Astro Career Center and "A Roadmap for Recruiting Medical Students into Radiation Oncology during a Period of Waning Interest"

fiji128

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Med students have already figured this out. Rad Onc is now one of the least competitive specialty in medicine based on US MDs to available spots.

The shocking part is the total lack of an appropriate response by "leadership."

Meanwhile I get a notice on Twitter from the Mayo clinic that they can now do breast RT in 3 fractions! (It wasn't disclosed how that is a huge benefit for their hospital system if they can keep patients in Rochester for treatment). If KO is really advocating for this, why not decrease your residency complement by 50% to reflect this new future?
 
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RadOncDoc21

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Med students have already figured this out. Rad Onc is now one of the least competitive specialty in medicine based on US MDs to available spots.

The shocking part is the total lack of an appropriate response by "leadership."

Meanwhile I get a noticed on Twitter from Mayo clinic that they can now do breast RT in 3 fractions! (It wasn't disclosed how that is a huge benefit for their hospital system if they can keep patients in Rochester for treatment). If KO is really advocating for this, why not decrease your residency complement by 50% to reflect this new future?
The goal is to get to 0 or one fraction. In the meantime every single patient will be getting some form of systemic therapy which apparently the surgeons are starting to get involved in delivering because they are figuring out how to change the light bulbs while the rad oncs are all stuck in a dark room complaining about the days when we used to use candles.

None of this would make sense in another world.
 
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fiji128

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Mayo Clinic Rochester is approved for 12 residency training spots. A big statement could be made if they decided to go down to 6. Fits well with decreased factions and decreased indications research they are promoting.
 
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ramsesthenice

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2) Immunotherapy is not curative.

By and large you are correct but over simplifying. The myth that we give it to widely metastatic patients and cure them is pure fallacy at this point. But...

1) For patients with low volume metastatic disease there appears to be some number of durable CRs with 2+ year follow up. Its not a high number but definitely higher than with chemo
2) As an adjuvant after chemoRT or surgery for some diseases IO offers significantly long-term DFS and OS which probably with more follow up will end up being a higher "cure" rate than adjuvant chemotherapy or observation

Checkpoint inhibitors and other immunotherapies are not the be all end all for cancer therapy. But there is a clear and progressive effort to move towards transitioning from traditional chemo to immune therapy as able. As a field, chemo is med oncs bedrock. There isn't a lot of external pressure to step on this turf because not many other providers want to mess with managing chemo (especially triplet+ combinations). But as referenced above, there are plenty of other disciplines that want to get in on the immunotherapy game and eventually they really might. Its also realistic to think that PPs could find themselves incentivized to higher an NP instead of a new grad if a substantial proportion of their volume is dedicated to immunotherapies.

Again, at this point, hypothetical predictions. In the absolute worst case they might be where we were 15 years ago. Anyone that gets in now should be comfortably established before any of these hypothetical predictions came to fruition. And maybe, just maybe, if they see supply and demand issues on the horizon their leadership will oh, I don't know, do something about it :shrug:
 
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RickyScott

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To decide against a specialty that you would otherwise really enjoy (rad onc) because you’re averse to what all your non-medical friends have to do (network) is pretty weak.
Implicit in your statement is the silly notion that networking actually creates jobs. What if all applicants took your advice- they all networked, would they all now get jobs?
Jobs were created where there were none because residents “networked”? Or, would some be outcompeted by smooth talkers and left out in the cold. Networking is a euphemism for a knife fight in this case.
 
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RSAOaky

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Right and now that ship has sunk even if patients really want treatment, we won’t get the opportunity to even discuss treatment with them even though there is a benefit. Imagine if med onc couldn’t flaunt their 3% decrease in PFS benefit for their 100k drug?
Exactly. Sadly, we all know how the next couple decades of radiation oncology are going to play out:

RO-APM hits.
We get paid per diagnosis.
A breast patient now reimburses somewhere between a 15 fraction treatment and a 30 fraction treatment.
People who have been aggressively hypofractionating may actually see a little bump in their reimbursement initially. People who have not been start to see that reimbursement drop.
5 fraction breast treatments become the new normal because hey, it pays the same so why not.
We now have 20 on beam instead of 40.
Administration says "why do we need two radiation oncologists for 20 patients?"
Jobs get cut.
Medicare starts to say "why are we paying so much money for 5 treatments?"
Reimbursements get cut.
Pay gets cut.

And finally. After the bottom has unequivocally fallen out from under us. It is Virtual ASTRO 2040 which we have all paid $1600 to attend. Mudit Chowdhary, Chairman of MSKCC, is giving the plenary session presenting the 20 year update of his seminal work on the radonc job market. KO is honored as FASTRO though he is no longer able to practice due to the vertigo he has suffered from flip flopping on supply/demand in radiation oncology one too many times. A rasping Anthony Zietman is carried up to the podium in his wheelchair by a throng of advanced radiation oncology fellows on H1B visas from the University of West Virginia and the University of Kansas. In a barely audible British accent he proclaims.

