2021 ARRO Graduating Resident Jobs Survey

[fiji128]

It would be great if there there was a study/survey/report done by a group who professionally studies labor markets and otherwise has expertise/background in this area. Instead, Astro has claimed for years that it can't know anything about the labor market because of anti trust laws. Astro can't even estimate the size of the work force and how many people maybe entering or leaving it. So lets hang our hats on an survey with an incomplete response rate that is sent out to residents by other residents before anyone even starts a position.

The "leadership" of this field have set thing up to know nothing and change nothing. However, this approach is increasingly difficult to sell to quality med students.

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[medgator]

It would be great if there there was a study/survey/report done by a group who professionally studies labor markets and otherwise has expertise/background in this area. Instead, Astro has claimed for years that it can't know anything about the labor market because of anti trust laws. Astro can't even estimate the size of the work force and how many people maybe entering or leaving it. So lets hang our hats on an survey with an incomplete response rate that is sent out to residents by other residents before anyone even starts a position.

The "leadership" of this field have set thing up to know nothing and change nothing. However, this approach is increasingly difficult to sell to quality med students.

Antitrust is perfectly fine when Dennis Hallahan complains about high faculty salaries and talks about training slots to drive down the cost of rad onc labor

 

[TheWallnerus]

I think we conflate jobs, the job market, and the overall health of radiation oncology for all its MD participators. Doing so gives false senses of securities. The overall health of RO is especially a big blind spot for the ~1 out of 10 radiation oncologists and radiation oncology centers treating as many patients today as they were 20 or more years ago. The other 9 out of 10 (whether they're aware or not) aren't as fortunate. The number of patients treated per year per center/per RO is down in the neighborhood of ~33% to 50% the last twenty years. To claim or act like this is not placing a stress (stress in finding jobs, stress in keeping jobs, stress on salaries, etc.) on the job market is silly... or to use some Spratticisms... "alarming," "dangerous," "irresponsible." Please, Lord, let us walk, chew gum, and discuss all threats to RO at the same time.

 

[radiation]

It would be great if there there was a study/survey/report done by a group who professionally studies labor markets and otherwise has expertise/background in this area. Instead, Astro has claimed for years that it can't know anything about the labor market because of anti trust laws. Astro can't even estimate the size of the work force and how many people maybe entering or leaving it. So lets hang our hats on an survey with an incomplete response rate that is sent out to residents by other residents before anyone even starts a position.

The "leadership" of this field have set thing up to know nothing and change nothing. However, this approach is increasingly difficult to sell to quality med students.

I think at this point this sort of analysis needs to be done by private groups. Its clear the way the current system has been set up that the biggest effect of expansion has been to the benefit of academics (and subsequently to the detriment of private practice). It would make a lot of sense for the largest private groups in the country to put together a consortium of sorts to discuss labor market etc. As many have said here, there is zero motivations for academics to do this sort of work as it will not lead to any benefits on their side.

 

[RickyScott]

I think at this point this sort of analysis needs to be done by private groups. Its clear the way the current system has been set up that the biggest effect of expansion has been to the benefit of academics (and subsequently to the detriment of private practice). It would make a lot of sense for the largest private groups in the country to put together a consortium of sorts to discuss labor market etc. As many have said here, there is zero motivations for academics to do this sort of work as it will not lead to any benefits on their side.

Ironically, system does not benefit the vast majority of academics, only chairs. Junior and mid levels are totally screwed- good luck getting a raise or lateraling if you find yourself in a malignant dept.

 

[thecarbonionangle]

louis potters posting on twitter slides from secret chair meeting saying many many jobs will open up over next few years. The fake news misanthropes have been defeated. Case closed folks!

 

[GapCalc]

It would make a lot of sense for the largest private groups in the country to put together a consortium of sorts to discuss labor market etc.

I'd really like to see a survey of people 3-5 years into practice. That would be enough time for people to understand the realities of their market, the pros/cons of their practice arrangement whether it be PP, main campus, satellite, etc., and if they would choose the field again today as a hypothetical MS3/MS4 knowing what they know now.

That being said, I suspect academicians driving this plane into the ground will do approximately nothing with this useful information.

 

[OTN]

I'm glad that graduating residents have been able to secure jobs, and I'm happy to say I'm pleasantly surprised by the data.

