2016 ARRO Seminar

[Gfunk6]

Just curious if anyone attended this year? Was there something to be optimistic about?


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[Gfunk6]

Some stats shared by an anonymous poster who attended:

Average on-site interviews: 4
Average job offers: 2

# ASTRO interviews that eventually became job offers: 0

Increase to 25% responding graduates being hospital employees compared to 6% in 2012.



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[Neuronix]

I wonder how this information is obtained? For example, I don't recall ever being surveyed.

 

[BobbyHeenan]

I do recall taking this survey at some point . I think it was via email invite but I really can't recall for sure. I definitely did a survey for ARRO/Terry Wall though 3-4 years ago after I was out in practice for about 9 months if I'm remembering correctly.

 

[DebtRising]

I didn't find anything to be optimistic about (maybe its me?).

Without divulging anything that may be construed as the contents of the conference, the fellowship panel consisted of people who graduated fellowships. So it was good for the 'experience of fellowship' but I was hoping / expecting another objective voice(s). I think ARRO genuinely wanted it to be about the former and not about fellowship expansion, which is great I guess, but took at as a sign that there is limited appetite to really critically evaluate why fellowship expansion has expanded dramatically.

There was overall little talk of the job market. Falit's poster on the labor supply was there but I don't think was even part of the ARRO poster walk. Someone already served up the hospital employed % - that's a stunning change in 3 years. That's an MBA evaluating your patient load and deciding how much you make, directly or indirectly, or being at a satellite, or not getting technical fees, etc. I hope these vague details do not cross the line about divulging information intended for participants, if so I will take them down.

You know what I took from this conference? That the field does not care about residency expansion or the job market (surprise!). There was almost nothing on it. What there was was a bunch of sessions on payment models and a lot of findings on hypofractionation, which in general requires less physician work (5x fraction for prostate, hypofract for lung unsuitable for CRT). In other words, 2 big driving factors that will decrease physician demand over the next decade, I think the lack of talking about the oversupply really struck me - as I have said before, when I applied ASTRO had the previous model touting increased demand for RO relative to positions on their website, maybe even on the front page of their 'education' section. But now it didn't get much and the lack of attention to how the large changes coming to the field affect the number of physicians needed and our record size graduating classes didn't engender any fuzzy feelings.

 

[Gfunk6]

Unsure why there needs to be secrecy. There are no copyrights or non-disclosure agreements that I am aware of. I certainly would not post slides but simply recalling facts from the slides is fine.


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[medgator]

Some stats shared by an anonymous poster who attended:

Average on-site interviews: 4
Average job offers: 2

# ASTRO interviews that eventually became job offers: 0

Increase to 25% responding graduates being hospital employees compared to 6% in 2012.



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I think the real percentage of hospital employed is probably higher. Everyone I know who has graduated in the last couple of years has taken a hospital-employed job and it reflects a trend that's been happening since last decade

 

[DukeNukem]

The difference between hospital employed and academic is getting very slim. There are plenty of academic jobs out there with no protected time. I certainly know my share of people who have an academic title, but are basically employed full time clinical rad oncs at either the main center or a satellite.

PP isn't much better. Getting what was always called partnership is increasingly difficult. Plenty of positions out there where the current partners are sharing the technicals but won't hire anyone (explicitly or by deceipt) who they'll share the technicals with. Plenty of "professional" partnerships and other gimmicks out there. Some don't even promise that.

Welcome to the future...

 

[medgator]

The difference between hospital employed and academic is getting very slim. There are plenty of academic jobs out there with no protected time. I certainly know my share of people who have an academic title, but are basically employed full time clinical rad oncs at either the main center or a satellite.

PP isn't much better. Getting what was always called partnership is increasingly difficult. Plenty of positions out there where the current partners are sharing the technicals but won't hire anyone (explicitly or by deceipt) who they'll share the technicals with. Plenty of "professional" partnerships and other gimmicks out there. Some don't even promise that.