"The Canaries Have Spoken."
 
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Gfunk6

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Exactly. Sadly, we all know how the next couple decades of radiation oncology are going to play out:

RO-APM hits.
We get paid per diagnosis.
A breast patient now reimburses somewhere between a 15 fraction treatment and a 30 fraction treatment.
People who have been aggressively hypofractionating may actually see a little bump in their reimbursement initially. People who have not been start to see that reimbursement drop.
5 fraction breast treatments become the new normal because hey, it pays the same so why not.
We now have 20 on beam instead of 40.
Administration says "why do we need two radiation oncologists for 20 patients?"
Jobs get cut.
Medicare starts to say "why are we paying so much money for 5 treatments?"
Reimbursements get cut.
Pay gets cut.

And finally. After the bottom has unequivocally fallen out from under us. It is Virtual ASTRO 2040 which we have all paid $1600 to attend. Mudit Chowdhary, Chairman of MSKCC, is giving the plenary session presenting the 20 year update of his seminal work on the radonc job market. KO is honored as FASTRO though he is no longer able to practice due to the vertigo he has suffered from flip flopping on supply/demand in radiation oncology one too many times. A rasping Anthony Zietman is carried up to the podium in his wheelchair by a throng of advanced radiation oncology fellows on H1B visas from the University of West Virginia and the University of Kansas. In a barely audible British accent he proclaims.

"The Canaries Have Spoken."
1605800402155.png

Man oh man, I love this site.
 
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evilbooyaa

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Exactly. Sadly, we all know how the next couple decades of radiation oncology are going to play out:

RO-APM hits.
We get paid per diagnosis.
A breast patient now reimburses somewhere between a 15 fraction treatment and a 30 fraction treatment.
People who have been aggressively hypofractionating may actually see a little bump in their reimbursement initially. People who have not been start to see that reimbursement drop.
5 fraction breast treatments become the new normal because hey, it pays the same so why not.
We now have 20 on beam instead of 40.
Administration says "why do we need two radiation oncologists for 20 patients?"
Jobs get cut.
Medicare starts to say "why are we paying so much money for 5 treatments?"
Reimbursements get cut.
Pay gets cut.

And finally. After the bottom has unequivocally fallen out from under us. It is Virtual ASTRO 2040 which we have all paid $1600 to attend. Mudit Chowdhary, Chairman of MSKCC, is giving the plenary session presenting the 20 year update of his seminal work on the radonc job market. KO is honored as FASTRO though he is no longer able to practice due to the vertigo he has suffered from flip flopping on supply/demand in radiation oncology one too many times. A rasping Anthony Zietman is carried up to the podium in his wheelchair by a throng of advanced radiation oncology fellows on H1B visas from the University of West Virginia and the University of Kansas. In a barely audible British accent he proclaims.

"The Canaries Have Spoken."
1605805696176.png

Two small edits - Chowdhary will be chairman at U of Nebraska - MSKCC and most top places aren't gonna let a grad from non MSKCC/MDACC/HROP/Penn/Stanford be chair.

KO will be Chair of Mayo Rochester, known as the Chair who is unable to safely practice without an advanced radiation oncology fellow on his clinical service of 5 patients.

I can imagine Anthony Zietman in the Luther Brady electric wheelchair like at the last ACRO meeting LB was at before he passed away.
 

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RickyScott

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View attachment 323481

Two small edits - Chowdhary will be chairman at U of Nebraska - MSKCC and most top places aren't gonna let a grad from non MSKCC/MDACC/HROP/Penn/Stanford be chair.

KO will be Chair of Mayo Rochester, known as the Chair who is unable to safely practice without an advanced radiation oncology fellow on his clinical service of 5 patients.

I can imagine Anthony Zietman in the Luther Brady electric wheelchair like at the last ACRO meeting LB was at before he passed away.
Mroga,Abro,lemmiwinks will be Astro fellows?
 
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Lamount

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By and large you are correct but over simplifying. The myth that we give it to widely metastatic patients and cure them is pure fallacy at this point. But...

