a modest proposal, for students

[yesmaster]

This post is for students, preclinical or clinical, who may be considering radiation oncology as a career choice. I considered posting this after the residency interview season and ROL submission, so as not to dismay any student applicants. Though I strive to be balanced, and suggest concrete actions that students can take, some readers may be better served by skipping this post. I recognize there's value in putting your head down and your nose to the proverbial grindstone. Hence, this post is directed at students that are not yet committed to radiation oncology, such as those in years 1-3 or on a gap or research year.

My modest proposal for students is to consider another field, or to dual-apply.

Dual-applying to radiation oncology was not uncommon a few years ago. When radiation oncology was highly competitive in the early to mid-2010's, dual-applying to medicine was recommended by career counselors as a safeguard, lest students be unmatched and negatively impact their school's match statistics. In those days, when radiation oncology kept company with dermatology and orthopedics, it was assumed that if you matched to ANY residency program, you'd be considered lucky and your future assured.

Sadly, that's no longer true. People disagree regarding the state of the job market, with some claiming all is well. The Internet has enabled fear-mongers to corrupt the perceptions of students! Others genuinely believe the sky is falling. The truth is either somewhere in the middle, or the bulls and the bears are BOTH correct. That is, the mere existence of vociferous disagreement illustrates rising heterogeneity in job outlook for graduating residents and young attendings. The golden ticket may still exist, or at least the silver ticket, but not for everyone or even for a majority.

Therefore, in this third decade of the new millennium, I'm suggesting dual-applying with a different purpose. It's likely that a small number of residency programs, by dint of their reputation, alumni network, and satellites, will always semi-guarantee jobs for their graduates. I'd estimate this to be top 25 programs for this year's residency graduates and top 10-15 programs for this year's student applicants.* Regardless of the number of residency programs that can be safely ranked, several categorical internal medicine programs ought to be ranked highly as well.

*So as not to offend anyone, or dismay any student applicants, I'll say that residents outside of the top 10-15 programs may still get jobs in 2025 by dint of individual effort or particular program qualities, and everyone's list of safe programs may differ.

This modest proposal has a number of corollaries.

• First, prepare for internal medicine. In the olden days, many applicants applied to transitional years because of their superior lifestyle compared to preliminary medicine. Now, I'd argue that preliminary medicine at a major academic center has a number of advantages, including optionality in dual-applying. Doing everything you can as a medical student to prepare for categorical medicine, such as a medicine sub-I and ICU rotation, will make you a more capable clinician, which will serve you well in IM, or in radiation oncology.
• Second, lean towards radiation oncology if you have genuinely strong mentorship from faculty at a top institution, and similarly, lean away from radiation oncology if you're lacking this mentorship. Being a small field, mentorship is incredibly important. Some of the loudest & most influential voices in the Twitterverse, if they genuinely champion you throughout medical school and residency, may aid you in your job search. Unfortunately, students are easily deluded, often by themselves. Faculty will be willing to work with many, many students clinically or academically, yet at the end of the day, they may only go to bat for a very few.

Of course, the superior and straightforward solution to radiation oncology's job market woes is to go into a different field. Without revealing too much, I'll just say that my medical school classmates in other fields are doing very well. For instance, my pals in heme/onc and radiology, who would've been unable to match into radiation oncology a few years ago, are now receiving very attractive job offers. Radiation oncology used to receive these attractive job offers, but it seems it's becoming much rarer.

It is not a good feeling to go through residency, much more concerned of the lack of jobs upon graduation, than of developing skill and competency. I wish I could say, as long as I become a skillful and competent radiation oncologist during residency, finding a job isn't a concern. I can't say that.

Unfortunately, radiation oncology is incredibly PC, in which we speak no ill of other people or other programs. This tendency to whitewash problems leads to a lack of quality control in residency education and program quality. Bad programs get approved by ACGME. Bad programs expand slots via ACGME. Of course, PC tendencies and forced groupthink have also left the expansionist tendencies of residency programs unchallenged.

These are just my two cents, as a random, semi-anonymous forum user, so I'll reiterate the advice of others far wiser than myself. Talk to people IRL. Just keep in mind that everyone has their prejudices and hidden agendas, faculty and residents alike. We may also be compromised in our ability to be fully honest at certain times of the year. The more you know someone in a genuine setting, outside a formal meeting or monthly update, the more they may open up to you.

Good luck and best wishes.

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[Krukenberg]

Is there anything novel in OP’s post? Dual applying has been discussed ad nauseum

 

[PhotonBomb]

Is there anything novel in OP’s post? Dual applying has been discussed ad nauseum

lol I know right

 

[scarbrtj]

Agree 100%. Your most powerful point is that if there were no growing schism/disagreement, there'd likely be no specialty-wide problems. And regarding your "two corollaries" (which I'd roughly summarize as "keep your options open" and "make sure you have a mentor/advocate")...

