Another Attempt at Optimism

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radiatepositivity

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SDN is a powerful tool. Around 9 years ago when I was looking into specialities, I went to SDN compulsively to learn about RadOnc, and if I had what it took to match into this awesome field. A lot has happened since then. This forum was once filled with eager, bright-eyed medical students asking about away rotations, if they were competitive, and of their realistic chances of matching into this great field.

Now, this forum remains honest and compelling. But, if I was a medical student now reading SDN RadOnc, I would have steered clear from radiation oncology and have thought this field to be in free-fall.

Medical students, despite the strong feelings posted here, our field is huge and filled with so many people who believe the best in radiation oncology is yet to come. That shorter, targeted treatments are not the downfall of our field, but actually the best way forward for patients and our ability to integrate with newer systemic therapies. That all fields in medicine have challenges, and that compensation is critical, but that the doom and gloom presented here is not the absolute reality or the future.

I know that no matter what, this positive post will be torn apart, dissected, and I will ultimately be made to look out-of-touch, unrealistic and to be ignoring the real issues.

But, I am compelled to join SDN and write as despite the challenges presented in this forum in grave detail, knowing what I know from my years of residency training (which were grueling and at points demoralizing) and my time in practice, that despite these challenges, I would now be more eager than ever to match into radiation oncology.

Our impact on patients, the role we play in all aspects of treating cancer, the generous compensation we receive, and the huge potential for radiation oncology to continue to grow/evolve in the management of cancer is overwhelming and, in my opinion, the negative developments and challenges we face are absolutely dwarfed in comparison by all the good.

Be well,
N
 
radiatepositivity said:
Medical students, despite the strong feelings posted here, our field is huge and filled with so many people who believe the best in radiation oncology is yet to come
Click to expand...
Actually the field has been shrinking over the last many decades.
That said, how do you feel about the med student's chances for a rad onc job (or underemployment), and "generous compensation" (and trends thereof), are today versus back when you were a med student reading SDN? Equal? Worse? Better? The Cal Pacific residency program shut down a while back and those residents (outliers, sure) certainly might regret their choice(s). It would be really bad were that to be a trend. And re: all the great things about our specialty: I agree. On the other hand, if you were to look at what we as a field are focused and perseverating on, it's 1) giving less treatments, 2) avoiding XRT altogether, and 3) not being gung ho about actively over-prescribing the new "targeted" XRT therapies (protons e.g.). How would you contextualize all that for a med student? Thanks in advance.
 
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We all love the field and the work. That is not issue. 1000 residents committed to graduating in next 5 years is. No way that is going to work out no matter how much we all love the pts, technology, science.
 
Hard not to argue that radiation therapy is awesome. Impressive local control rates with a great toxicity profile. We get to spend actual time with our patients and guide them through both cure and end of life situations. Really an amazing field. For me personally i think these supervision changes may actually improve my work/life balance. For new residents coming in, however, I would be very cautious especially with an already anemic job market.
 
scarbrtj said:
Actually the field has been shrinking over the last many decades.
That said, how do you feel about the med student's chances for a rad onc job (or underemployment), and "generous compensation" (and trends thereof), are today versus back when you were a med student reading SDN? Equal? Worse? Better? The Cal Pacific residency program shut down a while back and those residents (outliers, sure) certainly might regret their choice(s). It would be really bad were that to be a trend. And re: all the great things about our specialty: I agree. On the other hand, if you were to look at what we as a field are focused and perseverating on, it's 1) giving less treatments, 2) avoiding XRT altogether, and 3) not being gung ho about actively over-prescribing the new "targeted" XRT therapies (protons e.g.). How would you contextualize all that for a med student? Thanks in advance.
Click to expand...

I keep on beating this drum, but I do think SBRT for oligomets will help with some of the reduction in indications for XRT, along with the aging of the Boomers. Should help things more or less even out when it comes to demand.