1) For patients with low volume metastatic disease there appears to be some number of durable CRs with 2+ year follow up. Its not a high number but definitely higher than with chemo
2) As an adjuvant after chemoRT or surgery for some diseases IO offers significantly long-term DFS and OS which probably with more follow up will end up being a higher "cure" rate than adjuvant chemotherapy or observation

Checkpoint inhibitors and other immunotherapies are not the be all end all for cancer therapy. But there is a clear and progressive effort to move towards transitioning from traditional chemo to immune therapy as able. As a field, chemo is med oncs bedrock. There isn't a lot of external pressure to step on this turf because not many other providers want to mess with managing chemo (especially triplet+ combinations). But as referenced above, there are plenty of other disciplines that want to get in on the immunotherapy game and eventually they really might. Its also realistic to think that PPs could find themselves incentivized to higher an NP instead of a new grad if a substantial proportion of their volume is dedicated to immunotherapies.

Again, at this point, hypothetical predictions. In the absolute worst case they might be where we were 15 years ago. Anyone that gets in now should be comfortably established before any of these hypothetical predictions came to fruition. And maybe, just maybe, if they see supply and demand issues on the horizon their leadership will oh, I don't know, do something about it :shrug:
I don’t disagree with any of what you said... but “curative intent” is very appealing to patients and no one really wants to live the rest of their life in IO... it’s not chemo but it’s exhausting.

I see a fare amount of oligometastatic patients. Many of them want SBRT so that they can justify stopping systemic therapy altogether
 
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ramsesthenice

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I see a fare amount of oligometastatic patients. Many of them want SBRT so that they can justify stopping systemic therapy altogether

Me too. I have gotten better about trying exceptionally hard to find some way of documenting something symptomatic if you know what I mean.
 

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A breast patient now reimburses somewhere between a 15 fraction treatment and a 30 fraction treatment.
People who have been aggressively hypofractionating may actually see a little bump in their reimbursement initially. People who have not been start to see that reimbursement drop.

Last iteration I was aware of included a "historical factor" to give everyone a haircut no matter what. Basically, if you were hypofractionating already, they would query your cases over the last few years and CMS would rachet you down even further. Most ass backwards thing I'd ever heard of but someone really in the know told me it was the bonafide truth.
 
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medgator

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Last iteration I was aware of included a "historical factor" to give everyone a haircut no matter what. Basically, if you were hypofractionating already, they would query your cases over the last few years and CMS would rachet you down even further. Most ass backwards thing I'd ever heard of but someone really in the know told me it was the bonafide truth.
I think that was one of the big criticisms of APM.... Tying things to your previous billing amount with CMS rather than following guidelines, hyper fractionators rewarded more with the factor that CMS would apply to the apm formula
 

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re: med students applying to RadOnc. Our first interview date is coming up right after the holiday. What do you say to interviewees, if you harbor no illusions?
 
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re: med students applying to RadOnc. Our first interview date is coming up right after the holiday. What do you say to interviewees, if you harbor no illusions?

I've worked with a ton of med students now over the past several weeks/months because of this never-ending stream of virtual events (I actually think I've been exposed to more med students this year than any other year, though obviously the interactions are significantly more brief).

For the students who aren't applying this year, and are exploring options, I usually probe to see what they're interested in. 100% of the time they tell me at least 2-3 other specialties. We then have a conversation about why they're interested in RadOnc as well as the other specialties they're thinking about, if there are common themes, what they're looking for, etc. I have an almost "elevator pitch" talk I give them about the field's evolution over the last 20 years, the doubling of residents, the increase in fellowships, the static retirement, the APM and hypofrac. I tell them that if they can't see themselves doing ANYTHING else then obviously they need to pursue RadOnc, but, in doing so, they need to be aware that they're exposing themselves to significant risks down the road re: jobs, and they need to decide if they're OK with that risk. If they want further data, I show them some of the recent stuff published by Royce and Mudit and ARRO etc, (the things we all talk about here). Savvy people will bring up the ARRO data that there's little-to-no unemployment, I counter by saying that's literally the saddest metric I've ever heard - "obviously there shouldn't be unemployment for a doctor, that's the argument of someone who has their back against the wall". If they think "low unemployment" is a successful metric...I will not be able to convince them otherwise, haha.

For interviews (or kids rotating who have already applied)...that's a different beast. For me, I'm assuming these kids have made up their mind, and it's too late to back out now (unless they're dual applying). I explore what drew them to RadOnc, what they like about it, what they want in their career, etc. I ask them if they're aware of the job market issues and what they think about it. There are definitely faculty (and even residents) out there straight up telling kids that the job market is fine, everything on SDN is a lie, they should without question pursue RadOnc, etc. I have seen it done, or have been told about it after. In this case, I give a sort of dry account of what the job search has looked like this year, and acknowledge COVID has made things difficult. I usually say something like "I love Radiation Oncology as a specialty but would pick something else if I could go back in time".

I guess for the kids already applying and interviewing this year I spend most of the time talking to them about the actual mechanics of residency and what I think they should look for in a program - their souls are lost, I view myself as the ferryman of the River Styx at that point.
 
