Applying to Radiation Oncology as a DO

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lalalaland1234

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I have started looking into the field of radiation oncology recently and I have a couple of questions.

(1) What is the match rate is for DOs applying to Rad Onc? It does not seem like DOs even apply to this field based on recent match data but I assume it is close to 100% like the US MD match rate
(2) what are the best programs that DOs can expect to match at if they apply for radiation oncology? Is there glass ceiling in Rad Onc for DOs like there is in other specialties
(3) I have seen a lot posts on this forum stating that it is not a good idea to attend a program outside of the top 15-20 how realistic would it be for a DO with very mediocre grades to get a reputable (top 10-20) residency in Rad Onc?
(4) Is the job market really as horrible as everyone on here makes it out to be? It is shocking to believe that there are almost no jobs available for new grads in medical specialty that deals with cancer and was one of the most insanely competitive specialties just 5-10 years ago

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Sounds like you could use the search function and read the forums quite a bit.

With the highest number of unfilled slots for multiple years now, any US grad with a pulse and clean felony record should be able to match

 
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Haven't seen the match list for the top 20 programs, would be surprised though if the makeup hasn't changed compared to a decade ago
I'm sure it's changed. But a do with very mediocre grades who can't find the do match rate as a whole is still likely out of the top 20.
 
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I have started looking into the field of radiation oncology recently and I have a couple of questions.

(1) What is the match rate is for DOs applying to Rad Onc? It does not seem like DOs even apply to this field based on recent match data but I assume it is close to 100% like the US MD match rate
(2) what are the best programs that DOs can expect to match at if they apply for radiation oncology? Is there glass ceiling in Rad Onc for DOs like there is in other specialties
(3) I have seen a lot posts on this forum stating that it is not a good idea to attend a program outside of the top 15-20 how realistic would it be for a DO with very mediocre grades to get a reputable (top 10-20) residency in Rad Onc?
(4) Is the job market really as horrible as everyone on here makes it out to be? It is shocking to believe that there are almost no jobs available for new grads in medical specialty that deals with cancer and was one of the most insanely competitive specialties just 5-10 years ago

Are you a DO with a criminal record?

If not, you'll break through that glass ceiling higher than Charlie and Willy Wonka ever could
 
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Are you a DO with a criminal record?

If not, you'll break through that glass ceiling higher than Charlie and Willy Wonka ever could
If you do have a criminal record, you may have an issue matching in the top 10
 
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One way you can tell things have changed in our field: the "what are my chances" posts.

Before: Top 20 MD, Step 1 >250, 13 publications, 3 away rotations, knows the PD at home program, solid letters of rec... "Do you think I'll match anywhere?"
Now: Incapable of using Google or reading Charting Outcomes... "am I top 20 material?"
 
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1. 100%
2. no ceiling
3. realistic
4. The job market has improved somewhat, but the vast majority of the jobs are not jobs in which I would be interested.
 
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Top 25 programs has more spots than all US MD applicants combined, so there is room for do and fmgs. Will that go to mediocre dos, I dont know, but you will have a spot somewhere. Just dont see why you would take an existential risk with your career as opposed to going into IM and working hard and trying for medonc.

Put it this way, some of the bottom programs have been trying to recruit Herschel Walker in case he doesnt win the senate
 
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Top 25 programs has more spots than all US MD applicants combined, so there is room for do and fmgs. Will that go to mediocre dos, I dont know, but you will have a spot somewhere. Just dont see why you would take an existential risk with your career as opposed to going into IM and working hard and trying for medonc.

Put it this way, some of the bottom programs have been trying to recruit Herschel Walker in case he doesnt win the senate
Unfortunately, I don't think he'll be joining our ranks
 
People are saying Herschel Walker has been pre-emptively granted a lifetime ABR certification.


1666281147794.png
 
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Rad Onc historically is an incredibly snobby specialty prejudiced against DOs. There was a point of peak ridiculousness where even MD was looked down upon in favor of MD PhD in and of itself as a status marker regardless of academic motivations. DO was almost unheard of until recently and even still there seems to be a preference towards FMGs with MD initials instead.

