Any PGY-5s unable to find a job by this point?

[Radonky]

I won't get too specific here, but I can also corroborate negative changes being enacted to graduating resident contracts at MDA (from real life, non-SDN sources).

Although to be clear, I believe this is COVID related and not necessarily oversupply related.

Also, without being too specific, can confirm the above.

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[w00tz]

Well that sucks. COVID sucks. Ruined their clinical boards, probably their graduation and it sounds like the start on their new job. With so many rad oncs at MDA, if everyone took a temporary 2-3% pay cut pre-tax, it could really help subsidize the majority of two new attendings salary and probably would not even be noticed. Probably a bit more than the cost of TMC parking. I'm sure it's way more complicated than that though.

 

[RADONC4285]

Well that sucks. COVID sucks. Ruined their clinical boards, probably their graduation and it sounds like the start on their new job. With so many rad oncs at MDA, if everyone took a temporary 2-3% pay cut pre-tax, it could really help subsidize the majority of two new attendings salary and probably would not even be noticed. Probably a bit more than the cost of TMC parking. I'm sure it's way more complicated than that though.

Probably more like a 5% cut, but your point is well taken. I think it's as simple as that. I know with 100% certainty of two new grads whose contracts were put on hold by the administration of one of the biggest health systems in the country. The rad onc chairman then told the administration one of the senior attendings is retiring in a couple months and his salary would be more than enough to cover the two incoming attendings. Both contracts were honored after that. It's all about the bottom line for corporate america.

 

[Haybrant]

Can also verify this with 100% certainty

Heard also; 1 year deferral is what is stated. Tough situation to be in

 

[w00tz]

Probably more like a 5% cut, but your point is well taken. I think it's as simple as that. I know with 100% certainty of two new grads whose contracts were put on hold by the administration of one of the biggest health systems in the country. The rad onc chairman then told the administration one of the senior attendings is retiring in a couple months and his salary would be more than enough to cover the two incoming attendings. Both contracts were honored after that. It's all about the bottom line for corporate america.

Boomer comes to save the day. That's really awesome.

 

[scarbrtj]

Probably more like a 5% cut, but your point is well taken. I think it's as simple as that. I know with 100% certainty of two new grads whose contracts were put on hold by the administration of one of the biggest health systems in the country. The rad onc chairman then told the administration one of the senior attendings is retiring in a couple months and his salary would be more than enough to cover the two incoming attendings. Both contracts were honored after that. It's all about the bottom line for corporate america.

Seems people have glossed over:
[R] ≫ [A + B]
where

R = salary of retiring fullboomer
A = salary of newly hired physician #1
B = salary of newly hired physician #2

Lemme just say that 1) a greater than two-fold difference in salaries even if it's just because you're new is awful, and 2) it is hard to double your salary in your career even if you look at year 1 or, like, year 10 of your career. And A or B needs to double (or more?) to reach R.

 

[RickyScott]

thinking the same thing. This speaks to elasticity of job market. Radiation is not completely inelastic and with falling salaries, some of the large departments tempted to hire 2 for the price of one (and we know that there will be very little promotion and significant salary raised over the next 10 years). This is why we arent seeing dramatic uptick in frank unemployment up until now, although we probably will soon.
Unfortunately, as a one trick pony, this is the only type of elasticity that we have. ER can work in urgent care clinics, cardiologists can do some primary care etc.

 

[GapCalc]

In other news, heard through the grapevine MDA pulled two contracts for current PGY-5s.

I heard it was significantly more than 2 positions. Deferred due to COVID but duration of deferral is a big question mark. I feel badly for these new colleagues of ours. What a terrible and difficult way to start your first year in practice!

 

[medgator]

Can also verify this with 100% certainty

Heard also; 1 year deferral is what is stated. Tough situation to be in

Have not heard that a specific date was given, just that it would be reevaluated in Sept. Essentially these folks are being strung along until then.

The real bombshell is that I've heard it actually involves a total of 7 contracts. To make it clear, they haven't technically been revoked, not sure what a contract is worth without a definitive start date?

 

[RADONC4285]

Seems people have glossed over:
[R] ≫ [A + B]
where

R = salary of retiring fullboomer
A = salary of newly hired physician #1
B = salary of newly hired physician #2

Lemme just say that 1) a greater than two-fold difference in salaries even if it's just because you're new is awful, and 2) it is hard to double your salary in your career even if you look at year 1 or, like, year 10 of your career. And A or B needs to double (or more?) to reach R.