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scarbrtj

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re: med students applying to RadOnc. Our first interview date is coming up right after the holiday. What do you say to interviewees, if you harbor no illusions?
Just like ASTRO and the 800 year old knight in ‘Indiana Jones and the Last Crusade’... encourage them to choose wisely.
 
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fiji128

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Update of the current Astro Career Center Job posting on 1/25/2021:

1) Rad Onc academics with Peds focus with Johns Hopkins (Baltimore, MD).
2) Rad Onc private practice with Green Bay Oncology (Green Bay, WI).
3) Rad Onc private practice with Summa Health (Akron, OH).
4) Rad Onc private practice with Mercy Health (Janesville, WI).
5) Rad Onc private practice Alabama Cancer Care (Anniston, AL).
6) Rad Onc academic with University of New Mexico (Albuquerque, NM).
7) Rad Onc academics with Sarcoma focus with Mass Gen (Boston, MA).
8) Rad Onc private practice with Karmanos Cancer Network (Flint, MI).
9) Rad Onc private practice with Radiation Oncology Centers (Grand Rapids, MI).
10) Rad Onc academics with Mass Gen (Boston, MA).
11) Rad Onc private practice part time with Radiation Oncology Associates (Arlington Heights, IL).
12) Rad Onc hospital employed Ashland Bellefonte Cancer Center (Ashland, KY).
13) Rad Onc private practice with Radiation Oncology Specialists of Central Virginia (Fredericksburg, VA).
14) Rad Onc medical director private practice with MultiCare Regional Cancer Center (Tacoma, WA).
15) Rad Onc private practice with Cancer Care of North Texas (Plano, TX) this job has been posted a lot over the past 3 to 5 years.
16) Rad Onc private practice with West Florida Radiation Oncology (Palm Harbor, FL).
17) Rad Onc private practice with Radiation Oncology of Cedar Rapids (Cedar Rapids, IA).
18) Rad Onc Urorads with Regional Urology (Shreveport, LA).
19) Rad Onc private practice with Advanced Radiation Centers of New York (Metro NYC, NY).
20) Rad Onc academics with UCSF (San Francisco, CA).
21) Rad Onc private practice with Pacific Radiation Oncology (Honolulu, HI).
22) Rad Onc division head with Baptist MDACC in Jacksonville (Jacksonville, FL).
23) Rad Onc private practice with Toledo Clinic Radiation Oncology (Toledo, OH).
24) Rad Onc department chair with Moffitt (Tampa Bay, FL).
25) Rad Onc community academic with West Virginia University (Elkins, WV).
26) Rad Onc hospital employeed wth Morris Hospital (Morris, IL).
 
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fiji128

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I'll try and post this jobs list once a month until next astro just so folks out there can judge the job market themselves over the course of the year.

Generally the astro career center is considered the number one overall source for jobs so it is reflective of what is available to ASTRO's 5,500 members.

Posting an easily readable list is also necessary information in a era when folks like Emma Fields from VCU are trying so hard to distract medical students away from the realities of the field instead of actually addressing the root problems.
 
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I'll try and post this jobs list once a month until next astro just so folks out there can judge the job market themselves over the course of the year.

Generally the astro career center is considered the number one overall source for jobs so it is reflective of what is available to ASTRO 5,500 members.

Posting an easily readable list is also necessary information, especially in a era when folks like Emma Fields from VCU are trying so hard to distract medical students away from the realities of the field instead of actually addressing the root problems.
Also, for people just skimming the numbers: several of those postings are for Chairs/Chiefs/Directors etc, which are (obviously) not available to new grads.
 
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fiji128

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Update of the current Astro Career Center Job posting on 3/4/2021:


