Bleak new data from ASTRO 2020: decreased retirement of practicing RadOncs, Fellowships have doubled

[elementaryschooleconomics]

From Dr. Eichler's Presidential Address (starting around the 48-49 minute mark):

"Predicting supply and demand can be tricky business, as we have seen. In fact, as recently as 2008 an article by Smith et al suggested that there may be a shortage of Radiation Oncologists in the years ahead. Logically, if supply exceeds demand, the solution is to decrease supply to match the market. The reality, however, is that ASTRO doesn't control the market, or the supply, i.e. the number of residents in training. And, although we do advise the ACGME on training program requirements, that can only move the needle but so far. In fact, blatant attempts to do so constitutes collusion to control the marketplace, which is illegal. The matter that has gotten the most attention recently, however, is the fact that fewer US medical students are choosing careers in Radiation Oncology, as witnessed by the failure to fill available residency slots the past two years. Much has been written about this over the last 18 months. Earlier this year, the leadership of ARRO published a thoughtful editorial in the Red Journal that addressed this very issue and other concerns. SCAROP's response is, in my opinion, equally thoughtful...[reads an excerpt from the editorial]...in other words, the sky is not falling. The specialty remains exciting and progressive with a bright future. To medical students listening, let me assure you: we are in a period of uncertainty regarding the job market and training positions that history would suggest is temporary."
...
"Beware of the social media echo chamber, where a disaffected individual with inaccurate information can have a disproportionate amount of influence."
...
"Begin your job search early in training by networking extensively."
...
"Your ultimate objective should be to get A job, not necessarily THE job."

Invoking collusion eh? Most impressive. If ASTRO doesn't control the market, or supply, then how exactly would they be convicted of collusion? Has ASTRO decided "antitrust" no longer holds water and we're going with a buzzword of the current political era, "collusion"?

Yes, SDN and Twitter can definitely be echo chambers. I'm happy to let students read the numbers and decide for themselves...which they have. Good job, medical students of today and tomorrow!

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[Doctorer]

From Dr. Eichler's Presidential Address (starting around the 48-49 minute mark):
...
"Your ultimate objective should be to get A job, not necessarily THE job."

Yes, SDN and Twitter can definitely be echo chambers. I'm happy to let students read the numbers and decide for themselves...which they have. Good job, medical students of today and tomorrow!

So disappointing. In any case, medical students have spoken. If the national society doesn't care if residency graduates get good jobs, they shouldn't be surprised if they get A resident, not necessarily GOOD residents.

 

[deleted605854]

So disappointing. In any case, medical students have spoken. If the national society doesn't care if residency graduates get good jobs, they shouldn't be surprised if they get A resident, not necessarily GOOD residents.

Well said

 

[thecarbonionangle]

Before breadlines: “be happy you get A job”
Circa breadlines: “be happy you get A loaf”
Post breadlines: “be happy you get A crumb”

people will be fighting pizza rat for it in streets

 

[fiji128]

So disappointing. In any case, medical students have spoken. If the national society doesn't care if residency graduates get good jobs, they shouldn't be surprised if they get A resident, not necessarily GOOD residents.

awesome

 

[fiji128]

These people are total clowns. Astro could very easily come out and take a position on this. Everyone knows Astro doesn’t control the ACGME/RRC. This has nothing to do with antitrust or collusion or whatever.

 

[OTN]

From Dr. Eichler's Presidential Address (starting around the 48-49 minute mark):

"Predicting supply and demand can be tricky business, as we have seen. In fact, as recently as 2008 an article by Smith et al suggested that there may be a shortage of Radiation Oncologists in the years ahead. Logically, if supply exceeds demand, the solution is to decrease supply to match the market. The reality, however, is that ASTRO doesn't control the market, or the supply, i.e. the number of residents in training. And, although we do advise the ACGME on training program requirements, that can only move the needle but so far. In fact, blatant attempts to do so constitutes collusion to control the marketplace, which is illegal. The matter that has gotten the most attention recently, however, is the fact that fewer US medical students are choosing careers in Radiation Oncology, as witnessed by the failure to fill available residency slots the past two years. Much has been written about this over the last 18 months. Earlier this year, the leadership of ARRO published a thoughtful editorial in the Red Journal that addressed this very issue and other concerns. SCAROP's response is, in my opinion, equally thoughtful...[reads an excerpt from the editorial]...in other words, the sky is not falling. The specialty remains exciting and progressive with a bright future. To medical students listening, let me assure you: we are in a period of uncertainty regarding the job market and training positions that history would suggest is temporary."
...
"Beware of the social media echo chamber, where a disaffected individual with inaccurate information can have a disproportionate amount of influence."
...
"Begin your job search early in training by networking extensively."
...
"Your ultimate objective should be to get A job, not necessarily THE job."