First, the "keep your options open" approach requires one to set aside one's psychological immune system and can cause more unhappiness than choosing and not looking back. Although after one makes a choice a strong psychological immune system is needed to recognize and phagocytize any psychological antigens. There are more psychological antigens in rad onc now than 5 or 10y ago. Which says to me the antigens are growing. (Keeping in that theme, twitter's #RadonCrocks are an attempt at quarantining. No spoilers here: watch enough movies, and you know the quarantining always fails.)

Second, relying on a mentor/advocate for one's career or personal success is a kind of Blanche Dubois approach: "I have always depended on the kindness of strangers." Not really my cup of tea. But it could be for others. Here's to hoping rad onc doesn't start attracting a bunch of Blanches (I'm beginning to think I'm too late). Blanche, Tennessee Williams' favorite character of mine... a person who from "weakness or disability couldn't face the real world at all or had to opt out of it."

 

[elementaryschooleconomics]

The "professional athlete" analogy was used in another thread, and it seems to be the easiest way to think of RadOnc in 2020.

Having a strong/stable job in RadOnc in a geographic location which appeals to you is like making it in the NFL when you play college football.

Is it a great career for those who can make it? Absolutely.

Should you neglect your coursework and/or not complete your degree if you're a college athlete, banking that you'll go pro? Probably not.

Dual-applying or choosing a different specialty altogether is a reasonable choice for the ~26,000 American MD/DO graduates produced each year.

Betting your entire life on RadOnc is a reasonable choice for 50-100 of those 26,000 graduates.

Make choices based on your risk tolerance.

 

[scarbrtj]

The "professional athlete" analogy was used in another thread, and it seems to be the easiest way to think of RadOnc in 2020.

Having a strong/stable job in RadOnc in a geographic location which appeals to you is like making it in the NFL when you play college football.

Is it a great career for those who can make it? Absolutely.

Should you neglect your coursework and/or not complete your degree if you're a college athlete, banking that you'll go pro? Probably not.

Dual-applying or choosing a different specialty altogether is a reasonable choice for the ~26,000 American MD/DO graduates produced each year.

Betting your entire life on RadOnc is a reasonable choice for 50-100 of those 26,000 graduates.

Make choices based on your risk tolerance.

Odds of a college footballer making it into the NFL: ~1.6%.
Odds of a med school grad making it into a choice rad onc job: (~100/26000) = 0.4%
So med school grads, choose the NFL instead of rad onc. Your odds are better

 

[RickyScott]

If someone had announced at Astro 13 years ago that in 2020 hypofractionation would be widely adopted and that graduating residents will double, can you imagine the outrage? How could that come to be and the field still be “a ok”?

there is something about psychology of justifying the status quo that intrigues me.

It starts with the prestige that must motivate some extreme strivers who occupy top programs and now see threats to their identity. Need to keep the Ponzi scheme going by recruiting high achieving medstudents for them to reign over. If since high school, you have always been associated with top tier institutions (maybe got a PhD along the way) and suddenly you find yourself in a bottom tier specialty? Where is the respect in being a valdectorian of a community college?

internship is the toughest im year. Do one at a decent place and it can at the very least allow you to delay making a decision and carrying on to medonc when it becomes more and more clear that the Brian k’s and Paul h’s have really trashed this field for future generations.

 

[Pointless]

0.4%? 100 out of 26000? Have you guys absolutely lost your minds? I am hoping this is all tongue in cheek but, if not, and you are anywhere near serious with these absurd numbers, then I literally know all of the people who have found gainful employment in rad onc in the last 5 years. All of them. And I know like 10 people.

You guys really need to dial it back. Take a walk or something.

 

[RickyScott]

what would you put the odds off top of your head that a medstudent could get a residency and then good job in their top choice tier 1 preferred city. (This was my expectation leaving med school and I was not at top program)

 

[elementaryschooleconomics]

0.4%? 100 out of 26000? Have you guys absolutely lost your minds? I am hoping this is all tongue in cheek but, if not, and you are anywhere near serious with these absurd numbers, then I literally know all of the people who have found gainful employment in rad onc in the last 5 years. All of them. And I know like 10 people.

You guys really need to dial it back. Take a walk or something.

Dial it back how? Alright, fine:

Let's assume we remain with a constant 200 Radiation Oncology Residents graduating per year.

All 200 get and keep amazing jobs.

There are, literally, around 26,000 people graduating from American MD/DO medical schools every year.

Source for that number (20,000 MD and 6,000 DO).

200/26,000 = 0.00769 * 100 = 0.77%

We're making the assumption that not everyone will get a stable/good job in a region they desire. I assumed maybe 100/year, being optimistic.

You might be confused - I certainly don't believe 0.4% of RadOnc residents will have good jobs (again, probably 50-75% of RadOnc residents will get that).

This thread is aimed at medical students which have yet to choose a residency. This is literally basic math. If you have 26,000 doctors graduating every year, 100-200 RadOnc jobs/year = 0.4 to 0.8%...

