Away Rotation Strategy for someone who wants to end up in PP eventually

[TheIllusionist]

Currently an M3. Interest is to end up in PP (single or multispeciality group partnership on the E coast) rad onc. Yes I have read about doom and gloom in the field.

Large public MD School East Coast

Stats: 247 STEP1

Preclinical- P/F school. Not junior AOA

Clinical- H-Medicine, Surgery, Ob-gyn, Neurology, Psychiatry. Still have peds and FM to go. Shelf grades all 90th-99th percentile. Decent shot at possible senior AOA. Plan on taking STEP 2 CK early and trying to knock it out of the park (I know this won't help much, but it won't hurt and I just want to get it out of the way).

Research: Did a research year at a Top 3 (got connected via summer research program I did there between M1 and M2)- (all translational and/or basic) 2 abstracts, 1 presentation, will be middle author on 2 basic science papers hopefully out this year (I seriously hope that this isn't delayed). Currently working with department on a clinical project. I should have been way more on top of this 3rd year, but I am not naturally that amazing of a student, so I was trying to just focus and work my ass off to get honors in everything. Looking back, should have done more research stuff. I have random stuff research wise from undergrad, including a couple presentations at summer REU type research programs and math research presentation on combustion transition zones between laminar and turbulent flow (totally irrelevant stuff basically).

ECs: national level positions in the AMA over the past three years (bulk of time for EC related stuff). Did random stuff like testify in front of state legislature a couple times. Mandated to do 50 hours community service so helped lead SAT class for underprivileged kids in area (absolutely nothing special just cookie cutter filler crap)

What are some places that are more PP geared with a reasonable reputation that I have a chance at matching?

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[KHE88]

Apply before the ERAS deadline (on the deadline is probably fine) and have a pulse.

You can then spend your time gunning for the PP spot in Rapid City, SD with locums in ND as a backup. Oh, and spending 3 years memorizing a textbook for a cancer biology exam you have a 50% chance of failing.

Seriously (although the quip above was fairly serious), you need to better define your goals as to what "PP" is (perma-associate employee in a nice location, hospital employee, PSA partner, solo 1099 contractor, practice owner, etc), and what location you are looking for to get any meaningful help.

I strongly, strongly encourage you to consider literally any other field you think might be tolerable unless you meet some very specific and stringent criteria that probably apply to <5% of applicants.

 

[TheIllusionist]

Apply before the ERAS deadline (on the deadline is probably fine) and have a pulse.

You can then spend your time gunning for the PP spot in Rapid City, SD with locums in ND as a backup. Oh, and spending 3 years memorizing a textbook for a cancer biology exam you have a 50% chance of failing.

Seriously (although the quip above was fairly serious), you need to better define your goals as to what "PP" is (perma-associate employee in a nice location, hospital employee, PSA partner, solo 1099 contractor, practice owner, etc), and what location you are looking for to get any meaningful help.

I strongly, strongly encourage you to consider literally any other field you think might be tolerable unless you meet some very specific and stringent criteria that probably apply to <5% of applicants.

Singe/ Multi-specialty group Partnership track - East Coast (entire)

 

[FindMeOnTheLinks]

Current applicant, just finished up interviewing with rad onc programs and getting to know quite a few applicants on the trail so can provide a little bit of insight on the process.

(BTW, prepare for this thread to get completely derailed with responses like the two above, as >90% of threads on the rad onc forum do)

What type of school do you go to? Top 20 private school, large well-known state school, etc? Your step is fine, your research is probably average to above average. Try to do well on Step2CK. Otherwise, your application is competitive. Check out this year's spreadsheet to see for yourself, but I would expect you will get >15-20 interviews.

Most of the programs in the country send >50% of their grads to private practice, so its not like you need to go to a really well-known program to get you into private practice. The bigger concern would be location and networking (the 3 As are tossed around a lot on here as the biggest requirements to get a PP job - availability, affability, ability). If you are looking for an east coast job, probably better to match somewhere on the east coast.

Honestly, with your numbers and your research you would be competitive for an interview at all but a select few programs across the country. If you go to a top 20 med school, you could get interviews anywhere really.

