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

[evilbooyaa]

My comments to the above:

1) I'll let @TheWallnerus to the math for me as to what that means in terms of average # of patient's on beam
2) 6 attendings with more admin/research days than clinic days.... but still with 1:1 coverage by residents? What do the residents do with all those extra days not in clinic?
3) So it appears Jefferson normally has around 3 a year on average, but they took in a Cornell transplant for this incoming PGY-2 class, hence the temporary bump to 4. Jefferson having ~12 residents as a total complement makes more sense than them having ~16. It's still excessive.
4) If you're on your 4th PD since 2017 and malignancy is an ongoing issue, the problem is most likely NOT with your PDs, but likely with your chair, IMO.


Let's say the 6 attendings are 50% FTE in clinic, and the other 5 attendings are 100% FTE. That's 8 FTEs of attendings. For ~12 residents. I stick by my statements, man. Low, low hanging fruit.

---

Members don't see this ad.

 

[Mandelin Rain]

wrt 4) I think the malignancy is an attribute of the faculty and expecting the PD to change things without the support of the Chair is doomed to fail

It almost highlights the malignancy even more.

"What do you mean you didn't fix this entrenched problem, in a year, with no power to make faculty changes? You're FIRED!" (repeat x 4, annually)

 

[medgator]

Some anonymous facts about Jefferson that were recently PM'd to me by someone currently at the institution, posted without editorial comment:

#3 really shows how the residency classes are changing over time

 

[TheWallnerus]

My comments to the above:

1) I'll let @TheWallnerus to the math for me as to what that means in terms of average # of patient's on beam

Math is an SDN conspiracy to dissuade med students from going in to rad onc

 

[w00tz]

1600 patients a year / 8 residents (assuming 3 on research) = 200/yr or 4 a week
Definitely more than enough to meet ACGME minimums, but I think everyone agrees that the minimum is too low.
The attending:resident ratio is barely adequate.
Great example of a program taking all they can get. I'm sure the majority of programs are like this.

 

[TheWallnerus]

1600 patients a year / 8 residents (assuming 3 on research) = 200/yr or 4 a week
Definitely more than enough to meet ACGME minimums, but I think everyone agrees that the minimum is too low.
The attending:resident ratio is barely adequate.
Great example of a program taking all they can get. I'm sure the majority of programs are like this.

Someone said they don’t have 100 on beam? Project 120-150 on beam per day at 1600 new starts a year. Unless they treat a somewhat disproportionate bunch of SRS and SBRT (and 8 Gy in 1 fx in the palliative care network) in the mix.

 

[deleted941485]

Someone said they don’t have 100 on beam? Project 120-150 on beam per day at 1600 new starts a year. Unless they treat a somewhat disproportionate bunch of SRS and SBRT (and 8 Gy in 1 fx in the palliative care network) in the mix.

Jeff is a mega corporate health system. Hopefully that number does not disingenuously also apply some of their satellite facilities

 

[RickyScott]

Someone said they don’t have 100 on beam? Project 120-150 on beam per day at 1600 new starts a year. Unless they treat a somewhat disproportionate bunch of SRS and SBRT (and 8 Gy in 1 fx in the palliative care network) in the mix.

I understood new starts as across their network, not the main center?

 

[TheWallnerus]

I understood new starts as across their network, not the main center?

Maybe makes more sense then. At many programs the residents never darken satellites' doors; no idea if they do or don't at ThomJeff.

 

[lyltothend]

Someone said they don’t have 100 on beam? Project 120-150 on beam per day at 1600 new starts a year. Unless they treat a somewhat disproportionate bunch of SRS and SBRT (and 8 Gy in 1 fx in the palliative care network) in the mix.

By my highly suspect math I get 90-95 on beam per day. Either way paltry for the amount of coverage.

 

[deleted941485]

Maybe makes more sense then. At many programs the residents never darken satellites' doors; no idea if they do or don't at ThomJeff.

Im sure they would LOOOVVEE to do that. Resident coverage for all that crap under the guise of "learning". Admins would add another 10 spots if they could and these FMG/IMGs will be driving all over the PA/NJ area.

 

[fiji128]

Thomas Jefferson from acgme:
Total Approved Resident Positions:11 Total Filled Resident Positions*:11. Temporary Increase**1 Effective from 07/01/2019 thru 07/01/2024.

UPenn has 18. In no universe do these places need to be training that many residents. I’ve never heard anything about Jefferson’s residency program except for that it should be avoided at all cost. No way acgme is unaware of this reputation. Their PD turn over is a dead giveaway and must be some kind of record.

