2025 ABR Oral Exam Results

[fiji128]

Following is from the ABR website

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[fiji128]

Also results from the written portions

 

[fiji128]

Interesting that the heme section is now classified as "Hematologic and Benign Diseases"

 

[fiji128]

Also interesting is that only 176 total are taking the final exam.

 

[A_DeMichele]

77% pass rate... not completely unheard of.
It's probably due to a combination of declining quality of applicants starting in c. 2018 and overall frustration amongst academics today

 

[Gfunk6]

77% pass rate... not completely unheard of.
It's probably due to a combination of declining quality of applicants starting in c. 2018 and overall frustration amongst academics today

Or . . . . to paraphrase our past leader Paul Wallner, the residents suddenly became stupid.

 

[udrag14]

Or . . . . to paraphrase our past leader Paul Wallner, the residents suddenly became stupid.

Reading the complaints on X about the exam makes me wonder about these test takers.

 

[Ray D. Ayshun]

Reading the complaints on X about the exam makes me wonder about these test takers.

I don't have the ability to see this, but it didn't really feel like oral boards were about intellect.

 

[medgator]

I don't have the ability to see this, but it didn't really feel like oral boards were about intellect.

Disagree. But definitely not the same kind of intellect and skill needed for passing a standard written exam. Have to be good on your feet and not fall into traps etc

 

[udrag14]

Disagree. But definitely not the same kind of intellect and skill needed for passing a standard written exam. Have to be good on your feet and not fall into traps etc

Agree with this. Learning to answer the question while giving as little information as possible was an art.

The goal is to see if you are safe. It is funny how much we try to BS our way and create unsafe situations.

 

[Ray D. Ayshun]

Disagree. But definitely not the same kind of intellect and skill needed for passing a standard written exam. Have to be good on your feet and not fall into traps etc

tbh, it felt like I fell into traps on mine, I was just a reasonable human in getting out of them. I suppose you could make it to orals while being truly incompetent, but it felt like they were trying to parse out personality disorders as much as establish competence. seemed like more of a hazing ritual.

 

[thecarbonionangle]

You definitely needed a bit of “street smart” to get through orals without major issues. Some people in our field are very book smart but aren’t quick on their feet and lack common sense. Some people talk too much and get themselves in trouble.

 

[CurbYourExpectations]

Was reading about it on twitter. Saying the match rate blah blah stuff is correlation, not causation. The test is trash, everyone knows that, does anyone argue that it's not? There was a higher percent that need remediating than unfilled spots, and there is no evidence that those that need remediating are the ones that didn't apply initially.

Did we all forget that the highest fail rates in testing history were with arguably the best and brightest RadOnc years? Maybe RadOnc residents just aren't as smart as those that trained in the 2d era .

Maybe you shouldn't be a RadOnc if you can't draw a field on a whim for a cancer 99% of us have never treated/will never treat!

 

[Ray D. Ayshun]

Was reading about it on twitter. Saying the match rate blah blah stuff is correlation, not causation. The test is trash, everyone knows that, does anyone argue that it's not? There was a higher percent that need remediating than unfilled spots, and there is no evidence that those that need remediating are the ones that didn't apply initially.

Did we all forget that the highest fail rates in testing history were with arguably the best and brightest RadOnc years? Maybe RadOnc residents just aren't as smart as those that trained in the 2d era .

Maybe you shouldn't be a RadOnc if you can't draw a field on a whim for a cancer 99% of us have never treated/will never treat!

After now practicing fo 5 years, I realize that a totally valid board answer is: I'd visit themednet and develop a plan from there. Or, if breast, "visit SDN."

 

[drowsy12]

Was reading about it on twitter. Saying the match rate blah blah stuff is correlation, not causation. The test is trash, everyone knows that, does anyone argue that it's not? There was a higher percent that need remediating than unfilled spots, and there is no evidence that those that need remediating are the ones that didn't apply initially.

Did we all forget that the highest fail rates in testing history were with arguably the best and brightest RadOnc years? Maybe RadOnc residents just aren't as smart as those that trained in the 2d era .

