ASTRO Workforce Study

[PRAD_ONC]

It wasn’t just encouragement. She stated that her intention was to set standards that ensure low quality programs close if they don’t shape up. She criticized the RRC for being a “rubber stamp” to programs opening/expanding and clearly stated that was going to change under her.

easier said than done.

Any change will be years in the making.

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[xrthopeful]

easier said than done.

Any change will be years in the making.

Sounds like an excuse one would expect from someone against change?

I for one am happy to hear of this plan despite how hard or how long it may take

 

[OTN]

easier said than done.

Any change will be years in the making.

Sounds like we should have started years ago, then, back when SDN first raised the issue.

 

[medgator]

Sounds like an excuse one would expect from someone against change?

I for one am happy to hear of this plan despite how hard or how long it may take

Not how I interpreted that comment at all. It was very easy for the RRC to rubber stamp these programs the last decade. Do you think they will easily give up their programs and slots now, even if it is the right thing to do?

 

[xrthopeful]

Not how I interpreted that comment at all. It was very easy for the RRC to rubber stamp these programs the last decade. Do you think they will easily give up their programs and slots now, even if it is the right thing to do?

I mean the new head of the RRC saying that the past team did a shot job and she’s here to clean up the mess is a good thing. It may be hard and take a long time but it’s got to start somewhere

This is exactly what SDN has been hoping for

 

[Krukenberg]

I mean the new head of the RRC saying that the past team did a shot job and she’s here to clean up the mess is a good thing. It may be hard and take a long time but it’s got to start somewhere

This is exactly what SDN has been hoping for

Exactly. Falit made a convincing case that the anti-trust issues are a real threat, and Vapiwala’s mechanism of both increasing the quality of rad oncs produced and constraining # spots is a win-win.

People do pay attention to this board (how else did any of this get on the agenda at ASTRO) and if we support the RRC changes she proposes it will be harder for anti-change people to successfully oppose her. This is the only viable way to constrain #s and we can’t let the perfect (gentleman’s agreement) be the enemy of good.

 

[fiji128]

Didn't astro put out something in regards to raising the standards for training and it all just got watered down to the point of being almost meaningless in an effort to keep all the departments happy? I hope the standards can be raised by the RRC but its true that any effort in that regards probably wouldn't be felt in the job market for well over 10 years from now in the best case scenario.

It will be interesting to see what fruits the "lets bury our heads in the sand" approach will bear with this years match. 30 unfilled spots in 22 programs in 2018, wow. The lower and mid lower mid tier programs will probably just embrace non US grads this year and then claim there was never any problem to begin with and its all about marketing better to folks truely interested rad onc or some such non sense.

 

[PRAD_ONC]

...I hope the standards can be raised by the RRC but its true that any effort in that regards probably wouldn't be felt in the job market for well over 10 years from now in the best case scenario.

Totally agree. I'm all for rectifying the problem, but any fix wont be significantly noticeable for 10 years.

 

[RickyScott]

Yes, because he's retiring in 5 years.

FYI Steinberg "let them eat cake" earns 1 mill year (public info) and must of made tens of mill selling practices to vantage/21 C. The guy is basically saying radonc is hard to predict, so given the uncertainty, why not double residency numbers and things may sort themselves out over 20 years.
I have a lot of respect for Dr. Vapiwala trying to address this issue, and hope she runs for more senior position in ASTRO.
In meantime, programs will be looking for more "diverse" applicants. Maybe FMGs or felony or 2 can give a candidate a different, valued perspective.
Still, this was take almost a generation to correct, and just cant see anyone entering the field, taking comfort that maybe when they are in their late 40s, job market will improve.

 

[medgator]

In meantime, programs will be looking for more "diverse" applicants. Maybe FMGs or felony or 2 can give a candidate a different, valued perspective.

Ironically the same kind of candidates that probably got in a few decades ago that are now in positions of leadership to help exacerbate the problem and let everyone eat cake

 

[RickyScott]

Ironically the same kind of candidates that probably got in a few decades ago that are now in positions of leadership to help exacerbate the problem and let everyone eat cake

Am really curious, with head of the RRC admitting we have a real problem that she plans to act on, if anyone is willing to still dispute the oversupply and challenges that we face, perhaps by relating an anecdote about themselves or fellow resident obtaining a good job? Would it still be ethical to gaslight medical students, or is that frank malice? This whole notion of oversupply is not accepted by the twitter crowd.
Is it really ethical for ASTRO to make a concerted outreach effort to increase women and minorities in the field?

