZ
Arkansas
Kaiser LA
UC Irvine
Georgetown
Henry Ford
Minnesota
Dartmouth
Rutgers
SUNY Downstate
SUNY Upstate
Stoney Brook
Rochester
Zucker SOM (Long Island)
Allegheny
Jefferson
South Carolina
Baylor
Texas San Antonia
Texas Galveston
West Virginia
 
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Wow. Only 5 unfilled.

I had a few students this year from the local med school. They were very strong students. Sounds like they both matched. It seems to have gotten out of the danger zone of 20-30+ unfilled.

That being said, this revenue issue is going to be a problem. If even hospitals are 15=20% down, I wonder how the $550-600k starting stalaries can hold. It typically takes a few years for hospitals to adjust, but if a doc getting paid $600k was pulling in an additional $2.4k in technical, but now it's $1.9m, they may have to adjust. Seems like worthwhile if employed to lock in several year deal for the base or make it evergreen. But, evergreen may get adjusted.
 
WildRivers said:
Wow. Only 5 unfilled.

I had a few students this year from the local med school. They were very strong students. Sounds like they both matched. It seems to have gotten out of the danger zone of 20-30+ unfilled.

That being said, this revenue issue is going to be a problem. If even hospitals are 15=20% down, I wonder how the $550-600k starting stalaries can hold. It typically takes a few years for hospitals to adjust, but if a doc getting paid $600k was pulling in an additional $2.4k in technical, but now it's $1.9m, they may have to adjust. Seems like worthwhile if employed to lock in several year deal for the base or make it evergreen. But, evergreen may get adjusted.
Click to expand...
...did I miss a discussion here? Where did revenue come into this?
 
allseasons said:
...did I miss a discussion here? Where did revenue come into this?
Click to expand...
I skipped a thought.

I think the "sky is falling" and radiation oncology being in a bad way was not true and I presume the recovery in applications/unfilled programs was due to the fact that the job market remained strong. But, I don't know how that will hold up. That's what I meant. But, I think it is good that programs are mostly filling.
 
TheWallnerus said:
Decreased rad onc revenue may eventually be associated with decreased med students’ attraction towards the specialty
Click to expand...
I think what's being missed is that new medical students interested in the field may not have the same expectations that medical students who were trying to compete for this field a decade ago had. Many would be happy to be radiation oncologists even if they're making less.

It is possible for two things to be true:
- for people currently in the field to have to expect a decrease in the coming 5-10 years of compensation, which may lead to unhappiness
- for the rising class and people newly interested in the field to also be lowering their expectations and be totally happy with that
 
CaesarRO said:
I think what's being missed is that new medical students interested in the field may not have the same expectations that medical students who were trying to compete for this field a decade ago had. Many would be happy to be radiation oncologists even if they're making less.

It is possible for two things to be true:
- for people currently in the field to have to expect a decrease in the coming 5-10 years of compensation, which may lead to unhappiness
- for the rising class and people newly interested in the field to also be lowering their expectations and be totally happy with that
Click to expand...
That is definitely possible. But, honestly, hospital salaries have basically risen over last 5-6 years. People are getting hired in at or higher than my current base and I'm 15 years out. I hear these PGY5s telling me what they are getting at smaller hospitals. It's wild. I think that if things change downward, it could possibly go back to how it was 2018-2022. Hardest thing to predict is the future.
 
WildRivers said:
But, honestly, hospital salaries have basically risen over last 5-6 years. People are getting hired in at or higher than my current base and I'm 15 years out. I hear these PGY5s telling me what they are getting at smaller hospitals. It's wild.
Click to expand...

thanks for saying this. basically forbidden on this forum to talk about the last 5 years. but agree.
 
On a positive note, for those that have joined, welcome to the specialty!

Here's a letter to you all!

