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I figured this deserved its own thread. (note: SDN wouldn't let me insert all the screenshots in a single post, so I'll post them as replies)
Interesting results this year (and interesting to see what ARRO chose to share on Twitter). Full disclaimer, I am not attending ASTRO, so I did not personally witness the presentation. Perhaps some of my questions were answered verbally, and hopefully people who were there can fill in the blanks. Last year, ARRO was much more comprehensive in what they Tweeted (LINK). Maybe that's because it was totally virtual and whoever was running the account was doing it from their office computer, whereas this year someone is doing it from their phone while in Chicago?
As a reminder, this survey was sent to senior (PGY-5) residents on May 14th, 2021, prior to their graduation and prior to starting work as an attending. It was open till at least the end of June, when they Tweeted that they had collected most of the responses (LINK).
Here's what ARRO shared (LINK) (see below).
My immediate thoughts, and I'm very curious what everyone else thinks:
1) This seems like the lowest response rate we've seen in several years (someone please correct me if I'm wrong on that). The data point with the highest population size is 166 (compared to 179 last year, which was 94%). I'm not sure the exact number of potential respondents, but I assume it was similar. If so, 15-20% of the Class of 2021 did not respond to this survey. We can wildly speculate as to why that might be in ways which would support our personal interpretation of the job market, so I'll refrain from doing so.
2) It appears that the option to select "Neutral" in the "Satisfaction Domains" is new this year (here's what it looked like last year). I'm not quite sure what to make of this compared to previous surveys, as the domains are a little different and adding an additional response makes it hard to interpret. Personally, I think adding "Neutral" gives an "escape hatch" to someone who might choose "Dissatisfied" and skews the results away from having more negative values. As someone who filled out the survey this year, I was frustrated with these questions and answers. Ultimately, I am "satisfied" because I found A job within a few hundred miles of my preferred location. However, I had adjusted my expectations significantly lower than what they were when I matched into RadOnc, especially with COVID. So I was "satisfied" that I wasn't unemployed or in a fellowship, but it's more of a...begrudging satisfaction.
3) I don't know if it's valuable to collect newly-hired residents' perception of private practice partner salaries, since, even on the fastest tracks, they're still several years away from that. Regardless, that IQR ($500k-$650k) seems significantly lower than what it used to be, ESPECIALLY considering inflation. Putting aside the arguments of whether or not those doctors "should" earn that amount, I think this is a good barometer of the effects of hypofrac and reimbursement cuts. I also think this number is going to continue to fall. Can some of the more senior private practice folks comment on this?
4) The median PP starting salary appears unchanged. I need to double check, but hasn't this number been stable for at least 5 years? If you throw it in the CPI calculator, you get a sense for the value lost to inflation (not a perfect measure, obviously, but a stagnate salary is not a sign of a robust market).
5) That "Accepted Position Type" slide is very confusing, but appears negative, and seems to support the ASTRO tagline of "just get A job". It appears that they broke down each possible position type people were hired into, and asks if it's their "ideal position". The highest is a mere 43%, for private practice hospital based. If you average out all these values together, you find that a whopping 21.4% of people found their "ideal position". I agree that people shouldn't expect to land their ideal job right out of residency, but I imagine this number is higher for most other specialties, and I would be curious if they still consider this their "ideal position" after, you know, actually starting the job.
6) As predicted, unemployment remains low (1 person reported no offer in 2020 compared to 3 people in 2021). Now, an unscrupulous individual might paint this as "the number of unemployed new Radiation Oncology graduates has tripled in 2021", but I won't do that. Again, no one expects this number to be high this (or next) year. But with APM looming and a 9% cut to radiation services proposed in the 2022 MPFS from CMS - continually producing a surplus of Radiation Oncologists doesn't seem like a sound economic plan.
