3rd year grades...still as important for rad onc?

[Volfo]

Keep in mind we have one of the hardest if not hadest board certification process. With things which might be looking dimmer in furure, there will not be much appetite to make things easier to get BC, things may even get harder as this might be the only way to keep some people out of the workforce. Many will be screwed.

Why is it hard? And what is hard about it? And how do you know it’s harder than other specialities?🤔

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[Chartreuse Wombat]

Why is it hard? And what is hard about it? And how do you know it’s harder than other specialities?🤔

A Call for Change in the ABR Initial Certification Examination in Radiation Oncology - PubMed

A Call for Change in the ABR Initial Certification Examination in Radiation Oncology

pubmed.ncbi.nlm.nih.gov

RO is an outlier in requiring multiple written exams during residency and an oral examination.

 

[OTN]

Why is it hard? And what is hard about it? And how do you know it’s harder than other specialities?🤔

1. Memorizing worthless minutiae about cancer biology while trying to learn actual valuable information about your speciality is not easy. It's also maddening.

2. Physics boards are fine. Necessary, even.

3. The ABIM did away with oral boards when their internal data showed the examiner was the only variable which determined if the candidate passed or failed. After Dr. Patricia Eifel failed every Harvard grad several years ago for daring to use HDR brachytherapy to treat cervical cancer, I'm sure many in our specialty would agree with ABIM's approach.

 

[medgator]

The ABIM did away with oral boards when their internal data showed the examiner was the only variable which determined if the candidate passed or failed. After Dr. Patricia Eifel failed every Harvard grad several years ago for daring to use HDR brachytherapy to treat cervical cancer, I'm sure many in our specialty would agree with ABIM's approach.

I would have agreed circa 2010 or so.... But with the number of programs now open with questionable case mix, faculty coverage/standards etc., Not sure we should be making BC any easier.

It ain't perfect, but i feel like the oral boards (and the process to prepare for them with group study over Go-to meeting) made me a better physician, in a way cancer biology menutia never could

 

[RickyScott]

Ditto to the last 3 comments.

Plus, should also be aware of the nepotism that exists in rad onc. I'm sure of the handful of American grads that are still applying to rad onc, a good portion of them are going into rad onc knowing that their relative will help them secure a job. So if you don't already know someone with the ability to hire, I think the only thing you can do is train at a top 10 program to help you secure a decent job. Otherwise, you are taking on a huge risk of not finding a job. Not to mention, we have no idea how much lower salaries will be in the future. New grads will have less and less bargaining power as supply increases and I think we are on the cusp of seeing average starting salaries decline.

Of the few jobs available, some will be filled by nepotism, and it its possible that some will be earmarked for affirmative action. I am not convinced at all that a top ten program will secure a decent job. I really think that in 5-7 years, residents at MSKCC will be competing with each other for that satellite at the university of kentucky, Consolation prize for the Losers will be a fellowship.

 

[medgator]

Of the few jobs available, some will be filled by nepotism, and it its possible that some will be earmarked for affirmative action. I am not convinced at all that a top ten program will secure a decent job. I really think that in 5-7 years, residents at MSKCC will be competing with each other for that satellite at the university of kentucky, Consolation prize for the Losers will be a fellowship.

Some of the top 3 program grads even struggled this year

 

[elementaryschooleconomics]

Some of the top 3 program grads even struggled this year

50% of the Sloan class of 2021 went into fellowships.

 

[RickyScott]

50% of the Sloan class of 2021 went into fellowships.

Is this really true? What type of fellowship?

 

[theradiator]

50% of the Sloan class of 2021 went into fellowships.

Big news if true!

 

[RickyScott]

Big news if true!

I can see mskcc grads being too proud to take an exploitative pos job. This would severely limit their options. And their alumni network probably is not “robust” in places like glacier bay, Wisconsin.

 

[elementaryschooleconomics]

Is this really true? What type of fellowship?

This is what I was told in mid-to-late June, so it was true then, but perhaps things are different now. I believe 2 of the 3 went in a research-oriented (post doc esque) direction, and 1 of the 3 is unclear to me, I got the impression it was perhaps clinical?