Welcome to the future...

I would imagine (and from what I've seen) that hospital-employed pays better than an "academic" position in name only at the academic enter or nearby satellite.

Professional partnership isn't a gimmick. Partners may not want to bring anyone else into the technical, but that doesn't mean you can't be a on professional partnership track. Obviously scouting things out beforehand and looking at the practice's history is key.

 

[DebtRising]

Unsure why there needs to be secrecy. There are no copyrights or non-disclosure agreements that I am aware of. I certainly would not post slides but simply recalling facts from the slides is fine.


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Not sure how it works - does paying conference registration entail some exclusive right to the non-published material? No idea so err on side of caution.

Let's put it this way - the big news was no news. The labor market and fellowship expansion wasn't discussed any more than at face value, either in the fellowship or job application panel. Regarding the fellowship panel the people who spoke were very nice - but all were people who had gone through fellowship already. There was no focus on 'why do you think there are now 30-40' fellowships now?' or 'is it a sign that there are no good jobs when non-accredited fellowships are springing up like weeds'.
Here are two memorable lines
1. One gentleman on the panel talked about how his wife was graduating derm same year and how hard it was to coordinate interviews - because he felt there was such a narrow window of time to accept offers and a lot of work to get interviews, while she got interviews and a job everywhere she wanted. Anecdotal but interesting observation
2. One gentlewoman, who was quite informative, said something along the lines of 'I don't think having a fellowship hurts you for private practice.... my private practice is looking to open a fellowship'. I cringed inside. Appreciate her honesty, but everything about that statement is terrible.

The Terry Wall data does not have employment % and has a much lower completion rate then the resident survey from 2014 that was published (I think he cited only 35% completion? And much less for further years post graduation... could be wrong). It would benefit the field greatly if everyone fills them out, but it doesn't have questions the other survey had (difficulty with geography, couldn't find a job in academics, felt forced into fellowship, etc). Kudos to him though, what a great asset to the field that he does what he does.

So at this ASTRO, this issue was a no show.

 

[ramsesthenice]

Not sure how it works - does paying conference registration entail some exclusive right to the non-published material? No idea so err on side of caution.

Let's put it this way - the big news was no news. The labor market and fellowship expansion wasn't discussed any more than at face value, either in the fellowship or job application panel. Regarding the fellowship panel the people who spoke were very nice - but all were people who had gone through fellowship already. There was no focus on 'why do you think there are now 30-40' fellowships now?' or 'is it a sign that there are no good jobs when non-accredited fellowships are springing up like weeds'.
Here are two memorable lines
1. One gentleman on the panel talked about how his wife was graduating derm same year and how hard it was to coordinate interviews - because he felt there was such a narrow window of time to accept offers and a lot of work to get interviews, while she got interviews and a job everywhere she wanted. Anecdotal but interesting observation
2. One gentlewoman, who was quite informative, said something along the lines of 'I don't think having a fellowship hurts you for private practice.... my private practice is looking to open a fellowship'. I cringed inside. Appreciate her honesty, but everything about that statement is terrible.

The Terry Wall data does not have employment % and has a much lower completion rate then the resident survey from 2014 that was published (I think he cited only 35% completion? And much less for further years post graduation... could be wrong). It would benefit the field greatly if everyone fills them out, but it doesn't have questions the other survey had (difficulty with geography, couldn't find a job in academics, felt forced into fellowship, etc). Kudos to him though, what a great asset to the field that he does what he does.

So at this ASTRO, this issue was a no show.

I can appreciate everyone feeling nervous at this point but the paranoia is getting a little out of hand. Not all were advertised but I interviewed for/discussed real opportunities for good jobs in Raleigh-Durham, Portland, Chicago, Rochester NY, the Bay Area and a smattering of Midwest cities this year. I also saw adds for Jobs in NYC, Palo Alto, So Cal, Dallas, Indianapolis, Minneapolis, and other mid-sized cities. There are good jobs out there. Not everyone is doomed to a fellowship or crappy job. Even this year.

