Advice for M3 student interested in rad-onc

medM3phd

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    Hi radonc, I'm an M3, been a lurker here for a while, and hoping for some advice.

    I've been interested in radonc since shadowing in college, which lead me to apply to med school. I'm an MDPhD student at a non-MSTP/not top-40 program; PhD was in radonc-related engineering; strong publications with citations; step1 was 240. A few things I like about the specialty are working in oncology, research, lifestyle, importance of tech/physics. I've read many posts here, and I'm aware of the current issues discussed (jobs after residency, etc.). My personal goals are to train and work at a large research-friendly academic center in a metropolitan area. Salary isn't a big deal, but I have a family so the idea of owning a home eventually and balancing work/life are important to me. My specific questions are 1. am I competitive for these upper-tier academic programs where I could achieve these goals, and 2. are my specific goals still likely attainable in rad-onc? I appreciate any candid and honest advice - thanks for taking the time
     
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    thecarbonionangle

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      Hi radonc, I'm an M3, been a lurker here for a while, and hoping for some advice.

      I've been interested in radonc since shadowing in college, which lead me to apply to med school. I'm an MDPhD student at a non-MSTP/not top-40 program; PhD was in radonc-related engineering; strong publications with citations; step1 was 240. A few things I like about the specialty are working in oncology, research, lifestyle, importance of tech/physics. I've read many posts here, and I'm aware of the current issues discussed (jobs after residency, etc.). My personal goals are to train and work at a large research-friendly academic center in a metropolitan area. Salary isn't a big deal, but I have a family so the idea of owning a home eventually and balancing work/life are important to me. My specific questions are 1. am I competitive for these upper-tier academic programs where I could achieve these goals, and 2. are my specific goals still likely attainable in rad-onc? I appreciate any candid and honest advice - thanks for taking the time

      i would hate to see someone with your talents and potential end up in a bad no good place or stuck in a field with declining use, pay, opportunity, flexibility and terrible leadership. My advise to you is put on a nice set of sneakers and run for your life. Do not look back. If you fail to heed our warnings you may remember these words many years later and think “damn, i should have listened to that friendly croc”, now you’re in the swamp.

      today think about the freedoms you enjoy and pick a field with endless potential, flexibility and high pay. This is America after all. cheers to you and good luck!
       
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      medgator

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        Hi radonc, I'm an M3, been a lurker here for a while, and hoping for some advice.

        I've been interested in radonc since shadowing in college, which lead me to apply to med school. I'm an MDPhD student at a non-MSTP/not top-40 program; PhD was in radonc-related engineering; strong publications with citations; step1 was 240. A few things I like about the specialty are working in oncology, research, lifestyle, importance of tech/physics. I've read many posts here, and I'm aware of the current issues discussed (jobs after residency, etc.). My personal goals are to train and work at a large research-friendly academic center in a metropolitan area. Salary isn't a big deal, but I have a family so the idea of owning a home eventually and balancing work/life are important to me. My specific questions are 1. am I competitive for these upper-tier academic programs where I could achieve these goals, and 2. are my specific goals still likely attainable in rad-onc? I appreciate any candid and honest advice - thanks for taking the time
        Look to the mid 90s for thoughts/predictions where things could go job market wise. That's how bad this is, but in some ways probably worse given the trend towards shorter courses of xrt, bundled payments/APM etc. The bad 90s job market was saved by IMRT.

        Possibly could end up self correcting, but maybe not. If you absolutely cannot do anything else in medicine, be willing to compromise on anything when you get out... You may end up with an academic job you can tolerate in a city you can tolerate... Or maybe not. Could be PP in the middle of nowhere. Might take a year of non-accredited "fellowship" to get where you want... Either to wait out a terrible job market, or get your foot in the door somewhere
         
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        StIGMA

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          Believe it or not, your PhD record will be looked at very closely if you are intending to do Holman. Not having "strong publications" during PhD can hamstring your early career grants (like a K award). If you have very strong publications (the journals everyone knows about), that can make up for weaker areas in your application and allow for a foot in the door. My program has moved "Holman candidates" up or down significantly based on research potential. If you're not intending to apply for Holman, IMO your PhD record doesn't matter so much.
           
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          dieABRdie

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            I would also comment that if you intend to do Holman (Holman is the research pathway) then you really must train at a program which supports it. And by supports it I mean one that has a history of Holman residents... not one that just tells you that they support it.

