A Naive Thought

[medgator]

As much as most here may agree with the cynical criticisms espoused on this forum, one must acknowledge that SDN is not an unbiased sampling of our field. Anonymous forums appeal more to those with grievances than those with praise.

While self-flagellation may make many feel better, it's hard to see how its utility extends beyond catharsis. Absent objective data that demonstrates pervasive discontent in practicing rad oncs rad onc, don't presume that we all must feel this way. I can tell you that I don't.. and I am guessing we all have the same telepathic abilities to read the minds of everyone in our field.

So when you say that SDN is skewed towards those with grievances...are you saying there are a bunch of people practicing out in the real world (and not on SDN) trumpeting how great the oversupply problem is?

Basically every “complainer” on here that has exposed the poor job prospects and the horrible over-supply problem (both of which DO have objective data) hurting graduating residents have started or ended with “I am in a good place, but I feel for these new grads.”

Many of us would personally benefit from a labor oversupply quite honestly. $200k > $0 salary/year.

And I'm sure less scrupulous folks in Irvine, Salina, and many places in FL and TX probably are

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[Lamount]

So when you say that SDN is skewed towards those with grievances...are you saying there are a bunch of people practicing out in the real world (and not on SDN) trumpeting how great the oversupply problem is?

Basically every “complainer” on here that has exposed the poor job prospects and the horrible over-supply problem (both of which DO have objective data) hurting graduating residents have started or ended with “I am in a good place, but I feel for these new grads.”

"So when you say that SDN is skewed towards those with grievances...are you saying there are a bunch of people practicing out in the real world (and not on SDN) trumpeting how great the oversupply problem is?"

Appreciate this question at it allows me to distill my point. Within my sphere of practice, I think almost every single radiation oncologist would acknowledge the residency oversupply problem (myself obviously included). However, if you asked my colleagues "what are the five greatest challenges you face at work?"... or even "what do you think is the root cause for each of these challenges?", I don't think that "residency expansion" would find its way onto many lists.


"Basically every “complainer” on here that has exposed the poor job prospects and the horrible over-supply problem (both of which DO have objective data) hurting graduating residents have started or ended with “I am in a good place, but I feel for these new grads.”"

We all know that there is a spectrum of laments... and on the mild end, there is compassion for graduating residents who are facing a much steeper hill than even those of us hired last year. On the other end of the spectrum, Morgan Freeman is bracing us for impact.

 

[elementaryschooleconomics]

Within my sphere of practice, I think almost every single radiation oncologist would acknowledge the residency oversupply problem (myself obviously included). However, if you asked my colleagues "what are the five greatest challenges you face at work?"... or even "what do you think is the root cause for each of these challenges?", I don't think that "residency expansion" would find its way onto many lists.

This is exactly what prompted me to start posting more on SDN. I totally agree that this flies under the radar of the bulk of our colleagues - which is a travesty. "In any emergency, the first pulse you should take is your own". I can't speak for everyone, but I know that I personally came here to make noise about this issue which fundamentally affects the health of our entire field.

 

[Lamount]

This is exactly what prompted me to start posting more on SDN. I totally agree that this flies under the radar of the bulk of our colleagues - which is a travesty. "In any emergency, the first pulse you should take is your own". I can't speak for everyone, but I know that I personally came here to make noise about this issue which fundamentally affects the health of our entire field.

Why is this a travesty? This is the hyperbole to which I refer.

For me and many others I know, the following priority list at work seems most logical.

Health of patients>>Health of relationships with nurses/therapists > Health of relationships with other disease site physicians > Health of relationship with department/Hospital > Health the "the field".

If on any given day, concerns about the job market rank high on your list, you either 1) Don't have a job, 2) Don't like your job, or 3) are having a remarkably quiet day.

I am deeply concerned for current residents as they are facing an indeterminate period of anxiety and doubt and they are probably the least to blame out of all of us. I have had several meetings with PGY3-4s in the past few weeks to discuss strategies for finding a job... but as an oncologist with 15 sick patients under treatment, I don't know how that could make my top 5.

 

[Mandelin Rain]

Let's all post anecdotes about our own sick patients' current situations and query each other if our nurses seem happy enough with us. That's the purpose of this message board, right? It will certainly help "student doctors" on this "network" make informed decisions regarding their career choices as they seek to "become doctors".

Some snark is deserved snark.

 

[RadOncDoc21]

Let's all post anecdotes about our own sick patients' current situations and query each other if our nurses seem happy enough with us. That's the purpose of this message board, right? It will certainly help "student doctors" on this "network" make informed decisions regarding their career choices as they seek to "become doctors".

Some snark is deserved snark.

Having no snark is like eating bland biryani. I need the spice and more cowbell!

 

[Lamount]

Let's all post anecdotes about our own sick patients' current situations and query each other if our nurses seem happy enough with us. That's the purpose of this message board, right? It will certainly help "student doctors" on this "network" make informed decisions regarding their career choices as they seek to "become doctors".