 

[scarbrtj]

Do the data show that the unemployment rate for fresh rad onc grads is higher than the average BLS-cited U.S. unemployment rate? I kind of have that idea stuck in my mind, and if it's a false notion I'd really like to rid my mind of it. Falit has written about this cogently. My impression is he is anti-oversupply, recognizes its ills, etc. So his anti-trust warnings carry some water. Thus I am prepared to accept that the Antitrust Gestapo will come knocking if rad onc GME doesn't mind its legal p's and q's.

Am really curious, with head of the RRC admitting we have a real problem that she plans to act on, if anyone is willing to still dispute the oversupply and challenges that we face, perhaps by relating an anecdote about themselves or fellow resident obtaining a good job? Would it still be ethical to gaslight medical students, or is that frank malice? This whole notion of oversupply is not accepted by the twitter crowd.
Is it really ethical for ASTRO to make a concerted outreach effort to increase women and minorities in the field?

I don't think it's either gaslighting or frank malice. The entire Internet, and SDN, is now the movie Free Solo, a cautionary tale if you will for rad onc. If you watch Free Solo and decide to go climb without a rope, your death is all on you.

 

[Haybrant]

Steinberg biggest hater I’ve ever heard lol.

Residents aren’t cost effective LMAO.

Govt literally pays hospitals for our spot. We are FREE labor with an MD

Hospital pays half, upwards of 70-90k a res. But I agree when they say not cost effective they think they’re being so funny when their disconnected and sound like imbeciles. That’s steinberg tho who pulls in >900k a year for making imbecilic statements for a living.

Will say Vapiwalla is the leader we need. Wallner/Kachnic unfortunately are the schlubs we got.

 

[RickyScott]

Do the data show that the unemployment rate for fresh rad onc grads is higher than the average BLS-cited U.S. unemployment rate? I kind of have that idea stuck in my mind, and if it's a false notion I'd really like to rid my mind of it. Falit has written about this cogently. My impression is he is anti-oversupply, recognizes its ills, etc. So his anti-trust warnings carry some water. Thus I am prepared to accept that the Antitrust Gestapo will come knocking if rad onc GME doesn't mind its legal p's and q's.

I don't think it's either gaslighting or frank malice. The entire Internet, and SDN, is now the movie Free Solo, a cautionary tale if you will for rad onc. If you watch Free Solo and decide to go climb without a rope, your death is all on you.

to clarify, what constitutes malice and gaslighting is denial that there is a an oversupply issue. You liken entering xrt to free soloing at this point.

 

[RickyScott]

Do the data show that the unemployment rate for fresh rad onc grads is higher than the average BLS-cited U.S. unemployment rate? I kind of have that idea stuck in my mind, and if it's a false notion I'd really like to rid my mind of it. Falit has written about this cogently. My impression is he is anti-oversupply, recognizes its ills, etc. So his anti-trust warnings carry some water. Thus I am prepared to accept that the Antitrust Gestapo will come knocking if rad onc GME doesn't mind its legal p's and q's.

I don't think it's either gaslighting or frank malice. The entire Internet, and SDN, is now the movie Free Solo, a cautionary tale if you will for rad onc. If you watch Free Solo and decide to go climb without a rope, your death is all on you.

to clarify, what constitutes malice and gaslighting is denial that there is a an oversupply issue. medstudents are used to trusting their departments You liken entering xrt to free soloing at this point. KO still seems to think SDN is the problem, not his 3 residency programs..

 

[deleted774703]

Hopefully, this talk will be good and not either 1) An ASTRO sycophants paradise or 2) The end of this young man's career.

Seriously, hoping for a good discussion on this important topic

Interested to see what this resident discuss today.

 

[deleted774703]

Interested to see what this resident discuss today.

Very pleasantly surprised by the resident.

Shot down residency expansion!

Dr. Vapiwala and Olivier also did a great job supporting him

What did others think?