7) Finally, the slide I'm actually most interested in (and not Tweeted by ARRO) is the number of interviews and the number of offers. There was a median of 4 site interviews (or "virtual equivalent", the meaning of which was left for interpretation) for a median of 2 firm offers. I wish they went one step further, and asked how many applications/cold calls/etc it took to get those interviews. For me, it took more than 70 applications, emails, networking requests, etc to obtain a single site interview which led to a single offer, which I accepted. In talking to my friends, there seemed to be a bimodal distribution of experiences. There were people like me (who contacted a very large number of practices and institutions for a couple of interviews), and then there were people who were lucky enough to reach out to 2-3 places for their job (and it was almost always luck, in that the place they really wanted happened to be hiring last year, there was no secret underground club).
Applying to a large number of jobs for such a low rate of return is, to me, heralding what lies ahead. In an example of "history repeats itself", this was hypothesized in 1994 by Jonathan Sunshine in "Too many radiation oncologists? An empirical report", when he was talking about the job market concerns of the 90s:
“...when program faculty told us of an unemployed radiation oncologist, the story often involved someone who could look for work only where he or she trained, due to a spouse. Straightforward probability calculations show that if a physician has only a 10% chance of finding work in any one locality, he or she, nonetheless, has a 99.5% probability of finding work if he or she is willing to consider any of 50 localities. And there are literally hundreds of localities in the United States.”
One of the main differences between now and then is the application arms race that the Match (and just trying to get into medical school) has turned into. As has been talked about extensively on Twitter recently, my generation has been engaged in the practice of assuming we need to apply to dozens and dozens of residencies to have a chance of getting in. Many of us applied similar logic in trying to get a job in Radiation Oncology. 10-15 years ago, were there many people applying to 70+ places all over America for the chance to land a single job? I doubt it. Our expectation (and experience) with shotgun applying everywhere prepared us well for the current RadOnc job search.
This is a very long post just to say: I saw folks on Twitter implying this is positive data. I believe these people view the "internet misanthrope" narrative about the RadOnc job market as one where we're convinced there are no jobs left and we're all going to be homeless. This is not the case, and is like saying someone who is worried about global warming already believes the ice caps have melted and the polar bears are dead. This data is concerning in the ways I would expect, especially as significant reimbursement cuts loom.
As always, I appreciate the crew at ARRO for giving us pretty much the only data on the job market we ever get!
Interesting results this year (and interesting to see what ARRO chose to share on Twitter). Full disclaimer, I am not attending ASTRO, so I did not personally witness the presentation. Perhaps some of my questions were answered verbally, and hopefully people who were there can fill in the blanks. Last year, ARRO was much more comprehensive in what they Tweeted (LINK). Maybe that's because it was totally virtual and whoever was running the account was doing it from their office computer, whereas this year someone is doing it from their phone while in Chicago?
As a reminder, this survey was sent to senior (PGY-5) residents on May 14th, 2021, prior to their graduation and prior to starting work as an attending. It was open till at least the end of June, when they Tweeted that they had collected most of the responses (LINK).
Here's what ARRO shared (LINK) (see below).
My immediate thoughts, and I'm very curious what everyone else thinks:
1) This seems like the lowest response rate we've seen in several years (someone please correct me if I'm wrong on that). The data point with the highest population size is 166 (compared to 179 last year, which was 94%). I'm not sure the exact number of potential respondents, but I assume it was similar. If so, 15-20% of the Class of 2021 did not respond to this survey. We can wildly speculate as to why that might be in ways which would support our personal interpretation of the job market, so I'll refrain from doing so.
2) It appears that the option to select "Neutral" in the "Satisfaction Domains" is new this year (here's what it looked like last year). I'm not quite sure what to make of this compared to previous surveys, as the domains are a little different and adding an additional response makes it hard to interpret. Personally, I think adding "Neutral" gives an "escape hatch" to someone who might choose "Dissatisfied" and skews the results away from having more negative values. As someone who filled out the survey this year, I was frustrated with these questions and answers. Ultimately, I am "satisfied" because I found A job within a few hundred miles of my preferred location. However, I had adjusted my expectations significantly lower than what they were when I matched into RadOnc, especially with COVID. So I was "satisfied" that I wasn't unemployed or in a fellowship, but it's more of a...begrudging satisfaction.