 

[RadOncDoc21]

I can appreciate everyone feeling nervous at this point but the paranoia is getting a little out of hand. Not all were advertised but I interviewed for/discussed real opportunities for good jobs in Raleigh-Durham, Portland, Chicago, Rochester NY, the Bay Area and a smattering of Midwest cities this year. I also saw adds for Jobs in NYC, Palo Alto, So Cal, Dallas, Indianapolis, Minneapolis, and other mid-sized cities. There are good jobs out there. Not everyone is doomed to a fellowship or crappy job. Even this year.

True, there are good positions out there but for every one position there are up to 30-50 applications with around 5-10 interviewing for the position. If you are restricted to a location, it can be quite competitive.

 

[medgator]

1. One gentleman on the panel talked about how his wife was graduating derm same year and how hard it was to coordinate interviews - because he felt there was such a narrow window of time to accept offers and a lot of work to get interviews, while she got interviews and a job everywhere she wanted. Anecdotal but interesting observation
.

That's because derm has kept the number of residency spots fixed for several years. The leaders in that specialty care about their graduates and the work they took to even land a spot in the first place. The complete 180 that is going on in rad onc over the last few years by our "leadership" is sad to say the least

 

[medgator]

I can appreciate everyone feeling nervous at this point but the paranoia is getting a little out of hand. Not all were advertised but I interviewed for/discussed real opportunities for good jobs in Raleigh-Durham, Portland, Chicago, Rochester NY, the Bay Area and a smattering of Midwest cities this year. I also saw adds for Jobs in NYC, Palo Alto, So Cal, Dallas, Indianapolis, Minneapolis, and other mid-sized cities. There are good jobs out there. Not everyone is doomed to a fellowship or crappy job. Even this year.

It can't be emphasized enough... The "best" jobs aren't advertised on the astro site. It's where people post jobs that they have a hard time filling lately it seems. Half the postings seem to be fellowships now.

If you know you want to be somewhere specific geographically, and you have a couple of years to go, start putting out feelers now.

The market has tightened for sure, but the above has always been true

 

[ramsesthenice]

It can't be emphasized enough... The "best" jobs aren't advertised on the astro site. It's where people post jobs that they have a hard time filling lately it seems. Half the postings seem to be fellowships now.

If you know you want to be somewhere specific geographically, and you have a couple of years to go, start putting out feelers now.

The market has tightened for sure, but the above has always been true

Gator is right. And then some. A lot of places are required to do national searches to fill a position (for academics anyway). A couple of places posted jobs on ASTRO after expressing interest in bringing me out. I accepted my position before they finished interviewing everyone they had invited. If you wait for a "good" job to show up on ASTRO there is a chance they already know who they want to fill it before they start the process. You have to network and make connections early, academics or PP it's the same.

 

[DebtRising]

I can appreciate everyone feeling nervous at this point but the paranoia is getting a little out of hand. Not all were advertised but I interviewed for/discussed real opportunities for good jobs in Raleigh-Durham, Portland, Chicago, Rochester NY, the Bay Area and a smattering of Midwest cities this year. I also saw adds for Jobs in NYC, Palo Alto, So Cal, Dallas, Indianapolis, Minneapolis, and other mid-sized cities. There are good jobs out there. Not everyone is doomed to a fellowship or crappy job. Even this year.

That's great to hear, but it's not paranoia. Also I would point out that according to Wall's data, 0% of on site ASTRO interviews or recruitment lead to a job when this was the only point of contact (or maybe it was 0% for ads and only 25% for interview, can't recall). Not sure how many of those you cite fall into that category. And I would very much like to know the quality of those positions you site - because my impression was that there were 0 'good' jobs in the Bay area.