 

[OTN]

what would you put the odds off top of your head that a medstudent could get a residency and then good job in their top choice tier 1 preferred city. (This was my expectation leaving med school and I was not at top program)

<1%

 

[deleted956486]

If someone had announced at Astro 13 years ago that in 2020 hypofractionation would be widely adopted and that graduating residents will double, can you imagine the outrage? How could that come to be and the field still be “a ok”?

there is something about psychology of justifying the status quo that intrigues me.

It starts with the prestige that must motivate some extreme strivers who occupy top programs and now see threats to their identity. Need to keep the Ponzi scheme going by recruiting high achieving medstudents for them to reign over. If since high school, you have always been associated with top tier institutions (maybe got a PhD along the way) and suddenly you find yourself in a bottom tier specialty? Where is the respect in being a valdectorian of a community college?

internship is the toughest im year. Do one at a decent place and it can at the very least allow you to delay making a decision and carrying on to medonc when it becomes more and more clear that the Brian k’s and Paul h’s have really trashed this field for future generations.

Great assessment of why the field can't fix this. Acceptance is needed for recovery. Can't accept the truth if you're full of yourself. Too many ROs full of themselves. Meanwhile, other specialties working half as much as us, and finding jobs anywhere (e.g hospitalists week on week off for 400k with no restrictions). But yeah, we are the smartest cause we take 4 board exams and 5 years so we can suck up to urologists on twitter. Ok. Gotta be an idiot to go into RO when you read posts like below.

Ugh. Painful to read this. Mostly cause it’s just so awesome.

I am afraid to pull the trigger and do what you’ve done even with a blatant safety net.

I’m closing in on 2 years as a hospitalist myself. My father is a primary care physician who has an established solo practice for nearly 30 yrs now. Family always thought I was going to take over. I would inherit the practice straight up.

Instead I opted to become a hospitalist followed by, admin + telemedicine. I now work from home 80% of the week and make more money than I do as a hospitalist. Problem is...I still work for the man!

 

[scarbrtj]

But yeah, we are the smartest cause we take 4 board exams and 5 years so we can suck up to urologists on twitter.

what a visual!

 

[scarbrtj]

Dial it back how? Alright, fine:

Let's assume we remain with a constant 200 Radiation Oncology Residents graduating per year.

All 200 get and keep amazing jobs.

There are, literally, around 26,000 people graduating from American MD/DO medical schools every year.

Source for that number (20,000 MD and 6,000 DO).

200/26,000 = 0.00769 * 100 = 0.77%

We're making the assumption that not everyone will get a stable/good job in a region they desire. I assumed maybe 100/year, being optimistic.

You might be confused - I certainly don't believe 0.4% of RadOnc residents will have good jobs (again, probably 50-75% of RadOnc residents will get that).

This thread is aimed at medical students which have yet to choose a residency. This is literally basic math. If you have 26,000 doctors graduating every year, 100-200 RadOnc jobs/year = 0.4 to 0.8%...

Imagine your astronomically low odds if a DO, or an offshore MD. Something tells me their odds are looking up though.

 

[Pointless]

Perhaps I misunderstood what you meant by the denominator of 26000. You apparently meant all US medical school grads. But why is that number relevant in any way? Not all 26000 are going to be looking for rad onc jobs, only the 180-200 per year. So, if you apply to and get accepted into a rad onc residency, your competitive denominator is 200.

How many people graduating from rad onc residencies would I estimate find acceptable to good employment after graduation? I would estimate around 80%, at least in my little sphere of the world. I hear a lot of horror stories on SDN, but I honestly don't know many people at all in real life who ended up in a cringe-worthy situation post-residency.

Take it for what its worth, its anecdote, sure. I realize we have problems, but to suggest that most graduates are going to get screwed is disingenuous in my mind. Perhaps it gets worse in the future, but Yogi Berra said something about predictions once...

 

[FrostyHammer]

what would you put the odds off top of your head that a medstudent could get a residency and then good job in their top choice tier 1 preferred city. (This was my expectation leaving med school and I was not at top program)

I think this whole discussion heavily depends on the definition of "good" or "choice" job. The definition of such by many on this forum is that everything aligns - salary, geography, work lifestyle, etc etc. But let's please be adults about this. Life is rarely going to give you any situation in which one does NOT have to make some kind of compromise. If you have to compromise on 1-2 of the above factors, it does not make the job worthless, but it'll sure skew the estimated percentage of getting a "good" job even lower. It is simply impossible that jobs in other fields don't come with a similar compromise somewhere or another (and if it doesn't seem so to us, we're not looking hard enough), despite the oft used anecdotal evidence to discount this statement. Welcome to the real world, folks. Not the real rad onc world, but the real world in general. Let's collectively grow up a bit and stop acting like we're the only victims here.