I haven't followed up on this recently, so I'll put the disclaimer out that this might be old news.

 

[RickyScott]

This is what I was told in mid-to-late June, so it was true then, but perhaps things are different now. I believe 2 of the 3 went in a research-oriented (post doc esque) direction, and 1 of the 3 is unclear to me, I got the impression it was perhaps clinical?

I haven't followed up on this recently, so I'll put the disclaimer out that this might be old news.

Have been out of the loop a long time, but in the past, very rare to hear of post-docs in this field. Never heard of medonc medical scientist doing a postdoc after their training?

 

[medgator]

This is what I was told in mid-to-late June, so it was true then, but perhaps things are different now. I believe 2 of the 3 went in a research-oriented (post doc esque) direction, and 1 of the 3 is unclear to me, I got the impression it was perhaps clinical?

I haven't followed up on this recently, so I'll put the disclaimer out that this might be old news.

All that hardcore clinical training with surgical hours so they can go to a lab?

 

[RickyScott]

All that hardcore clinical training with surgical hours so they can go to a lab?

I don’t know Sean McBride personally, but on Twitter he comes off as extremely smart, yet he was still arguing several months ago that there was no evidence of residency oversupply? 2022 there will be double number of mskcc grads hitting the job market- can see this snowballing?

 

[dieABRdie]

Why is it hard? And what is hard about it? And how do you know it’s harder than other specialities?🤔

Don't take our word for it. Find out yourself:

1) Go to a job website like PracticeLink. Look how many jobs are posted and how many graduates per year from that specialty from the NRMP data. Also, note not just how many but where they are located.
PracticeLink: Radiation Oncology Jobs | Nationwide (not agency jobs... those are temp)

2) Ask graduating residents from those specialties how many job interviews or offers they have gotten.... and where those jobs are at. Or ask anyone who has been through the process in the last two years. Do not ask attendings who are way out of training.

 

[RickyScott]

This is what I was told in mid-to-late June, so it was true then, but perhaps things are different now. I believe 2 of the 3 went in a research-oriented (post doc esque) direction, and 1 of the 3 is unclear to me, I got the impression it was perhaps clinical?

I haven't followed up on this recently, so I'll put the disclaimer out that this might be old news.

Does anyone know of mskcc grad going into a fellowship in prior years, let alone 3?

 

[evilbooyaa]

All that hardcore clinical training with surgical hours so they can go to a lab?

At least one of the 2020 (not 2021) grads is doing a post-doc in a lab at MSKCC.
Another of the 2020 grads did a 'clinical fellowship' for a few months as per Linked In before joining another academic institution as an attending.

The 2021 grads probably haven't shown up on updated websites as of yet. Post-doc for lab I get. Clinical fellowship after going to MSKCC should be a red flag IMO.

 

[elementaryschooleconomics]

At least one of the 2020 (not 2021) grads is doing a post-doc in a lab at MSKCC.
Another of the 2020 grads did a 'clinical fellowship' for a few months as per Linked In before joining another academic institution as an attending.

The 2021 grads probably haven't shown up on updated websites as of yet. Post-doc for lab I get. Clinical fellowship after going to MSKCC should be a red flag IMO.

Ah, man, I didn't know about that.

Though I'm not a huge fan of talking about specific residents/classes on the open forum, I think this particular discussion is an important canary for the job market discussions. Everyone assumes if you go Harvard/Sloan/Anderson you'll be OK...I do not believe that to be true (perhaps it never was, but definitely not now).

 

[RickyScott]

Ah, man, I didn't know about that.

Though I'm not a huge fan of talking about specific residents/classes on the open forum, I think this particular discussion is an important canary for the job market discussions. Everyone assumes if you go Harvard/Sloan/Anderson you'll be OK...I do not believe that to be true (perhaps it never was, but definitely not now).

I hope these lab post docs are for MDs with no lab background who suddenly got turned onto the lab during residency? Or are they medical scientists who had extensive lab work in med school and residency and still find it necessary to do a postdoc?

