2019 ERAS Data Release

[Mandelin Rain]

I may be a card carrying liberal, but what happened to personal responsibility here? The decision to live rurally has pros (more space, cleaner environment, cheaper housing etc) and cons, one of which is more difficult access to high level care. There is not and shouldn’t be a right to tertiary level care in your backyard.

So yes, some patients will defer care, or delay care if they have to travel an hour Or 2 or 3 to see a (linac, urologist, surgical oncologist, etc). That is a personal decision. That doesn’t mean we shouldn’t do our best to help them through telemedicine, consolidating appointments, hypoFx, etc, but at some point we have to accept that we are their doctors, not their parents.

Agree. If they can, they should. agreement. If they are choosing to live somewhere with terrible schools and have a way out, but choose not to, that’s their problem.

Is this the same as people who have
money, buy a plot of land 2 hours outside of Denver and expect high level care?

I hear so many times from my long distance patients (1-2 hours away) - “I would never live in ____”. Even though it’s cheaper to live in the city or near it.

Ummm. Rich people in the country in America get health care. There is no need to worry about them. Similarly, rich people in the city send their kids to decent schools. This is distinctly not what I’m talking about.

---

Members don't see this ad.

 

[Mandelin Rain]

I mean, this is why so many liberals support desegregation bussing and school consolidation. It saves on costs overall and reduces inequality, at the expense of rich suburbanites having to tolerate their kids going to the same schools as poor people.

Are we talking a 30 minute bus ride or a 4 hour bus ride? I’m sure the kids can just get a hotel during the week to attend. To suggest otherwise is specious sanctimony.

 

[Timewinders]

Are we talking a 30 minute bus ride or a 4 hour bus ride? I’m sure the kids can just get a hotel during the week to attend. To suggest otherwise is specious sanctimony.

30 minutes of course. Some states in the country have such a fractured school district system that a 15 mile radius could have a dozen school districts inside them. Consolidation could provide massive gains there.

 

[deleted1002574]

Ummm. Rich people in the country in America get health care. There is no need to worry about them. Similarly, rich people in the city send their kids to decent schools. This is distinctly not what I’m talking about.

You cannot build a linac every 20
miles. You can’t have a organ transplant center every 100 miles. You can’t have a pediatric hospital every hundred miles. It doesn’t work like that. No one is saying the rural poor don’t deserve good care. I think everyone deserves good care. But with scarcity of resources, I’m not sure of the value of worrying about someone driving an hour or more in the middle of nowhere. There are limits. We can’t even get people to fill these jobs, let alone fill the linacs that are built. We all (mostly) care about everyone equally.

There are pros and cons of living everywhere. People in Canada (spacious country) drive far to radiation centers. We did it because we had to for the sake of our lives. Europe has centralized centers.

If people want to build a center, if someone wants to staff it, and the economics make sense, I’m all for it! No one is saying not to. You’re missing the point... There are pros and cons to the American system (in all aspects, not just health care), and we are aware of that. No one is bad for recognizing the limits.

 

[Mandelin Rain]

I completely understand that there are limits and problems in all corners of this country.

I think people who live in densely populated pockets forget how vast this nation is and how different real people have it than they do.

It leads to notions like poor, rural head and neck patients with a trach/PEG can easily pack a bag and drive hours to the city to stay at a Ramada Inn for 7 weeks during their highly toxic treatment. And that anyone suggesting this is an unreasonable expectation is being sanctimonious.

I live and practice in the city, and many of my patients struggle to make it 5 minutes down the street to see me.

Im not saying I have a solution, but I’m suggesting the idea that people “choose” to live in rural poverty is not helpful. No more helpful than saying people choose to live in urban poverty.

That’s not me being sanctimonious. That’s just me being honest. With a tinge of virtue signaling.

Edit: if our country does adopt the notion of healthcare as a “right”, then the economics of decisions have to go out the window in favor of access. What good is a “right” if you have no logistic ability to exercise it because you didn’t win the birth proximity lottery.

 

[deleted1002574]

Agreed. Full stop.

 

[Mandelin Rain]

While I’m ranting, there are probably 12-15 linacs within a 25 minute circumference of my clinic (not a CON state). None of which are treating 25 people per day. Some single digit. Some a dozen. Maybe a couple at 20 patients. But this side of town has a high percentage of private insurance. Head to the other side of the city where there is a high state sponsored/no insurance population and try to find a linac. Good luck.