3) I don't know if it's valuable to collect newly-hired residents' perception of private practice partner salaries, since, even on the fastest tracks, they're still several years away from that. Regardless, that IQR ($500k-$650k) seems significantly lower than what it used to be, ESPECIALLY considering inflation. Putting aside the arguments of whether or not those doctors "should" earn that amount, I think this is a good barometer of the effects of hypofrac and reimbursement cuts. I also think this number is going to continue to fall. Can some of the more senior private practice folks comment on this?
4) The median PP starting salary appears unchanged. I need to double check, but hasn't this number been stable for at least 5 years? If you throw it in the CPI calculator, you get a sense for the value lost to inflation (not a perfect measure, obviously, but a stagnate salary is not a sign of a robust market).
5) That "Accepted Position Type" slide is very confusing, but appears negative, and seems to support the ASTRO tagline of "just get A job". It appears that they broke down each possible position type people were hired into, and asks if it's their "ideal position". The highest is a mere 43%, for private practice hospital based. If you average out all these values together, you find that a whopping 21.4% of people found their "ideal position". I agree that people shouldn't expect to land their ideal job right out of residency, but I imagine this number is higher for most other specialties, and I would be curious if they still consider this their "ideal position" after, you know, actually starting the job.
6) As predicted, unemployment remains low (1 person reported no offer in 2020 compared to 3 people in 2021). Now, an unscrupulous individual might paint this as "the number of unemployed new Radiation Oncology graduates has tripled in 2021", but I won't do that. Again, no one expects this number to be high this (or next) year. But with APM looming and a 9% cut to radiation services proposed in the 2022 MPFS from CMS - continually producing a surplus of Radiation Oncologists doesn't seem like a sound economic plan.
7) Finally, the slide I'm actually most interested in (and not Tweeted by ARRO) is the number of interviews and the number of offers. There was a median of 4 site interviews (or "virtual equivalent", the meaning of which was left for interpretation) for a median of 2 firm offers. I wish they went one step further, and asked how many applications/cold calls/etc it took to get those interviews. For me, it took more than 70 applications, emails, networking requests, etc to obtain a single site interview which led to a single offer, which I accepted. In talking to my friends, there seemed to be a bimodal distribution of experiences. There were people like me (who contacted a very large number of practices and institutions for a couple of interviews), and then there were people who were lucky enough to reach out to 2-3 places for their job (and it was almost always luck, in that the place they really wanted happened to be hiring last year, there was no secret underground club).
Applying to a large number of jobs for such a low rate of return is, to me, heralding what lies ahead. In an example of "history repeats itself", this was hypothesized in 1994 by Jonathan Sunshine in "Too many radiation oncologists? An empirical report", when he was talking about the job market concerns of the 90s:
“...when program faculty told us of an unemployed radiation oncologist, the story often involved someone who could look for work only where he or she trained, due to a spouse. Straightforward probability calculations show that if a physician has only a 10% chance of finding work in any one locality, he or she, nonetheless, has a 99.5% probability of finding work if he or she is willing to consider any of 50 localities. And there are literally hundreds of localities in the United States.”
One of the main differences between now and then is the application arms race that the Match (and just trying to get into medical school) has turned into. As has been talked about extensively on Twitter recently, my generation has been engaged in the practice of assuming we need to apply to dozens and dozens of residencies to have a chance of getting in. Many of us applied similar logic in trying to get a job in Radiation Oncology. 10-15 years ago, were there many people applying to 70+ places all over America for the chance to land a single job? I doubt it. Our expectation (and experience) with shotgun applying everywhere prepared us well for the current RadOnc job search.
This is a very long post just to say: I saw folks on Twitter implying this is positive data. I believe these people view the "internet misanthrope" narrative about the RadOnc job market as one where we're convinced there are no jobs left and we're all going to be homeless. This is not the case, and is like saying someone who is worried about global warming already believes the ice caps have melted and the polar bears are dead. This data is concerning in the ways I would expect, especially as significant reimbursement cuts loom.
As always, I appreciate the crew at ARRO for giving us pretty much the only data on the job market we ever get!