I'm going to leave it all alone, just like last week when I was networking my butt off, but it is certainly not paranoia. The fellowship expansion isn't fictitious and certainly isn't a product of benevolence. Neither is residency expansion in the face of declining RT utilization and a clearly tightening job market in almost all of the most desirable regions. Neither is the only true employment survey 2 years back showing some pretty poor outcomes in terms of actually getting a job, getting an academic job, and getting a desired region (7% unemployment, 16% couldnt get academics, 33% couldn't get region).

That story is old, it's not changing, might as well put your head down and grin. There is extremely little appetite to address it, and with declining reimbursement everyone from academics to PP will look to residents or fellows as a very cheap labor source - especially when the only verification they need on the clinical side of things is a case log the resident is perversely incentivized to maximize(or nothing at all for fellows).

 

[Reaganite]

I have to say reading these threads reinforces my long-held belief that the disdain for urorads, dermrads, etc. was misguided. At least those guys were paying well. Also, I'm starting to think the stories about overutilization of services were carefully crafted by academic centers (you know, the same guys starting all these suspect fellowships) because they were losing the business. Don't get me wrong-utilization does go up with urorads--but that is probably a good thing for patients (less surgery for high risk CA, more adjuvant xrt for + marings, etc.). The salaries I hear for some of these academic positions and satellites are ridiculous. I treat 10 patients in a private practice setting, and I'm making the same as my colleague busting his butt carrying 20-30 patients in a satellite office. Also, many of these programs are just filling positions with their own graduates. That's why you never hear about positions in desirable areas. Programs are expanding to fill satellites with their own. And don't think you have automomy; these positions are like extended residency. Many of these new grads are basically the chairman's b*tch.

There are ways to fight back. Although the hospitals are buying out medical oncologists, other specialists--urologists, surgeons, etc.--are still at play. Also, insurance companies do not want to contact with big hospitals. Funny thing is, HMOs are actually saving private practice oncology in some communities because they refuse to contract with expensive cancer centers. I'm definitely seeing a push-back in my community, and have actually seen MORE private practice med oncs enter the community. You can undercut the big academic center and still make a profit. Get together with other referring docs in your community and fight back.

As far as jobs, send out feelers early. Fish your desired geography years before you graduate.

 

[radiaterMike]

That's great to hear, but it's not paranoia. Also I would point out that according to Wall's data, 0% of on site ASTRO interviews or recruitment lead to a job when this was the only point of contact (or maybe it was 0% for ads and only 25% for interview, can't recall). Not sure how many of those you cite fall into that category. And I would very much like to know the quality of those positions you site - because my impression was that there were 0 'good' jobs in the Bay area.

I'm going to leave it all alone, just like last week when I was networking my butt off, but it is certainly not paranoia. The fellowship expansion isn't fictitious and certainly isn't a product of benevolence. Neither is residency expansion in the face of declining RT utilization and a clearly tightening job market in almost all of the most desirable regions. Neither is the only true employment survey 2 years back showing some pretty poor outcomes in terms of actually getting a job, getting an academic job, and getting a desired region (7% unemployment, 16% couldnt get academics, 33% couldn't get region).

That story is old, it's not changing, might as well put your head down and grin. There is extremely little appetite to address it, and with declining reimbursement everyone from academics to PP will look to residents or fellows as a very cheap labor source - especially when the only verification they need on the clinical side of things is a case log the resident is perversely incentivized to maximize(or nothing at all for fellows).

If ASTRO is the only point of contact that means there was no follow up interview. The 0% then is no surprise (unless I am misinterpreting this). Nobody is going to accept a job and no employer will hire if the only interview was at ASTRO. ASTRO is to gauge mutual interest not to finalize an offer without ever seeing the practice or meeting other docs I the practice, staff, referring docs, hospital administrators, etc.