Some snark is deserved snark.

okay, fine. Let me have a go at this...

I’ll give it to you, I feel a little better lol

 

[FifthDayOfMay]

Why is this a travesty? This is the hyperbole to which I refer.

For me and many others I know, the following priority list at work seems most logical.

Health of patients>>Health of relationships with nurses/therapists > Health of relationships with other disease site physicians > Health of relationship with department/Hospital > Health the "the field".

If on any given day, concerns about the job market rank high on your list, you either 1) Don't have a job, 2) Don't like your job, or 3) are having a remarkably quiet day.

I am deeply concerned for current residents as they are facing an indeterminate period of anxiety and doubt and they are probably the least to blame out of all of us. I have had several meetings with PGY3-4s in the past few weeks to discuss strategies for finding a job... but as an oncologist with 15 sick patients under treatment, I don't know how that could make my top 5.

This is good stuff. One’s perspective and position will alter their relative priorities.

 

[elementaryschooleconomics]

Why is this a travesty? This is the hyperbole to which I refer.

For me and many others I know, the following priority list at work seems most logical.

Health of patients>>Health of relationships with nurses/therapists > Health of relationships with other disease site physicians > Health of relationship with department/Hospital > Health the "the field".

This is good stuff. One’s perspective and position will alter their relative priorities.

Hmm I think y'all are reading this too literally.

It's a little silly (and a false equivalence) to say that anyone on SDN cares more about "the health of the field" vs "the health of [their] patients".

For me, the job market is a surrogate endpoint - the PFS of Radiation Oncology. It reflects how our field is being led, what it values, and its near-to-mid term trajectory. The leadership and vision of the field has direct consequences on the front line doctors, therapists, nurses - which, in turn, has direct consequences on the patients.

When I say "this is a travesty", I mean this general myopic attitude that job market concerns are overblown. You're talking about climate and weather - do I care that I'm caught in a thunderstorm of a patient developing new metastatic disease? You bet. But I'm also concerned about the melting icecaps which is the Palliative Radiation Oncology Fellow coming down to consult on the case.

 

[FifthDayOfMay]

Hmm I think y'all are reading this too literally.

It's a little silly (and a false equivalence) to say that anyone on SDN cares more about "the health of the field" vs "the health of [their] patients".

For me, the job market is a surrogate endpoint - the PFS of Radiation Oncology. It reflects how our field is being led, what it values, and its near-to-mid term trajectory. The leadership and vision of the field has direct consequences on the front line doctors, therapists, nurses - which, in turn, has direct consequences on the patients.

When I say "this is a travesty", I mean this general myopic attitude that job market concerns are overblown. You're talking about climate and weather - do I care that I'm caught in a thunderstorm of a patient developing new metastatic disease? You bet. But I'm also concerned about the melting icecaps which is the Palliative Radiation Oncology Fellow coming down to consult on the case.

I don’t think it’s too literal at all. I know a lot of busy private practice doctors who spend 2% of their time at most worrying about the health of the job market in our field. Is that selfish of them or is it just not that important to their reality? I think it’s a bit presumptuous to think that anyone’s given top set of worries should absolutely be anyone else’s.

 

[elementaryschooleconomics]

I don’t think it’s too literal at all. I know a lot of busy private practice doctors who spend 2% of their time at most worrying about the health of the job market in our field. Is that selfish of them or is it just not that important to their reality? I think it’s a bit presumptuous to think that anyone’s given top set of worries should absolutely be anyone else’s.

Presumptuous? You're the one that started this thread suggesting what we should focus on.

 

[FifthDayOfMay]

Presumptuous? You're the one that started this thread suggesting what we should focus on.

Did I say what we should focus on or what attitude we should approach what we focus on with?

Moreover, I’m not even saying supply economics of the field aren’t a worthy focus, I’m saying it’s not nearly as important to some people as it is to others.

 

[Lamount]

Hmm I think y'all are reading this too literally.

It's a little silly (and a false equivalence) to say that anyone on SDN cares more about "the health of the field" vs "the health of [their] patients".

For me, the job market is a surrogate endpoint - the PFS of Radiation Oncology. It reflects how our field is being led, what it values, and its near-to-mid term trajectory. The leadership and vision of the field has direct consequences on the front line doctors, therapists, nurses - which, in turn, has direct consequences on the patients.

When I say "this is a travesty", I mean this general myopic attitude that job market concerns are overblown. You're talking about climate and weather - do I care that I'm caught in a thunderstorm of a patient developing new metastatic disease? You bet. But I'm also concerned about the melting icecaps which is the Palliative Radiation Oncology Fellow coming down to consult on the case.

Point taken and well explained. My point is that weather is a thing you naturally talk about everyday, icecaps are not.