            And be careful mentioning "Holman" during interviews unless you know for sure they support it. I called it "dropping the H-bomb" because back when I interviewed if you said you wanted to do Holman at certain places you were dead in the water. It might not matter quite as much in this environment regarding matching but its still very likely those places will refuse to let you do it. Most places would much rather have you in the clinic doing their notes over doing research.

            Regarding your specific questions:

            1) As mentioned before you would be competitive for upper tier programs
            2) I agree obtaining work at an academic institution near a metropolitan area will be challenging. If you are dead set on this you better prepare your family for the eventual possibility of moving to a rural area for a private practice job.
             
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            elementaryschooleconomics

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              I could be totally off-base and would be interested in what others have to say, but I think the idea of "lifestyle" is vastly misrepresented to medical students. From what I've seen, in MANY specialties, once you're an attending, the lifestyle is pretty reasonable. What medical students mostly observe are the residents in those specialties, and extrapolate from there. It's very true that, compared to other specialties, the RadOnc residency has a great lifestyle, but the benefit isn't quite as large once you're an attending...especially depending on where you practice (ask the SERO crew).

              If your final goal is to practice in an academic center in a major metro area, this is literally the worst specialty to join. Even if you say you'd take a huge hit in salary to do it - it's just not an option, the jobs aren't there.

              So, what exactly appeals to you about RadOnc? Is it the Oncology part? The obvious answer there is HemeOnc - only a year more of training, vastly better geographic options. Lifestyle is probably more variable as an attending...but at my institution, when the MedOncs aren't on service (just doing clinic), their lifestyle seems fairly similar to the RadOncs.

              If it's anything else about the specialty which appeals to you most - lifestyle, research, tech, etc - there are a hundred other better options.
               
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              deleted774703

                Hi radonc, I'm an M3, been a lurker here for a while, and hoping for some advice.

                I've been interested in radonc since shadowing in college, which lead me to apply to med school. I'm an MDPhD student at a non-MSTP/not top-40 program; PhD was in radonc-related engineering; strong publications with citations; step1 was 240. A few things I like about the specialty are working in oncology, research, lifestyle, importance of tech/physics. I've read many posts here, and I'm aware of the current issues discussed (jobs after residency, etc.). My personal goals are to train and work at a large research-friendly academic center in a metropolitan area. Salary isn't a big deal, but I have a family so the idea of owning a home eventually and balancing work/life are important to me. My specific questions are 1. am I competitive for these upper-tier academic programs where I could achieve these goals, and 2. are my specific goals still likely attainable in rad-onc? I appreciate any candid and honest advice - thanks for taking the time

                Again, terrible decision by medical student but will tell you how to succeed:

                Start a trial that reduces the role of RT or makes us obsolete

                You will become beloved by our dumb a** specialty and end up at MDACC. Whooooooo!
                 
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                thecarbonionangle

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                  Many of my clasmates who went into other fields ended up in “top” cities in specialties like PMR, Med onc, GI, ENT, plastics, derm, cards, urology, psychiatry,etc. Hell even one of the “dumbest” guys in my class ended up ivy league fellowship trained in a top city. The residency was tough but they secured enviable employment with good pay and plenty of options. Don’t like your job? You can lateral to the many practices across town, your family stays in same house, your kids stay in same good school, your wife stays happy. In rad onc, you may find yourself completely shut out of big geographical areas with zero way to get in or lateral. You’re simply SOL. Your wife and kids lose their job and schools. You have much better options if you’re willing to do a harder residency. Trust me, based on what you write and your ask it is not for you. Nobody can guarantee you anything in this field (0 out of the “big 3”)
                   
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                  Grubbe-a-dub-dub

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                    Medical students - no matter how stacked your application is - apply to another specialty. There is nothing left for anyone here, and anyone that tells you otherwise is plain lying.

                    You are setting up your career and life for a giant disappointment.
                     
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                    RickyScott

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                      Look to the mid 90s for thoughts/predictions where things could go job market wise.

                      Possibly could end up self correcting, but maybe not. If you absolutely cannot do anything else in medicine, be willing to compromise on anything when you get out...
                      I don’t think in history of American medicine any speciality has expanded residencies so aggressively- doubling them- while demand/utilization is substantially falling. We are in uncharted territory.
                       