Same issue as rural folks. Access is a problem based on being poor.

There are plenty of linacs in this country to treat everyone. They are just highly concentrated in certain areas and almost all are completely underutilized.

 

[RSAOaky]

The drop in applicants is not unexpected given recent history but nevertheless quite fascinating. Radonc as a field has self-selected to a large extent. Students really don't get exposed to it during medical school and so it attracts people that specifically seek it out. It was competitive despite its low numbers because it promised a good salary, good work life balance, and intellectual stimulation. Med students were willing to do a ton of research, pretend they had any interest in physics/radbio, do multiple away rotations, suck up to the awkward academics they needed letters from, and jump through tons of hoops to MAYBE match at a program and for it to MAYBE be a program they wanted to be at. It was an embarrassment of riches for the ivory tower academics to be able to actually SELECT from a pool of highly qualified self selected applicants. Medical students were willing to jump through the hoops because the prospects on the other end were just that good.

They aren't anymore.

If you're interested in oncology, medical oncology has made far greater strides in the last 5 years and there is actually work being done to actively move the field forward. If you were even remotely qualified for radonc 5 years ago you could pretty much walk into a top internal medicine program in your desired city without having to jump through all the radonc hoops mentioned above and this would all but guarantee your spot in a heme/onc fellowship. Medoncs are currently in high demand and have excellent job opportunities anywhere in the country.

Radonc is no longer the holy grail. Residency is not as cush as it once was and there are many downright malignant radonc programs. The payoff is no longer there as we make less, have little opportunity for advancement, and have fewer GOOD QUALITY job prospects. There has been little done to improve either the quality or the effectiveness of the treatments we do. You have to write 3 board exams and do an oral exam and, at a whim, someone may decide to fail half of you. All the downsides of our field still exist, the upsides have dropped off a cliff, and our competitors have become more competitive. Despite all this, programs are still looking to expand and new programs are looking to start up.

Residency programs had it too good for too long and they took advantage of it. Unfortunately rather than looking inwards and admitting "we caused this," the problem is that "radonc has a PR problem" and that a the loud opinions of a handful of internet misanthropes are convincing the top 1% of medical students to seek other careers. It will be interesting to see how programs change their tunes. In my day the pre-interview pep talk was "we only choose to interview the best and brightest, so if you're sitting at this table then you owe yourself a pat on the back." Now it's more like "you're here because your body is warm, your judgement is clouded, and frankly...you applied."

Enjoy the SOAP.

 

[Mandelin Rain]

 

[radoncgrad2019]

KHE - any good Szechuan in your neck of the woods?

 

[deleted1002574]

If I can’t get some mapo tofu within 30 minutes of the cancer center, there is NO WAY I’m working there. Life and death, ya dig?

 

[medgator]

If I can’t get some mapo tofu within 30 minutes of the cancer center, there is NO WAY I’m working there. Life and death, ya dig?

For me it's poke bowls and bibimbap

 

[radoncgrad2019]

I googled bimbimbap and all I see is a pic of tortured baby Koreans

 

[thecarbonionangle]

If I can’t get some mapo tofu within 30 minutes of the cancer center, there is NO WAY I’m working there. Life and death, ya dig?

second this.

 

[medgator]

, we’re putting in a satellite there and we’d love if you could staff it for $200k/yr after you finish your three year research fellowship in Ralph Weischelbaum’s lab.

I still think that's above the median peds salary. Ralph won't be happy

 

[deleted1002574]

I really think at least 20% of chairs actually think like he does. He’s just one of the few older chairmen on twitter. You telling me the Michigan chair who expressly doesn’t want people going into private practice or the clown at UPMC don’t agree?

 

[KHE88]

KHE - any good Szechuan in your neck of the woods?

By all means, don't let me stop you all from parodying yourselves.
Also strong work trolling while on probationary status.

 

[radoncgrad2019]

Everyone hold on - when did anyone in academics say people shouldn’t care about where they live?

Fake news.

 

[radoncgrad2019]

You need to spend more time on academic twitter. There are whole threads shaming people for only wanting to live in “coastal cities,” eating their bi bim bap, lamb biryani like entitled bourgeois millennials ... and presumably avocado toast.

I’m all over twitter. I’ve seen a lot but I have not seen this at all.