Maybe you shouldn't be a RadOnc if you can't draw a field on a whim for a cancer 99% of us have never treated/will never treat!

I think there are a group of people who really get off on the idea that they’re way better physicians than people who graduated a few years after them. This was like catnip for them. The usual suspects did what they do.

 

[yesmaster]

I think there are a group of people who really get off on the idea that they’re way better physicians than people who graduated a few years after them.

Yeah I just have a big head if I ask questions about declining Step 1 scores, rising SOAP rates, and declining pass rates. Let’s see what happens next year.

Personally I vote we just replace the ABR certifying exam with a urine test. Pee in a cup, if no cocaine, you’re safe to practice rad onc.

 

[Ray D. Ayshun]

I think there are a group of people who really get off on the idea that they’re way better physicians than people who graduated a few years after them. This was like catnip for them. The usual suspects did what they do.

...IS a group...

 

[drowsy12]

...IS a group...

Ok Stannis.

And yep you are right.

 

[CurbYourExpectations]

I'm sure many of us that see OSH plans have seen some pretty terrible radiation plans from people of all generations. Not sure that single subjective test is preventing bad RadOncs.

OSH is the worst.

 

[DrProtonX]

As a newer generation it’s so disheartening to see people are waiting for any opportunity to jump on the “see I told you the quality of applicants has gone down, see I told you half of the programs are hellpits that should shut down” train. Even though there’s no data to suggest those people who failed had lower step 1/2 score, are from smaller programs or were soap’d into the specialty. Especially since we all know that exam, by no means, is reflective of how well someone is practicing clinically

 

[CurbYourExpectations]

While the impeccable intelligence and "scoreability" was exceptional and there were very hard working and motivated students in 2012-2018, there is no evidence to say that this cohort is better at radiation than any other cohort. Selection of people that produced the higher amount of retrospective studies/case reports and got 3-5 more questions correct on step 1, while maybe can be statistically significant, is not significant in the real world and does not improve cancer care, it's just something people unfortunately had to sacrifice for a few years to get into the field they wanted to be in a time of over competition due to small field size.

The irony is that due to that they will now diminish anyone else. Even though they probably wished they didn't have to write a 20 ****ty papers no one ever read or not spend all night studying the kreb cycle, no matter how cool citrate is.

It was also self selection bias, the field was never actually competitive, which is the funniest thing about it all. Competition means you're competing against someone else, Derm is "competitive", CT surgery is "competitive", radiation oncology was objectively not competitive. Most years 99% of people matched despite step scores or research, it's pretty funny if you dig in to it with that context.

Edit- @TheWallnerus since you appreciate conceptual alliteration with references, is it real or is it "The greatest lie that was ever told?"

 

[medgator]

.



It was also self selection bias, the field was never actually competitive, which is the funniest thing about it all. Competition means you're competing against someone else, Derm is "competitive", CT surgery is "competitive", radiation oncology was objectively not competitive. Most years 99% of people matched despite step scores or research, it's pretty funny if you dig in to it with that context.

Patently false. I didn't match with several interviews and that was true of many other US MD students during the peak competitive era. 99% of spots going to US MD students during the peak does NOT mean 99% of applicants matched

 

[thecarbonionangle]

As a newer generation it’s so disheartening to see people are waiting for any opportunity to jump on the “see I told you the quality of applicants has gone down, see I told you half of the programs are hellpits that should shut down” train. Even though there’s no data to suggest those people who failed had lower step 1/2 score, are from smaller programs or were soap’d into the specialty. Especially since we all know that exam, by no means, is reflective of how well someone is practicing clinically

I know this is my first time saying this but repeat after me: “half of the programs are hellpits that should shut down”.

 

[CurbYourExpectations]

Patently false. I didn't match with several interviews and that was true of many other US MD students during the peak competitive era. 99% of spots going to US MD students during the peak does NOT mean 99% of applicants matched

Sorry brother, I know you're a good doc. Of course outliers, but let me tell you about how RadOnc was never a competitive field with receipts. Of course there will be anectdotal complaints. Would you consider RadOnc Having one of the lowest apps per position in a "competitive year" "competitive"?