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                      medM3phd

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                        First off, I seriously appreciate the speed and volume of the advice you all have offered. Particularly helpful was the family-oriented stuff that I hadn't read elsewhere. I am indeed interested in Holman. Specifically, my dissertation work was medical image analysis and a lot was also rads oriented (attended conferences & journal pubs). I could easily see a future for myself in DR for reasons both similar and different to what appeals to me about rad-onc. Maybe something like DR could be more conducive for my long-term career aspirations, and I definitely will do more reading and thinking as I move through my clerkships. Thanks again for your input
                         
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                        medgator

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                          First off, I seriously appreciate the speed and volume of the advice you all have offered. Particularly helpful was the family-oriented stuff that I hadn't read elsewhere. I am indeed interested in Holman. Specifically, my dissertation work was medical image analysis and a lot was also rads oriented (attended conferences & journal pubs). I could easily see a future for myself in DR for reasons both similar and different to what appeals to me about rad-onc. Maybe something like DR could be more conducive for my long-term career aspirations, and I definitely will do more reading and thinking as I move through my clerkships. Thanks again for your input
                          If interested in rad onc with rads background research, I'd probably look into rads with a nuc/onc focus rather than rad onc, personally. Way more options in rads job wise, they are cycling back up
                           
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                          StIGMA

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                            Recommend you PM Neuronix who has similar background. Last 3 holmans in my program, and almost every majority-research (75/25 or 80/20) I know has a mouse/cell/molecular bio background. If you’re a heavy hitter in AI or some other “hot areas” that are potential niches will help, but regardless would be good to figure out some people who do what you are thinking about, consider reaching out to them early, identifying potential residency mentors, etc. You’ll need to be extremely proactive about this to make it work, find out how to get funded early (work with good mentors), etc. Just like PhDs, you can’t easily demand protected time unless you can prove you can bring in money, and applying for faculty jobs while already able to cover part of your salary is the best chance. Best wishes-
                             
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                            medM3phd

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                              Recommend you PM Neuronix who has similar background. Last 3 holmans,
                              In my program, and almost every majority-research (75/25 or 80/20) I know has a mouse/cell/molecular bio background. If you’re a heavy hitter in AI or some other “hot areas” that are potential niches will help, but regardless would be good to figure out some people who do what you are thinking about, consider reaching out to them early, identifying potential residency mentors, etc. You’ll need to be extremely proactive about this to make it work, find out how to get funded early (work with good mentors), etc. Just like PhDs, you can’t easily demand protected time unless you can prove you can bring in money, and applying for faculty jobs while already able to cover part of your salary is the best chance. Best wishes-

                              Very helpful, thank you. Yeah PhD was AI-focused
                               

                              StIGMA

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                                100% agree with looking at other fields, but there’s a consistent stream of residents entering physician scientist jobs each year, appx 5/year past 3 years that I’m more familiar with. Whereas there’s about 10-12 or so Holman a year (numbers approximate), plus a few people who want physician scientist jobs but were not able to do Holman. https://www.theabr.org/wp-content/uploads/2019/07/Holman_Research_Pathway_Graduates.pdf

                                edit: looks like post I was responding to got deleted.
                                 
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                                hbosch

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                                  Please apply to another specialty. Please. Don’t assume some magical new way of treatment is going to arise. And even if it dies, again, we do research to not use our treatment while every other specialty does research to increase usage. You will not find a job in a large city. And as another poster said, once established in a city - you are stuck with that practice. I’ve literally never heard of someone doing a lateral move, which is actually very sad. We do not have flexibility at all.
                                   
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                                  radiation

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                                    Hi radonc, I'm an M3, been a lurker here for a while, and hoping for some advice.

                                    I've been interested in radonc since shadowing in college, which lead me to apply to med school. I'm an MDPhD student at a non-MSTP/not top-40 program; PhD was in radonc-related engineering; strong publications with citations; step1 was 240. A few things I like about the specialty are working in oncology, research, lifestyle, importance of tech/physics. I've read many posts here, and I'm aware of the current issues discussed (jobs after residency, etc.). My personal goals are to train and work at a large research-friendly academic center in a metropolitan area. Salary isn't a big deal, but I have a family so the idea of owning a home eventually and balancing work/life are important to me. My specific questions are 1. am I competitive for these upper-tier academic programs where I could achieve these goals, and 2. are my specific goals still likely attainable in rad-onc? I appreciate any candid and honest advice - thanks for taking the time

                                    I'm not going to beat the dead horse around that the job market is tight right now and there is a obvious oversupply in the field. That being said, assuming the ease of getting jobs and geographic availability in other specialties 7+ years from now is very difficult especially in a post-COVID world. I would put in the same diligence in looking at pro/cons of each specialty from those in that field (radiologists know much more their job opportunities than a rad onc).