You can go to every program's website and look at current residents. You will find lots of FMGs, career changers, and a few DOs filling PGY-2 spots.
Getting a spot is not a problem. The competitive name programs will be out of reach for you, but there are a few malignant ones with good names that have always had trouble recruiting. FMGs are there now. Maybe they will take a DO.

The field is actively attracting less motivated med students primarily interested in avoiding call/nights/weekends. In the past at least the field was recruiting people interested in both the nature of what we do as well as the lifestyle given the immense amount of self-selection and outside work as a med student to demonstrate interest and match.

I would imagine it would be difficult to find work outside of a hospital corporation (the worst place to work) in a less desirable area with a DO entering the field during a time when it is common knowledge that nobody else was applying.

Pursuing an IM residency would open many more doors for you. It will be more work and a far less chill residency.
 
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Throw out a bobber and apply to 15-20 programs.

I would agree that if you are not in top program, will be a little harder to find something, but not impossible.
The jobs available are fine. Generally high floor, low ceiling, limited mobility and dependent on hospital's largesse.

Less biased against, these days. I see a lot more DOs in specialists in MI and WA (last few places I've worked).

Jobs analysis in Red Journal today is not good news.
 
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I will tell you that if you can predict the future, you belong in a different profession altogether.

When I started, there was this packet (I have it somewhere) with a yellow coversheet. The whole thing (circa 1996) was about how RO was doomed.. doomed I say. This author was the guy who published "the end is near" in the red journal type stuff.. kinda like what we are seeing now.

Well, I bought in low and lets just say it could not have been at a better time. From 2004 onward it was gold.. Jerry... GOLD !

That said.. if you're going to a bottom tier training program, and expecting to find work, you're going to have to be prepared for a long winter. Also, you'll have to accept working in places you would otherwise not consider.. heck thats true even for good rad oncs.. who want to make serious coin.

Most importantly, learning RO is not easy. There is a huge amount of book and practical knowledge... so if you are not seriously into whats ahead.. don't do it...
 
Harder than what?

We get 4 years to learn something that can be learned in 3 years.

The certification exams are terrible. But the content is simply not harder than, for example, intensive care medicine.

(Clearly, this is subjective and an opinion)
 
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Honestly you could commit a misdemeanor and still be A OK.

Screw it even if it was a crime, just tell them you were wrongly convicted they’ll buy it

I sincerely hope you aren’t considering doing any actual research in RO or even a clinical rotation in it. Consider diminishing margin returns here…expressing an interest Is literally 100% of what is needed. All other efforts have a 0% return.
 
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Honestly you could commit a misdemeanor and still be A OK.

Screw it even if it was a crime, just tell them you were wrongly convicted they’ll buy it

I sincerely hope you aren’t considering doing any actual research in RO or even a clinical rotation in it. Consider diminishing margin returns here…expressing an interest Is literally 100% of what is needed. All other efforts have a 0% return.
This is a specialty that failed almost half of people who took boards and told them they were not trained to practice with minimal competence, a cohort who previously scored top 10% on their USMLE exams and probably every standardized exam they have ever taken. Go ahead and give that same board exam to people who couldn't get in US med schools and failed USMLE and couldn't match OB-gyn. Clownshow.
 
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This is a specialty that failed almost half of people who took boards and told them they were not trained to practice with minimal competence, a cohort who previously scored top 10% on their USMLE exams and probably every standardized exam they have ever taken. Go ahead and give that same board exam to people who couldn't get in US med schools and failed USMLE and couldn't match OB-gyn. Clownshow.
Totally.

That would be fun to watch, actually. The ABR is such a dismal certification board.
 
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Harder than what?

We get 4 years to learn something that can be learned in 3 years.

The certification exams are terrible. But the content is simply not harder than, for example, intensive care medicine.