As I've said from the get-go, however, satellite academic jobs hold zero interest for me, and that appears it's where most of the new jobs are being generated. I would rather retrain in a different specialty than work for one of those centers.

Simul disagrees with me, as do many others, but I never had any interest in working in what really is a non-academic position while getting academic pay. If that's for you, great, it does appear as if radonc still has those opportunities.

 

[medgator]

Ironically, system does not benefit the vast majority of academics, only chairs. Junior and mid levels are totally screwed- good luck getting a raise or lateraling if you find yourself in a malignant dept.

Someone reached out to me recently looking for a sunbelt relocation after being out in practice for 3 years at a well known NCI designated CC in a big east coast city. I was honestly shocked a board certified physician with a full clinical load was still being paid $300k a year with no bonus. It's disgusting, honestly, and he/she knew the same when he/she inadvertently found out how much he/she was collecting in charges for the dept in just 1 month... Seven figures

 

[deleted1111261]

I'm glad that graduating residents have been able to secure jobs, and I'm happy to say I'm pleasantly surprised by the data.

As I've said from the get-go, however, satellite academic jobs hold zero interest for me, and that appears it's where most of the new jobs are being generated. I would rather retrain in a different specialty than work for one of those centers.

Simul disagrees with me, as do many others, but I never had any interest in working in what really is a non-academic position while getting academic pay. If that's for you, great, it does appear as if radonc still has those opportunities.

I don’t think I disagree with you. I think if you’re staying like if UMich buys a center, turns the doc into an associate professor, and pretends it is an academic job, I wouldn’t want that either. The branded network site that I worked for wasn’t really the same as that. It paid the mgma median. I don’t know - maybe from your vantage point they are lumped together, but I think pretty different.

 

[fiji128]

louis potters posting on twitter slides from secret chair meeting saying many many jobs will open up over next few years. The fake news misanthropes have been defeated. Case closed folks!

That’s about a 55% response from the 90 “academic” programs. Great data there! Probably time to start expanding those residency programs again!

 

[deleted1111261]

Also, had a great chat with Dr. Adler of CyberKnife fame last night. He is a neurosurgeon, but believes in radiation. Much more than many RadOncs believe in it. We need people passionate about radiation as a modality, like he is. I think the man is incredible and we need ten of him in our own leadership. Charisma and passion just emanates from the man.

 

[GapCalc]

That’s about a 55% response from the 90 “academic” programs. Great data there! Probably time to start expanding those residency programs again!

"Spread the word!" (that LIJ needs note writers).

Just ignore the math of fewer fractions, fewer indications, less cancer AND more residents. 50% of chairs are saying they are hiring in 2-3 years. Rejoice!

I don't know about you, but a tweet from a guy who has a vested interest in finding more residents isn't exactly the kind of data I would need to match rad onc in 2022 or beyond...

 

[TheWallnerus]

That’s about a 55% response from the 90 “academic” programs. Great data there! Probably time to start expanding those residency programs again!View attachment 344920

New grads… the word is “buttcheeks.”

Spread the word!!!

 

[thecarbonionangle]

New grads… the word is “buttcheeks.”

Spread the word!!!

If you dont drop the soap, it will be dropped for you. Potters is a heavy hitter!

 

[elementaryschooleconomics]

That’s about a 55% response from the 90 “academic” programs. Great data there! Probably time to start expanding those residency programs again!View attachment 344920

I also have some beachfront property that my sources predict will triple in value over the next five years, but you've got to invest now if you don't want to miss out on this great opportunity!

 

[Mandelin Rain]

You heard it straight from the horse’s mouth: ~50% of academic centers “anticipate” hiring someone in the next 3 years.

May the odds always be in your favor.

 

[communitydoc13]

That’s about a 55% response from the 90 “academic” programs. Great data there! Probably time to start expanding those residency programs again!View attachment 344920

This is the dumbest data point.

First, in a field with dwindling interest because of job market concerns, one has to question the legitimacy of the numbers to begin with.

However, even if these numbers really represent the number of entry level positions in academia, it is not a good measure of health of the field.

Why are these "entry level" jobs anticipated? As is well documented, we are not nationally treating more patients or more fractions.

Is it because of impending retirements? I doubt this is a major contributing factor, although it would be nice.

Is it because we need more awesome physician-scientists in the medico-scientific juggernaut that is radonc? Probably not.