 

[brushbeamscanning]

They're a md phd being funded as an institutional k12 fellow grant. Sometimes these positions are also offered in an instructor/assistant professor role where your protected time is funded via the grant and you make the remainder with clinical volume. Obviously I'm not privy to their specific scenario, but the hope would be to be prolific enough to obtain independent investigator funding.

 

[metview]

I mean what would a realistic salary look like? I'm not looking for half a million or anywhere near it, but will have 300-400k in debt.

Btw I'm also just a DO student with a 22x on Step lol.

No offense, but DOs always face uphill battles with getting into certain fields. As a DO with a 22x step 1, you will definitely get into rad onc because it's a joke to get into, but you likely wont get into a top 20 program (based on reputation). Given that the market WILL get worse because of lag time, it wouldn't be good idea to go a program that is average/below average. Other fields such as doing IM and then Cards, GI, Rheum, Allergy, Med Onc pay much better in better cities. If you cannot get into a top 10 rad onc program (based on reputation), it makes no sense to go into this field right now. And even coming from a top 10 program, it is still tough.

 

[Datypicalpremed]

So my thread got pretty derailed, but since I’m interested in hearing about how these “elite” program alumni are doing I’ll bite 😉

Anyone know how often these top programs take up their own graduates for academic appointments? I’m more interested in academics/research afterwards (prob dead giveaway since I’m md/phd), so just curious. More than happy to receive a DM to avoid doxing anyone, I know the field is pretty small…

REALLY don’t want to do a post doc post residency so can’t really relate with those MSK folks 😂

 

[medgator]

REALLY don’t want to do a post doc post residency so can’t really relate with those MSK folks 😂

A decade ago you wouldn't have had to. The fact that people are now should tell you something

 

[elementaryschooleconomics]

So my thread got pretty derailed, but since I’m interested in hearing about how these “elite” program alumni are doing I’ll bite 😉

Anyone know how often these top programs take up their own graduates for academic appointments? I’m more interested in academics/research afterwards (prob dead giveaway since I’m md/phd), so just curious. More than happy to receive a DM to avoid doxing anyone, I know the field is pretty small…

REALLY don’t want to do a post doc post residency so can’t really relate with those MSK folks 😂

I would say the most common scenario is an institution hiring their own people. You're a known quantity, and you know the software/hardware/workflow so you can hit the ground running vs someone who comes from a place that used entirely different technology.

That being said, two caveats:

1) They usually can't hire everyone from every class, so it's not a guarantee, and someone who wants to stay might get left out, which leads to the most important point:

2) Matching at the place you'd want a job is an incredibly sharp, double-edged sword. You better be able to perform and be liked from DAY ONE and not have a snag for four whole years. A common sentiment I heard when I was interviewing for prelim year intern spots was that people wanted to do internship at a different institution from their residency so their first impression to an institution wasn't as a brand new know-nothing intern. First impressions can be brutal.

I heard many tales from the hiring process at my residency institution, and it was always very interesting to hear what folks remembered when a residency graduate was being considered. The smallest things - one attending didn't like that someone would go back to the resident office down the hallway when they didn't have a patient (they would rather have that resident sit quietly at a clinic computer), another attending liked that a resident would email them about volumes on Saturday because it showed dedication, etc etc. These are very minor quirks that played into people's hiring process, whereas if you're being considered from an outside institution your references are more likely to talk about you in broad strokes...vs that time you wore sneakers that clashed with your outfit.

 

[evilbooyaa]

Ah, man, I didn't know about that.

Though I'm not a huge fan of talking about specific residents/classes on the open forum, I think this particular discussion is an important canary for the job market discussions. Everyone assumes if you go Harvard/Sloan/Anderson you'll be OK...I do not believe that to be true (perhaps it never was, but definitely not now).

Agreed - I do not want people to post names of these folks, but I do believe it is important to know the situations that aren't residency --> attending position, especially for those coming from MSKCC.

 

[RickyScott]

They're a md phd being funded as an institutional k12 fellow grant. Sometimes these positions are also offered in an instructor/assistant professor role where your protected time is funded via the grant and you make the remainder with clinical volume. Obviously I'm not privy to their specific scenario, but the hope would be to be prolific enough to obtain independent investigator funding.