"You don't understand, 7 people that ranked EM higher than RadOnc didn't match RadOnc!"

 

[madchemist89]

I think your analysis of competitive is overly simplistic. Using your methodology, ENT would have been one of the least competitive specialties. You need to look at step 1 and 2 scores, class ranking ,AOA, research publications, and phds. There is a lot of self selection prior to applying to a specialty.

 

[CurbYourExpectations]

I think your analysis of competitive is overly simplistic. Using your methodology, ENT would have been one of the least competitive specialties. You need to look at step 1 and 2 scores, class ranking ,AOA, research publications, and phds. There is a lot of self selection prior to applying to a specialty.

Yes! small field, paradoxically uncompetitive years. there are years of them with 1.4ish per spot, but every now and then you get a weird year and it's self selected competitive, but not actually competitive. RadOnc has objectively never been competitive (edit, maybe those years around 2012). Maybe the most competitive recently actually.

"Dude you don't get it, there were 200 spots and 210 people applied, 20 wasn't their preferred specialty"

 

[CurbYourExpectations]

The super competitive docs unironically harmed themselves by thinking the field was competitive, no one applied to the field, or at least, much less people applied to the field on average

 

[medgator]

Yes! small field, paradoxically uncompetitive years. there are years of them with 1.4ish per spot, but every now and then you get a weird year and it's self selected competive, but not actually competitive. RadOnc has objectively never been competitive. Maybe the most competive recently actually, if you get objective about things, which we all know, the crew here is super duper objective

Dude you don't get it, there were 200 spots and 210 people applied, 20 wasn't their preferred specialty, I was so much smarter than other people. (Go and look at what the scores were for people who matched and didn't, do you think it was a higher ratio of <220 step scores or 230-240 step scores? The answer may surprise you!)

Peak rad onc never had 200 spots in the match.

 

[CurbYourExpectations]

No it didn't...

You don't get it guys, scores mattered?

RadOnc in competitive years was so elite, as elite as surgical specialties, RadOnc:

Surgery Specialty:

We are so smart with AOA status:

That awkward moment when you don't realize AOA status was non significant

 

[RickyScott]

the quality of the median graduating resident almost certainly hasn’t changed from when the specialty was competitive.

This is not likely to be true for the bottom 10-20% … as would be expected from matching medstudents who failed boards or rotations or some other red flag..

 

[goodluck1234]

The recent examinees started PGY2 during peak COVID in 2020. Most didactics were virtual and teaching quality took a hit as work from home became a thing. The beginning of PGY2 is when you have the most questions and benefit the most from in person learning, so while it certainly affected all years I think it affected the recent examinees quite a bit.

I think this might be contributing to the higher fail rate this year.

 

[medgator]

No it didn't...

You don't get it guys, scores mattered?
View attachment 403794
RadOnc in competitive years was so elite, as elite as surgical specialties, RadOnc:

View attachment 403795
Surgery Specialty:

View attachment 403798
We are so smart with AOA status:

View attachment 403797
That awkward moment when you don't realize AOA status was non significant


Good try tho guys, maybe you should keep talking **** to med students anonymously and not speak out about actual important things.

No one said it did curb, what mattered was research, LORs etc. But things like scores and AOA could seal the deal at big programs.

Rad onc was not a sure match 2001-2015. We will have to agree to disagree. They were 99% filling with US MDs with solid stats, research and letters, and really elite places were MD PhD crazy

 

[Faol]

Full disclosure, I’m someone who SOAP’d into Rad Onc from another speciality during this lull in competitiveness. In my med school residency selection, I didn’t even bother looking at Rad Onc, as my step one wasn’t high enough and I wasn’t a prolific researcher. I only mention this because there was a bit of selection bias amongst students even prior to applying. I think it’s a bit disingenuous to suggest that Rad Onc wasnt for the more academically inclined medical students and was effectively closed to the bottom 3/4ths. Does that justify some people’s weird sense of superiority? Not at all, as being a good doctor is more than standardized tests or memorizing pathways. NPs do that quite well. Hopefully whatever wrinkle was introduced into this exam process is corrected so people can more accurately be evaluated during this hazing process.