It is because of planned expansion. Planned expansion in a national market without expected growth of patients means expansion at the cost of existing practices.

If these academic practices are forecasting 98 positions in the next 2-3 years, I'm guessing that they are probably forecasting at least 60 of these to be replacement jobs for existing pp/community positions.

I would like to hear from some of our academic colleagues 5-10 years into practice what they are experiencing in terms of healthy culture of promotion, opportunities for lateral career moves and general academic morale. Maybe its all good.

 

[metallica81788]

I'd like hear how many of their 70+ "leaders" will retire opening up said jobs - or will they just bleed it dry until death

 

[RSAOaky]

If you ask a prisoner whose just completed a 30 year sentence how they feel, I'd bet they feel pretty damn good.

These jobs surveys have to be taken for what they are. It is a snapshot of how a resident feels on the precipice of 7x-ing their salary after 30 years of intense schooling/training, making nothing or next to nothing, in the midst of a pandemic, in a field that continues to have an incredibly worrying future. I'd say that under this scenario, my bar for satisfaction would be fairly low tbh. Being satisfied with a job opportunity is completely subjective and says nothing about whether that opportunity is a good one. For example, maybe someone is satisfied with making $200k in NYC because their spouse still has 3 years of residency training there and it's a highly competitive market. Furthermore, if 90% of graduating residents are satisfied with their job offers, then why do so many of them change jobs within the first 3 years? If you want to make statements about the health of the field you don't ask those who are just getting released from prison, you ask those that have been out for a few years.

Objectively, the "compensation" is up. I'm not sure if this refers to salary/cash compensation specifically or includes benefits and I'm not sure how that compares to the methodology of the past. My starting salary was about 340k a few years back but my employer listed my "compensation" as 390k. If the starting salaries are in fact up this year then that's great for the graduating residents and i'm very happy for them.

Maybe there are other explanations for this, maybe it is simply that salaries are going up, who knows. However, if our best and brightest, for all the time they spend critically analyzing data, are willing to declare that radonc is still great because of a $20k increase in base salaries and survey data that amounts to "a bunch of prisoners are happy on release day," will they declare that radonc is dead as soon as this trend reverses?

 

[elementaryschooleconomics]

Meanwhile, Dave Adler is out here Tweeting the numbers that really matter:

But yeah, the ARRO resident survey and Potters' SCAROP survey are definitely reassuring...

 

[OTN]

20% cuts for some treatment + runaway inflation over this year and next = PAIN

 

[DebtRising]

Yes, the CMS target is squarely set on rad oncs back. Those are some hefty cuts.

It’s great that new graduates don’t immediately feel bad about their futures, and only a few were forced into fake fellowships.

It’s bad we are in a field that ABR leadership publishes we abuse the fellowship moniker, and the evidence for a good job market is a new resident survey, when ASTRO and company ignored the workforce survey of practicing radiation oncologists that reported >50% of the active work force was worried or very worried about oversupply ( DEFINE_ME ). I don’t understand why that survey got sidelined while this one and Potters are cheered - oh wait, yes I do, this allows the consolidation to continue by driving salaries and working conditions lower.

Glad for new residents, again sad to see how this data driven field picks and chooses what data on employment it wants to pay attention to.

 

[metallica81788]

Meanwhile, Dave Adler is out here Tweeting the numbers that really matter:

But yeah, the ARRO resident survey and Potters' SCAROP survey are definitely reassuring...

So when do hospital employed Radoncs start seeing those salaries or $$/RVU decrease given this information? That looks pretty painful.

 

[elementaryschooleconomics]

That’s about a 55% response from the 90 “academic” programs. Great data there! Probably time to start expanding those residency programs again!View attachment 344920

I just keep looking at this Tweet, it's so goofy.

80% of the 10 academic Chairs responding to the survey in the "West" say they "anticipate" hiring new grads in the next 3 years.

Eight institutions in the "West" of America, which evidently means every inch of geography between the Pacific Ocean and the Rocky Mountains, think they might hire between now and 2024.

Eight whole institutions for that region, which includes California. They might hire new grads in the next 2-3 years...which is only relevant to current residents. This is not relevant at all to current M3s and M4s. Of note, it doesn't say "offering entry level positions FOR the next 2-3 years", just "IN the next 2-3 years". So a Chair who thinks they might hire a single new grad in the next 3 years can answer in the affirmative on this survey?