I just want to reassure those of you that have matched … despite the negativity online (even here), I don’t believe it is a fair representation of how people in the specialty actually feel about their day to day job. I love what we do for our patients, but I don’t care for how our specialty society has operated and don’t always feel they have the best interests of community patients and physicians in mind. That doesn’t mean the specialty has not been great to me personally and that I’m not devoted to it. I’ve recorded so many episodes of our podcast, written thousands of words on this Substack, advised dozens of students and residents and junior attendings. I socialize with many of you and am friends with even more of you. For crying out loud, my son’s middle name is Gray! Radoncs are mostly great people, if not a little weird. Well, I don’t think so, but my wife assures me we are. Anyways …
 
WildRivers said:
I skipped a thought.

I think the "sky is falling" and radiation oncology being in a bad way was not true and I presume the recovery in applications/unfilled programs was due to the fact that the job market remained strong. But, I don't know how that will hold up. That's what I meant. But, I think it is good that programs are mostly filling.
Click to expand...

I wouldn't call our job market "strong" compared to other specialties. Yes, in the rural upper midwest the job market remains strong. In other locations it's not that simple. If you need to live in X city, that's still a very dicey proposition if you can't find a job there or have to leave the job you're in. And I have seen several institutions in coastal cities purposely get rid of good radiation oncologists because they know there's no problem recruiting another one.

Meanwhile, the medical oncologists and radiologists are getting unsolicited offers constantly. The med onc fellows where I trained 15 years ago were getting recruited from day one of their fellowship with salary guarantees higher than I make now and double what I took my first year out in the job I basically begged for.

One other major factor in programs filling is that their standards dropped dramatically. For example, FMGs were once rare as hens teeth and basically out of the question at almost all programs. If we took FMGs out of the equation over the past few years, a lot of spots would still go unfilled. I'm not arguing whether that's a good or bad thing.

The point of my post is that that both the applicants and the programs have had their expectations re-calibrated over the past 5 years.
 
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Speaking of things forbidden to talk about…

Well I don’t know about forbidden. But definitely not discussed. And it’s the following.

The increased laxity of supervision rules, the ability to do more remote work, the lowering of standards at rad onc programs, and the significant decrease in rad onc reimbursement the last 5 years has resulted in an association with improvement in the rad onc job market and an increase in salaries.

Right?

I say this in the same spirit as I’d say that increase in fossil fuel use and increased CO2 levels has been associated with a dramatic improvement in human QOL and lifespan and greening of the planet. But all this I can sort of understand. I can’t understand the rad onc association.
 
Neuronix said:
I wouldn't call our job market "strong" compared to other specialties. Yes, in the rural upper midwest the job market remains strong. In other locations it's not that simple. If you need to live in X city, that's still a very dicey proposition if you can't find a job there or have to leave the job you're in. And I have seen several institutions in coastal cities purposely get rid of good radiation oncologists because they know there's no problem recruiting another one.

Meanwhile, the medical oncologists and radiologists are getting unsolicited offers constantly. The med onc fellows where I trained 15 years ago were getting recruited from day one of their fellowship with salary guarantees higher than I make now and double what I took my first year out in the job I basically begged for.

One other major factor in programs filling is that their standards dropped dramatically. For example, FMGs were once rare as hens teeth and basically out of the question at almost all programs. If we took FMGs out of the equation over the past few years, a lot of spots would still go unfilled. I'm not arguing whether that's a good or bad thing.

The point of my post is that that both the applicants and the programs have had their expectations re-calibrated over the past 5 years.
Click to expand...
Totally agree. I am generally a very optimistic person and strong is not the word I would use to describe our job market though I agree with WildRivers that it isn't entirely trash either. The quality of the job market is very subjective. I've seen a lot of graduating residents over the last 10 years and almost all of them were happy with where they ended up (on both coasts and in the midwest) and the sky has not fallen. But it is completely undeniable that other specialties have more options for people looking in a given location at a given time.
 