Invoking collusion eh? Most impressive. If ASTRO doesn't control the market, or supply, then how exactly would they be convicted of collusion? Has ASTRO decided "antitrust" no longer holds water and we're going with a buzzword of the current political era, "collusion"?

Yes, SDN and Twitter can definitely be echo chambers. I'm happy to let students read the numbers and decide for themselves...which they have. Good job, medical students of today and tomorrow!

"Predicting job market fluctuations is really hard for scientists with zero training in that field. Why, look at what a terrible job Dr. Benjamin Smith did in 2008! With a history of failure like that, how do we even really know what's going on?"

Quite the hot take there, Dr. Eichler.

 

[Ray D. Ayshun]

"Predicting job market fluctuations is really hard for scientists with zero training in that field. Why, look at what a terrible job Dr. Benjamin Smith did in 2008! With a history of failure like that, how do we even really know what's going on?"

Quite the hot take there, Dr. Eichler.

****. He can argue all he wants about not being able to officially control supply. Whatevs. On the other hand, the last ten ASTRO's have been headlining trials that are meant to reduce demand.

 

[RickyScott]

Because we are a small field and job market is hard to predict, it obviously was a great idea to double resident numbers.

 

[scarbrtj]

Other conclusions from the poster:

View attachment 321323

@scarbrtj, care to comment on the increase in beneficiaries per RadOnc?

Also, would anyone care to comment on the fact that they used Medicare Data to estimate RadOnc numbers, instead of the explicit numbers provided by the AAMC?

View attachment 321324

Again to show discrepant workforce numbers in rad onc.
Here on this graph from this ASTRO 2020 poster, it's about 4600-4700 rad oncs in 2017.
Here's another analysis that says there are 5,338 rad oncs in 2017.

The ASTRO 2020 poster may be mildly wrong, or horribly incorrect, depending on what twitter hashtags you favor.

 

[metallica81788]

From Dr. Eichler's Presidential Address (starting around the 48-49 minute mark):
...
"Beware of the social media echo chamber, where a disaffected individual with inaccurate information can have a disproportionate amount of influence."
...
"Begin your job search early in training by networking extensively."
...
"Your ultimate objective should be to get A job, not necessarily THE job."

Wow, this is even more embarrassing than anticipated.

 

[Chartreuse Wombat]

Wow, this is even more embarrassing than anticipated.

That Eichler is the President of ASTRO should end all discussion about the vitality of RO.

 

[deleted605854]

That Eichler is the President of ASTRO should end all discussion about the vitality of RO.

Having met the man I agree completely

 

[RickyScott]

That Eichler is the President of ASTRO should end all discussion about the vitality of RO.

Does he practice? Part time? Locums?

 

[elementaryschooleconomics]

Trying to watch some of EDU 22 which was released at midnight before clinic, this slide from Mudit caught my eye:

From his survey of graduates from the classes of 2013-2017 (with around a 50% response rate). I believe he published this last year (I admit I haven't read this paper yet).

Only half of graduates get the type of job they want in the geography they want? Yikes. I wonder how this compares to other specialties - perhaps they discuss it in the paper.

I can already hear ASTRO's response now - you just need A job.

And academic departments just need A resident.

 

[RSAOaky]

From Dr. Eichler's Presidential Address (starting around the 48-49 minute mark):

"...In fact, as recently as 2008..."

I was studying for the MCAT in 2008. A lot has changed since then.

 

[Ray D. Ayshun]

Trying to watch some of EDU 22 which was released at midnight before clinic, this slide from Mudit caught my eye:

View attachment 321500

From his survey of graduates from the classes of 2013-2017 (with around a 50% response rate). I believe he published this last year (I admit I haven't read this paper yet).

Only half of graduates get the type of job they want in the geography they want? Yikes. I wonder how this compares to other specialties - perhaps they discuss it in the paper.

I can already hear ASTRO's response now - you just need A job.

And academic departments just need A resident.