 

[yesmaster]

Let's make match competitiveness very simple:
- # of applicants per position
- % filled by US seniors

Rad Onc

	Applicants per Position	% spots filled by US seniors
2022	1.13	58%
2021	1.01	54%
2020	1.05	65%
2019	1.00	77%
2018	1.25	92%
2017	1.31	93%
2016	1.33	92%
2015	1.32	94%
2014	1.39	94%
2013	1.32	84%
2012	1.65	98%

2011	1.45	90%
2010	1.48	87%
2009	1.41	86%

For my own curiosity:

Derm - highly competitive

	Applicants Per Position	% spots filled by US seniors
2020	1.46	77%
2015	1.67	87%
2010	1.72	82%

Radiology - somewhat competitive, except mid-2010's

	Applicants Per Position	% spots filled by US seniors
2020	1.49	67%
2015	1.14	58%
2010	1.51	84%

These numbers don't reflect the real differences in competitiveness between specialties, since medical school counselors & deans won't advise a mediocre student to apply to dermatology since they likely won't match and it'll reflect negatively on the school, so there's a fair amount of self selection. On the flip side, if someone has lower grades and test scores, medical school deans will encourage them to pursue less competitive specialties.

Competitiveness of the field imo already started dropping in 2013 when I was in medical school when the bloodbath article came out questioning program expansion from 2001-2012, but it took several years for the job market to become increasingly saturated, for new attendings to start complaining online about their lack of job mobility, undesirable geography, & career advancement opportunities, and for students to adjust their specialty decisions accordingly.

Many large hospital systems, universities, the VA, private equity, even some physician-owned practices just want worker drones with high compliance more than anything, who follow a system, clinical pathways, etc. and that's what most of rad onc is. The changing desirability of a rad onc job, versus other specialties, is always what drives applicant numbers.

 

[CurbYourExpectations]

That's fair, good points. I think from a numbers standpoint RadOnc has mostly been around middle of the pack competitiveness (except a huge emphasis on research production) from a body to spot standpoint, but man, that 2012 year was rough lol

I think that data you used also includes people that didn't rank the specialty as their preferred specialty. In RadOnc, typically the preferred specialty applicant/spot ratio is around 1.1-1.2 in competitive years. Which is interesting to me.. because people were applying to RadOnc as a back up back then? lol why

Funnily enough the numbers are back up there with the early 2010s numbers of applicants, can't wait to see if it starts getting more and more self selecting again.

2018- Fail rate through the roof, "This is outrageous, f angoff methodology."
2025- Fail rate through the roof, "They're not very smart and good residents."

 

[A_DeMichele]

58% spots filled by US seniors - dismal!!

 

[yesmaster]

2018- Fail rate through the roof, "This is outrageous, f angoff methodology."
2025- Fail rate through the roof, "They're not very smart and good residents."

That’s fair. I’d say part of the difference is that physics radbio is not nearly as relevant to clinical practice and my understanding is that a cutoff is set by statistics for the written exams to determine who fails. For the oral clinical exam, a group of senior peers and mentors decide you’re not safe to practice rad onc, that’s how you fail and that’s how multiple oral boards examiners explained their threshold to fail somebody.

Plus some people remember that several PD’s published a paper in red journal swearing on the Bible and their grandmother not to SOAP to get warm bodies, especially students with no prior interest in rad onc, and rad onc residencies did just that, and now that cohort is starting to take oral boards. It’s residency programs’ job to get trainees to be competent rad onc’s and one way of assessing that independently is oral boards. It’s dumb to focus solely on criticizing the exam and scoring process and rule out other possibilities when the consequences of handing out board certification like Girl Scout cookies could include bad outcomes for patients.