 

[RadOncG]

I think this whole discussion heavily depends on the definition of "good" or "choice" job. The definition of such by many on this forum is that everything aligns - salary, geography, work lifestyle, etc etc. But let's please be adults about this. Life is rarely going to give you any situation in which one does NOT have to make some kind of compromise. If you have to compromise on 1-2 of the above factors, it does not make the job worthless, but it'll sure skew the estimated percentage of getting a "good" job even lower. It is simply impossible that jobs in other fields don't come with a similar compromise somewhere or another (and if it doesn't seem so to us, we're not looking hard enough), despite the oft used anecdotal evidence to discount this statement. Welcome to the real world, folks. Not the real rad onc world, but the real world in general. Let's collectively grow up a bit and stop acting like we're the only victims here.

Let's say a medical student wished to minimize the number of future compromises they have to make. They have worked hard in their life and already made many sacrifices. They are now 30+ maybe with a family to support etc. Would you recommend this specialty for this hypothetical medical student?

 

[Pointless]

Let's say a medical student wished to minimize the number of future compromises they have to make. They have worked hard in their life and already made many sacrifices. They are now 30+ maybe with a family to support etc. Would you recommend this specialty for this hypothetical medical student?

If their main goal was to avoid sacrificing regional flexibility, then, categorically no, I would not recommend radiation oncology. That hasn't changed for many years. Rad onc is a niche field and it was never a good one if you wanted to pick and choose your locale.

FrostyHammer nailed it in the post above. If you are unwilling to sacrifice anything in your search for an acceptable job, then go into IM and be done with it. You'll find relatively (for IM) well-paying jobs wherever the hell you want, provided you have a pulse.

Conversely, if you are willing to sacrifice on location, you can find an absurdly good job in radiation oncology that will pay you multiples of the IM guy/gal while working half the hours. But no biryani. There's the dirty little secret of radiation oncology.

 

[deleted956486]

If their main goal was to avoid sacrificing regional flexibility, then, categorically no, I would not recommend radiation oncology. That hasn't changed for many years. Rad onc is a niche field and it was never a good one if you wanted to pick and choose your locale.

FrostyHammer nailed it in the post above. If you are unwilling to sacrifice anything in your search for an acceptable job, then go into IM and be done with it. You'll find relatively (for IM) well-paying jobs wherever the hell you want, provided you have a pulse.

Conversely, if you are willing to sacrifice on location, you can find an absurdly good job in radiation oncology that will pay you multiples of the IM guy/gal while working half the hours. But no biryani. There's the dirty little secret of radiation oncology.

Bolded is blatantly false.

 

[Pointless]

Bolded is blatantly false.

Ha, ok.

 

[radoncradonc]

What type of med students should go into rad onc at this moment?

1. Superstars that can match into the top 3 rad onc programs
2. Students with grades or clinical skills so bad that they could not match into a heme onc fellowship after IM.
3. FMGs who are here for the green card

 

[elementaryschooleconomics]

Perhaps I misunderstood what you meant by the denominator of 26000. You apparently meant all US medical school grads. But why is that number relevant in any way? Not all 26000 are going to be looking for rad onc jobs, only the 180-200 per year. So, if you apply to and get accepted into a rad onc residency, your competitive denominator is 200.

How many people graduating from rad onc residencies would I estimate find acceptable to good employment after graduation? I would estimate around 80%, at least in my little sphere of the world. I hear a lot of horror stories on SDN, but I honestly don't know many people at all in real life who ended up in a cringe-worthy situation post-residency.

Take it for what its worth, its anecdote, sure. I realize we have problems, but to suggest that most graduates are going to get screwed is disingenuous in my mind. Perhaps it gets worse in the future, but Yogi Berra said something about predictions once...

The 26,000 number is trying to put things into perspective for your average M1 considering their future. It's a way to assess what level of risk you're comfortable with.

If you're comfortable with pursuing a specialty which represents <1%/year of all new doctors, one where we have spent ENDLESS amounts of bandwidth debating whether or not the addition of ~100 residents/year has put the American RadOnc job market in serious jeopardy, one which has ALWAYS been a niche specialty with severe geographic limitations, one which now faces new CMS regulations, etc etc etc...

If you're a current medical student and cool with all of that, welcome aboard.

Hence the NFL analogy. It worked out for Tom Brady. If you know you're the Tom Brady of medical students, declare for the draft - apply RadOnc. We can hang out at ASTRO. If you're not comfortable with a high level of risk and can see yourself practicing other types of medicine...don't declare for the draft. Don't put yourself and your family through bonus stress above and beyond what being a doctor in America already means.

 

[RadOncG]

That hasn't changed for many years. Rad onc is a niche field and it was never a good one if you wanted to pick and choose your locale.

So you would argue that nothing has changed about job prospects/geography and that the compromises that may be necessary in the future for current medical students are the same compromises that have been made throughout the history of this niche field?

 

[Pointless]

The 26,000 number is trying to put things into perspective for your average M1 considering their future. It's a way to assess what level of risk you're comfortable with.