Region and population size kinda seem linked. Our "big 3" is something different, and includes salary and lifestyle. In any case, to get my Tuesday started I did a little math as I didn't see mentioned the number that got none of the 3, and based on the percentages of each individual component, it didn't seem that they assorted independently. 53%, or 158 got all 3. If they assorted independently, it would've been .75 x .73 x .82 = around 44% should've gotten all 3, and around 1% 0/3. So what about the others? If 158/299 got all 3, then another 141 got the scraps. Inside that group, 44% got the region they wanted, 45%the size, and 61% the job type (salary would be a nice variable). Inside this group, 12% went 0/3, which overall means around 5% went 0/3. I didn't see the 0fers mentioned, and if they did I feel foolish, but if you told me there's a 1/20 chance I'll go through this much training and have a job that meets none of my criteria, I'm not sure how I'd feel, particularly as this number must be higher now. 10% chance you get nothing?

 

[RickyScott]

expectations have also shifted downward. When I graduated, if you took a MSKCC satellite, that would have been 1 of the 3 (location). Eichler trying to reset expectations again.

 

[deleted605854]

expectations have also shifted downward. When I graduated, if you took a MSKCC satellite, that would have been 1 of the 3 (location). Eichler trying to reset expectations again.

He's got 0 charisma though . Maybe he needs to get a surgeon to do his job for him. Typical for rad oncs from his generation

 

[thecarbonionangle]

Most def low T/energy guy. SAD

 

[RSAOaky]

expectations have also shifted downward. When I graduated, if you took a MSKCC satellite, that would have been 1 of the 3 (location). Eichler trying to reset expectations again.

Expectations have absolutely shifted downward. Interestingly I did a google search for "radiation oncology residency positions by year" yesterday. This link is the first hit: Radiation Oncology | Residency Roadmap

If these numbers are still the expectation then good luck. I can tell you in my top 10 metro region the "median academic salary" is closer to what I expect to peak at as a clinician.

 

[OTN]

Expectations have absolutely shifted downward. Interestingly I did a google search for "radiation oncology residency positions by year" yesterday. This link is the first hit: Radiation Oncology | Residency Roadmap

View attachment 321501

If these numbers are still the expectation then good luck. I can tell you in my top 10 metro region the "median academic salary" is closer to what I expect to peak at as a clinician.

Well, sure, that was before Dr. Dennis E. Hallahan* (chair of the very department to whose website you linked) colluded with other department chairs to lower academic (and non-academic) salaries by flooding the job market with radiation oncologists.

*I've decided to go full name, including title, for everyone now. Don't want to be accused of anything, and the Twitter discussion about informal vs formal introductions clearly shows it doesn't matter what the data shows, it will be twisted to align to the viewpoint of the discussants.

 

[scarbrtj]

"Beware of the social media echo chamber, where a disaffected individual with inaccurate information can have a disproportionate amount of influence."

That's a lot of dis-'s and be-'s and in-'s. The inverse is just as likely to be true and much easier to follow, logically:

Heed the social media echo chamber, where an affected individual with accurate information can have a proportionate amount of influence.

Expectations have absolutely shifted downward. Interestingly I did a google search for "radiation oncology residency positions by year" yesterday. This link is the first hit: Radiation Oncology | Residency Roadmap

View attachment 321501

If these numbers are still the expectation then good luck. I can tell you in my top 10 metro region the "median academic salary" is closer to what I expect to peak at as a clinician.

same link/source

 

[fiji128]

Trying to watch some of EDU 22 which was released at midnight before clinic, this slide from Mudit caught my eye:

View attachment 321500

From his survey of graduates from the classes of 2013-2017 (with around a 50% response rate). I believe he published this last year (I admit I haven't read this paper yet).

Only half of graduates get the type of job they want in the geography they want? Yikes. I wonder how this compares to other specialties - perhaps they discuss it in the paper.

I can already hear ASTRO's response now - you just need A job.

And academic departments just need A resident.

Region is a garbage metric intended to make the data look better then it is. Wanted Boston area but got western Pennsylvania well that is the same region. Wanted San Diego but got Grand Junction Colorado, well that the same region. It would be infinitely more useful if it said Metropolitan Region or something like that, but we all know why it doesn't.

 

[deleted605854]

Region is a garbage metric intended to make the data look better then it is. Wanted Boston area but got western Pennsylvania well that is the same region. Wanted San Diego but got Grand Junction Colorado, well that the same region. It would be infinitely more useful if it said Metropolitan Region or something like that, but we all know why it doesn't.

Don't worry the candidates applying to this field now aren't as good at dissecting the data as the current batch of folks. Easy to hoodwink them

 

[metallica81788]

same link/source

Well that's a load of bs coming from someone directly involved around those years. Didn't go downhill until a few years later.
But it's my anecdotal bs and no randomized data, so guess it's not true or doesn't matter. Carry on.