 

[Chartreuse Wombat]

I was frustrated that Dr Steinberg was pushing back against the claim that residents pay for themselves as suggested by Drs Lee and Falit. I did not know the "RAND study" to which he referred.

Google points to a RAND study on the financing of GME from 2013. I cannot know if this is what he means and the entire paper is only available for a fee but the summary is available on line. Below is verbatim from the webpage-

Does It Cost More to Train Medical Residents or to Replace Them?

If a hospital has service needs, adding a resident presents a marginal benefit. This is especially true for more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare revenues related to graduate medical education.

www.rand.org

"Marginal financial impacts are more likely to influence sponsor decisions on changes in GME program size and offerings and help explain why GME program expansions are occurring without additional Medicare funding. If the hospital has service needs, there is a marginal benefit to adding a resident, particularly in the more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare GME-related revenues."

I admit that I have not read the entire thing but I think the findings are exactly opposite of what Dr Steinberg said they were. This study can support why the number of spots is growing (money) as RadOnc is clearly lucrative to hospitals/health systems.

Posted for the benefit of SDN readers.

Cheers

 

[deleted956486]

I was frustrated that Dr Steinberg was pushing back against the claim that residents pay for themselves as suggested by Drs Lee and Falit. I did not know the "RAND study" to which he referred.

Google points to a RAND study on the financing of GME from 2013. I cannot know if this is what he means and the entire paper is only available for a fee but the summary is available on line. Below is verbatim from the webpage-

Does It Cost More to Train Medical Residents or to Replace Them?

If a hospital has service needs, adding a resident presents a marginal benefit. This is especially true for more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare revenues related to graduate medical education.

www.rand.org

"Marginal financial impacts are more likely to influence sponsor decisions on changes in GME program size and offerings and help explain why GME program expansions are occurring without additional Medicare funding. If the hospital has service needs, there is a marginal benefit to adding a resident, particularly in the more-lucrative specialty and subspecialty programs, before considering the additional benefits of any Medicare GME-related revenues."

I admit that I have not read the entire thing but I think the findings are exactly opposite of what Dr Steinberg said they were. This study can support why the number of spots is growing (money) as RadOnc is clearly lucrative to hospitals/health systems.

Posted for the benefit of SDN readers.

Cheers

He can't read. That makes sense.

 

[medgator]

He can't read. That makes sense.

Or he's gaslighting. Wouldn't be the first time a leader in RO did that #WallnerEditorial

 

[deleted956486]

Or he's gaslighting. Wouldn't be the first time a leader in RO did that #WallnerEditorial

Should be the theme of this year's ASTRO:

Innovation by Gaslighting

 

[Mandelin Rain]

I paid for myself several times over in residency just in litigation fees/malpractice payouts by catching mistakes made by attendings before they hit the patient.

 

[evilbooyaa]

I paid for myself several times over in residency just in litigation fees/malpractice payouts by catching mistakes made by attendings before they hit the patient.

Haha, good one. Nobody gets sued in Rad Onc for being crap at radiation oncology. Only if you actually kill somebody.

Nobody gets sued for cancer recurrence because the radiation contours/fields were garbage, even in the 3D and IMRT era.

 

[medgator]

I paid for myself several times over in residency just in litigation fees/malpractice payouts by catching mistakes made by attendings before they hit the patient.

Don't forget all that positive karma that will hopefully catch up to you at some point

 

[seper]

Rare to be sued for marginal recurrence, but I know one person that was found to liable for a skimpy head and neck field.

Haha, good one. Nobody gets sued in Rad Onc for being crap at radiation oncology. Only if you actually kill somebody.

Nobody gets sued for cancer recurrence because the radiation contours/fields were garbage, even in the 3D and IMRT era.

 

[scarbrtj]

Rare to be sued for marginal recurrence, but I know one person that was found to liable for a skimpy head and neck field.

There's an old classic plenary session abstract that showed whether crap fields, good fields, juicy fields, skimpy fields... what have you... in H&N IMRT make little dosimetric difference. YMMV. I guess if you're found "liable" for a H&N recurrence because of skimp contouring, either you had really bad contouring or didn't know about this abstract

 

[seper]

Nice abstract, Nick should have expanded into the full paper.
The H&N case I know was egregious: very high risk lip cancer was treated with electrons to the flap, instead of wide fields. Predictably, the young man suffered from fatal recurrence.