If you're comfortable with pursuing a specialty which represents <1%/year of all new doctors, one where we have spent ENDLESS amounts of bandwidth debating whether or not the addition of ~100 residents/year has put the American RadOnc job market in serious jeopardy, one which has ALWAYS been a niche specialty with severe geographic limitations, one which now faces new CMS regulations, etc etc etc...

If you're a current medical student and cool with all of that, welcome aboard.

Hence the NFL analogy. It worked out for Tom Brady. If you know you're the Tom Brady of medical students, declare for the draft - apply RadOnc. We can hang out at ASTRO. If you're not comfortable with a high level of risk and can see yourself practicing other types of medicine...don't declare for the draft. Don't put yourself and your family through bonus stress above and beyond what being a doctor in America already means.

Right, I understand that I guess, but if you DID want to go into rad onc, you're not competing against all 26000 people. 25800 are going for another specialty. As has been pointed out ad nauseum on this forum, rad onc has never been easier to match into. So, realistically, this is nothing close to the NFL analogy. You will be likely have little difficulty matching rad onc, then you will be competing against the 180-200 others graduating with you.

 

[Pointless]

So you would argue that nothing has changed about job prospects/geography and that the compromises that may be necessary in the future for current medical students are the same compromises that have been made throughout the history of this niche field?

I would say that it is probably as hard as it has ever been to find a job in radiation oncology. It will likely continue to be moreso. That does not mean, in my estimation, that the whole field should be thrown in the garbage and all US med students need look elsewhere.

Despite the many attempts on this forum to declare our specialty dead and buried, there are still many (and new grads joining the ranks) of us who are highly satisfied with their work. I realize that this viewpoint is somehow highly offensive to some on this board, but I will continue to share it for as long as there are those who seem fully dedicated to trolling our field.

 

[deleted956486]

Ha, ok.

Yeah. And, "provided you have a pulse." ? LOL, where do you think rad onc is? Clearly, you are in denial.

FrostyHammer nailed it in the post above. If you are unwilling to sacrifice anything in your search for an acceptable job, then go into IM and be done with it. You'll find relatively (for IM) well-paying jobs wherever the hell you want, provided you have a pulse.

 

[RadOncG]

I would say that it is probably as hard as it has ever been to find a job in radiation oncology. It will likely continue to be moreso. That does not mean, in my estimation, that the whole field should be thrown in the garbage and all US med students need look elsewhere.

So it seems that you agree that geographic flexibility is decreasing and will continue to decrease. This certainly makes sense with decreased utilization and increasing residents

Despite the many attempts on this forum to declare our specialty dead and buried, there are still many (and new grads joining the ranks) of us who are highly satisfied with their work. I realize that this viewpoint is somehow highly offensive to some on this board, but I will continue to share it for as long as there are those who seem fully dedicated to trolling our field.

I must be reading a different board. I see people that love this specialty and would like to continue practicing for as long as possible.

You acknowledge that geographic flexibility, while always challenging, is becoming more challenging. Yet people that warn medical students about this fact are trolls? Some may argue that those that conceal these facts are the trolls.

 

[elementaryschooleconomics]

I would say that it is probably as hard as it has ever been to find a job in radiation oncology. It will likely continue to be moreso. That does not mean, in my estimation, that the whole field should be thrown in the garbage and all US med students need look elsewhere.

Despite the many attempts on this forum to declare our specialty dead and buried, there are still many (and new grads joining the ranks) of us who are highly satisfied with their work. I realize that this viewpoint is somehow highly offensive to some on this board, but I will continue to share it for as long as there are those who seem fully dedicated to trolling our field.

Ugh, not this narrative again.

The viewpoint that you either find Radiation Oncology a rewarding field OR that it is an insecure economic choice for a personal career is a false dichotomy.

You CAN actually think both things.

I find RadOnc in 2020 to be amazing as a discipline of medicine.

I find RadOnc in 2020 to be dubious as a personal career choice for a doctor, given the alternatives.

No one here ever argues that radiation is not a fundamental modality in the modern treatment of cancer and certain other pathologies. THAT IS NEVER THE ARGUMENT. Stop painting it as such!

 

[Pointless]

Ugh, not this narrative again.

The viewpoint that you either find Radiation Oncology a rewarding field OR that it is an insecure economic choice for a personal career is a false dichotomy.

You CAN actually think both things.

I find RadOnc in 2020 to be amazing as a discipline of medicine.

I find RadOnc in 2020 to be dubious as a personal career choice for a doctor, given the alternatives.

No one here ever argues that radiation is not a fundamental modality in the modern treatment of cancer and certain other pathologies. THAT IS NEVER THE ARGUMENT. Stop painting it as such!

I... didn't say anything of the sort? I am genuinely confused.

I am disagreeing with the narrative that our field is going to hell in a hand basket. I am disagreeing that you can't find good employment currently. I am disagreeing that you will be unable to find a good job in 5-10 years unless you graduate from a "Top 3" program.