Do medonc fellows at mskcc get funded on k12 fellow grants after graduation or are they just plain junior attendings with a start up package?. 50% of the class coinciding with worsening job market is unlikely to be a coincidence.

 

[elementaryschooleconomics]

50% of the class coinciding with worsening job market is unlikely to be a coincidence.

I feel like this is a good time to note that 100% of the Anderson 2021 class went private practice, even their bench science kids (I think at least one was Holman).

That coincides precisely with my experience - academic jobs in traditionally desirable locations and institutions were few and far between. While the #RaRaRadOnc crowd will cry "COVID!", and I would agree, I'm more concerned about the butterfly effect of 2021 grads taking fellowships/any job they can get re-entering the job search for 2022 and 2023, putting added pressure on those classes...and so on and so forth.

 

[thecarbonionangle]

Why is it hard? And what is hard about it? And how do you know it’s harder than other specialities?🤔

Basically general knowledge and speaking to people. No other specialty has to take physics and cancer biology boards then clinical written boards and the archaic no open book oral boards, no lets just talk about cases you did over the past year (like some surgical fields) etc. it is basically an all day pimp session with like cases where you are basically at the mercy of who examines you and a shadowy cabal decides if you fail or pass. Nobody in their right mind would decide something on a whim if they couldnt remember or were not sure. You ask people. You read, etc etc. it is a total bs process.

Videos are immediately deleted. There is no way to appeal or anything as they no longer have the videos.
Med oncs take IM boards then med onc and they are done. I feel like we have been testing for so long it leads to legit burn out. I talk to a lot of colleagues and many just feel regret and like overall fatigue with the process.

 

[SubserviantToABR]

I feel like this is a good time to note that 100% of the Anderson 2021 class went private practice, even their bench science kids (I think at least one was Holman).

That coincides precisely with my experience - academic jobs in traditionally desirable locations and institutions were few and far between. While the #RaRaRadOnc crowd will cry "COVID!", and I would agree, I'm more concerned about the butterfly effect of 2021 grads taking fellowships/any job they can get re-entering the job search for 2022 and 2023, putting added pressure on those classes...and so on and so forth.

MD Anderson alumni list: Radiation Oncology Residency

You can see their trend, where they went from hiring a good number of their own to none this past year. There's probably a lot that goes into a job selection that is unbeknownst to us from looking at the alumni list...but something to ponder.

 

[fiji128]

MD Anderson alumni list: Radiation Oncology Residency

You can see their trend, where they went from hiring a good number of their own to none this past year. There's probably a lot that goes into a job selection that is unbeknownst to us from looking at the alumni list...but something to ponder.

Looks like they went from taking 7 residents/year to 6/year. Small win.

 

[medgator]

Looks like they went from taking 7 residents/year to 6/year. Small win.

If only every program cut one slot, we'd be in much better shape. Good for them

 

[Triple_AAA]

Sorry if I derailed your thread at all OP.


Ima figure out what I want to be when I grow up and I don't think it's going to be a rad onc lol.

 

[SubserviantToABR]

Sorry if I derailed your thread at all OP.


Ima figure out what I want to be when I grow up and I don't think it's going to be a rad onc lol.

Good call. Our current leaders and organizations have effed up our wonderful field that you would be fighting an uphill battle all of your life. You'll be better off, even though your username is perfect for the field (AAA - analytical anisotropic algorithm).

 

[brushbeamscanning]

Do medonc fellows at mskcc get funded on k12 fellow grants after graduation or are they just plain junior attendings with a start up package?. 50% of the class coinciding with worsening job market is unlikely to be a coincidence.

MSK K12 Clinical Translational Cancer Research Training Program

This award provides training opportunities for the next generation of translational cancer physicians.

www.mskcc.org

Looks like they probably take 7-8 a year from various specialties with a guarantee of 3 years of funding + some amount of start-up funds with an expectation to obtain some independent funding K08-R01 level, with supposedly promotion to a junior level faculty position (either instructor or assistant attending level for senior fellow applicants by the start of their second year in the program, at the latest.

Seems reasonable at first blush, but likely promotion is dependent on securing grant funding, and continued success contingent on surviving the rat race of academia.