 

[medgator]

I’m all over twitter. I’ve seen a lot but I have not seen this at all.

They just deny there is a problem with the job market at all



although this tweet admitted it

 

[deleted941485]

They just deny there is a problem with the job market at all



although this tweet admitted it

The benefit of rad Onc is that you’ll have a great personal statement when you Apply for that second residency. If I get another 7 years out of this specialty it’ll be nothing short of a miracle. Save up!

 

[radoncgrad2019]

They just deny there is a problem with the job market at all



although this tweet admitted it

Dude. That is such a reach. Literally last week we were praising Tendulkar’s tweets here. See the rest of them in context. He’s not denying there is a problem. He’s not part of the problem.

This is the **** that makes SDN look silly.

 

[medgator]

Dude. That is such a reach. Literally last week we were praising Tendulkar’s tweets here.

Wrong. That was an older tweet, before he recently saw the light regarding the ERAS numbers and the arro survey. Even Sushil Beriwal was saying it wasn't based on facts previously, despite what we all knew and continue to know. The arro results and ERAS numbers are finally making believers out of them it seems.

Many are even more out of touch like Ralph, KO etc although the last match and the forthcoming match will force them to become aware of and acknowledge the problem

 

[radoncgrad2019]

Old tweet lmao it was oct 13. But you are right Medgator, no one else has thought about this problem or thought there was a problem before you!!!! You are first.

Also Tendulkar said that they will not SOAP.

 

[xrthopeful]

There were plenty of tweets about the low application numbers from the week of ASTRO. This has been known. That was the first tweetstorm.

no clue what Medgator is talking about.

 

[medgator]

Old tweet lmao it was oct 13. But you are right Medgator, no one else has thought about this problem or thought there was a problem before you!!!! You are first.

Also Tendulkar said that they will not SOAP.

There were plenty of tweets about the low application numbers from the week of ASTRO. This has been known. That was the first tweetstorm.

no clue what Medgator is talking about.

Sorry you can't read/comprehend the tweets I've posted. Tendulkar clearly gaslighted on the job market concerns in the tweet I posted. bottom line. He

Better luck next time?

I'm glad to hear Tendulkar and Beriwal have seen the light though after the ARRO survey results. Plenty haven't, though even after the last match opened plenty of eyes (including probably yours).

 

[KHE88]

They just deny there is a problem with the job market at all



although this tweet admitted it

Cool, we can add Cleveland Clinic to the list of programs with tweeting leaders that don't get it...

Cleveland Clinic
Mayo
Columbia
UPMC
Chicago
Michigan

"TALK TO PEOPLE IN REAL LIFE"

Keep up the strong work, academics.
What's our ulterior motive here to provide disinformation?
What's the ulterior motive of the academics to provide disinformation?
Which scenario is more likely?

I have personally witnessed the academics lie to medical students. It makes them look good to recruit the best of the best. They will say anything. That's why they want them to talk to them in real life. It's like that girlfriend we all had at some point who doesn't want you to talk to anyone but her. Don't talk to your friends, family, strangers, etc. Because they will tell you she is lying and manipulative and FOS. Also LOL about them having a clue about the practice of rad onc outside the academic bubble.

 

[radoncgrad2019]

KHE, youll learn the hard way.

 

[KHE88]

KHE, youll learn the hard way.

Cool. Threats. Come and get me Twitter mob

 

[xrthopeful]

The guy/gal doesn't have to threaten you, all they have to do is send you a gift card to an Ethiopian restaurant.

Shook!

 

[medgator]

The guy/gal doesn't have to threaten you, all they have to do is send you a gift card to an Ethiopian restaurant.

Shook!

Probably less than a third of ASTRO job listings have the ability to buy those probably. Assuming there are actually 190 positions jobs listed for rad onc

 

[xrthopeful]

well Szechuan > Biryani > Korean >>>>>Ethiopian so it's cool

 

[deleted1002574]

well Szechuan > Biryani > Korean >>>>>Ethiopian so it's cool

You’re a good dude, but that’s just wrong.

Go to DC, get a table at Zenebach, order whatever the hostess tells you what she likes and get back to me.

Korean = Sichuan > Biryani = Ethiopian

 

[xrthopeful]

I quite like all of the first three. could have been tied. I have not had good ethiopian food. It's bland, you want it to spicy because of how it looks, but then tastes like bland Indian.