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[kat_i'm_a_kitty_kat]

Long time lurker, first(ish) time poster. It might be my naïveté with RadOnc that will (hopefully) get better over the years, but with more work into multi-modal therapy (and research-oriented RadOncs spearheading efforts to find radiation/systemic combinations), might not the job market look a little better down the road? Any take on the increased efforts to train proceduralists (IORT, brachy, interventionalists) as a means to secure, or even expand, our place? With more emphasis on targeted agents (biologics and otherwise), might RadOncs end up being a little more like MedOncs in terms of managing systemic therapies with concurrent RT? I mean...I kind of trust those MedOnc nurses and NPs to run the show for infusions more than the MedOnc MDs. Was that sacrilege to say?

 

[BobbyHeenan]

Long time lurker, first(ish) time poster. It might be my naïveté with RadOnc that will (hopefully) get better over the years, but with more work into multi-modal therapy (and research-oriented RadOncs spearheading efforts to find radiation/systemic combinations), might not the job market look a little better down the road? Any take on the increased efforts to train proceduralists (IORT, brachy, interventionalists) as a means to secure, or even expand, our place? With more emphasis on targeted agents (biologics and otherwise), might RadOncs end up being a little more like MedOncs in terms of managing systemic therapies with concurrent RT? I mean...I kind of trust those MedOnc nurses and NPs to run the show for infusions more than the MedOnc MDs. Was that sacrilege to say?

I think in the U.S. at least it's far fetched to think widespread administration of biologics, immune therapy, or other targeted agents by rad onc will ever happen. In addition to the obvious turf issues with med onc, there are a lot of regulatory/pharmacy issues a hospital based practice must meet and having that infrastructure in place in addition to the radiation rules/regs is a major undertaking.

The proceduralist thing may give you a few niche slots around the country, but nothing that will move the needle. It would be very hard to have a busy rad onc practice but have to spend big chunks of your time out of the clinic doing IR procedures and/or taking IR call. We are already hearing people talk about the need for a "fellowship" after a standard radiation residency to gain more exposure to certain things, so how do we think that one is going to be competent in clinic/patient face to face management, external beam radiation oncology, interventional radiology, and brachytherapy without an extremely long residency that doesn't compromise on some other things?

With that said, the Trojan horse to the rad onc/IR person is that if you do the biopsy, give the results, then you "own" the patient and you can funnel him/her into radiation rather than to the med onc as first line of oncology contact. In that aspect I like it. So maybe there will be a spot for a non-emergent IR-light type of person who could do CT or US guided biopsies but not put in stents or biliary drains or IVC filters or something.

IMO the big things that will keep the job market afloat would be:

• halting residency expansion (the only variable we can 100% control - so control it)
• ensuring a med onc or whomever is not financially "penalized" by referring to radiation in whatever new payment models come about
• a big landmark trial or major shift in a common situation that involves expanding use of radiation (ie showing no benefit to high risk patients having prostatectomy vs. ADT/XRT, lung stage 1 SBRT equal to lobectomy, or some sort of second line chemo +/- SBRT for oligomets showing clear benefit)....something we may never see get done though.
• some sort of NCCN guideline or other quality measure or mandate for prostate cancer that says patients diagnosed with prostate cancer should/must be seen by a rad onc prior to choosing primary modality therapy

 

[DukeNukem]

I would imagine (and from what I've seen) that hospital-employed pays better than an "academic" position in name only at the academic enter or nearby satellite.

In my area, there's a lot of fluctuation. It's not uncommon to see hospital based or private practice offering new grads ~250k while the academic center is paying ~300k.

Professional partnership isn't a gimmick. Partners may not want to bring anyone else into the technical, but that doesn't mean you can't be a on professional partnership track. Obviously scouting things out beforehand and looking at the practice's history is key.

Yeah right, it's a total gimmick. New grads don't know the difference between technical partnerships and professional partnerships. About 80% of the reimbursement for radiation oncologists is technical. Your salary on professional reimbursement alone will be peanuts. Everyone assumes partnership means technicals. Without that, what's the point of partnership at all? You're basically just employed. You might as well go work for the hospital system or academic center down the street.