Fortunately, a whopping 92% of the 13 responding Chairs of southern institutions might offer jobs to current residents.

Spread the word, friends. Salvation is at hand! The RadOnc job market can support its residents, as has been clearly demonstrated by this data.

 

[medgator]

 

[TheWallnerus]

Let them eat a plethora of cake

 

[elementaryschooleconomics]

Let them eat a plethora of cake

Potters is such a goofball.

So much anecdote being tossed around with the job market, with the only real data showing the supply of Radiation Oncologists growing every year (goofball translation: more people are entering the workforce than leaving). While modern radiation methods (VMAT) require significantly more effort, we're still mostly paid by FFS, which means fractions. Hypofractionation and SBRT are the law of the land now (if not outright omission).

So, Dr Potters, I ask you: how do reconcile continued growth of supply with continued decrease in demand? Do you expect senior folks like yourself and your $1.2 million/year salary to take a pay cut to hire more people? Surplus reimbursements generated by RadOnc are often redistributed to other, less profitable departments in large academic institutions - perhaps Infectious Disease doesn't really need that fellowship program, eh? You have that kind of power, right?

With the stock market doing what it did, and the stress that COVID is putting on healthcare workers, I imagine we're seeing above-average retirements, stepping back from full-time clinical duties, or taking non-clinical jobs. How much "bonus" elasticity does this provide the RadOnc system? The oversupply naysayers seem eager to find out.

Good luck to the 200 new residents starting in July!

 

[jondunn]

Yeah his post was bad. He doesn’t seem to fully get it. He’s declaring ‘Mission Accomplished’ on the ship, Bush style

 

[Ray D. Ayshun]

I've been prepping my app for the Sarasota job this weekend. My favorite place in Florida. Thanks, drug addiction, for helping fix the market!

 

[deleted1111261]

Yeah his post was bad. He doesn’t seem to fully get it. He’s declaring ‘Mission Accomplished’ on the ship, Bush style

I had a post about the job market that was saying it was … fine. Not great. Not breadlines. Lots of employed positions. Very few private practice jobs. Okay locations. This dude engages with a sock puppet and says “plethora of jobs… blah blah blah”. I mean come on. Note that not one LIJ grad has stayed on as faculty.

 

[OTN]

I had a post about the job market that was saying it was … fine. Not great. Not breadlines. Lots of employed positions. Very few private practice jobs. Okay locations. This dude engages with a sock puppet and says “plethora of jobs… blah blah blah”. I mean come on. Note that not one LIJ grad has stayed on as faculty.

“Very few private practice positions” equals a very bad job market for my particular preferences (i would prefer not to be exploited if possible).

 

[SubserviantToABR]

I had a post about the job market that was saying it was … fine. Not great. Not breadlines. Lots of employed positions. Very few private practice jobs. Okay locations. This dude engages with a sock puppet and says “plethora of jobs… blah blah blah”. I mean come on. Note that not one LIJ grad has stayed on as faculty.

Looking at their page, out of the past five years' worth of graduates, 3 went into fellowship: Our trainees - For Professionals | Northwell Health

There is one who was a research fellow but unsure if they continued on a research-based track or in straight clinical practice.

 

[deleted1111261]

“Very few private practice positions” equals a very bad job market for my particular preferences (i would prefer not to be exploited if possible).

I get that, but I think that’s a medicine trend maybe and less of an RO trend? But, point is taken - as a whole there are very few private practice jobs available, and even fewer true partnerships.

 

[elementaryschooleconomics]

Looking at their page, out of the past five years' worth of graduates, 3 went into fellowship: Our trainees - For Professionals | Northwell Health

There is one who was a research fellow but unsure if they continued on a research-based track or in straight clinical practice.

I'd be curious to know how many faculty that have been hired to staff LIJ main campus were new grads...I have heard it's very low to non-existent.

So again we return to finding A job - it sounds like things are not as tough this year as they were last year, but it's mostly academic satellites (with academic pay, private practice workload, and grim opportunities for advancement) or hospital employed (high floor, low ceiling...unless they switch you to production based after the 2-3 year initial honeymoon, in which case, hope you have 40 on beam if you want to maintain that high floor).