There's an old classic plenary session abstract that showed whether crap fields, good fields, juicy fields, skimpy fields... what have you... in H&N IMRT make little dosimetric difference. YMMV. I guess if you're found "liable" for a H&N recurrence because of skimp contouring, either you had really bad contouring or didn't know about this abstract

 

[medgator]

The H&N case I know was egregious: very high risk lip cancer was treated with electrons to the flap, instead of wide fields. Predictably, the young man suffered from fatal recurrence.

Similar case I know of that happened thanks to a dermatologist using superficial tx in the office of the primary and then ignoring appropriate oncologic wu and evaluation of the bilateral neck.

Patient had bulky bilateral neck nodes when I saw him and opted for hospice rather than further surgery/chemo/xrt

 

[deleted774703]

Similar case I know of that happened thanks to a dermatologist using superficial tx in the office of the primary and then ignoring appropriate oncologic wu and evaluation of the bilateral neck.

Patient had bulky bilateral neck nodes when I saw him and opted for hospice rather than further surgery/chemo/xrt

This seems like malpractice. For these cases, can you report the dermatologist? or not worth it?

 

[medgator]

This seems like malpractice. For these cases, can you report the dermatologist? or not worth it?

Too busy taking care of the patient to worry about that. I'm sure a younger, fitter pt would have likely done all that for me

 

[scarbrtj]

This seems like malpractice. For these cases, can you report the dermatologist? or not worth it?

When someone says “report,” I think criminal. Like calling 911 to report a break-in at my neighbor’s I witnessed. But malpractice is civil of course. (All these ads for “have you been harmed by a hernia mesh?” or “do you have mesothelioma from asbestos?”... you call and “report” to an attorney’s office, and you’d have to be the person harmed.) Worst you could do is report the other rad onc dermatologist to a state medical board, but for one isolated case of a cancer recurrence I doubt it’d go anywhere no matter how bad you make the other rad onc dermatologist (rightly) appear to be.

 

[medgator]

When someone says “report,” I think criminal. Like calling 911 to report a break-in at my neighbor’s I witnessed. But malpractice is civil of course. (All these ads for “have you been harmed by a hernia mesh?” or “do you have mesothelioma from asbestos?”... you call and “report” to an attorney’s office, and you’d have to be the person harmed.) Worst you could do is report the other rad onc to a state medical board, but for one isolated case of a cancer recurrence I doubt it’d go anywhere no matter how bad you make the other rad onc (rightly) appear to be.

In this case it would be a dermatologist, derm rads is a real problem medico-legally and, as it has been shown, isn't just a "turf war"

 

[deleted941485]

In this case it would be a dermatologist, derm rads is a real problem medico-legally and, as it has been shown, isn't just a "turf war"

Desperate times desperate measures

 

[deleted941485]

At any rate, how is the job market for the 2020 grads now? Is it any better. I know Astro just happened.

 

[medgator]

At any rate, how is the job market for the 2020 grads now? Is it any better. I know Astro just happened.

Feels like I've seen more physicist jobs at the site lately...

 

[deleted941485]

Feels like I've seen more physicist jobs at the site lately...

Hmm weird I don’t really get the dynamics of their market. Not very encouraging to say the least.

I mean we’re not hiring and we are still getting unsolicited resumes and cover letters.

 

[medgator]

I mean we’re not hiring and we are still getting unsolicited resumes and cover letters.

I got an unsolicited email last week from a chief resident who doesn't have roots or connections to my area.

I get the sense that people are shotgunning it now, application wise and I feel really bad for RO residency graduates from here on out.

 

[deleted941485]

I got an unsolicited email last week from a chief resident who doesn't have roots or connections to my area.

I get the sense that people are shotgunning it now, application wise and I feel really bad for RO graduates from here on out.

Let me guess. “I’m not from here but I’m very geographically flexible”. God it makes me want to cry.

 

[medgator]

Let me guess. “I’m not from here but I’m very geographically flexible”. God it makes me want to cry.

But somehow I'm a bad person for maligning the field...