 

[DebtRising]

The ACGME seems to act like more of a rubber stamp of ridiculously low standards rather than an actual force for good. That may be from the legal side and not the MD membership who helps, but it is what it is. The ACGME only acts when a survey reports something wrong, and it’s obvious that resident surveys in classes of 1-4 residents are going to be easy targets for retribution. Yet here we are, year after year. It does not take deep insight that a different mechanism is needed.

 

[deleted941485]

By my highly suspect math I get 90-95 on beam per day. Either way paltry for the amount of coverage.

Overstaffed and they want slave labor...this place used to be RTOG headquarters right? Now its a joke. Seriously any establishment or anybody I ever respected as a student or looked up to turned out to be a POS towing company line. Christ only one of them had the decency to die before I had the chance to hate them.

 

[thecarbonionangle]

IMO the issue with hellpits is often not just a single person. Rather, it is a cultural problem, which often starts at the top or the weak leadership is unable or unwilling to right the ship. Sometimes you have to clean out a place and start from scratch but few to none are actually willing to do this.
there are many terrible no good places which i would avoid and run for my life. It is funny to me that the poor PD is blamed for “malignancy” when we all know it is basically a thankless toothless job in many places, basically a puppet to mantain “bottomline”.

 

[OTN]

IMO the issue with hellpits is often not just a single person. Rather, it is a cultural problem, which often starts at the top or the weak leadership is unable or unwilling to right the ship. Sometimes you have to clean out a place and start from scratch but few to none are actually willing to do this.
there are many terrible no good places which i would avoid and run for my life. It is funny to me that the poor PD is blamed for “malignancy” when we all know it is basically a thankless toothless job in many places, basically a puppet to mantain “bottomline”.

Current leadership is a problem, as they all got into radonc in the 90s when it was once again bottom-of-the-barrel. Not surprising, then, that leadership both at the institutional level and at ASTRO has been very poor at protecting our specialty/advancing our field.

Up-and-coming leaders are going to be great, as they're from radonc's incredibly competitive era. However, I don't know if they're going to be able to reverse the damage caused by their predecessors.

 

[thecarbonionangle]

Current leadership is a problem, as they all got into radonc in the 90s when it was once again bottom-of-the-barrel. Not surprising, then, that leadership both at the institutional level and at ASTRO has been very poor at protecting our specialty/advancing our field.

Up-and-coming leaders are going to be great, as they're from radonc's incredibly competitive era. However, I don't know if they're going to be able to reverse the damage caused by their predecessors.

Ya intelligence can only take one so far. By the time some of these boomer “leaders” allow the baton to be passed down when they are found dead drooling checking films in their 80s at their office, it might be too late.

 

[Mandelin Rain]

I have no faith whatsoever in the "up and coming leaders". They will all work for the same deans, hospital CEOs, and private equity suits.

This is America in 2021, really since it's inception. C.R.E.A.M.

I'm at the point of, "As long as the checks keep clearing for 15 more years, I'll be good." Could probably make it 5-10 if **** really went south.

 

[fiji128]

Update of the current Astro Career Center Job posting on 7/12/2021:


1) Rad Onc VA medical center (Atlanta and Decatur, GA).
2) Rad Onc private practice with Radiation Oncology Associates (Milwaukee, WI).
3) Rad Onc private practice with Radiation Oncology Care at Meridian Park (Portland, OR).
4) Rac Onc employed with WellSpan Health (Chambersburg, PA).
5) Rad Onc academics with Yale (New Haven, CT).
6) Rad Onc academics with University of Oklahoma (Oklahoma City, OK).
7) Rad Onc community academics with West Virginia University (Wheeling, WV).
8) Rad Onc community academics at UPenn (Lancaster, PA).
9) Rad Onc private practice with Costal Radiation Oncology (Santa Maria, CA).
10) Rad Onc community academics with Medical University of South Carolina (Murrell’s Inlet, SC).
11) Rad Onc employed at Community Health Network (Indianapolis, IN).
12) Rad Onc academics at Henry Ford Health System (Detroit, MI).
13) Rad Onc private practice with NY Cancer and Blood Specialists (Queens, NY).
14) Rad Onc employed with Aultman Hospital (Canton, OH).
15) Rad Onc private practice with Therapy Associates (Evansville, IN).
16) Rad Onc private practice with Tennessee Oncology (Nashville, TN).
17) Rad Onc private practice with Oklahoma Proton Center (Oklahoma City, OK).
18) Rad Onc community academics with MGH (Exeter, NH).
19) Rad Onc community academics with UPMC (Williamsport, PA).
20) Rad Onc employed with Mercy Clinic (Fort Smith, AK).
21) Rad Onc employed with Baptist Health (New Albany, IN).
22) Rad Onc employed with Associated Medical Professionals (Central New York State).
23) Rad Onc employed with US Oncology (Prescott Valley, AZ).
24) Rad Onc employed with Ballad Health (Abingdon, VA).
25) Rad Onc VA medical center (Memphis, TN).
26) Rad Onc hospital employed at the Marshfield Medical Center (Eau Claire, WI).
27) Rad Onc VA medical center (New Albany, NY).
28) Rad Onc private practice at Kadlec Clinic (Kennewick, WA).
29) Rad Onc academics physician scientist at NYU (New York, NY).
30) Rad Onc employed via Jackson Physician Search 100K sign on bonus (Southwest, MN).
31) Rad Onc employed at the Guthrie Clinic (Corning, NY).
32) Rad Onc hospital employed with Geisinger (Danville, PA).
33) Rad Onc hospital employed with Morris Hospital (Morris, IL).