I am agreeing that people who are geographically limited should very much factor that into their decision-making before entering this specialty. I do agree that we are training more than we should and we likely shouldn't be opening new programs/expanding right now.

See? Several thoughts at once.

 

[elementaryschooleconomics]

I... didn't say anything of the sort? I am genuinely confused.

I am disagreeing with the narrative that our field is going to hell in a hand basket. I am disagreeing that you can't find good employment currently. I am disagreeing that you will be unable to find a good job in 5-10 years unless you graduate from a "Top 3" program.

I am agreeing that people who are geographically limited should very much factor that into their decision-making before entering this specialty. I do agree that we are training more than we should and we likely shouldn't be opening new programs/expanding right now.

See? Several thoughts at once.

"Despite the many attempts on this forum to declare our specialty dead and buried, there are still many (and new grads joining the ranks) of us who are highly satisfied with their work. I realize that this viewpoint is somehow highly offensive to some on this board, but I will continue to share it for as long as there are those who seem fully dedicated to trolling our field. "

This particular statement is what I was referring to. It implies you're arguing against those who are claiming people aren't satisfied with their work.

I apologize if that's not what you meant, because I strongly agree that people are indeed satisfied with their work. My concern is the obtaining and keeping of that work for this generation of residents.

 

[Lamount]

As far as I can tell, there are zero reliable data regarding the job market... just anecdotes and extrapolations... and people tend to believe only those data that support their prejudice.
If you think things are terrible, then you are likely taken by the anecdote of that new grad who lost a job offer because the change to supervision rules. If you have a rosier outlook, you may pay attention to those of us recent grads who have gotten jobs that we like.

So here is my honest advice for students.
Don’t go into rad onc if:
1) You want to know you are guaranteed a top-tier job, simply by matching into the field
2) Your highest priority is finding a job in a highly competitive location.
3) You feel you have earned a cushy job by virtue of your grades and board score

Do go into rad onc if:
1) you absolutely love the field and would prefer it to others
2) have already began to establish yourself in rad onc with research/connections and have a path to train at a successful program
3) are will to work hard to get where you want to be, despite having already gotten great grades and boards scores.
When I was applying, I was told that a great job was a foregone conclusion the moment I matched into radiation oncology. I don’t know if that was actually true at the time, but it wasn’t true when I tried to get a job -I had to work for it, and I am just fine with that. It isn’t going to be a cakewalk for future graduates... but likely nothing else about becoming a doctor was either

 

[Pointless]

"Despite the many attempts on this forum to declare our specialty dead and buried, there are still many (and new grads joining the ranks) of us who are highly satisfied with their work. I realize that this viewpoint is somehow highly offensive to some on this board, but I will continue to share it for as long as there are those who seem fully dedicated to trolling our field. "

This particular statement is what I was referring to. It implies you're arguing against those who are claiming people aren't satisfied with their work.

I apologize if that's not what you meant, because I strongly agree that people are indeed satisfied with their work. My concern is the obtaining and keeping of that work for this generation of residents.

Fair enough. Just trying to illustrate that there are still very good jobs to be had, currently, and there likely will be for the foreseeable future, despite the headwinds. I don't share the opinion of many on here that things will get as bad as people here are expecting.

Someone just accused me of being in denial in a different post... I suppose that's possible. But I think not. I think if (when) everything hits the fan, adjustments will be made and the crisis will be mitigated. Would it be better if they went ahead and adjusted things now? For certain, but like all things political, the game is to kick the can until you can't anymore. We likely have a few more years of this expansion nonsense before people come to their senses.

 

[RadOncG]

Fair enough. Just trying to illustrate that there are still very good jobs to be had, currently, and there likely will be for the foreseeable future, despite the headwinds. I don't share the opinion of many on here that things will get as bad as people here are expecting.

That's very reasonable. Many would agree with you. When discussing these issues with medical students it is important to say I do not think it is as bad as many others think. That is very different from saying everything is great and I will continue to fight against the trolls that hate this specialty.

When a medical student hears "Hey I think there are still good jobs in radiation oncology and I think there will be for the foreseeable future" they may decide "Why in the hell would I go into a specialty where this is under debate"

 

[Pointless]

That's very reasonable. Many would agree with you. When discussing these issues with medical students it is important to say I do not think it is as bad as many others think. That is very different from saying everything is great and I will continue to fight against the trolls that hate this specialty.

When a medical student hears "Hey I think there are still good jobs in radiation oncology and I think there will be for the foreseeable future" they may decide "Why in the hell would I go into a specialty where this is under debate"

That's fine, but that's not what I was saying, for the record. I don't think "Everything is great". This fun little detour happened because someone threw out some number like 0.4% of people finding a good job in radiation oncology and comparing it to college football players getting to the NFL, and then it started to gain traction with others, and that is the exact point at which my brain broke.

There is only so much a person can take, you see.