Basically, you can do aways anywhere you want but would avoid places that are notorious for not interviewing all of their rotators (Penn, Yale, Harvard, MDACC, MSKCC, UF, UCSD, Michigan). Since you are interested in private practice, you don't need to gun for a match at a top tier academic place. But it also doesn't hurt to go to a place like that in case you change your mind later and want to do academics, and a place like that definitely wouldn't hinder you from going PP (though some do look down upon it). Basically, since you want PP, all the options are on the table for you. Just pick somewhere like.

 

[TheIllusionist]

Current applicant, just finished up interviewing with rad onc programs and getting to know quite a few applicants on the trail so can provide a little bit of insight on the process.

(BTW, prepare for this thread to get completely derailed with responses like the two above, as >90% of threads on the rad onc forum do)

What type of school do you go to? Top 20 private school, large well-known state school, etc? Your step is fine, your research is probably average to above average. Try to do well on Step2CK. Otherwise, your application is competitive. Check out this year's spreadsheet to see for yourself, but I would expect you will get >15-20 interviews.

Most of the programs in the country send >50% of their grads to private practice, so its not like you need to go to a really well-known program to get you into private practice. The bigger concern would be location and networking (the 3 As are tossed around a lot on here as the biggest requirements to get a PP job - availability, affability, ability). If you are looking for an east coast job, probably better to match somewhere on the east coast.

Honestly, with your numbers and your research you would be competitive for an interview at all but a select few programs across the country. If you go to a top 20 med school, you could get interviews anywhere really.

Basically, you can do aways anywhere you want but would avoid places that are notorious for not interviewing all of their rotators (Penn, Yale, Harvard, MDACC, MSKCC, UF, UCSD, Michigan). Since you are interested in private practice, you don't need to gun for a match at a top tier academic place. But it also doesn't hurt to go to a place like that in case you change your mind later and want to do academics, and a place like that definitely wouldn't hinder you from going PP (though some do look down upon it). Basically, since you want PP, all the options are on the table for you. Just pick somewhere like.

Not top 20 school. MD flagship state school on East Coast with decent reputation. Chair well known as one of the "Godfathers" of the field. Are Duke and Gtown known to rank their rotators highly? Duke says it does on its website, and I was going to just take that at face value. From heresay, someone said Gtown places well for PP. I just got really nervous looking at spread sheets last year. Those 260s with the 15 pubs are intimidating to look at. So I don't want to set my standards too high. I agree that I want to avoid rotating at places notorious for not giving rotators interviews.

 

[FindMeOnTheLinks]

Not top 20 school. MD flagship state school on East Coast with decent reputation. Chair well known as one of the "Godfathers" of the field. Are Duke and Gtown known to rank their rotators highly? Duke says it does on its website, and I was going to just take that at face value. From heresay, someone said Gtown places well for PP. I just got really nervous looking at spread sheets last year. Those 260s with the 15 pubs are intimidating to look at. So I don't want to set my standards too high. I agree that I want to avoid rotating at places notorious for not giving rotators interviews.

Duke would be a good place to rotate as you could get a letter from somebody well known, and they also count the rotation as your interview. Not familiar with GT as I didn’t interview there. Since you mentioned Duke and GT (east/southeast), other good places to do aways would be Vanderbilt, Moffitt, UNC, UAB, Fox Chase, Maryland. If you don’t have geographic restrictions, other places with great track records for clinical training include any of the Mayo locations, Cleveland Clinic, Colorado, UWisconsin, Beaumont. These are all solid programs that send graduates into PP but also send some to academics as well. Honestly pretty much any place will get you to a job in private practice, maybe places with less academic/more clinical focus would be better though. Search around on SDN and the spreadsheet for away/interview impressions, there is a lot of info out there.

Don’t be intimidated by the numbers on the spreadsheet, the vast majority are candidates similar to you (and the pub numbers are inflated by abstracts, very very few actually have 15 real publications). The ongoing trend is the Rad Onc match is getting less competitive every year, and this trend will more than likely continue. You will likely match well

 

[medgator]

The ongoing trend is the Rad Onc match is getting less competitive every year, and this trend will more than likely continue. You will likely match well

This. There will likely be less AMGs than spots this coming year overall.

 

[deleted18755]

Currently an M3. Interest is to end up in PP (single or multispeciality group partnership on the E coast) rad onc. Yes I have read about doom and gloom in the field.