 

[deleted941485]

But somehow I'm a bad person for maligning the field...

Exactly. This is the sort of stuff a field with actual demand doesn’t deal with this nonsense on such a persistent basis. But here it’s the number 1 thought

 

[scarbrtj]

But somehow I'm a bad person for maligning the field...

I think this person maligned it too. (Throw a rock you can hit a maligner 'round here these days.)

"Besides SDN, where did you gather information leading you to decide against rad onc?"
"Mostly from residents at my home program who have difficulty finding jobs in their desired locations."

 

[radOresident]

Let me guess. “I’m not from here but I’m very geographically flexible”. God it makes me want to cry.

As one of the (presumably many) chiefs that have used the "geographically flexible" line I feel personally attacked

Being completely honest, I was aware of the job market concerns when I decided to go into this field but assumed that they were overblown. I regret not taking it seriously when I had the chance. I would give anything to go back and do internal medicine or medical oncology

 

[thecarbonionangle]

As one of the (presumably many) chiefs that have used the "geographically flexible" line I feel personally attacked

Being completely honest, I was aware of the job market concerns when I decided to go into this field but assumed that they were overblown. I regret not taking it seriously when I had the chance. I would give anything to go back and do internal medicine or medical oncology

Its like fishing, some will bite, some may not!

 

[evilbooyaa]

As one of the (presumably many) chiefs that have used the "geographically flexible" line I feel personally attacked

Being completely honest, I was aware of the job market concerns when I decided to go into this field but assumed that they were overblown. I regret not taking it seriously when I had the chance. I would give anything to go back and do internal medicine or medical oncology

I have also used this line. Now I see why my response rate is so incredibly low (teens), as apparently that is not what an employer wants to hear (?). I was (and am) shotgunning to areas I don't have connections to. I would rather live in your relatively large city that I don't have connections to rather than end up in rural kansas/alabama or without a job, is that one would prefer to hear?

I mean it's one thing if you aren't hiring and you're getting unsolicited resumes, but is this what people who are actually looking to hire this year think like as well?

 

[RickyScott]

I have also used this line. Now I see why my response rate is so incredibly low (teens), as apparently that is not what an employer wants to hear (?). I was (and am) shotgunning to areas I don't have connections to. I would rather live in your relatively large city that I don't have connections to rather than end up in rural kansas/alabama or without a job, is that one would prefer to hear?

I mean it's one thing if you aren't hiring and you're getting unsolicited resumes, but is this what people who are actually looking to hire this year think like as well?

I really dont see why that line is a problem, in fact I would expect that of most candidates. Certainly it is a plus if someone has serious connections to the area, but how often does that happen?

 

[taserlaser]

Will be really interesting to hear how current fellows/R6s fare with their success. Either through connections (perhaps increasingly unlikely), or through the acquiring of additional expertise (or ‘expertise’). From the no ties to a location category, I suspect (but could be wrong), deference in hiring will be made in favor of the fellows vs new grads. That’s gong to be an increasingly large chunk, and higher opportunity cost for the field too. Any other fellows want to chime in with things?

 

[RickyScott]

Will be really interesting to hear how current fellows/R6s fare with their success. Either through connections (perhaps increasingly unlikely), or through the acquiring of additional expertise (or ‘expertise’). From the no ties to a location category, I suspect (but could be wrong), deference in hiring will be made in favor of the fellows vs new grads. That’s gong to be an increasingly large chunk, and higher opportunity cost for the field too. Any other fellows want to chime in with things?

Fellowships almost never add expertise and certainly wont provide an advantage outside of a university system (granted they are a large portion of employers)

edit- what probably adds expertise in this field is regular participation in online forums like this or mednet, probably indicates something about your real interest in the specialty.

 

[thecarbonionangle]

Fellowships almost never add expertise and certainly wont provide an advantage outside of a university system (granted they are a large portion of employers)

Look up fellowship survey and see how much it “helped” those fellows

 

[medgator]

Fellowships almost never add expertise and certainly wont provide an advantage outside of a university system (granted they are a large portion of employers)

Completely agree. 3 As, connections to the area matter much more imo in pp.

Fellowships will buy you an extra year to "wait" things out though, hoping a position opens in one's preferred geographic locale