(Clearly, this is subjective and an opinion)

I don't think it's "harder" but there is a high risk to have a bad time compared to other specialties.

As an exception, I do think PGY2 year is objectively "harder" than many other types of PGY2 year, only because you go from internship to acting like a fellow in an apprenticeship model overnight. There is a lot of highly technical information that may also be weird and/or unnecessarily confusing. Oncology is emotionally challenging and requires some maturity compared to some other fields with a lot less face to face patient contact. You may have only 0 or 1 or 2 "peers" to struggle together. And unfortunately there are a lot of toxic people working in academic departments it seems (based on my experience at a few centers).
 
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I don't think it's "harder" but there is a high risk to have a bad time compared to other specialties.

As an exception, I do think PGY2 year is objectively "harder" than many other types of PGY2 year, only because you go from internship to acting like a fellow in an apprenticeship model overnight. There is a lot of highly technical information that may also be weird and/or unnecessarily confusing. Oncology is emotionally challenging and requires some maturity compared to some other fields with a lot less face to face patient contact. You may have only 0 or 1 or 2 "peers" to struggle together. And unfortunately there are a lot of toxic people working in academic departments it seems (based on my experience at a few centers).
Agree with this.

But, as far as content... learn the cancers. Learn how to treat them by stage. Learn systematically the target volumes. Learn how to manage side effects. Know that you can phone a friend/email/ask questions. It is a specialty that is tailor made for crowdsourced learning/teaching.

I just don't think it's comparable to being a doc in the unit or trauma surgery or something.

I don't subscribe that all specialties are equally challenging. Yes, some may be. But some are just easier. Dermatology may be better paid that many other fields, but being a good general derm is not as hard as being a good nephrologist. Doesn't make one specialty better than the other, and doesn't make the person better than the other person. I think people have a hard time separating their medical identity from the rest of their sense of self.

(again, just subjective opinions from random internet guy, not a knock on any field)
 
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Agree with this.

But, as far as content... learn the cancers. Learn how to treat them by stage. Learn systematically the target volumes. Learn how to manage side effects. Know that you can phone a friend/email/ask questions. It is a specialty that is tailor made for crowdsourced learning/teaching.

I just don't think it's comparable to being a doc in the unit or trauma surgery or something.

I don't subscribe that all specialties are equally challenging. Yes, some may be. But some are just easier. Dermatology may be better paid that many other fields, but being a good general derm is not as hard as being a good nephrologist. Doesn't make one specialty better than the other, and doesn't make the person better than the other person. I think people have a hard time separating their medical identity from the rest of their sense of self.

(again, just subjective opinions from random internet guy, not a knock on any field)

What I’ve learned is that difficulty and prestige and pay in medicine is largely arbitrary. I refused to believe it for the longest time.
 
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Agree with this.

But, as far as content... learn the cancers. Learn how to treat them by stage. Learn systematically the target volumes. Learn how to manage side effects. Know that you can phone a friend/email/ask questions. It is a specialty that is tailor made for crowdsourced learning/teaching.

I just don't think it's comparable to being a doc in the unit or trauma surgery or something.

I don't subscribe that all specialties are equally challenging. Yes, some may be. But some are just easier. Dermatology may be better paid that many other fields, but being a good general derm is not as hard as being a good nephrologist. Doesn't make one specialty better than the other, and doesn't make the person better than the other person. I think people have a hard time separating their medical identity from the rest of their sense of self.

(again, just subjective opinions from random internet guy, not a knock on any field)
I think you can function quite well as a radonc with a below average iq. I doubt this is the case for nephrology or ID
 
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What I’ve learned is that difficulty and prestige and pay in medicine is largely arbitrary. I refused to believe it for the longest time.

Agree. It is probably related to supply/demand though...

I think you can function quite well as a radonc with a below average iq. I doubt this is the case for nephrology or ID

The path to even getting in to medical school is ridiculous. I think any MD has the intelligence and ability to learn to do any job, it's just whether the job aligns with strengths, weaknesses, and preferences.