Doctors in other specialties like surgeons have a more rigorous oral boards imo and they can continue to practice without board certification but with some limitations which is how it should be.

 

[CurbYourExpectations]

Agreed, mostly, just not a fan of that test in general due to the subjectivity, and failing people because they didn't know how to HDR a prostate when they've never done it before.

Idk if it really improves outcomes, no one in the real world gets a random rare cancer and has to come up with a treatment plan and fields on the fly with no reference.

 

[udrag14]

Agreed, mostly, just not a fan of that test in general due to the subjectivity, and failing people because they didn't know how to HDR a prostate when they've never done it before.

Idk if it really improves outcomes, no one in the real world gets a random rare cancer and has to come up with a treatment plan and fields on the fly with no reference.

If that test taker get a referral for a patient who has a history of HDR prostate, will they refer it out because they never did it? Doubt it.

You should have a basic understanding of protons, cyberknife, GK. You aren't expected to perform it but if you should be able to evaluate a treatment plan.

 

[thecarbonionangle]

If people are getting out of residency truly having no idea how to evaluate a prostate HDR or proton plan then that residency should be shut down. It is by definition a hellpit that provides subpar training. We need to start shutting down residencies that consistently have board failures.

 

[CurbYourExpectations]

I guess it's fair to have those opinions.

That thread had 3 currently practicing GU docs talking about how they felt it was a BS case. I doubt they're bad RadOncs.

I don't understand the need to trash talk the young in the field. They also happened to go into the field at the best time, the best job market, despite everyone telling them it was going to be way worse. So I get the resentment from that standpoint, where people had to break their back in 2012 to get into the field and graduated into an objectively bad job market. But what help is it trashing young RadOncs? It's not like they can change things, and it's not like all spots won't eventually get filled anyways.

 

[gmsquid]

Was a 2012 unmatched fwiw

 

[yesmaster]

It’s a slippery slope to say you shouldn’t be tested on HDR prostate brachytherapy.

By that token, 95% of us shouldn’t be tested on peds. I haven’t treated a single peds patient since residency.

If you go into academics doing breast rad onc, maybe you shouldn’t be tested on 7 of the 8 sections.

If the government equalized payments for HDR prostate vs VMAT or made HDR prostate as remunerative as 45 fractions VMAT and then insurance companies refused to pay for more than 28 fractions VMAT, there’d be more rad onc’s jumping to do HDR prostate I’m sure.

Plus this: https://www.nrc.gov/docs/ML1008/ML100820091.pdf

As my spouse says, in a different professional field, I can’t imagine anyone successful or high-ranking at my company having trouble passing our field’s entrance exam. It’s just the basics. Whether it’s coding exams at Google/Epic, or the bar exam, CFA 1-3, etc. Their pass rates are also much lower than 80-90% and no one is getting hurt because Citadel retains a fund manager that didn’t pass CFA III.

 

[CurbYourExpectations]

Yeah, good points. The tests could be better and more relevant. It is an oral exam, so you should be able to pick your treatment, of which there are what seem like unlimited options for most risk prostates, but I digress. I don't think it is "unsafe" to say, "I wouldn't treat that prostate with HDR, for UIR I prefer, whatever, 28 fractions." I don't think that should be a reason someone fails, maybe if they couldn't explain how to treat a prostate at all, then that's a big deal.

On the topic of specializing for a whole year and then going back to do oral boards.... who thought of that timing?

 

[radoncftw]

I think there is room for improvement, but I do agree with Karna Sura.
I took boards 2 years ago and I was told/trained that I would need to be able to describe HDR brachy for prostate. Similar to 3D CSI for peds, etc.
There are ample resources in 2025 with scripts, etc. that you can memorize.
I do not mean to criticize the person who conditioned, but you would think if you were a GU subspecialist, you would have even a more keen interest in being able to describe all the modalities.
I have anecdotally heard stories where examiners are testing people in a combined section (thorax/sarcoma) and have verbatim told the examinee who was a sarcoma doc, "you probably know more about this than I do".