Large public MD School East Coast

Stats: 247 STEP1

Preclinical- P/F school. Not junior AOA

Clinical- H-Medicine, Surgery, Ob-gyn, Neurology, Psychiatry. Still have peds and FM to go. Shelf grades all 90th-99th percentile. Decent shot at possible senior AOA. Plan on taking STEP 2 CK early and trying to knock it out of the park (I know this won't help much, but it won't hurt and I just want to get it out of the way).

Research: Did a research year at a Top 3 (got connected via summer research program I did there between M1 and M2)- (all translational and/or basic) 2 abstracts, 1 presentation, will be middle author on 2 basic science papers hopefully out this year (I seriously hope that this isn't delayed). Currently working with department on a clinical project. I should have been way more on top of this 3rd year, but I am not naturally that amazing of a student, so I was trying to just focus and work my ass off to get honors in everything. Looking back, should have done more research stuff. I have random stuff research wise from undergrad, including a couple presentations at summer REU type research programs and math research presentation on combustion transition zones between laminar and turbulent flow (totally irrelevant stuff basically).

ECs: national level positions in the AMA over the past three years (bulk of time for EC related stuff). Did random stuff like testify in front of state legislature a couple times. Mandated to do 50 hours community service so helped lead SAT class for underprivileged kids in area (absolutely nothing special just cookie cutter filler crap)

What are some places that are more PP geared with a reasonable reputation that I have a chance at matching?

Over the course of even the past 5-7 years the line between "academics" and "private practice" has really blurred so who knows what "private practice" will mean when you are looking for a job and what "partnership" will likewise be like10-12 years from now when you would be expecting to be a "partner."

I know it doesn't answer your question and isn't what you are hoping for, but the safest thing to do (coming from a man with a wife and kids who is probably 20-25 years older than you) is to focus on trying to match at the program with the best training in the city where you would most like to live/work and from the very beginning make it clear that you want to stay in the region and try to secure a spot at one of the satellite centers of the University where you end of for residency. Keep in mind right now the satellites are anywhere from 15 minutes to across state lines from the "mother ship" but anywhere on the east coast probably entails something like 50% of the US population.

 

[RickyScott]

Over the course of even the past 5-7 years the line between "academics" and "private practice" has really blurred so who knows what "private practice" will mean when you are looking for a job and what "partnership" will likewise be like10-12 years from now when you would be expecting to be a "partner."

I know it doesn't answer your question and isn't what you are hoping for, but the safest thing to do (coming from a man with a wife and kids who is probably 20-25 years older than you) is to focus on trying to match at the program with the best training in the city where you would most like to live/work and from the very beginning make it clear that you want to stay in the region and try to secure a spot at one of the satellite centers of the University where you end of for residency. Keep in mind right now the satellites are anywhere from 15 minutes to across state lines from the "mother ship" but anywhere on the east coast probably entails something like 50% of the US population.

Totally agree. Dont equate not being at a university with private practice. Most of us in desirable locations are employed and I imagine by the time you graduate, this will also be the cases in undesirable metros as well.

 

[evilbooyaa]

For residency applications, geographical bias is a thing.

Couple of questions - open to ALL of the east coast (meaning even southeastern US)? The fact you mentioned Duke suggests yes.

Depending on where your med school is, do aways up and down the east coast. With your score and research thus far, you don't need to do more than your home rotation and 2 aways. Shoot for well-respected names in the field, even if they aren't the chair (cause everybody wants a letter from a chair).

Get a letter from the 'grandfather' in your department.

As long as you interview not terribly, aren't incredibly socially awkward, and not racist/sexist/whatever -ist, you will match just fine.

Just know that getting an east coast job, even in PP, may be difficult. If you are geographically flexible (including rural areas) up and down the entire east coast, you should be able to find an employed position.

*PUTTING ON MY MOD HAT PRE-EMPTIVELY* - THIS IS NOT THE THREAD TO HAVE DISCUSSIONS ABOUT THE JOB MARKET. PROLONGED BACK AND FORTH DISCUSSIONS ABOUT JOB MARKET WILL LEAD TO POST DELETION AND WARNINGS.

 

[KHE88]

(BTW, prepare for this thread to get completely derailed with responses like the two above, as >90% of threads on the rad onc forum do).