Yeah, that is right - I agree - not in comparison to other specialties. But, in comparison to when I was looking for jobs before it feels better than before.
 
fiji128 said:
From the spread sheet apparently the University of Virginia program got shut down in 2024-25. "Reminder: do not go to UVA Rad Onc. They plan to reopen within 1-2 years after suddenly closing the program which forced residents to find positions outside of the match. We almost lost our careers because of their actions for which they have no remorse. David Penberthy (former PD) and James Larner (chair) are the root causes of the program's closure, and were directly mentioned in the ACGME citation letter which resulted in the program initially being placed on probation, as they created a truly malignant workplace culture. Their actions are closely followed by those of Chris Luminais and Kara Romano (both former APDs) who held virtually no regard for resident experience or well-being despite being fairly recent grads. The faculty ultimately decided to close the program instead of addressing numerous issues to ensure the viability and success of the program, viewing us as a "bad batch of residents" instead of a new group with unique educational needs. The experience of medical students and even residents from other specialties were optimized over ours. We were treated as second class citizens by the faculty and other members of the department, and our goal is to ensure no one here has such an experience. Until there is new leadership and new faculty, the department will not change and we encourage you to seek training elsewhere."
Click to expand...
Is this a fair opinion?

I trained around the same time as Kara and she was very nice. What happened?
 
StealthTech said:
Is this a fair opinion?

I trained around the same time as Kara and she was very nice. What happened?
Click to expand...
Two things can be true at same time. People can be “nice” socially or in training and can turn into absolute tyrants when they have power. Im generally speaking as i dont know this person but if former residents are writing that, there must be a reason.

I seriously dont know why MS, UT galveston, and all these hellpits still exist. In the words of a great thinker, “is our children learnin’?!”
 
CaesarRO said:
I think what's being missed is that new medical students interested in the field may not have the same expectations that medical students who were trying to compete for this field a decade ago had. Many would be happy to be radiation oncologists even if they're making less.

It is possible for two things to be true:
- for people currently in the field to have to expect a decrease in the coming 5-10 years of compensation, which may lead to unhappiness
- for the rising class and people newly interested in the field to also be lowering their expectations and be totally happy with that
Click to expand...
This is so true. Most of the people applying rad onc right now are elated that they have this non competitive option that seems amazing. Their other non competitive options are FM, IM, peds, and psych.
 
To say that the market is bad everywhere is not true. BUT to say that the market is overall “good” is also a lazy generalization. The answer is it depends. Many cities are hard to get into or lateral to another place. It also depends on your definition because if you compare it to other fields, our market is extremely unhealthy and toxic IMO. Reasonable people may disagree!
 
thecarbonionangle said:
To say that the market is bad everywhere is not true. BUT to say that the market is overall “good” is also a lazy generalization. The answer is it depends. Many cities are hard to get into or lateral to another place. It also depends on your definition because if you compare it to other fields, our market is extremely unhealthy and toxic IMO. Reasonable people may disagree!
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But has it ever been any other way for RadOnc ? It’s a small field - geographic issues common in 1985 and 2025. The guy I replaced in Port Huron - his only option in 1984 was to go to Petoskey, MI and he had to wait several years for something closer to Detroit. I think for me - not sure what year you are or where you look for jobs - the offers I see are far better than what I have been offered in past. I would say my predictions did not pan out (as of yet). Just my POV, but it’s better for graduates in 2026 than it was in 2016 in many locales. But, that could be just bias based on locations I looked at (AZ, WA, MI, CA).
 
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WildRivers said:
But has it ever been any other way for RadOnc ? It’s a small field - geographic issues common in 1985 and 2025. The guy I replaced in Port Huron - his only option in 1984 was to go to Petoskey, MI and he had to wait several years for something closer to Detroit. I think for me - not sure what year you are or where you look for jobs - the offers I see are far better than what I have been offered in past. I would say my predictions did not pan out (as of yet). Just my POV, but it’s better for graduates in 2026 than it was in 2016 in many locales. But, that could be just bias based on locations I looked at (AZ, WA, MI, CA).
Click to expand...

Yep exactly.
 