1) Rad Onc private practice with US Oncology Network (Lawrenceville, GA).
2) Rad Onc private practice with Arizona Oncology Associates (Greater Phoenix, AZ).
3) Rad Onc hospital employed with Karmanos Cancer Institute (Flint, MI).
4) Rad Onc hospital employed with Northwell Health (Westchester, NY).
5) Rad Onc community academics with HaysMed part of the University of Kansas Health System (Hays, KS, which 250 miles west of Kansas City and even 100 miles west of Salina).
6) Rad Onc community academics with Mass Gen at Exeter Hospital (Exeter, NH).
7) Rad Onc hospital employed with St. Joesph’s Hospital (Lexington, KY).
8) Rad Onc private practice looking for PRN vacation overage (Phoenix, AZ).
9) Rad Onc private practice with Alabama Cancer Care (Anniston, AL).
10) Rad Onc private practice with Radiation Oncology Centers (Grand Rapids, MI).
11) Rad Onc private practice with Genesis Care (Asheville, NC).
12) Rad Onc private practice with Genesis Care (Las Vegas, NV).
13) Rad Onc academic vice chair of business development Thomas Jefferson University (Philadelphia, PA).
14) Rad Onc private practice part time with Radiation Oncology Associates (Arlington Heights, IL).
15) Rad Onc academic with University of New Mexico (Albuquerque, NM).
16) Rad Onc academic department chair with Dartmouth (Dartmouth, NH).
17) Rad Onc academics with Sarcoma focus with Mass Gen (Boston, MA).
18) Rad Onc hospital employed with Methodist Health System (Omaha, NE).
19) Rad Onc DermRads with SET Solutions (The Villages, FL).
20) Rad Onc private practice with KSK Medical Cancer Center (Irvine, CA).
21) Rad Onc private practice with US Oncology Network (Chicago Ridge, IL).
22) Rad Onc academics with University of Maryland (Baltimore, MD).
23) Rad Onc community academic with West Virginia University (Elkins, WV).
24) Rad Onc private practice with US Oncology Network (Covington, GA).
25) Rad Onc private practice with Gettysburg Cancer Center (Gettysburg, PA).
26) Rad Onc part time private practice with confidential (90 mins north of Atlanta, GA).
27) Rad Onc private practice with Cancer Care Group (Terre Haute, IN).
28) Rad Onc community academics with Johns Hopkins at Sibley Memorial Hospital (Washington, DC)
29) Rad Onc community academics with University of Michigan (Grand Rapids, MI).
30) Rad Onc academics with Gyn focus University of Washington (Seattle, WA).
31) Rad Onc private practice with Ascension Medical Group (Newburgh, IN).
32) Rad Onc private practice with Green Bay Oncology (Green Bay, WI).
 
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RickyScott

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Update of the current Astro Career Center Job posting on 3/4/2021:


1) Rad Onc private practice with US Oncology Network (Lawrenceville, GA).
2) Rad Onc private practice with Arizona Oncology Associates (Greater Phoenix, AZ).
3) Rad Onc hospital employed with Karmanos Cancer Institute (Flint, MI).
4) Rad Onc hospital employed with Northwell Health (Westchester, NY).
5) Rad Onc community academics with HaysMed part of the University of Kansas Health System (Hays, KS, which 250 miles west of Kansas City and even 100 miles west of Salina).
6) Rad Onc community academics with Mass Gen at Exeter Hospital (Exeter, NH).
7) Rad Onc hospital employed with St. Joesph’s Hospital (Lexington, KY).
8) Rad Onc private practice looking for PRN vacation overage (Phoenix, AZ).
9) Rad Onc private practice with Alabama Cancer Care (Anniston, AL).
10) Rad Onc private practice with Radiation Oncology Centers (Grand Rapids, MI).
11) Rad Onc private practice with Genesis Care (Asheville, NC).
12) Rad Onc private practice with Genesis Care (Las Vegas, NV).
13) Rad Onc academic vice chair of business development Thomas Jefferson University (Philadelphia, PA).
14) Rad Onc private practice part time with Radiation Oncology Associates (Arlington Heights, IL).
15) Rad Onc academic with University of New Mexico (Albuquerque, NM).
16) Rad Onc academic department chair with Dartmouth (Dartmouth, NH).
17) Rad Onc academics with Sarcoma focus with Mass Gen (Boston, MA).
18) Rad Onc hospital employed with Methodist Health System (Omaha, NE).
19) Rad Onc DermRads with SET Solutions (The Villages, FL).
20) Rad Onc private practice with KSK Medical Cancer Center (Irvine, CA).
21) Rad Onc private practice with US Oncology Network (Chicago Ridge, IL).
22) Rad Onc academics with University of Maryland (Baltimore, MD).
23) Rad Onc community academic with West Virginia University (Elkins, WV).
24) Rad Onc private practice with US Oncology Network (Covington, GA).
25) Rad Onc private practice with Gettysburg Cancer Center (Gettysburg, PA).
26) Rad Onc part time private practice with confidential (90 mins north of Atlanta, GA).
27) Rad Onc private practice with Cancer Care Group (Terre Haute, IN).
28) Rad Onc community academics with Johns Hopkins at Sibley Memorial Hospital (Washington, DC)
29) Rad Onc community academics with University of Michigan (Grand Rapids, MI).
30) Rad Onc academics with Gyn focus University of Washington (Seattle, WA).
31) Rad Onc private practice with Ascension Medical Group (Newburgh, IN).
32) Rad Onc private practice with Green Bay Oncology (Green Bay, WI).
Recall someone on twitter with uber-absurd credentials announcing that they were the taking the Green bay job. Hope they are from green bay because this would never have happened in the past ....
 