I've actually interfaced with two bad nephrologists in my life where I was a caregiver. One was a total academic dinosaur, guy would've crushed in Rad Onc. I could envision him, say, failing an entire class's board exams because reasons. The other was deer in headlights when I was trying to have him help me synthesize the data and would've been a horrible rad onc.
 
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I can’t find the link right now but a well known academic rad onc department was “busted” for keeping an older rad onc on faculty years after a mentally debilitating stroke
 
As an exception, I do think PGY2 year is objectively "harder" than many other types of PGY2 year, only because you go from internship to acting like a fellow in an apprenticeship model overnight. There is a lot of highly technical information that may also be weird and/or unnecessarily confusing. Oncology is emotionally challenging and requires some maturity compared to some other fields with a lot less face to face patient contact. You may have only 0 or 1 or 2 "peers" to struggle together. And unfortunately there are a lot of toxic people working in academic departments it seems (based on my experience at a few centers).
Wow, this is a perfect summary of something I have been struggling to conceptualize for myself.

Personally, I felt PGY2 was just absolutely brutal. Way harder than intern year. Now, at the other end, after board certification and independent practice...I think a lot of RadOnc is quite silly.

Most patients come to us already packaged. If they don't, well, there's an app for that.

Treatment planning can still be tricky, but not the way I anticipated. Some people out there...y'all are incredibly dogmatic. The evidence just isn't that good. The patients don't actually hold that still. Monte Carlo isn't a perfect algorithm. Calm down about those pixels.

But mostly I use my AI-assisted MS Paint and double check against eContour and Nancy Lee. When I get plans back from Dosi...there's an app for that.

I wonder what those treatment plans actually look like? Let's see:

27 in 3, 54 in 3, 50 in 5?

40.05 in 15, 50 in 25, 50.4 in 28, 54 in 30?

Maybe 30-35 fractions for 56-70Gy?

On treatment, am I giving Flomax? Aquaphor? Silvadene? Magic Mouthwash?

Obviously, I'm painting with a grossly broad brush for humor. There's also a tendency for the human mind to find things "easy" once you learn it, and forget how hard it was in the beginning.

But man, there has GOT to be a better way to do our training and certification. There is NO REASON that the first year is so hard, other than it is literally being thrown into a 1:1 fellowship-level experience overnight.
 
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In the community, some times patients are fully and properly worked up. Other times, it is a horrible mess until I see the patient. Our oncology training should not be diminished as medical oncologists and surgeons in the community may not know how to properly work up and treat a patient. They may not perform the appropriate physical exam either. About 5-10% of my consults are inappropriate for radiation, and I have to redirect them. I think a lot of our training and testing are warranted, but I agree there may be better ways to implement it.
 
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In the community, some times patients are fully and properly worked up. Other times, it is a horrible mess until I see the patient. Our oncology training should not be diminished as medical oncologists and surgeons in the community may not know how to properly work up and treat a patient. They may not perform the appropriate physical exam either. About 5-10% of my consults are inappropriate for radiation, and I have to redirect them. I think a lot of our training and testing are warranted, but I agree there may be better ways to implement it.
10-15% is good! It means you’re not just a technician / treater !
 
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Wow, this is a perfect summary of something I have been struggling to conceptualize for myself.

Personally, I felt PGY2 was just absolutely brutal. Way harder than intern year. Now, at the other end, after board certification and independent practice...I think a lot of RadOnc is quite silly.

Most patients come to us already packaged. If they don't, well, there's an app for that.

Treatment planning can still be tricky, but not the way I anticipated. Some people out there...y'all are incredibly dogmatic. The evidence just isn't that good. The patients don't actually hold that still. Monte Carlo isn't a perfect algorithm. Calm down about those pixels.

But mostly I use my AI-assisted MS Paint and double check against eContour and Nancy Lee. When I get plans back from Dosi...there's an app for that.