While we've created our own Fiefdom of Misery with residency expansion/focus of research on reducing XRT, we're also being swept along with the current of American Healthcare, where retiring docs from the last generation sold their practices to hospitals/academia, VC/PE swooping in, and the stranglehold of the insurance industry choking both doctor and patient alike.

I cannot begin to guess what medicine (let alone RadOnc) will look like in 30 years. Things might change where it gets "better", but what does that mean, exactly? All I know is I'm drowning in mouse clicks and paperwork to make sure Big Daddy eviCore throws some dollars to my hospital, and sometimes I find time to practice medicine in between.

 

[RickyScott]

Looking at their page, out of the past five years' worth of graduates, 3 went into fellowship: Our trainees - For Professionals | Northwell Health

There is one who was a research fellow but unsure if they continued on a research-based track or in straight clinical practice.

most of the stanford residents do fellowships as did half of mskcc, yet the surverys show basically no one does a fellowship

 

[medgator]

most of the stanford residents do fellowships as did half of mskcc, yet the surverys show basically no one does a fellowship

Justification for doing a fellowship seems to have changed over the years as well, it used to be considered ok to do one if you needed a job in a certain place and wanted to wait out the market a year, now it is ok for "research" or if you are an IMG/FMG, etc

The mental gymnastics of folks who continue to support the proliferation of unaccredited fellowships in our specialty never ceases to amaze me

 

[jondunn]

‘Justification for doing a fellowship seems to have changed over the years as well, it used to be considered ok to do one if you needed a job in a certain place and wanted to wait out the market a year, now it is ok for "research" or if you are an IMG/FMG, etc’

That’s a confusing sentence. This would be a good thing, the premise of your statement. Less people taking fellowships for ‘not being able to get a job’ reasons.

 

[medgator]

‘Justification for doing a fellowship seems to have changed over the years as well, it used to be considered ok to do one if you needed a job in a certain place and wanted to wait out the market a year, now it is ok for "research" or if you are an IMG/FMG, etc’

That’s a confusing sentence. This would be a good thing, the premise of your statement. Less people taking fellowships for ‘not being able to get a job’ reasons.

Yet fellowships have proliferated and there are anecdotes of Sloane and Stanford grads doing them recently. So what gives?

 

[deleted1111261]

‘Justification for doing a fellowship seems to have changed over the years as well, it used to be considered ok to do one if you needed a job in a certain place and wanted to wait out the market a year, now it is ok for "research" or if you are an IMG/FMG, etc’

That’s a confusing sentence. This would be a good thing, the premise of your statement. Less people taking fellowships for ‘not being able to get a job’ reasons.

Yeah, like I know what he’s trying to say…

 

[medgator]

Yeah, like I know what he’s trying to say…

My point is that the goalposts for why people keep doing fellowships seems to be moving around, but the bottom line is that they are all unaccredited and a symptom of not being able to find a job after training.

Proliferation of fellowships in our specialty has been well documented over the last decade, and it isn't a good thing, but possibly may be used by some less than stellar places to funnel their graduates into.... Like Potters program at lij for example.

The cart is being placed before the horse with the expectation that all of these excess grads who aren't getting jobs at big practices, hospitals or even their own training programs will end up doing fellowships for a year. It's sinister

 

[deleted1111261]

My point is that the goalposts for why people keep doing fellowships seems to be moving around, but the bottom line is that they are all unaccredited and a symptom of not being able to find a job after training.

Proliferation of fellowships in our specialty has been well documented over the last decade, and it isn't a good thing, but possibly may be used by some less than stellar places to funnel their graduates into.... Like Potters program at lij for example.

If the job market was 1999 great and there were 3 times as many fellowships, I wouldn’t give a damn. If no one is taking them, it doesn’t matter. If American grads have to take them because there are breadlines, that is a problem. Are we there yet? The data does not suggest that. American grads appear to be satisfied taking employed positions and either lying on the surveys or are truly satisfied with where they landed. If they are lying, then it’s on them. If they are happy, what do I care? The quality of the jobs have decreased, the real salary for work done has decreased, the market is sticky. These are signs .. but for whatever reason, vocal faculty and residents claim that all is good. Why should I have conflict with them? If they think things are fine, then I guess my work was for naught. That’s okay, too. I gots things to do.