                                    If you look at the pure time commitment and opportunity cost of the closest specialty ie, heme/onc, you have to ask yourself if 3 years of wards medicine plus 3 years of fellowship training is something you are willing to do for more geographic predictability and job availability. Alternatively, if you are set on doing academics, there is not a huge difference time and money wise for 6 years of med/onc training vs. 5 years of rad onc + 1 year of instructor/fellowship at a major academic center and staying on. Similarly, diagnostic radiology is basically a required 5 years +1 fellowship, with a lot more job flexibility. I'm sure I will get tons of flak that anyone would even suggest a track like this in rad onc should even exist, but it is the reality of the way things are and we can debate tragedy of the rac onc workforce in a thousand other threads.

                                    Finally, the best advice advice I can give is to reach out to the people who actually have the kinds of jobs you want, like @Neuronix. If you need a couple viewpoints on an academic rad onc career focused on AI, would reach out to recent grads like

                                    For someone more senior, I actually think Clifton Fuller used to post on these boards, but haven't seen him post recently
                                     
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                                    deleted774703

                                      Don't ignore surgonc or gynonc...those are also great fields.

                                      On a related topic...

                                      The FDA commissioner (himself radonc) cares more about his job than the public health.

                                      While I understand it is difficult to go against the boss (POTUS), but when the POTUS lies all the time, the FDA commissioner needs to stand up.
                                      He works for "the people", not for DT.




                                      Now, you know why this field is in such BIG trouble, no leadership...
                                      - FDA commissioner has no spine.
                                      - The so-called ASTRO "leadership" (if you call that leadership) will stay silence. Trust me, ASTRO will stay silence.
                                      If ASTRO does nothing to the post from the man in the City of Angels, then they will say nothing to this FDA commissioner fiasco.

                                      Soon or later, the FDA commissioner will become history, in a bad way. He had the opportunity to shine and stood up, he blew it, just like DT blew the pandemic...

                                      Im willing to cut Steve a break

                                      How many attendings in our field have any guts whatsoever to tell their chair they are wrong for residency expansion?

                                      <1% IMO

                                      If we don’t have ppl who can tell their bosses something that benign, then how can we hold Steve to a high standard in publicly bashing the president?

                                      Do you trust MDACC to return Steve to his prior post? They revoked 7 contracts recently and thankfully are resuming but that wasn’t clear for a long time
                                       

                                      scarbrtj

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                                        Hi radonc, I'm an M3, been a lurker here for a while, and hoping for some advice.

                                        I've been interested in radonc since shadowing in college, which lead me to apply to med school. I'm an MDPhD student at a non-MSTP/not top-40 program; PhD was in radonc-related engineering; strong publications with citations; step1 was 240. A few things I like about the specialty are working in oncology, research, lifestyle, importance of tech/physics. I've read many posts here, and I'm aware of the current issues discussed (jobs after residency, etc.). My personal goals are to train and work at a large research-friendly academic center in a metropolitan area. Salary isn't a big deal, but I have a family so the idea of owning a home eventually and balancing work/life are important to me. My specific questions are 1. am I competitive for these upper-tier academic programs where I could achieve these goals, and 2. are my specific goals still likely attainable in rad-onc? I appreciate any candid and honest advice - thanks for taking the time
                                        I know this is gauche but "salary isn't a big deal"... what if you could do one of two things, both of which you liked, and one paid $400Ks a year and the other $750Ks plus. There will be a time in your life when this will either matter, or be something you spend a lot of time pondering. It's nigh impossible to make $1 million plus in rad onc anymore. But if salary truly isn't a big deal... I would focus more on the likelihood of just being a practicing rad onc. The research part may be a bit more of a stretch. Rad onc got you interested in medicine, though; this will be tough to mentally abandon. I know MDPhDs in rad onc angling for rural pure private practice jobs in this market. Woulda been unheard of 10 years ago and is now common. But IMHO you're the type of person that should in theory get a slot and a job later on. You'll just have to hope to meet some people along your journey who're in power who think the same. Rad onc is in relation to other specialties in terms of jobs and geography a rough road. If you can handle that, and not mind seeing your friends in other specialties having it easier, then rad onc is still for you.
                                         
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                                        elementaryschooleconomics

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                                          Is there at least a 10-30% chance that 5 years from now 50+% of grads can not find jobs?