When I looked for jobs, the same practices that were offering technical partnerships a few years ago have now all switched to not offering partnerships or offering these gimmicky professional partnerships. My favorite are the practices that overvalue their technical partnerships to the point where they tell you it would cost millions to buy into their practices to become a technical partner. It's such a scam. Nobody used to do this, but now it's common since there are so many new grads and so many bad jobs out there to take advantage of you.

 

[fiji128]

I can offer my job hunting experience having completed residency in June of this year from a small program with no job placement help what so ever. I did interview at Astro and even interviewed at a fellowship. Ultimately ended up signing with a private practice group in a top 10 metro area (by population) that I initially interviewed with at Astro and singed with in December. So got a decent location but not my first choice, probably 25 to 35%-tile in starting salary with excellent benifits and overall quality of the practice it about the same as the pay but with low patient loads (hours 8 to 3 pm on average with about 2-3 hours spent in commuting a day depending on traffic could be much lower if I did not live want to live downtown). I did fill out the Wahl survey.

Simply "networking" for a good position is tuff if you are from a small program. Positions in desirable locations will not call you back if you cold call them or just sending CV's to places you may know are hiring, this approach really netted me no real responses. I'm specifically talking about places in the greater New York/Philly area. Even the graduates that I knew from those city's own residency programs have a hard time finding good positions in those metro areas. From what I heard, those from MSKCC and Penn get first dibs and it works it way down from there. I would imagine the same goes for LA/SFO/BOS/DC/SD/Seattle areas. I know residents who had to do fellowships to get their toe in the door in these locations with no guarantee of anything and after taking a huge hit on that year's salary.

If you are willing to entertain working outside those areas it becomes easier to find positions in places like Chicago/Minneapolis/St Louis/Atlanta/Miami/Kansas City/Cincinnati/Texas (not Austin). If you purse positions in these areas you are somewhat likely to get an interview without having to kiss too much ass (if they are hiring). Same probably goes for most other towns that are large enough to host a professional sports franchise but otherwise not consider super desirable on the coast metro areas. If you find a position in a town with a population of less then 750 K (not counting Santa Barbara type places), they are likely to engage with you almost immediately. It used to be said you can get 2 of 3 things in your job; quality of position, salary and location. After talking to others who interviewed last year, its getting hard to maximize any two of those things. It's moving towards maybe getting one of these things for your first job with a highly desirable location not being realistic for some geographic areas.

I think everyone who reads this realizes that the more residents that graduate and the longer the boomer generation avoids retirement your position in the job market gets eroded. Some of the folks I graduated med school or intern year with have had very little trouble getting good jobs anywhere they want including NYC and SFO while those in other sub-specialties talk about over-saturated job markets. Unfortunately, rad onc is currently in that latter group as the proliferation of garbage fellowships that qualify you for nothing attest to.

Just my impressions.

 

[Gfunk6]

Your salary on professional reimbursement alone will be peanuts.

I have to disagree with this statement. I know many RO MDs who are making a very comfortable living in a "professional only" relationship with the hospital with very nice vacation times. Remember that in the "professional only" model, your overhead cost is virtually nil (except perhaps for a billing guy). You don't pay for the machine, maintenance, staff, or anything else. Very generally speaking you probably need one full-time RO for ~15 patients on treatment assuming a usual mix of IMRT/3D/SRS/SBRT/2D. I those scenarios you can easily bill out $400k+ annually on pro fees alone.

 

[medgator]

About 80% of the reimbursement for radiation oncologists is technical. Your salary on professional reimbursement alone will be peanuts.

Your first statement is true, your second isn't, unless you consider $400K+/year peanuts. In some "professional" free-standing contracts, you get a generous percentage that ends up including a little sliver of technical along with it.