 

[Neuronix]

So my thread got pretty derailed, but since I’m interested in hearing about how these “elite” program alumni are doing I’ll bite 😉

Anyone know how often these top programs take up their own graduates for academic appointments? I’m more interested in academics/research afterwards (prob dead giveaway since I’m md/phd), so just curious. More than happy to receive a DM to avoid doxing anyone, I know the field is pretty small…

REALLY don’t want to do a post doc post residency so can’t really relate with those MSK folks 😂

PM me if you want to discuss. I am the MD/PhD forum moderator too.

If you want a significant research job (i.e. 50% or more protected time and startup package), you often need to do a fellowship or instructor level position to secure independent funding before starting a job at full assistant professor pay. This isn't everywhere and every situation, but is common out there, especially at the bigger name institutions.

These instructor/fellowship jobs typically pay more than residency pay, but not attending pay. $100-$200k range is typical. I suspect that's what we're seeing from the MSKCC grads we're discussing, though I don't really know. I've known some people over the years who have sat anywhere from 2-5 years in such positions before successful transition or giving up. Even these positions are not unlimited and somewhat competitive to obtain.

 

[RickyScott]

PM me if you want to discuss. I am the MD/PhD forum moderator too.

If you want a significant research job (i.e. 50% or more protected time and startup package), you often need to do a fellowship or instructor level position to secure independent funding before starting a job at full assistant professor pay. This isn't everywhere and every situation, but is common out there, especially at the bigger name institutions.

These instructor/fellowship jobs typically pay more than residency pay, but not attending pay. $100-$200k range is typical. I suspect that's what we're seeing from the MSKCC grads we're discussing, though I don't really know. I've known some people over the years who have sat anywhere from 2-5 years in such positions before successful transition or giving up. Even these positions are not unlimited and somewhat competitive to obtain.

it sounded like one of the mskcc residents was entering a clinical fellowship.

 

[Neuronix]

it sounded like one of the mskcc residents was entering a clinical fellowship.

This happens too, especially for brachytherapy or peds. Job competition at major academic institutions in coastal locations (i.e. northeast) is quite high, and the grad may have been told to do it to get a clinical job at a certain institution or group of institutions next year. I've seen that over the past few years as well.

 

[medgator]

This happens too, especially for brachytherapy or peds. Job competition at major academic institutions in coastal locations (i.e. northeast) is quite high, and the grad may have been told to do it to get a clinical job at a certain institution or group of institutions next year. I've seen that over the past few years as well.

I've seen AMGs do it for at the least the last 5-7 years to "wait out" a cycle and try to find a job in a certain location. They end up getting a job and then may or may not use the fellowship training there after

 

[StIGMA]

it’s not the most common, but some who do fellowships already have a job lined up and are getting paid for that year by their future employer.

 

[OTN]

it’s not the most common, but some who do fellowships already have a job lined up and are getting paid for that year by their future employer.

Doubt

 

[RickyScott]

I've seen AMGs do it for at the least the last 5-7 years to "wait out" a cycle and try to find a job in a certain location. They end up getting a job and then may or may not use the fellowship training there after

This is really sad if it is happening at top places. An mskcc grad should not have to sit out for a year to get an academic job in the northeast.

 

[StIGMA]

Doubt

Well I'm not going to out anyone. Seen this for a specialized position in a difficult-to-recruit area, partnership-track.

 

[medgator]

Well I'm not going to out anyone. Seen this for a specialized position in a difficult-to-recruit area, partnership-track.

Why didn't they just start the job?

 

[RickyScott]

Why didn't they just start the job?

In the case of a mskcc resident, they are not lacking brachy experience (or peds). Absolutely 0 reason for clinical fellowship other than job market.

 

[evilbooyaa]

Well I'm not going to out anyone. Seen this for a specialized position in a difficult-to-recruit area, partnership-track.

Someone went to a Rad Onc residency and was then hired for an attending position but the hiring group wanted that new grad to get fellowship training, and compensated the new grad some amount of money to go get a fellowship?

Every *single* fellowship PD should be shouting this story from the rooftops and publishing it in IJROBP as an anecdote of how useful their Rad Onc fellowships are.