 

[elementaryschooleconomics]

That's fine, but that's not what I was saying, for the record. I don't think "Everything is great". This fun little detour happened because someone threw out some number like 0.4% of people finding a good job in radiation oncology and comparing it to college football players getting to the NFL, and then it started to gain traction with others, and that is the exact point at which my brain broke.

There is only so much a person can take, you see.

There are approximately 200 active-roster Wide Receivers in the NFL every year.

Coincidence? I think not.

 

[RadOncG]

That's fine, but that's not what I was saying, for the record. I don't think "Everything is great". This fun little detour happened because someone threw out some number like 0.4% of people finding a good job in radiation oncology and comparing it to college football players getting to the NFL, and then it started to gain traction with others, and that is the exact point at which my brain broke.

There is only so much a person can take, you see.

I think we are on the same page. You will tell medical students that everything is not great in the specialty but you do not think it is all doom and gloom.

I will tell medical students everything is not great in the specialty and I would recommend exploring other options where less sacrifices have to be made in the future.

 

[Neuronix]

Ha, ok.

Shoot I will. Please send me that job interview invite. Multiples of IM salary for half the work? I've never been offered even close to such a thing, and I'm pretty location agnostic.

 

[deleted1002574]

Average IM makes about 300k

So... liar is harsh. Maybe just ridiculous?

 

[Neuronix]

Average IM makes about 300k

So... liar is harsh. Maybe just ridiculous?

600k-900k for half the work? Sign me up. That's all I'm saying.

 

[Pointless]

600k-900k for half the work? Sign me up. That's all I'm saying.

OK, that's like 3 votes for me being a liar. I suppose me just telling you that there are indeed such jobs out there won't suffice?

Fine, let's go to the data. 2018 MGMA report median total compensation:

IM (general) : $249k
IM (hospitalist) : $289k
Radiation Oncology : $540k

A quick definition: multiple, noun, a number that can be divided by another number without a remainder.

So, just looking at national averages, we see that rad onc makes twice as much as IM (that's a multiple, yes?). This is not even taking into account that many rad oncs make significantly more than $540k.

Now, the half as much part. Sure, maybe an exaggeration. Typical rad onc schedule around 40 hours a week, likely less for the many who work 4 day weeks. IM can work upwards of 60+ hours, particularly those that are on the higher end of the pay range. Half as much? OK, maybe not.

Would you all be satisfied if I said it as follows: in rad onc, you should absolutely expect to make twice as much as IM while spending ~25% less time at work. Better?

 

[RadOncG]

OK, that's like 3 votes for me being a liar. I suppose me just telling you that there are indeed such jobs out there won't suffice?

Fine, let's go to the data. 2018 MGMA report median total compensation:

IM (general) : $249k
IM (hospitalist) : $289k
Radiation Oncology : $540k

A quick definition: multiple, noun, a number that can be divided by another number without a remainder.

So, just looking at national averages, we see that rad onc makes twice as much as IM (that's a multiple, yes?). This is not even taking into account that many rad oncs make significantly more than $540k.

Now, the half as much part. Sure, maybe an exaggeration. Typical rad onc schedule around 40 hours a week, likely less for the many who work 4 day weeks. IM can work upwards of 60+ hours, particularly those that are on the higher end of the pay range. Half as much? OK, maybe not.

Would you all be satisfied if I said it as follows: in rad onc, you should absolutely expect to make twice as much as IM while spending ~25% less time at work. Better?

Maybe if you post links to the jobs you are describing it would help

PGY-5s are looking for available jobs not jobs that are already filled that pay MGMA average

Medical students thinking about radiation oncology are interested in available jobs

 

[deleted947887]

OK, that's like 3 votes for me being a liar. I suppose me just telling you that there are indeed such jobs out there won't suffice?

Fine, let's go to the data. 2018 MGMA report median total compensation:

IM (general) : $249k
IM (hospitalist) : $289k
Radiation Oncology : $540k

A quick definition: multiple, noun, a number that can be divided by another number without a remainder.

So, just looking at national averages, we see that rad onc makes twice as much as IM (that's a multiple, yes?). This is not even taking into account that many rad oncs make significantly more than $540k.

Now, the half as much part. Sure, maybe an exaggeration. Typical rad onc schedule around 40 hours a week, likely less for the many who work 4 day weeks. IM can work upwards of 60+ hours, particularly those that are on the higher end of the pay range. Half as much? OK, maybe not.

Would you all be satisfied if I said it as follows: in rad onc, you should absolutely expect to make twice as much as IM while spending ~25% less time at work. Better?

But hospitalists work a week on week off???

 

[Pointless]

Maybe if you post links to the jobs you are describing it would help

PGY-5s are looking for available jobs not jobs that are already filled that pay MGMA average

Medical students thinking about radiation oncology are interested in available jobs

Jobs typically don't post pay and I don't feel compelled to comb through job postings to prove what I have already proven with survey data. I would venture to say that most hospital-employed positions, when you take into account productivity bonus, are paying $500k+. It isn't the "starting salary" that matters, its the productivity rate that matters. Nobody is going to hand you a contract that says you make $700k. They are going to hand you a contract with a base salary, probably somewhere between $350-450k with a productivity bonus that is likely based on work RVUs that should get you over 500k.