It is awful to have that kind of discrepancy, but it's true. 10 year track to increase your salary by 2.2

 

[thecarbonionangle]

The “anderson way”, folks! Voila! C’est magnifique!

 

[RickyScott]

The “anderson way”, folks! Voila! C’est magnifique!

probably why ben smith was so quick on twitter to speak out against residency expansion the other day. BTW he is a coauthor on some of the work from Harvard that has been warning about the consequences of expansion:

The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation
Benjamin P Falit 1, Hubert Y Pan 2, Benjamin D Smith 2, Brian M Alexander 3, Anthony L Zietman 4
Affiliations expand 2016

• PMID: 27681745
• DOI: 10.1016/j.ijrobp.2016.05.029

Abstract
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors, and entrenched professional groups. Policymakers must recognize that the number of practicing radiation oncologists is a poor surrogate for clinical capacity. There is likely to be significant opportunity to augment capacity without increasing the number of radiation oncologists by improving clinic efficiency and offering targeted incentives for geographic redistribution. Payment policy changes significantly threaten radiation oncologists' income, which may encourage physicians to care for greater patient loads, thereby obviating more personnel. Furthermore, the implementation of alternative payment models such as Medicare's Oncology Care Model threatens to decrease both the utilization and price of radiation therapy by turning referring providers into cost-conscious consumers. Medicare funds the vast majority of graduate medical education, but the extent to which the expansion in radiation oncology residency slots has been externally funded is unclear. Excess physician capacity carries a significant risk of harm to society by suboptimally allocating intellectual resources and creating comparative shortages in other, more needed disciplines. There are practical concerns associated with a market-based solution in which medical students self-regulate according to job availability, but antitrust law would likely forbid collaborative self-regulation that purports to restrict supply. Because Congress is unlikely to create one central body to govern residency controls for all specialties, we recommend better reporting of program-specific employment metrics and careful, intellectually honest re-evaluation of existing Accreditation Council for Graduate Medical Education accreditation standards.

 

[OTN]

probably why ben smith was so quick on twitter to speak out against residency expansion the other day. BTW he is a coauthor on some of the work from Harvard that has been warning about the consequences of expansion:

The Radiation Oncology Job Market: The Economics and Policy of Workforce Regulation
Benjamin P Falit 1, Hubert Y Pan 2, Benjamin D Smith 2, Brian M Alexander 3, Anthony L Zietman 4
Affiliations expand 2016

• PMID: 27681745
• DOI: 10.1016/j.ijrobp.2016.05.029

Abstract
Examinations of the US radiation oncology workforce offer inconsistent conclusions, but recent data raise significant concerns about an oversupply of physicians. Despite these concerns, residency slots continue to expand at an unprecedented pace. Employed radiation oncologists and professional corporations with weak contracts or loose ties to hospital administrators would be expected to suffer the greatest harm from an oversupply. The reduced cost of labor, however, would be expected to increase profitability for equipment owners, technology vendors, and entrenched professional groups. Policymakers must recognize that the number of practicing radiation oncologists is a poor surrogate for clinical capacity. There is likely to be significant opportunity to augment capacity without increasing the number of radiation oncologists by improving clinic efficiency and offering targeted incentives for geographic redistribution. Payment policy changes significantly threaten radiation oncologists' income, which may encourage physicians to care for greater patient loads, thereby obviating more personnel. Furthermore, the implementation of alternative payment models such as Medicare's Oncology Care Model threatens to decrease both the utilization and price of radiation therapy by turning referring providers into cost-conscious consumers. Medicare funds the vast majority of graduate medical education, but the extent to which the expansion in radiation oncology residency slots has been externally funded is unclear. Excess physician capacity carries a significant risk of harm to society by suboptimally allocating intellectual resources and creating comparative shortages in other, more needed disciplines. There are practical concerns associated with a market-based solution in which medical students self-regulate according to job availability, but antitrust law would likely forbid collaborative self-regulation that purports to restrict supply. Because Congress is unlikely to create one central body to govern residency controls for all specialties, we recommend better reporting of program-specific employment metrics and careful, intellectually honest re-evaluation of existing Accreditation Council for Graduate Medical Education accreditation standards.