I wonder what those treatment plans actually look like? Let's see:

27 in 3, 54 in 3, 50 in 5?

40.05 in 15, 50 in 25, 50.4 in 28, 54 in 30?

Maybe 30-35 fractions for 56-70Gy?

On treatment, am I giving Flomax? Aquaphor? Silvadene? Magic Mouthwash?

Obviously, I'm painting with a grossly broad brush for humor. There's also a tendency for the human mind to find things "easy" once you learn it, and forget how hard it was in the beginning.

But man, there has GOT to be a better way to do our training and certification. There is NO REASON that the first year is so hard, other than it is literally being thrown into a 1:1 fellowship-level experience overnight.
I think part of it is most attendings on the first day of PGY-2 act like you’ve just entered a hallowed sanctum of nearly unattainable knowledge. They also couple in the radiation fear factor. Versus just saying “hey kid, don’t be scared… lemme show you some neat stuff!”
 
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I think part of it is most attendings on the first day of PGY-2 act like you’ve just entered a hallowed sanctum of nearly unattainable knowledge. They also couple in the radiation fear factor. Versus just saying “hey kid, don’t be scared… lemme show you some neat stuff!”
I wish my attendings did this. It was more like "hey kid, we've got 10 follow ups and 5 consults you need to dictate. Get the contours finished too. See you in the morning."
 
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I wish my attendings did this. It was more like "hey kid, we've got 10 follow ups and 5 consults you need to dictate. Get the contours finished too. See you in the morning."
The morning of my literal, very-first clinic I got pimped on "the Minksy trial".

I can assure you, I had no idea what "the Minksy trial" was before noon on my first day.
 
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If you didn't know the answer, the response was always "you're going to fail your boards."
 
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I wish my attendings did this. It was more like "hey kid, we've got 10 follow ups and 5 consults you need to dictate. Get the contours finished too. See you in the morning."
lol. yes. my PGY2 year was an absolute mess. your co-residents and chief residents were supposed to teach you or you just magically were supposed to know how to run a service.

i distinctly remember a service with a very senior rad onc who was upset that i couldnt complete a full H&P, discuss all mgmt options and eligible trials, and consent a patient in 20 minutes. nearly got kicked out of residency. cried multiple times as a fully grown adult on that service and fundamentally changed how i viewed academia, medical training, etc.
 
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The amazing part is attendings seemingly forget the knowledge base that PGY2s have coming in when they see it EVERY SINGLE YEAR and have no comprehension of the learning curve despite living it themselves. Then they fight over not getting any PGY2s early in the year.

Just be a reasonable human - too much to ask for many in our field
 
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lol. yes. my PGY2 year was an absolute mess. your co-residents and chief residents were supposed to teach you or you just magically were supposed to know how to run a service.

i distinctly remember a service with a very senior rad onc who was upset that i couldnt complete a full H&P, discuss all mgmt options and eligible trials, and consent a patient in 20 minutes. nearly got kicked out of residency. cried multiple times as a fully grown adult on that service and fundamentally changed how i viewed academia, medical training, etc.
Ah. It's good to see I'm not alone.
 
The amazing part is attendings seemingly forget the knowledge base that PGY2s have coming in when they see it EVERY SINGLE YEAR and have no comprehension of the learning curve despite living it themselves. Then they fight over not getting any PGY2s early in the year.

Just be a reasonable human - too much to ask for many in our field
My bet is many don't know which ones are the 2's when the rotations start (who can remember the PGY year of all 12-28 residents, much less their names)?. Expectation is to show up and perform, for everyone
 
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lol. yes. my PGY2 year was an absolute mess. your co-residents and chief residents were supposed to teach you or you just magically were supposed to know how to run a service.

i distinctly remember a service with a very senior rad onc who was upset that i couldnt complete a full H&P, discuss all mgmt options and eligible trials, and consent a patient in 20 minutes. nearly got kicked out of residency. cried multiple times as a fully grown adult on that service and fundamentally changed how i viewed academia, medical training, etc.
So many ****hole hellpit programs that should have been shut down by now.... But nope, just keep creating new ones!!
 