While I didn't count them there are easily 2:1 Med Onc vs Rad Onc positions posted this month. Several good positions posted this month with lots of repeats. Good luck to everyone going for that costal and somewhat Santa Barbara adjacent (60 miles away) private practice California job!

 

[thecarbonionangle]

I was talking to med onc fellows the other day, both finishing first year, both have multiple pp and academic main site offers. They are in such high demand that it is a buyers market. In our field, we can’t even agree something consequential has to be done

 

[medgator]

I waa talking to med onc fellows the orher day, both finishing first year, both have multiple pp and academic main site offers. They are in such high demand that it is a buyers market. In our field, we can’t even agree something consequential has to be done

It starts young

 

[thecarbonionangle]

It is possible Stanford grads are doing fine and there are no issues but Stanford is known to keep several of their own as “fellows” over the years. You make your own conclusions folks.

I find the thinking of “us” vs “them” unproductive. Blaming “forums” is bizarre.

we have to get to a point where people care about the overall job situation for ALL graduates not just their own.

 

[TheWallnerus]

It starts young

I speak to residents somewhat a lot. I have been told within past month eg that a resident from probably the top rad onc program in the south had either a very bad, or unsuccessful, time finding a job recently. But as I always say, sure you can “talk” to people. Have you even tried talking to math though? It’s a very one way conversation.

 

[ROforbetterorworse]

It starts young

I looked at this residents profile. He is PGY2

how is he supposed to speak about culture
2 weeks after starting residency

This is definition of Propaganda

 

[Ray D. Ayshun]

I looked at this residents profile. He is PGY2

how is he supposed to speak about culture
2 weeks after starting residency

This is definition of Propaganda

Haha, will be fun to see how things change over the next few years.

 

[TheWallnerus]

I looked at this residents profile. He is PGY2

how is he supposed to speak about culture
2 weeks after starting residency

This is definition of Propaganda

Haha, will be fun to see how things change over the next few years.

He’s like the little boy in “Life is Beautiful.” Oh, this is fun! It’s all a game! Why does everyone else have such a sour face???

 

[Ray D. Ayshun]

He’s like the little boy in “It’s a Beautiful Life.” Oh, this is fun! It’s all a game! Why does everyone else have such a sour face???

I don't have Twitter, but I'm pretty sure I said what (don't know preferred pronoun) said when I was a pgy2. Or maybe I just stfu until I felt I could have an opinion. Either way.

 

[RickyScott]

I speak to residents somewhat a lot. I have been told within past month eg that a resident from probably the top rad onc program in the south had either a very bad, or unsuccessful, time finding a job recently. But as I always say, sure you can “talk” to people. Have you even tried talking to math though? It’s a very one way conversation.

And both duke and Emory seemed to have expanded their resident numbers

 

[theradiator]

In this Orwellian dystopia, he is a "useful idiot" who is brainwashed by propaganda

 

[fiji128]

Stanford rad onc, at least historically, has been known as being malignant and scunt heavy. No way a PGY-2 not even two weeks in can speak to this and the department's culture. Strange they would even post that on twitter.

 

[medgator]

Stanford rad onc, at least historically, has been known as being malignant and scunt heavy. No way a PGY-2 not even two weeks in can speak to this and the department's culture. Strange they would even post that on twitter.

Must have been "encouraged"

 

[Ray D. Ayshun]

Stanford rad onc, at least historically, has been known as being malignant and scunt heavy. No way a PGY-2 not even two weeks in can speak to this and the department's culture. Strange they would even post that on twitter.

Every time I've been to Palo alto I've felt great.

 

[metallica81788]

My experiences and feelings toward my program as a PGY2/3 vs PGY 4/5 were worlds apart. PGY2s know nothing about their current programs and their inner workings.

 

[Ray D. Ayshun]

My experiences and feelings toward my program as a PGY2/3 vs PGY 4/5 were worlds apart. PGY2s know nothing about their current programs and their inner workings.