Also, for medical students and residents, yes, the initial pay will likely be less. Particularly if you are joining a partnership track, you may see salaries ~$250k. But, within a few years, you should be making pay as noted above. You guys can gnash your teeth and call me a liar, but it is what it is.

But hospitalists work a week on week off???

Do they all? Not the ones I work with. But let's say they do. Fine, we work the same amount and we make at least twice as much. And the actual work of our job, at least as far as I am concerned, is about ~3000 times better. And before you argue the ~3000 factor, it is an unassailable, scientifically proven fact.

 

[deleted956486]

Jobs typically don't post pay and I don't feel compelled to comb through job postings to prove what I have already proven with survey data. I would venture to say that most hospital-employed positions, when you take into account productivity bonus, are paying $500k+. It isn't the "starting salary" that matters, its the productivity rate that matters. Nobody is going to hand you a contract that says you make $700k. They are going to hand you a contract with a base salary, probably somewhere between $350-450k with a productivity bonus that is likely based on work RVUs that should get you over 500k.

Also, for medical students and residents, yes, the initial pay will likely be less. Particularly if you are joining a partnership track, you may see salaries ~$250k. But, within a few years, you should be making pay as noted above. You guys can gnash your teeth and call me a liar, but it is what it is.

Hahaha. Ok. Yeah.

 

[RadOncG]

Jobs typically don't post pay and I don't feel compelled to comb through job postings to prove what I have already proven with survey data. I would venture to say that most hospital-employed positions, when you take into account productivity bonus, are paying $500k+. It isn't the "starting salary" that matters, its the productivity rate that matters. Nobody is going to hand you a contract that says you make $700k. They are going to hand you a contract with a base salary, probably somewhere between $350-450k with a productivity bonus that is likely based on work RVUs that should get you over 500k.

Great. I'm excited to start the job search.

These jobs must've been buried between all the exciting and innovative fellowship opportunities.

 

[Pointless]

Hahaha. Ok. Yeah.

Touche. You got me

 

[Neuronix]

I suppose me just telling you that there are indeed such jobs out there won't suffice?

No. I've never been offered anywhere close to the MGMA median even at full production and been laughed at for saying those numbers. I went academics, but salaries in the private offers were always very similar for me.

Also, I work at least 50 hours a week. When I only work 50 I fall behind, but I'm having trouble finding the stamina to stay at 60+.

 

[xrthopeful]

Jobs typically don't post pay and I don't feel compelled to comb through job postings to prove what I have already proven with survey data. I would venture to say that most hospital-employed positions, when you take into account productivity bonus, are paying $500k+. It isn't the "starting salary" that matters, its the productivity rate that matters. Nobody is going to hand you a contract that says you make $700k. They are going to hand you a contract with a base salary, probably somewhere between $350-450k with a productivity bonus that is likely based on work RVUs that should get you over 500k.

Also, for medical students and residents, yes, the initial pay will likely be less. Particularly if you are joining a partnership track, you may see salaries ~$250k. But, within a few years, you should be making pay as noted above. You guys can gnash your teeth and call me a liar, but it is what it is.



Do they all? Not the ones I work with. But let's say they do. Fine, we work the same amount and we make at least twice as much. And the actual work of our job, at least as far as I am concerned, is about ~3000 times better. And before you argue the ~3000 factor, it is an unassailable, scientifically proven fact.

you're doing God's work. Keep it up.

idk why it gets some of these people so worked up. some like NamThrow and Sphinx known trolls. Some like Neuronix who are hard-core academics seem confused that they don't make these salaries.

 

[xrthopeful]

Great. I'm excited to start the job search.

These jobs must've been buried between all the exciting and innovative fellowship opportunities.

I really don't know why you or others get worked up about fellowship postings when it's often the same ones being posted again and again through the year because people aren't taking them

the real jobs are being taken, both the ones that post and the ones that don't post.

are you graduating next year? You'll be fine. work hard and hustle.

 

[Pointless]

No. I've never been offered anywhere close to the MGMA median and been laughed at for saying those numbers. I went academics, but salaries in the private offers were always very similar for me.

Also, I work at least 50 hours a week. When I only work 50 I fall behind, but I'm having trouble finding the stamina to stay at 60+.

So, is it your supposition that the survey numbers are fabricated? I don't know what kind of jobs you have interviewed for but I guess I should have clarified "not academic". I am happy to discuss this with you at greater length via PM if you want.

Anyway, literally the first job post on ASTRO is a private practice track that I bet would get you over $500k after the 2 year partnership.

'therapy OR associates OR evansville OR in OR STATECODE:"IN"' Jobs | ASTRO Radiation Oncology Career Center

3,404 'therapy OR associates OR evansville OR in OR STATECODE:

careers.astro.org