Edit: I have to admit I don't like all this "optimism" cheerleading stuff. We've had people be optimistic in other posts as a response, which is fine. This board is supposed to try to get to the truth of things, and stating you want a particular thread to be "optimistic" is essentially saying you don't want anyone to be able to post counter-narratives to what you're saying. It's not really what SDN is about.
 
As a resident, I want to be optimistic, I want rad onc to be a great field. I want to have a decent job after graduating. I agree with the OP, but what changes are being made to solve this issue of residency expansion/oversupply? I feel like this has been known for the past 5 years but ONLY now after last year's match are people in positions of power realizing this. These same people are talking about changes will be made.....but what changes? I haven't heard a single action plan that will change our current trajectory. What's going to stop those unfilled spots being taken by IMGs/FMGs/DOs/rejects of other fields?

Until there is a plan to change this, how can we be optimistic? All we have right now is talk. And some individuals have the audacity to claim that there isn't an oversupply problem which is sickening.
 
I don't understand these posts. There are ZERO people saying that the job of a radiation oncologist isn't the best job in the world. Let's be clear and separate that.

That's not the issue: the job market is.
 
Th OP implies that there are radonc haters here, which has never been true. We all love the practice. But, unfortunately, doesnt matter how wonderful the field is if you cant find a job or forced into an exploitative one.
In term of optimism, I am in total agreement with the OP that my engagement with patients, technology, science will continue to be satisfying over the next 10-15 years and that I will always love my job. I have no problem radiating my love for the practice of this specialty.
 
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RickyScott said:
Th OP implies that there are radonc haters here, which has never been true. We all love the practice. But, unfortunately, doesnt matter how wonderful the field is if you cant find a job or forced into an exploitative one.
In term of optimism, I am in total agreement with the OP that my engagement with patients, technology, science will continue to be satisfying over the next 10-15 years and that I will always love my job. I have no problem radiating my love for the practice of this specialty.
Click to expand...
Went in to work today with a 95% happiness level. Because I have a coveted full-spectrum pp job with an extensively developed referral network over the last several years.

Love my job. Would not love to be looking for a job in 2020
 
Sigh. This is exhausting. Multiple threads about a similar topic are allowed.

I mostly agree with OP that at the current time. The issues of the job market are the critical factor for medical students picking Rad Onc. Almost everything else about it is awesome. I'll leave it at that. I appreciate those who are actively taking steps to counteract this (MDACC contracting, Sushil Beriwal saying he won't take anybody who doesn't have clinical experience in Rad Onc or a LoR from a rad onc in the SOAP), but IMO these steps are not moving the needle sufficiently.
 
I'm not sure if I have ever seen anybody on SDN post anything negative about the actual practice of radiation oncology. Now that I think about it, I'm not sure if I have ever met anybody who didn't think it was incredible. So much so, that I would tell any and all interested medical students to go into radiation oncology even if they knew compensation would be 25-50% of what it is now when they graduate 8-10 years from now. The issue isn't salary of $500,000 or $250,000 or even $200,000 to literally oftentimes cure cancer and when that's not the case provide palliation using technology that is so cool that sometimes I don't even believe it . . . it's whether they will actually be able to practice and the salary will be $0 because one simply can't find a job (or at least one that works within whatever geographic restrictions one may have).

PS: I'm just a simple backwoods country radiation oncologist and I don't have too many contacts with other radiation oncologists, but I can tell you for a fact that 3 of 4 radiation oncology friends I have spoken with in the past few days have gone from actively recruiting (or trying to do so . . . it's very difficult to get a young radiation oncologist to come, let alone the spouse and family) or preparing to do so to totally scraping those plans with the new supervision requirement. The fourth doesn't plan on ever hiring a locums again. Literally the most difficult part of running our practices is finding coverage/staffing rural sites and now that we don't have to do that our job satisfaction instantly improve, as did our compensation, and it's better for society and patients (but obviously not those looking for jobs).

Just in my little niche (which quite honestly was never appealing to graduates and very much not representative of the entire country since everybody I noted above works in "rural undesirable" practices) but that's 3 less jobs in the next year or two. . .
 
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