Discussing the job market and overtraining situation isn't really derailing as these topics need to be discussed in any honest conversation with a med student wanting to go into rad onc, especially those with specific goals (location, practice type, etc).

Over the course of even the past 5-7 years the line between "academics" and "private practice" has really blurred so who knows what "private practice" will mean when you are looking for a job and what "partnership" will likewise be like10-12 years from now when you would be expecting to be a "partner."

I also agree with this, which is why I asked the OP to clarify what his/her goals were with "PP"

Given that the goal is "anywhere on the east coast" and a partnership track single/multi-specialty group, I'd say the following:
- "anywhere on the east coast" is a reasonable geographic goal to have as long as that means honestly accepting rural south carolina as much as accepting NE metro areas. If the goal is "any big city on the east coast," then this is not a realistic mindset.
- It's extremely difficult to predict what the job market will be in 7 years when you are looking, especially if you look at the dramatic change that happened over the past 7 years. But I would not expect the satellite acquisition business to stop. There are some good satellite jobs where you have autonomy, are paid fairly well, and they basically function like hospital-owned "private practice." There are others where you are paid like, or worse than, an academic at the main site, but expected to be in clinic 5 days a week while also publishing and training residents, and having everything you do micromanaged and criticized by the site specific attendings at the main site. It is foolish to think that downward pressure on starting salaries will not continue given the incentives the academics have to save money and the increasing glut of grads competing for a relatively fixed number of jobs. I have personally heard academic leadership make off the cuff/hot mic remarks about how it's great that the job market is in their favor and will help them get a new grad with a cheaper price tag.
- The proportion of true partnership track jobs where you are able to buy-in and become an owner after 2-3 years is already low. More and more of these are selling and becoming employed. There are some good remaining ones, but typically not in large cities or even within commuting distance, and competition for these is fierce. There are also some remaining ones scattered throughout the country that remain profitable by operating in less desirable areas with less competition and exploiting new grads and grads who need visas (who are used to cover multiple sites at low pay, directed to perform questionable treatments by the owners, and never become partner).
- There are also a number of psuedo-private practice jobs where you have a PSA with a hospital or you are managed by private equity owned companies, us oncology, etc. The future of these is anybody's guess.

All that to say landing a true partnership track job anywhere on the east coast that puts you in a position where you are a partner in 10 years from today and getting an equitable cut of technical fees is possible, but increasingly unlikely and you should not plan on it and be expecting to work for an academic satellite in a less desirable location starting at $250k/year and topping out at $400k/year in your career. Competition for these academic jobs will be very strong, and you will be locked in with a take-it-or-leave-it offer and absurd non-competes and have little bargaining power either up front or later in your career.

If you are willing to go further into the country's interior, you will (currently) fare a LOT better. I can't promise how much better that will be in 7-10 years.

As to where he/she should rotate. Pick three well known/big institutions on the east coast. Simple. Matching in this current environment somewhere on the east coast is a non-issue for someone with a 247 who can interview without being overly creepy.

 

[OTN]

More well-established programs will have more extensive alumni connections which are invaluable to the job search process, so I would focus on programs that have been around for awhile.

 

[TheIllusionist]

Is Yale known to interview its rotators? I didn't get a good sense on the spreadsheet. Is it always worth doing a month long stint at my home rotation, if I've already done a 2 week elective and am in continued contact with the faculty for research?

 

[RickyScott]

Is Yale known to interview its rotators? I didn't get a good sense on the spreadsheet. Is it always worth doing a month long stint at my home rotation, if I've already done a 2 week elective and am in continued contact with the faculty for research?

Its no like you are rushing SAE. Everyone is going to get interviews.

 

[FindMeOnTheLinks]

Is Yale known to interview its rotators? I didn't get a good sense on the spreadsheet. Is it always worth doing a month long stint at my home rotation, if I've already done a 2 week elective and am in continued contact with the faculty for research?

if you look on the spreadsheets, every year there are a handful of people who rotated at Yale but don't get an interview

 

[evilbooyaa]

Is Yale known to interview its rotators? I didn't get a good sense on the spreadsheet. Is it always worth doing a month long stint at my home rotation, if I've already done a 2 week elective and am in continued contact with the faculty for research?

Not sure about first question - for second question, I would encourage it, as it will give a LoR writer a sense of how you perform clinically, longer than the 2 weeks you spend with them.