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fiji128

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I know someone at that GB practice on the physics end, its supposed be a good group if you are location agnostic.

I can't help but wonder what the University of Kansas is paying for that job that is 250 miles west of Kansas City and 100 miles west of Salina. I'm sure its shockingly underwhelming.

There are probably about 10-15'ish solid positions of this month's list, but again, you must be location agnostic.
 
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For the last some 20 years...

- Out of every 100 M3 or M4 students that rotated with me, only 2-4 went into radonc. The rest of students did the rotation
as an elective "just for fun" to learn some oncology. Most of them went into PCP, IntMed, Peds, Ob-Gyn, GenSurg, etc. etc.
I did the same thing as a med student: I did Nephrology as an elective to learn acid-base balance, electrolyte management etc.
I am NOT a nephrologist.

- So I see no need for all of these "celebrities" to go on twitter to advertise to med students. If they want to learn radiation oncology, then go into Int Med, that is fine. In fact, I enjoy teaching these folks the most bc I know they will never go into radonc, I emphasized concepts that are important in PCP such as screening, staging, diagnostic errors, and proper referral to medonc, radonc or surgery.

- If an M3 says on twitter she/he wants to go into radonc. That is fine, no need to entice them even more.

- If an M3 or M4 comes to me for advice re radonc as a career, I always say this:
1. I love this field and I enjoy it.
2. You are smart, you like radonc, and you should pursue it....but
3. You should independently verify the job situation yourself. By saying this, I don't deceive them.
If they truly want it, they will find a way to do it by matching to TOP programs with the hope of finding jobs 5-6 yrs later.

- Sadly for me, during the last 2-4 yrs, I have lost a few truly outstanding MD-PhDs (Step 1 score at 99 percentile and all that jazz). These are the kids that are way smarter than I am, and they usually ended up in surgonc or medonc...They are not dumb. They do their research. Interestingly, they still call/talk to me and thanks me for my best advice bc I place their future ABOVE my desire.

- But at the same time, I am happy bc I am not a "snake oil salesman" (to paraphrase Eli Glatstein lol).
I have discharged my responsibility and conscience, which is very important to me.

The situation right now is free-market, dictated by supply demand ratio, and it is what it is...
 
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RickyScott

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For the last some 20 years...

- Out of every 100 M3 or M4 students that rotated with me, only 2-4 went into radonc. The rest of students did the rotation
as an elective "just for fun" to learn some oncology. Most of them went into PCP, IntMed, Peds, Ob-Gyn, GenSurg, etc. etc.
I did the same thing as a med student: I did Nephrology as an elective to learn acid-base balance, electrolyte management etc.
I am NOT a nephrologist.

- So I see no need for all of these "celebrities" to go on twitter to advertise to med students. If they want to learn radiation oncology, then go into Int Med, that is fine. In fact, I enjoy teaching these folks the most bc I know they will never go into radonc, I emphasized concepts that are important in PCP such as screening, staging, diagnostic errors, and proper referral to medonc, radonc or surgery.

- If an M3 says on twitter she/he wants to go into radonc. That is fine, no need to entice them even more.

- If an M3 or M4 comes to me for advice re radonc as a career, I always say this:
1. I love this field and I enjoy it.
2. You are smart, you like radonc, and you should pursue it....but
3. You should independently verify the job situation yourself. By saying this, I don't deceive them.
If they truly want it, they will find a way to do it by matching to TOP programs with the hope of finding jobs 5-6 yrs later.

- Sadly for me, during the last 2-4 yrs, I have lost a few truly outstanding MD-PhDs (Step 1 score at 99 percentile and all that jazz). These are the kids that are way smarter than I am, and they usually ended up in surgonc or medonc...They are not dumb. They do their research. Interestingly, they still call/talk to me and thanks me for my best advice bc I place their future ABOVE my desire.

- But at the same time, I am happy bc I am not a "snake oil salesman" (to paraphrase Eli Glatstein lol).
I have discharged my responsibility and conscience, which is very important to me.

The situation right now is free-market, dictated by supply demand ratio, and it is what it is...
It is very difficult for me to conceive of how an informed medical student could be intelligent yet still choose xrt today.
 
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RadOncDoc21

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Fake news, I saw like 3 fellowship positions in Jacksonville.
 
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OTN

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It is very difficult for me to conceive of how an informed medical student could be intelligent yet still choose xrt today.
"Informed" is the issue. If academicians are able to convince medical students that SDN is not a good place to go for information, then those medical students will not have been properly consented before entering into the radonc match. We've seen Dr. David S Chang call SDN 4Chan on Twitter, seen Dr. Jacob Scott implore students not to come to this website on his chalkboard, etc.