One thing the feelings never get, are better.

 

[Mandelin Rain]

I'm shocked that a new MD/PhD trainee feels at home in a rad onc department less than 2 weeks out from doing overnight calls in the ICU during COVID all year.

Mission Accomplished.

 

[Lamount]

I'm shocked that a new MD/PhD trainee feels at home in a rad onc department less than 2 weeks out from doing overnight calls in the ICU during COVID all year.

Mission Accomplished.

That's why I tell everyone to do an intense hardcore internship: the rest of your training will always seem better by comparison lol

 

[Ray D. Ayshun]

That's why I tell everyone to do an intense hardcore internship: the rest of your training will always seem better by comparison lol

I tell everyone to do a ty as it's way better.

 

[ROforbetterorworse]

I tell everyone to do a ty as it's way better.

LOL yeaaa I remember some colleagues choosing gen surg year to be hardcore or bc it helps them understand operations and margins blah blah

For some reason, they started giving me dirty looks after 1 month while I was going out on Friday nights during TY

 

[elementaryschooleconomics]

It starts young

Little does the author of this particular Tweet know, he HAS talked to me in real life.

Talk to me in person, talk to me on the forums...my point of view doesn't change. One of the last things I did in my last days of residency was try to talk a student out of RadOnc. I consider it part of the Oath, at this point.

 

[lyltothend]

It starts young

 

[Ray D. Ayshun]

Little does the author of this particular Tweet know, he HAS talked to me in real life.

Talk to me in person, talk to me on the forums...my point of view doesn't change. One of the last things I did in my last days of residency was try to talk a student out of RadOnc. I consider it part of the Oath, at this point.

You're potentially doxxing yourself as the one and only recent pgy5 who thinks there are problems.

 

[elementaryschooleconomics]

You're potentially doxxing yourself as the one and only recent pgy5 who thinks there are problems.

The silent majority!

I automatically assume that my job-seeking colleagues who deny the issues were looking for jobs in western Pennsylvania or Ohio....

 

[medgator]

The silent majority!

I automatically assume that my job-seeking colleagues who deny the issues were looking for jobs in western Pennsylvania or Ohio....

Don't forget Wisconsin and Michigan!

 

[fiji128]

These NYC private practice jobs keep on posting month after month. Has to be some kind of story with these places/positions. Total exploitation or is anything in NY State now considered super undesirable?

 

[medgator]

These NYC private practice jobs keep on posting month after month. Has to be some kind of story with these places/positions. Total exploitation or is anything in NY State now considered super undesirable?

There has been a general migration out of NY for years except NYC but even they are seeing some emigration as well as crime spikes higher

 

[fiji128]

When I finished residency a few years ago I would’ve been super excited about that position in Queens. Now I’m like ya that’s a hard pass (knowing it probably would require lots more work for significantly less take home pay). But with so with so many graduating from nyc residencies I’d think anything in the metro area would be snapped up without having to post the position, despite what you see in the news.

 

[MegaVoltagePhoton]

I guess I feel charitable and will give the benefit of the doubt. Stanford does have a reputation of being super malignant and so maybe that’s what he’s getting at. Still, not a great idea to post that within two weeks of getting there (to an objective viewer)

 

[elementaryschooleconomics]

These NYC private practice jobs keep on posting month after month. Has to be some kind of story with these places/positions. Total exploitation or is anything in NY State now considered super undesirable?

I know several folks who have interviewed for those jobs (and not taken them).

The two things I've been told:

1) Personality differences with the existing docs/partners

2) Maybe not exploitative, in the traditional sense, but what we've talked about often on here: no path to partnership, a set salary that hovers around the national median without room for production bonuses, etc. So, not necessarily a bad gig (in that your salary is guaranteed), but I don't think the people looking for a NYC PP job are generally the type of people willing to settle for the national average pay forever (because the average RadOnc salary in NYC doesn't go as far as people think)

 

[medgator]

I know several folks who have interviewed for those jobs (and not taken them).

The two things I've been told:

1) Personality differences with the existing docs/partners

2) Maybe not exploitative, in the traditional sense, but what we've talked about often on here: no path to partnership, a set salary that hovers around the national median without room for production bonuses, etc. So, not necessarily a bad gig (in that your salary is guaranteed), but I don't think the people looking for a NYC PP job are generally the type of people willing to settle for the national average pay forever (because the average RadOnc salary in NYC doesn't go as far as people think)

No one is buying a $2M place in Manhattan on a $400-500k rad onc salary

 

[elementaryschooleconomics]

No one is buying a $2M place in Manhattan on a $400-500k rad onc salary

From what I heard, $400k was the absolute best case scenario.