 

[ramsesthenice]

Agreed, mostly, just not a fan of that test in general due to the subjectivity, and failing people because they didn't know how to HDR a prostate when they've never done it before.

Idk if it really improves outcomes, no one in the real world gets a random rare cancer and has to come up with a treatment plan and fields on the fly with no reference.

I’m not with you on this specific one my friend. Prostate Brachy is 100% fair game. I don’t personally agree with examiners choosing if it will be LDR or HDR as both are valid procedures. But these are very similar procedures and a competent resident who knows how to do LDR should be able to give a passable description of HDR. Especially if they were prepared for the “game” that is the oral boards. Additional thoughts:

1) not being prepared to describe either approach is a failure of the training program. I only do HDR at my program, but I make sure to teach our residents how to do both (including real-time AND preplanned LDR). Not just for boards, but so they can like, take a job that requires some LDR.

2) I doubt people are failing “just” because they can’t do HDR. It’s natural to want to blame it on something out of your comfort zone, but probably not the whole story. Again, if they can’t think on their feet enough to say, “I offer LDR because it’s what I’m most familiar with, but here is a general description of an HDR procedure”, my guess is they are not exactly knocking the rest of the test out of the park.

3) exam/examiner quality. Getting worse? Maybe. Virtual exams are hard since you still miss a lot of peoples body language and I can’t see that being a good thing. Examiners are still doing it on a “volunteer” basis and the phrase you get what you pay for is universal. I know people who have done it for years as a legit service. I also know some of the rest who can’t grasp the basic concept of competence vs world expert or recognize the way things are done at the one place they trained and then took a job are not sacrosanct.

4) what I am about to say is not universal to rad onc and I’m not making blanket statements, but I’ve seen a notable uptick in trainees with an almost pathological hubris. Case in point: had a resident finish in the last couple of years who could do the job fine and specifically draw quite passable contours. But anytime I asked them to verbally describe say, post op prostate bed volumes, couldn’t do it. Would go even further and tell me it shouldn’t matter if they can describe it if they can draw it. I repeatedly warned them that’s not how the exams worked and gave them scripts, atlases from RTOG etc and they made a conscious effort to dig in on this (and other) points. I was 0% surprised to find out they got a conditional pass. Two of my best friends are PDs in urology and gen surg and are seeing the same thing so I don’t think this is just declining applicant quality in rad onc. I want to be clear, it’s not all or even most of the new crops but definitely seems to be more of a low level constant and less of a year to year fluke.

5) It’s one year. Let’s get more data before drawing any conclusions.

 

[communitydoc13]

5) It’s one year. Let’s get more data before drawing any conclusions.

This is everything. Absolute change in pass status actually low.

FWIW...I've known two people who conditioned (many years ago). Other than inconvenience, it had zero impact on career.

 

[ramsesthenice]

This is everything. Absolute change in pass status actually low.

FWIW...I've known two people who conditioned (many years ago). Other than inconvenience, it had zero impact on career.

Most of the time that is true and the implications for failure (which is how ACGME views a conditional pass...PASS) are typically worse for the training program than the trainee. However, one of the biggest name ivory towers in our region didn't renew someone's probationary contract after they got a conditional. Was there more at play and they used that as a convenient out? I have no idea. I just know I won't be telling anyone the worst thing that will happen is you have to take it again; even though that is still probably true.

 

[communitydoc13]

one of the biggest name ivory towers in our region didn't renew someone's probationary contract after they got a conditional

Wow...if this was a conditional on a first try, truly remarkable. Of course, persistent failure of boards has always resulted in loss of employment.

 

[ramsesthenice]

Wow...if this was a conditional on a first try, truly remarkable. Of course, persistent failure of boards has always resulted in loss of employment.

A lot of these places make terminating people more difficult than it needs to be out of fear of getting sued. I suspect there were other issues and this was what was given to give themselves "cover". Its very hard for me to see anyone cutting an otherwise good performer loose over their first attempt at the oral boards. All that the people I know who work there are willing to share is that the probationary contract wasn't renewed because of a boards failure.