While many of us did know about SDN and knew how important it was to find unbiased information about any specialty, not every medical student (and especially those from under-represented backgrounds) is going to have the resources or generational knowledge/experience/contacts to know that academicians may not be giving advice that is in their best interest.
 
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fiji128

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"Informed" is the issue. If academicians are able to convince medical students that SDN is not a good place to go for information, then those medical students will not have been properly consented before entering into the radonc match. We've seen Dr. David S Chang call SDN 4Chan on Twitter, seen Dr. Jacob Scott implore students not to come to this website on his chalkboard, etc.

While many of us did know about SDN and knew how important it was to find unbiased information about any specialty, not every medical student (and especially those from under-represented backgrounds) is going to have the resources or generational knowledge/experience/contacts to know that academicians may not be giving advice that is in their best interest.

That's why I decided to post these jobs. It's what on Astro's own career center where it has been published something like 50% of available positions are posted. There is no bias or "fake" information here. I leave it up to the reader to look at the monthly list themselves so they can make their own judgment about the health of the labor market in a field with about 5,500 practicing docs. In the end the data will speak for itself.
 
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Current MS4 who finalized his rank list for medicine here. Wanted to thank you all for being "woke". Went into medical school a/w one of the programs ya'll routinely crap on and was thinking rad onc. Got a lot of support from the department, but after reading your comments and hearing one of my buddies applying a surg subspecialty SOAPing into the field I decided not to. It sucks. FWIW, the leadership of the program whom ya'll discuss regularly has always been nice to me, but does paint a picture very different from what you all and charting the outcomes present.

GL on the quest to save rad onc.
 
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thecarbonionangle

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Current MS4 who finalized his rank list for medicine here. Wanted to thank you all for being "woke". Went into medical school a/w one of the programs ya'll routinely crap on and was thinking rad onc. Got a lot of support from the department, but after reading your comments and hearing one of my buddies applying a surg subspecialty SOAPing into the field I decided not to. It sucks. FWIW, the leadership of the program whom ya'll discuss regularly has always been nice to me, but does paint a picture very different from what you all and charting the outcomes present.

GL on the quest to save rad onc.
You escaped an early death from scurvy at the breadlines. Congrats to ya brotha! Go forth and procreate non rad oncs!
 
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medgator

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Current MS4 who finalized his rank list for medicine here. Wanted to thank you all for being "woke". Went into medical school a/w one of the programs ya'll routinely crap on and was thinking rad onc. Got a lot of support from the department, but after reading your comments and hearing one of my buddies applying a surg subspecialty SOAPing into the field I decided not to. It sucks. FWIW, the leadership of the program whom ya'll discuss regularly has always been nice to me, but does paint a picture very different from what you all and charting the outcomes present.

GL on the quest to save rad onc.
Enjoy matching into a specialty where you will be hopefully recruited for a job at the end of it all rather than having to spend years "networking" for one
 
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Current MS4 who finalized his rank list for medicine here. Wanted to thank you all for being "woke". Went into medical school a/w one of the programs ya'll routinely crap on and was thinking rad onc. Got a lot of support from the department, but after reading your comments and hearing one of my buddies applying a surg subspecialty SOAPing into the field I decided not to. It sucks. FWIW, the leadership of the program whom ya'll discuss regularly has always been nice to me, but does paint a picture very different from what you all and charting the outcomes present.

GL on the quest to save rad onc.
I'm curious what department this is, haha.

Thinking about this, I do want to say - in my experience, the individual people in a department I/we think is "poor quality" are, in general, nice and supportive people. At least for me, when I think of places to avoid, it's generally about time/structure/opportunity for education, research, and career advancement. It's almost never about a culture of abuse or anything like that - though those situations and experiences definitely exist.
 

TheWallnerus

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I'm curious what department this is, haha.

Thinking about this, I do want to say - in my experience, the individual people in a department I/we think is "poor quality" are, in general, nice and supportive people. At least for me, when I think of places to avoid, it's generally about time/structure/opportunity for education, research, and career advancement. It's almost never about a culture of abuse or anything like that - though those situations and experiences definitely exist.
If the people in these depts were TRULY nice they'd be displaying the equivalent of very tough love. Or kind of like the commanders at Navy SEAL training. "You don't want to be here. This is not for you. It's OK. Ring the bell. Go home. Go do something else. This is not for everyone." Instead they're supportive and kind. Or worse: give out treats (see UCLA) just like the witch in Hansel and Gretel.
 
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If the people in these depts were TRULY nice they'd be displaying the equivalent of very tough love. Or kind of like the commanders at Navy SEAL training. "You don't want to be here. This is not for you. It's OK. Ring the bell. Go home. Go do something else. This is not for everyone." Instead they're supportive and kind. Or worse: give out treats (see UCLA) just like the witch in Hansel and Gretel.
Yeah, very true. People do conflate "this person is nice to me" with "this is a genuinely nice person in character".