                                          This is what I'm wondering. I feel like we're in sort of a transient equilibrium decay scheme, and we've yet to go over the edge. With >120% increase in residents over the last 20 years, I feel like 2020-2030 is when we're going to feel the full impact (when retiring docs no longer keep up with fresh docs).
                                           
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                                          medgator

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                                            This is what I'm wondering. I feel like we're in sort of a transient equilibrium decay scheme, and we've yet to go over the edge. With >120% increase in residents over the last 20 years, I feel like 2020-2030 is when we're going to feel the full impact (when retiring docs no longer keep up with fresh docs).
                                            We're seeing warning flashes now... Contracts postponed/cancelled, locums market drying up in many desirable areas, less jobs/partnership track positions in desirable areas etc
                                             
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                                            medgator

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                                              First off, I seriously appreciate the speed and volume of the advice you all have offered. Particularly helpful was the family-oriented stuff that I hadn't read elsewhere. I am indeed interested in Holman. Specifically, my dissertation work was medical image analysis and a lot was also rads oriented (attended conferences & journal pubs). I could easily see a future for myself in DR for reasons both similar and different to what appeals to me about rad-onc. Maybe something like DR could be more conducive for my long-term career aspirations, and I definitely will do more reading and thinking as I move through my clerkships. Thanks again for your input
                                              A good "buy" signal for rad onc would be if half the number of spots in the match disappeared before you were going to enter the match... Ideally we need to get back down near ~90-100 for a few years to get a decent job market back
                                               
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                                              medM3phd

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                                                Hey guys, thanks for your input. I feel like I've gotten a pretty good picture of things for now. I'm still going to keep an open mind about specialties, but maybe I will schedule my DR elective first and give that strong consideration. (along with a similar post in the rads forum). Cheers
                                                 
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                                                deleted774703

                                                  Hey guys, thanks for your input. I feel like I've gotten a pretty good picture of things for now. I'm still going to keep an open mind about specialties, but maybe I will schedule my DR elective first and give that strong consideration. (along with a similar post in the rads forum). Cheers

                                                  Another medical student saved.

                                                  Great job gang!

                                                  Best of luck @medM3phd
                                                   

                                                  scarbrtj

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                                                    Hey guys, thanks for your input. I feel like I've gotten a pretty good picture of things for now. I'm still going to keep an open mind about specialties, but maybe I will schedule my DR elective first and give that strong consideration. (along with a similar post in the rads forum). Cheers
                                                    One of the top ITN videos from 2019:
                                                    Y90 Embolization of Liver Cancer at Henry Ford Hospital
                                                    "One of the biggest growth areas in interventional radiology has been a subspecialty called interventional oncology; that's minimally invasive treatment of cancers that can be anywhere in the body."
                                                     
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                                                    randomname2018

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                                                      I agree with others this far.

                                                      A different point though...I question the ability of chairs and PDs to appreciate your knowledge base AND to provide the necessary opportunities. There are maybe 5 programs that could support you reasonably well. I'd look elsewhere.
                                                       
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                                                      StIGMA

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                                                        Some successful people, at the time of interview and soon after (pre rank list), proactively network with a future mentor, may get verbal arrangements for protected research time (Holman) and research personnel support, or if not this much, at least a genuine verbal commitment to be supported on this career path combined with an actual plan to make it happen. A lot of the places that do this have a loosely defined long-term intention to hire , or at least offer, this person a job if they perform adequately. It is more than 5 programs that do this, but the numbers seem that low because very low numbers of "great candidates" that can be reliably identified this early in the process and linking them that early on with the right people, combined with a preference of these "great candidates" for the big 3 programs. Less than half of the PhD applicants fit this mold- numbers probably closer to 1 in 5 or so. If you don't realize it before applying, you figure it out when you either get all the research faculty + chair + PD tripping over themselves to try to recruit you, or not. Ask people at your own program where you stand, with the caveat that the next few years will be less competitive overall. See my post #6.
                                                         
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                                                        radiation

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                                                          Yeah, tbh it's starting to feel like it's a risk. I don't want to create uncertainty for my wife and kids futures because of a specialty choice.

                                                          Its an important point. Also salient to think about life changes/potential moves when applying to fellowships for med onc and diagnostic rads if you end up going to a different place than your residency. Taking overnight calls and working weekends during residency can also put strain on family time. Lot of factors to consider, but if you need geographic certainty rad onc is not ideal
                                                           
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