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Getting back to OP’s original inquiry…

Obviously the radonc match now is a completely different world than it used to be for DOs. There are DOs applying this year who have multiple huge red flags (step failures, mult course failures), and getting interviews at top-tier programs. But ask any DO (or IMG for that matter) who applied pre-2019 about their experience. Back then, it wasn’t enough to be just a good student with no red flags, you had to out-perform every USMD applicant to get a smattering of interviews. Even then, there were many PDs/Chairs who claimed they’d just “never rank a DO.”

Now, obviously, the game has drastically changed, much to the surprise. Those same Chairs are suddenly quite interested in matching average DO applicants, even below avg, bc hey, better than not filling and risking closure of your program. Also, they’re not even the ones who are paying your resident salary, and honestly, the consequences of matching a “bad” resident are also relatively pretty low (hey they’re still a warm body who can write notes, right?)

Here’s the thing. The radonc Chairs who stigmatized being a DO in the field in the first place, who’d never interviewed a DO prior to 2019, who said they’d never rank a DO, are the same folks who are in charge of faculty hiring. And just bc you graduate from residency, does NOT mean that they owe you a job.

Now, no one can predict the future, esp in this field. Could be that going to a top-10 program would negate the DO stigma after all is said and done. But as bad as the rad onc match gets, there will always also be a decent handful of USMDs who are finishing residency and entering the job pool each year. And those Chairs who used to put all DO residency apps at the bottom of the pile, will quite likely do the same with your job CV. The stakes are much higher when you’re talking about hiring a permanent, independent physician faculty member, with a 350K+/yr price tag, compared to filling a resident slot.

Could be that non-academic department chairs and PPs wouldn’t see things the same way, but keep in mind, they’re also used to receiving 200 apps from MD PhD Ivy-pedigree type grads for a single job opening. Rad onc is also not one of those fields (typically) where a hiring practice needs to fill an empty position urgently - most places would be a-ok waiting a year or 2, to find exactly what they’re looking for.

I should emphasize, most of this is my own speculation. Again, in this field, no one can predict the future, even over the next few years. But I think any applicant, esp any DO or IMG, should strongly consider that job opportunities in the field might be extremely limited for yourself, no matter where you do residency.

If you can think of yourself applying for jobs in 5yrs, and having limited geographic and job-type freedom of choice, and you’re okay with that, then sure go ahead and apply. But so you really want to take that risk with your career, when you don’t have to?
 
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NO US grad MD or DO should go into rad onc….
We got DO’s matching derm at god damn UW, ENT at duke ,neurosurgery at big name places. for jeez Christ don’t go into Rad onc
Look at all the better fields available to a US grad..
Also the speculation that some of these “chairs” won’t hire a DO even from a top 10 Rad onc program is straight up ridiculous lol… even more reason to avoid this train wreck of a field. Rad onc is dead and buried stay away..I don’t think this field is ever going to recover.
 
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If you go to a top 10 radonc training program you'll be fine. Nobody can predict the pendulum. Horrible in 1997, amazing in 2005, horrible in 2020 it comes and goes. I've made serious 0's in my career, and continue to # it out.

Get good training, network, and be flexible and you too can enjoy this life. Also, "buy low" (e.g. 1997) we may be at another moment here now... justsayin'
 
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NO US grad MD or DO should go into rad onc….
We got DO’s matching derm at god damn UW, ENT at duke ,neurosurgery at big name places. for jeez Christ don’t go into Rad onc
Look at all the better fields available to a US grad..
Also the speculation that some of these “chairs” won’t hire a DO even from a top 10 program is straight up ridiculous lol… even more reason to avoid this train wreck of a field. Rad onc is dead and buried stay away..I don’t think this field is ever going to recover.
What's a top 10 DO school? Isn't that like bragging about winning the arena league football title?
 
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