Reference: Esther Choo (ALLEGEDLY)
 
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Current MS4 who finalized his rank list for medicine here. Wanted to thank you all for being "woke". Went into medical school a/w one of the programs ya'll routinely crap on and was thinking rad onc. Got a lot of support from the department, but after reading your comments and hearing one of my buddies applying a surg subspecialty SOAPing into the field I decided not to. It sucks. FWIW, the leadership of the program whom ya'll discuss regularly has always been nice to me, but does paint a picture very different from what you all and charting the outcomes present.

GL on the quest to save rad onc.

You have clearly made a wise choice but most importantly, an informed decision. Wish you the best of luck in IM or IM sub-specialty. I think this is why so many of us are here, talking about the issues. We have seen the issues in person, living through the hellscape that is the current state of our field now, and yet our "leadership" continues to largely ignore the major problems as it would directly interfere with their own personal gain.



Med student who wants do well by their future patients, have a nice life near family while getting paid well: I want to learn about medical specialties, heard some things about rad onc, let’s check it out.

(visits rad onc dept associated with med school)
Local rad onc dept: jobs? don’t worry, so many jobs, ignore the lack of good job postings on ASTRO career hub. most important thing to remember is don’t go onto SDN or you’ll get HIV/AIDS.
Med student: wtf

(goes to Twitter)
Twitterati: come get a stipend, delay your entire life by an unnecessary 12 months, and do a research year with us! oh, and SDN is the leading cause of anal cancer. #radoncrocks
Med student: …but that’s not true

(goes to ASTRO ROHub)
ASTRO ROHub: just agree with everything said by Marcus “I need more resident slaves” Randall and Louis “SOAP no matter what” Potters. if you don’t, we will delete all your posts, ban you, and low key try to destroy your career.
Med student: is this North Korea?

(gets direct messaged by brainwashed resident promoting rad onc to simp at attending academic Twitter accounts)
Private message: SDN runs the 2nd largest human trafficking ring in the continental US and is the primary reason there is a lack of basic human rights in sub-Saharan Africa. #radoncrocks
Med student: uh what?

(goes to SDN)
SDN: look, we just want you to make an informed choice. rad onc was great but then chairs got greedy for resident slave labor and buying up practices where they could take the technical and steal a portion of the physician’s professional fees. then due to things like hypofrac and all these RT omission trials, we don’t need as many rad oncs anymore because each rad onc can see more pts. oh and when you get hired at an academic place, they won’t pay you what you’re worth because the chairs will take a part of your professional fee collections and you won’t have negotiating power because there are now over 200 residents graduating/year. and you probably won’t be able to find a good paying job in any major metro area for the first 5-10 years out of residency. oh, and did you know we have the most board exams including boards in physics and rad bio which really suck? if you still want to do rad onc, we’ll support you but there are other great options for specialties where you can get paid what you are worth and have geographic freedom.
Marcus “I need more resident slaves” Randall: those SDN people have tried to literally murder me. but first, let me up my pubs complaining about this attempted murder because that’s what academic rad oncs do.
Med student: ...is this real life?



To all the med students, the only thing we want you to do is be informed. Nothing more, nothing less. Other than a few good souls out there in practice already, you will not find the real truth anywhere but here on SDN. Most everyone else out there in your rad onc dept and Twitter has a hidden agenda and that is promotion – self-promotion and academic promotion. They will disguise it as "mentorship" but given the state of the field, what mentor could knowingly encourage a med student to go into rad onc today? Academic rad oncs need good med students like you to be interested in the field to do their crap research and hopefully as a resident, all their clinical scut work. We here on SDN have an agenda – it is to tell the truth, however ugly it may be. We love rad onc but it is an absolute mess right now with no clear end in sight. With so many great specialties out there that can you give the trifecta of pay, type of job, and location, you really need to think twice about going into rad onc. Things will only get much, much worse with jobs due to the massive residency over-expansion and having 200 residents/year graduate + no clear plan to contract residencies (see what happened to pathology and is now happening to emergency medicine). In time, maybe we can correct that, maybe we won’t.

Regardless, the thing you won’t hear us doing is telling you not to get more information. Go onto Twitter, talk to local rad oncs, go onto ROHub, read all the SDN posts -- then, make your own judgement about the state of the field, job market, and (what I believe to be) the hypocrisy of those academic rad oncs who are often most vocal on social media and academic publications. You should all wonder why so many in academia and rad onc “leadership” consistently promote censorship by warning you all to stay away from SDN.
 
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