‘There were jobs in every city, which is why the field became competitive’


Respectfully, I’ve been on this forum for along time and have read many posts you’ve made on here and Twitter including your prolific inflammatory comments to and about trainees, but this may be the silliest one
 
RickyScott said:
I was in one of the first competitive classes. There were jobs in every city, which is why the field became competitive
Click to expand...
Rad onc has never been that good. But a lot of good private jobs where you could get ownership back then
 
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medgator said:
Rad onc has never been that good. But a lot of good private jobs where you could get ownership back then
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I hear different things from different people. It was before my time. Our old program director used to say that they had seven job offers in South Florida when they finished their training. Was it an exaggeration?
 
Recent ARRO data iirc showed median job offers per resident was one.

Of course in, say, urology it’s something like 30 plus but I digress.

When I finished residency, I had way more than one job offer!
 
TheWallnerus said:
Recent ARRO data iirc showed median job offers per resident was one.

Of course in, say, urology it’s something like 30 plus but I digress.

When I finished residency, I had way more than one job offer!
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To be fair, number of job offers is a biased metric. When people perceive the market as bad, they are more likely to jump on the first offer they get and stop looking. We had one graduating resident this year and they had 3 offers (all in major metro areas). Im usually pretty involved in most of our graduating residents job searches and I can only think of 2 residents who only got a single offer and both of them were PP jobs in their target areas that they pounced on immediately. In my experience, 2-3 offers has been the norm for about the last 8 years.

Big picture, Im not arguing with you. 2-3 offers would still be considered horrifying for many fields. And admittedly, most of our residents have been realistic about their searches and been flexible on location. If we ask how many offers did they get in their target area/region, I'd say 1.25 is an accurate average.
 
Median 30.

That means 50% of them went on at least 30
Interviews and got 30 offers. Even someone as good at this process as me 😂 has lower than 100% yield rate. So, let’s say 75% lead to offers. That means half or more urology trainees go to 40+ interviews. If Pareto stuff happening some of these folks going on 100 interviews and getting 70 job offers. I find this very hard to believe bc then my urology friends appear to be in 1st percentile.
 
WildRivers said:
Median 30.

That means 50% of them went on at least 30
Interviews and got 30 offers. Even someone as good at this process as me 😂 has lower than 100% yield rate. So, let’s say 75% lead to offers. That means half or more urology trainees go to 40+ interviews. If Pareto stuff happening some of these folks going on 100 interviews and getting 70 job offers. I find this very hard to believe bc then my urology friends appear to be in 1st percentile.
Click to expand...
I don’t know the data or claim to be an expert, but my best friend is a urologist who completed training about 6 years ago. He did 5 interviews and got 4 offers in the span of about 2 months. Mind you, his wife is a breast surgeon and hers was really the limiting factor as that is also a small field. His ability to quickly get good positions after she landed interviews was impressive and would have been a tall order for us. He also started getting countless recruiters and ads for positions going into his last year of training. I don’t doubt that he could have had double digit offers if he wanted.

Caveat: he’s a generalist that mostly treats stones. My understanding is that oncology focused urology positions are a bit more competitive. Better than us, but still fewer positions than general community urologists.
 
ramsesthenice said:
In my experience, 2-3 offers has been the norm for about the last 8 years.
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Darn it, my bad, I was off by one; in fact, it is median 2 offers per rad onc resident (~20% get one).
1774272875650.png

WildRivers said:
Median 30.

That means 50% of them went on at least 30
Interviews and got 30 offers. Even someone as good at this process as me 😂 has lower than 100% yield rate. So, let’s say 75% lead to offers. That means half or more urology trainees go to 40+ interviews. If Pareto stuff happening some of these folks going on 100 interviews and getting 70 job offers.
Click to expand...
I was picking on urology, but I don't have urology data per se. I'm making assumptions about which specialties are "inundated" with the job opportunities (narrator's voice: it's not rad onc).

1774272972354.png
 
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