Hard to take Ben Smith seriously when he predicted an undersupply of radoncs just a few years prior.

 

[frijoles]

I work for a hospital-based practice and a freeze on hiring has been put in place for the entire medical group. However, existing contracts will be honored, so this will not be affecting our new hire this year. Shocking that MDA would defer hires...

 

[RickyScott]

I work for a hospital-based practice and a freeze on hiring has been put in place for the entire medical group. However, existing contracts will be honored, so this will not be affecting our new hire this year. Shocking that MDA would defer hires...

just a guess, but 1) would think many pts less likely to travel for care in the covid era. 2) places like MDACC and mayo which for years have been price gouging and cant keep much of that excess money in the bank due to nonprofit status, have plowed much of it over the years into totally inflated administrative and support staff (and large buildings with lots of upkeep expenses) who they dont want to completely lay off.

 

[RadOncMegatron]

Have not heard that a specific date was given, just that it would be reevaluated in Sept. Essentially these folks are being strung along until then.

The real bombshell is that I've heard it actually involves a total of 7 contracts. To make it clear, they haven't technically been revoked, not sure what a contract is worth without a definitive start date?

IF true WOW .. Looks like even the "elite residents" are not guaranteed a job. As we said many times before, if you make a fragile system liable to blow up (like 100% stock portfolio with 50% emerging market funds) then don't be surprised when it blows! The analogy here is that the ones who made the fragility are not the ones who are taking on the risk. Forget collecting data for a study... the collective anger will be enough. How many programs will be upfront about things like this?

 

[RickyScott]

As we said many times before, if you make a fragile system liable to blow up (like 100% stock portfolio with 50% emerging market funds) then don't be surprised when it blows! The analogy here is that the ones who made the fragility are not the ones who are taking on the risk.

This has what Taleb has been saying in antifragile and black swan and skin in the game.
Also wanted to post another emerging issue he has cited which is prevalent in our field ie. where is the data that doubling residents could affect the job market?

 

[yesmaster]

The folks who suggested 2019-2020 job market better-than-ever because MDA offered 12 jobs this application cycle, may want to reassess now that MDA delaying start date for 2 to 7 of those jobs.

Lesson is that rad onc job market will be better-than-ever, just need to play waiting game. Patience!

 

[OTN]

This has what Taleb has been saying in antifragile and black swan and skin in the game.
Also wanted to post another emerging issue he has cited which is prevalent in our field ie. where is the data that doubling residents could affect the job market?

The entire field of economics should provide plenty of data that supply and demand are a real thing.

 

[thecarbonionangle]

“The best job markets are yet to come”

 

[deleted941485]

“The best job markets are yet to come”

For the employer maybe certainly not the employee.

 

[Chartreuse Wombat]

For the employer maybe certainly not the employee.

I think the post was intended to be ironic. Of course i don't know, maybe the ion man is an Academic Department Chair eager to create lots of cheap labor.

 

[Lamount]

Have not heard that a specific date was given, just that it would be reevaluated in Sept. Essentially these folks are being strung along until then.

The real bombshell is that I've heard it actually involves a total of 7 contracts. To make it clear, they haven't technically been revoked, not sure what a contract is worth without a definitive start date?

That’s crazy. Also kinda crazy that they were hiring 7 in one year.

 

[Mandelin Rain]

The folks who suggested 2019-2020 job market better-than-ever because MDA offered 12 jobs this application cycle, may want to reassess now that MDA delaying start date for 2 to 7 of those jobs.

Lesson is that rad onc job market will be better-than-ever, just need to play waiting game. Patience!

Decent cautionary tale for prospective job hunters. It's always nice to be needed. If 7 of 12 jobs were so superfluous that they could be delayed indefinitely, you are probably already starting in a bad spot.

 

[RadOncDoc21]

The “anderson way”, folks! Voila! C’est magnifique!

I wish I was crafty enough to make a sign of the word “job” and cross it out.

 

[thecarbonionangle]

I think the post was intended to be ironic. Of course i don't know, maybe the ion man is an Academic Department Chair eager to create lots of cheap labor.

Many people are saying it! You may be onto something wombat, follow that scent!!