I will surely try that place next time in DC, thanks.

 

[Neuronix]

Ethiopian food is great when it's spicy. Like Indian, a lot of times it gets toned down in American restaurants.

I'm voting Sichuan > Mexican > Indian (I prefer curry over biryani) > Ethiopian > Korean, but all good.

 

[KHE88]

The guy/gal doesn't have to threaten you, all they have to do is send you a gift card to an Ethiopian restaurant.

Shook!

Interestingly there are a lot of Ethopian immigrants around here as they work in the meat-packing and agricultural industry. So there is an Ethiopian store/restaurant.

I'll eat basically anything that isn't overly processed or made of tortured animals. Food = fuel, don't get why people make such a big deal out of it. Eat some fresh veggies and lean meats and save my calories for beer.

Anyway, where's all the Ethopians in rad onc? I don't think I've ever met one. Why are we systematically shutting them out of the field? Need some tenure-hungry $500k salaried academics to pump out some NEJM publications on this.

 

[medgator]

You’re a good dude, but that’s just wrong.

Go to DC, get a table at Zenebach, order whatever the hostess tells you what she likes and get back to me.

Korean = Sichuan > Biryani = Ethiopian

>>>>>>>>>>>>>>> White Castle > Waffle house > Bob Evans=Friendly's > Walmart Grab N Go > gas station hotdogs/sushi












(ASTRO job cuisine)

 

[RadOncDoc21]

Don’t

>>>>>>>>>>>>>>> White Castle > Waffle house > Bob Evans=Friendly's > Walmart Grab N Go > gas station hotdogs/sushi












(ASTRO job cuisine)

Don’t sleep on Publix or Sheetz!

 

[deleted1002574]

Music = noise , don’t get why people make such a big deal about it

Novels = words in order on paper, don’t get why people make such a big deal about it

Paintings = colors on canvas, don’t get why people make such a big deal about it

Rad onc job in Rhinelander = income, don’t get why people make such a big deal about it

Philistinism is not good for an enlightened society

 

[medgator]

Don’t


Don’t sleep on Publix or Sheetz!

Love me some Publix subs. Wawa coffee too

 

[radoncgrad2019]

Calories for Beer > Veggies > Lean Meat BRO

 

[deleted1002574]

Wonder which rural area KHE88 is crushing it in, dumpsters full of hundies. Minot job is no longer posting ...

 

[KHE88]

Music = noise , don’t get why people make such a big deal about it

Novels = words in order on paper, don’t get why people make such a big deal about it

Paintings = colors on canvas, don’t get why people make such a big deal about it

Rad onc job in Rhinelander = income, don’t get why people make such a big deal about it

Philistinism is not good for an enlightened society

Well Hannibal Lecter liked the finer things too. The finest wines, the finest music, the finest tortured humans.

 

[deleted1002574]

Hannibal was a good guy. Misunderstood. Used to play racquetball with him on Tuesdays. Lamestream media really sucker punched him.

 

[RadOncDoc21]

Wonder which rural area KHE88 is crushing it in, dumpsters full of hundies. Minot job is no longer posting ...

I haven’t seen the Wichita, KS one in awhile.

 

[medgator]

I haven’t seen the Wichita, KS one in awhile.

Chillicothe OH made it to my inbox once. Think it advertised an $800k guarantee. Never saw it again.

 

[RadOncDoc21]

Chillicothe OH made it to my inbox once. Think it advertised an $800k guarantee. Never saw it again.

Not going to lie, I would definitely at least google the area and give it a thought or two before moving on with my day. It’s the ones in similar locations advertising at 350k that make me cringe. I don’t know much about Chillicothe, OH but appreciate the dept/recruiters for doing what needs to be done. That’s how you get people to come to your area and provide great care!

 

[deleted1002574]

Meth country but only 45 miles south of Columbus. I’d take that for 8 hundy

 

[thecarbonionangle]

Meth country but only 45 miles south of Columbus. I’d take that for 8 hundy

i little meth never hurt anybody, just brush your teeth after you consume that tasty tortured mutton Biriyani. I’m not going to jump on the Ethiopian food bandwagon, actually agree with Khe, yuck!!

 

[medgator]

I’m not going to jump on the Ethiopian food bandwagon, actually agree with Khe, yuck!!

Not everyone can appreciate injera and wot