Aiming to end up as a rad onc in CA

[ohrly]

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Hi,

I am a post-MS1 pretty strongly interested in radonc. Unfortunately, given the small and competitive nature of the field, this seems to conflict with my (possibly) even stronger preference to do residency and eventually practice in my home state of California. Everything I've read and heard from current attendings is that it's difficult to impossible to practice in a specific geographical area, especially one as desirable as the west coast

I think I can likely be a (fairly to very) competitive radonc applicant but am rethinking whether this will be the best path for me.

1) What are some steps I can take to maximize my residency chances at cali institutions?
2) Is it even a feasible goal to shoot for radonc residency in California? Or should I consider switching into a different specialty if being in CA is the most important to me?

EDIT: probably relevant, did undergrad and now doing medical school on the east coast

 

[deleted4401]

Do you have to spend every part of your life there?
If not, I think you can eventually get back. You must be at a CA school already, because it sounds like you have a very deep attachment to the state. That's a good start. I would say you're more likely to match at a regional institution if you so desire. Job stuff is based on needs of practices.
I'm not you, so I can't say I understand you, but the idea that where you live dictates the 30-40 year trajectory of your career seems short sighted. If you are 35 and have an ex with kids that lives in CA and won't move, I understand. If you're 23 and unmarried, I sort of question things. I understand loving where you live, but choosing a different specialty based on location seems misguided. I'm not aiming to insult or belittle you, but I hope you have a good reason other than sunshine, laid back lifestyle, and good produce to make a decision on your career. If you're already worried about this, don't do it - you'll blame this great field on your inability to reside in CA.

 

[Tanner]

Which one are you more strongly interested in: to live in California or to be a rad onc? If it is location, I recommend a back up, just in case from a practicality point of view. But I agree with Simul, I think professional gratification is more important than location.

 

[GorillaPanic]

I find this topic interesting. Can someone explain why it's so hard to find a rad onc gig in CA? It seems to me that this is said about EVERY specialty. Is it more pronounced for radonc?

I ask because I, too, am from CA and would like to return there to practice.

 

[medgator]

I find this topic interesting. Can someone explain why it's so hard to find a rad onc gig in CA? It seems to me that this is said about EVERY specialty. Is it more pronounced for radonc?

I ask because I, too, am from CA and would like to return there to practice.

Probably true in many specialties. Good weather, desirable cities etc. Depending on the salary and work conditions you are willing to accept, you probably can find a job in any location.

There are three aspects in finding a good job: location, salary and the quality of the job itself. Often you'll have to take a hit in one or two of those to help out the others

 

[GorillaPanic]

The population in California is huge, though... With all these aging baby boomers, how is the market oversaturated? Especially with all these docs supposedly retiring when the ACA takes full effect.

 

[eklope2000]

the idea that where you live dictates the 30-40 year trajectory of your career seems short sighted. If you are 35 and have an ex with kids that lives in CA and won't move, I understand. If you're 23 and unmarried, I sort of question things. I understand loving where you live, but choosing a different specialty based on location seems misguided.

I would like to offer a counterpoint: that it may be equally short-sighted to prioritize practicing one particular type of medicine, among many options, while ignoring other important considerations about your life.

True, the original poster may want to keep a more open mind about possibilities in his or her life. Things change all the time and you may not even want to live anywhere in CA someday.

But don't deny that radonc like every other specialty has disadvantages in addition to advantages. The high desirability and competitiveness of the specialty can at times cloud one's judgement over possible drawbacks to a field that everyone seems so eager to match into. And one of those drawbacks might be that there is less job flexibility in rad onc than in some other specialties. Those in all the primary care fields as well as probably many general specialists in medical and surgical fields will have more choices about where they practice, and more choices about picking up and going elsewhere when life circumstances change.

 

[Gfunk6]

1) What are some steps I can take to maximize my residency chances at cali institutions?

a) Rotate through one or more Rad Onc residency programs in CA as an MS4. I would rotate through one 'larger' program and one 'smaller' one to cover your bases.
b) Try to develop professional connections with Rad Onc attendings either through research (challenging since you are on the east coast) or clinically (when you rotate)
c) It helps if you have some time of 'family' connection to CA as it can help convince people ranking you for residency that you are serious about moving there

2) Is it even a feasible goal to shoot for radonc residency in California? Or should I consider switching into a different specialty if being in CA is the most important to me?

I will define feasible for you:

Possible to do easily or conveniently

By that definition it is certainly feasible to 'shoot' for a Rad Onc residency in CA but it is not feasible to assume that you will get one with any high degree of probability.