 

[radiation]

I would posit the following thought exercise for those thinking the oversupply is the single biggest problem in the field right now. Imagine we cut the workforce by 20%, skip one cycle of incoming residents, and start a guiding precedent to cap the total number of residents according whatever the current "demand" of radiation oncology is. And we do this every 10 years to account for what government, payors, and executives (and even other referring specialties) think our "worth" is. Fast forward 25 years, 50 years from now. What are the med oncs doing during this time? What are their numbers in proportion to ours? What will our demand look like then, and more importantly will we have an even less say of what that demand will be? The natural history of cutting supply to meet decreasing demand does not seem to have a happy ending. Will we ever have another IMRT-like black swan billing event?

Imagine if every patient that had a potential indication for radiation (early stage lung, skin cancer, bladder cancer, etc) saw a radiation oncologist at some point. Compared to what we have now, don't you think in that world there is a net positive for patients in terms of getting more informed care, less morbid surgeries, less cancer pain, less dysfunction etc? Do you all agree most new oncology drugs cost too much for too little benefit? Aren't the costs of oncology drugs unsustainable? Yet we are the ones with a gross oversupply. Does that not drive anybody else crazy?

 

[medgator]

I would posit the following thought exercise for those thinking the oversupply is the single biggest problem in the field right now. Imagine we cut the workforce by 20%, skip one cycle of incoming residents, and start a guiding precedent to cap the total number of residents according whatever the current "demand" of radiation oncology is. And we do this every 10 years to account for what government, payors, and executives (and even other referring specialties) think our "worth" is. Fast forward 25 years, 50 years from now. What are the med oncs doing during this time? What are their numbers in proportion to ours? What will our demand look like then, and more importantly will we have an even less say of what that demand will be? The natural history of cutting supply to meet decreasing demand does not seem to have a happy ending. Will we ever have another IMRT-like black swan billing event?

Imagine if every patient that had a potential indication for radiation (early stage lung, skin cancer, bladder cancer, etc) saw a radiation oncologist at some point. Compared to what we have now, don't you think in that world there is a net positive for patients in terms of getting more informed care, less morbid surgeries, less cancer pain, less dysfunction etc? Do you all agree most new oncology drugs cost too much for too little benefit? Aren't the costs of oncology drugs unsustainable? Yet we are the ones with a gross oversupply. Does that not drive anybody else crazy?

You think increasing our numbers will increase referrals to our specialty?

 

[Mandelin Rain]

If you build it, they will come.

 

[Mandelin Rain]

I can walk and chew gum.

I can care about my patients, staff, and family off the Internet.

I can worry about the future of my profession and those who enter it on this particular website dedicated to the discussion of professions for the benefit of students entering them.

it’s not even that hard to do the above, and I’m not a particularly dynamic person.

for the record, I too care more about my patients, family, and staff than the residency oversupply issue.

 

[thecarbonionangle]

The theory is similar to mormonism, quite simple: we have to make more of us to have more visibility and longevity. Our “leaders” are very forward thinking people.

 

[RadOncG]

Imagine if every patient that had a potential indication for radiation (early stage lung, skin cancer, bladder cancer, etc) saw a radiation oncologist at some point. Compared to what we have now, don't you think in that world there is a net positive for patients in terms of getting more informed care, less morbid surgeries, less cancer pain, less dysfunction etc? Do you all agree most new oncology drugs cost too much for too little benefit? Aren't the costs of oncology drugs unsustainable? Yet we are the ones with a gross oversupply. Does that not drive anybody else crazy?

If only there was data on radiation utilization in the setting of a doubling of residency positions.

 

[thecarbonionangle]

If only there was data on radiation utilization in the setting of a doubling of residency positions.

yeah would be very interesting if we had the data. I guess we just have to wait and see what happens

 

[RadOncG]

yeah would be very interesting if we had the data. I guess we just have to wait and see what happens

I've started hyperfractionating everything now that we have double the residents. I told Evicore "Sorry, but drugs are too expensive."

 

[radiation]

You think increasing our numbers will increase referrals to our specialty?

Maybe, maybe not. But I know decreasing our numbers is not likely to increase referrals long term. I'm am just playing this out to its logical conclusion. 100% agree we need a cut now. But where do we draw the line on when to stop? We are not the ones controlling our demand. If demand goes down because our numbers go down, our innovation stagnates, med onc laps us in research, etc how many times do we cut our numbers?

 

[deleted774703]

Maybe, maybe not. But I know decreasing our numbers is not likely to increase referrals long term. I'm am just playing this out to its logical conclusion. 100% agree we need a cut now. But where do we draw the line on when to stop? We are not the ones controlling our demand. If demand goes down because our numbers go down, our innovation stagnates, med onc laps us in research, etc how many times do we cut our numbers?

OMG are you serious??

Med onc already has lapped us in research. Not b/c of numbers, but b/c of PHARMA

We can't compete with pharma regardless of how many we train

The problem is where are our hires going? Should start at academics where They should hire more radoncs at main campus so we have backup

How many times have you been in a tumor board where you were outnumbered by every other specialty x 3?

It's not b/c there aren't enough grads graduating, but b/c not enough jobs to help our colleagues fight to get the patient