 

[Gfunk6]

If the job market was 1999 great and there were 3 times as many fellowships, I wouldn’t give a damn. If no one is taking them, it doesn’t matter. If American grads have to take them because there are breadlines, that is a problem. Are we there yet? The data does not suggest that. American grads appear to be satisfied taking employed positions and either lying on the surveys or are truly satisfied with where they landed. If they are lying, then it’s on them. If they are happy, what do I care? The quality of the jobs have decreased, the real salary for work done has decreased, the market is sticky. These are signs .. but for whatever reason, vocal faculty and residents claim that all is good. Why should I have conflict with them? If they think things are fine, then I guess my work was for naught. That’s okay, too. I gots things to do.

It looks like new grads subverted our expectations! 🤔

 

[elementaryschooleconomics]

It looks like new grads subverted our expectations! 🤔

 

[deleted1111261]

I’m just tired of the same old fight.

The young generation tells us on paper that the landscape is good. Potters’ says things are fine and only a sock puppet and me respond. Nobody publicly will admit that they are working harder for less, that they have less autonomy, that admin is making their lives more difficult, that the day to day practice is not the same, that it’s fine. Someone made a comment about how the applicants are amazing this year. If they say that and no one disagrees, then who’s to say they are wrong? I have no way of knowing.

They seem to be fine - in their minds - that’s all that really matters. I know what I perceive to be issues. But, what good is it if the key stakeholders and the people most affected don’t share the values that I have?

If junior faculty don’t push back against their chairman to contract, if residents don’t do the same, if people keep signing contracts with academic satellites but don’t non-anonymously complain about their situation, if people don’t stop SOAPing in to the field (forget about the programs - if residents’ make that choice, they really aren’t victims), if people don’t tell us about their difficulties with obtaining employment, if people don’t publicly let us know about unscrupulous practices … basically, if the #radonc community doesn’t do something about it (including me - all I do is write and talk), then why would we think it’s going to change?

I feel like I’ve done all I can. I’ll stick to food pics, travel stories, pics of my beautiful family and clinical stuff. I’ve done all I could, but I feel like Jerry McGuire (“who’s coming with me?”) but I’m not even able to get the goldfish to join me…

If people have good points to make, I’ll jump in and comment, but man it’s lonely. I can’t believe not a soul responded to Potters. Must mean it’s all good in the hood.

 

[Lamount]

If the job market was 1999 great and there were 3 times as many fellowships, I wouldn’t give a damn. If no one is taking them, it doesn’t matter. If American grads have to take them because there are breadlines, that is a problem. Are we there yet? The data does not suggest that. American grads appear to be satisfied taking employed positions and either lying on the surveys or are truly satisfied with where they landed. If they are lying, then it’s on them. If they are happy, what do I care? The quality of the jobs have decreased, the real salary for work done has decreased, the market is sticky. These are signs .. but for whatever reason, vocal faculty and residents claim that all is good. Why should I have conflict with them? If they think things are fine, then I guess my work was for naught. That’s okay, too. I gots things to do.

Speaking as someone who has been in practice for a little over two years, I can tell you why I am generally “happy”.

I really like my job and I make more money than I know what to do with. This is the type of job I wanted as a kid.

No virtue signaling, no BS.
When I became an attending, I saw my solid middle class wage as a resident/fellow increase 6+ fold. I still haven’t gotten used to it.

I completely get that the macroeconomics of the field aren’t going in the right direction. I agree that residency expansion is selfish. I get that things aren’t nearly as good in radiation oncology as it used to be, but from my longitudinal perspective, things have gone very well. Having grievances feels… ungrateful. I think things would be different if I saw things get worse.

 

[medgator]

Speaking as someone who has been in practice for a little over two years, I can tell you why I am generally “happy”.

I really like my job and I make more money than I know what to do with. This is the type of job I wanted as a kid.

No virtue signaling, no BS.
When I became an attending, I saw my solid middle class wage as a resident/fellow increase 6+ fold. I still haven’t gotten used to it.

I completely get that the macroeconomics of the field aren’t going in the right direction. I agree that residency expansion is selfish. I get that things aren’t nearly as good in radiation oncology as it used to be, but from my longitudinal perspective, things have gone very well. Having grievances feels… ungrateful. I think things would be different if I saw things get worse.

It's all relative. Job market has never been amazing but when i finished up training over a decade ago, the 2/3 expectation was there including a decent selection of well established hospital and freestanding based private practices. Now they are like finding unicorns these days and geographic options have not exactly gotten any better either

If expectations were reset given what has been happening, of course surveys could make lowered expectations look great

 

[TheWallnerus]

I’m just tired of the same old fight.