Like most things in life, getting into a Rad Onc residency in a specific place is not a strictly meritocratic process. Sure you have to have decent board scores, grades, evaluations, pedigree, research, etc. But there will always be that 'X' factor. Usually it is that you made a great impression on someone who matters.

If going to CA is most important to you, then have a back up.

 

[ohrly]

Hi all, thanks for the helpful responses.

I agree that life situations can change quickly, and by the time I reach the residency application stage I may not have such a strong geographical preference. In that case, great, I won't have this issue to worry about. However, I can envision a plausible or probable scenario in which being in CA is my foremost priority, so I would like to be prepared for that contingency.

A couple of followup questions:
1) Gfunk you say to "have a backup". What does that mean? Does that mean applying to a different specialty if my application isn't strong enough? Or does it mean applying to radonc and a secondary specialty, then ranking the CA locations highest? Giving up on radonc? Or something else?
2) If I took a research year at a CA institution, would this help (maybe with forming connections)?

Thanks

 

[Gfunk6]

By 'backup' I mainly meant applying to Rad Onc as your primary specialty and having another field as your back-up in case you don't match.

Research year might help. However, Rad Onc residency in Cali is still a crapshoot. I know multiple med students who did a research year in CA who matched well, but not in CA.

 

[HoboCommander]

What about if you want to go into a medium competitive specialty in California like emergency medicine or general surgery? How difficult is that?

 

[Gfunk6]

What about if you want to go into a medium competitive specialty in California like emergency medicine or general surgery? How difficult is that?

Ask in the appropriate specialty forum.

 

[Sheldor]

As a recent applicant and native of California I just wanted to share my experience/thoughts:

I was a competitive applicant, not the most competitive by far, but solid with a few invites in the SDN top 10, and many just outside of that. I was born in California, did college in california, and all my family is still there. I did not, however, go to medical school in California. I also chose not to do aways there, for two reasons: One, I didn't really want to go back (more on that in a second) and I figure that birth and college were enough ties to the state.

The results: I ended up with 4 interview invites in CA, and I went to two of them. These were not the big dogs in CA, but the middle. So all of this to say, that I could have easily had numbers 1-4 of my rank list be CA schools, giving me a quasi high probability of matching there. Mind you, this was with no effort to make myself more attractive to CA institutions.

Before I offer my advice on how to match in CA, let me first offer life advice: California, while a great state, is not the wonderland that native californians believe it to be. There are too many reasons to list, but just understand that if you need to live in Oregon, Washington, Nevada, New Mexico, Idaho, or Utah your life will not be vastly changed, or ruined. I promise. So much so, that my wife and I have no intention of moving back to CA ever, because we realized the rest of the country is beautiful, and there are other oceans/mountains/desserts what have you to satifisy our desires.

Advice: If you can do all the other stuff to make yourself competitive: AOA, 250+, at least a few first author publications that are rad onc related, the people who I saw be successful in CA went all in and did multiple aways in the state. I'd do two aways in CA, and one away somewhere else you'd be happy. If you do the aways and are that kind of applicant, you will likely get at least as many interviews as I did if not more, and if you can stack the top 5 or 6 spots on your rank list with california institutions you can likely fulfill your goal of getting back to CA. That said, you may not end up not at UCSF or Stanford, but you will be in CA and enjoy the cost of living mark up for 4 years 🙂

Best of luck, and honestly, Rad Onc is an amazing field so I'd think really really really hard before giving it up for geography during residency and the first few years after.

 

[deleted4401]

I'd also like to say I don't know your situation personally, but home is important to many of us and location is important to many of us. My point wasn't to say that CA isn't worthwhile. In reality, if my parents and family weren't out east, I'd pay the sunshine tax and love out there. However, we spend 40-50 hrs a week, 40-45 weeks a year doing what we do. My boss always tells me that (in the context of why we need to like who we work with). In the same vein, I think you can get back to CA, but don't jeopardize a great medical career in a great specialty for immediate gratification of location. I wholeheartedly believe rad onc is the pinnacle of medicine, and so a few years in exile a worthwhile. A job will open up, a practice will need someone, but once you do radiology or EM or gas, the door is closed to change fields (if not theoretically, then practically). That's what I really meant. Pick the job you like and life will work it's way around it. I'm certain of it. I met no doctor that said, "I should have picked a different field so I could have lived somewhere else," but I have met many that have said "I wish I picked a different field".