The young generation tells us on paper that the landscape is good. Potters’ says things are fine and only a sock puppet and me respond. Nobody publicly will admit that they are working harder for less, that they have less autonomy, that admin is making their lives more difficult, that the day to day practice is not the same, that it’s fine. Someone made a comment about how the applicants are amazing this year. If they say that and no one disagrees, then who’s to say they are wrong? I have no way of knowing.

They seem to be fine - in their minds - that’s all that really matters. I know what I perceive to be issues. But, what good is it if the key stakeholders and the people most affected don’t share the values that I have?

If junior faculty don’t push back against their chairman to contract, if residents don’t do the same, if people keep signing contracts with academic satellites but don’t non-anonymously complain about their situation, if people don’t stop SOAPing in to the field (forget about the programs - if residents’ make that choice, they really aren’t victims), if people don’t tell us about their difficulties with obtaining employment, if people don’t publicly let us know about unscrupulous practices … basically, if the #radonc community doesn’t do something about it (including me - all I do is write and talk), then why would we think it’s going to change?

I feel like I’ve done all I can. I’ll stick to food pics, travel stories, pics of my beautiful family and clinical stuff. I’ve done all I could, but I feel like Jerry McGuire (“who’s coming with me?”) but I’m not even able to get the goldfish to join me…

If people have good points to make, I’ll jump in and comment, but man it’s lonely. I can’t believe not a soul responded to Potters. Must mean it’s all good in the hood.

I truly believe that an inflection point is coming and hard data re: bad times will be here soon. 'Til then we are climate modeling and forecasting really bad problems. And comparing to the past when things were awesome... things are easily much less awesome now, but they are not conflagrational. APM cancellation provided a respite.

More rad oncs are keeping upward pressure on the amount of money rad onc "costs" society; this cost would be falling were it not for rad onc over-supply (hypofractioning and decreasing RT utilization would mean less cost... these are hard facts and not predictions!). One ever increasing sign of rad onc over-supply, and a thorn in all of our sides, is more and more Evicore battling... and Medicare's APM fascination.

One thing is for certain: workforce studies, or papers on under- or over-supply, are COMPLETELY USELESS in rad onc. No one listens to data; everyone just will believe whatever one wants to believe to fit one's own narrative(s). There's a plethora of jobs in rad onc, and 2 solid job offers per graduating resident is 95% or more less job offers than residents in other specialties but 100% more job offers than one really needs!

 

[communitydoc13]

Having grievances feels… ungrateful.

This is a good answer.

I'd be a schmuck to not be grateful for what I have.

I just don't think we need many more radoncs. (I do believe something real happened with covid/retirement accounts/age demographics that will make the job market a little better for the next couple years). But, it was easy for me to recruit and it is much, much, much harder to recruit other specialties critical for my practice (medonc, surgonc, specialty surgeons).

I like my job, but aside from the paperwork, it is not hard. I feel like I am watching oncology pass me by. Standard of care for multiple diseases changing on like a quarterly basis for medical oncology.

 

[elementaryschooleconomics]

Having grievances feels… ungrateful. I think things would be different if I saw things get worse.

This is a good answer.

I'd be a schmuck to not be grateful for what I have.

This is what "they" are counting on.

In American culture, it's relatively taboo to talk about salary. Doubly so with medical culture, with the added wrinkle that people often refer to it as a "calling" and whenever physicians indicate that they're human beings with wants and needs (like geography preferences), it can get quickly twisted into you "not doing what's best/right for your patients".

Throw into the mix: to successfully survive the gauntlet of education and training it requires to independently practice medicine in America, it requires years of making sure you're conforming to the system and only answering "how high" to the question of "jump", lest you not get a much needed "Honors" in a clerkship, a rec letter for residency, or a phone call on your behalf for a job.

This is how the system has evolved to where it is, RadOnc or otherwise. They'll continue to pay us just enough where we feel guilty voicing grievances. Compared to the prior generation of Radiation Oncologists, we get paid less (certainly in relative terms, and often in absolute terms), with less autonomy, and more paperwork. However, we still get paid significantly more than the average American household income, and so we feel bad about asking for more.

Isn't there the metaphor about frogs placed in a pot of warm water? It's like that.