 

[RickyScott]

Region is a garbage metric intended to make the data look better then it is. Wanted Boston area but got western Pennsylvania well that is the same region. Wanted San Diego but got Grand Junction Colorado, well that the same region. It would be infinitely more useful if it said Metropolitan Region or something like that, but we all know why it doesn't.

that would be so manipulative. Why not just subdivide into continental us....

 

[Ray D. Ayshun]

Region is a garbage metric intended to make the data look better then it is. Wanted Boston area but got western Pennsylvania well that is the same region. Wanted San Diego but got Grand Junction Colorado, well that the same region. It would be infinitely more useful if it said Metropolitan Region or something like that, but we all know why it doesn't.

That's what they did in a separate paper we discussed earlier, where one of the metrics included >250,000. What it didn't say was metro area as opposed to city, and included any counties that were a part of a metro area of that size. In turn, your county border could be around an hour from the city driving the population, and you could be on the other side of the county, and counted as living in a metro. It's all bull****.

 

[elementaryschooleconomics]

Region is a garbage metric intended to make the data look better then it is. Wanted Boston area but got western Pennsylvania well that is the same region. Wanted San Diego but got Grand Junction Colorado, well that the same region. It would be infinitely more useful if it said Metropolitan Region or something like that, but we all know why it doesn't.

This always has driven me nuts about the geography metric.

From this other Mudit poster (I swear to God I'm not Mudit Chowdhary secretly promoting his own work):

This is the classification of "Region", from the US Census Bureau:

If you're interested in the Northeast:

Say you're from Pittsburgh, that's where all your family is.

A job was recently posted in Presque Isle, Maine. Say you get that job (if you're lucky):

That's a 15+ hour drive between the two...but by all these surveys, you got your region of choice! Huzzah for you!

 

[OTN]

Region is a garbage metric intended to make the data look better then it is. Wanted Boston area but got western Pennsylvania well that is the same region. Wanted San Diego but got Grand Junction Colorado, well that the same region. It would be infinitely more useful if it said Metropolitan Region or something like that, but we all know why it doesn't.

For those of us who love to mountain bike/fish/ski/board, Grand Junction would be incredible. Many consider Fruita to be one of the premier Colorado mtb towns.

 

[radonc17]

Hi all,

Thanks so much for your support in general as well as your feedback to the project!

I agreed that overall region is very broad. I lumped it together due to small numbers in individual subregions.

I also attempted a subset analysis based on Sub-Regions, but the numbers are so small it's hard to make anything of it "stats wise"

It does show there is a big difference intuitively: for example in the West, big difference in desire going to California vs Wyoming etc

I'm attaching it here for convenience. Of note, I removed the ppl who said they had "no regional preference"

Thanks!

-Mudit

 

[elementaryschooleconomics]

Hi all,

Thanks so much for your support in general as well as your feedback to the project!

I agreed that overall region is very broad. I lumped it together due to small numbers in individual subregions.

I also attempted a subset analysis based on Sub-Regions, but the numbers are so small it's hard to make anything of it "stats wise"

It does show there is a big difference intuitively: for example in the West, big difference in desire going to California vs Wyoming etc

I'm attaching it here for convenience. Of note, I removed the ppl who said they had "no regional preference"

Thanks!

-Mudit

Great work!

 

[thecarbonionangle]

This is a gorgeous beautiful country, may the almighty continue to bless it. Many current residents will end up in rural places. I suggest you open up your mind to “hunting” “fishing” and “outdoors”. Don’t set yourself up with dreams of fresh baby lamb biryani at the touch of a button or a quick drive, while talking to your multiple highly educated liberal friends. Many are setting themselves up for serious unhappiness. Embrace it, there is no escaping it.

 

[thecarbonionangle]

This always has driven me nuts about the geography metric.

From this other Mudit poster (I swear to God I'm not Mudit Chowdhary secretly promoting his own work):
View attachment 321509

This is the classification of "Region", from the US Census Bureau:

View attachment 321508

If you're interested in the Northeast:

View attachment 321510

Say you're from Pittsburgh, that's where all your family is.

A job was recently posted in Presque Isle, Maine. Say you get that job (if you're lucky):

View attachment 321511

That's a 15+ hour drive between the two...but by all these surveys, you got your region of choice! Huzzah for you!

are the marks supposed to represent metros of over 250k people? Or where people got jobs?

 

[deleted605854]

This is a gorgeous beautiful country, may the almighty continue to bless it. Many current residents will end up in rural places. I suggest you open up your mind to “hunting” “fishing” and “outdoors”. Don’t set yourself up with dreams of fresh baby lamb biryani at the touch of a button or a quick drive, while talking to your multiple highly educates liberal friends. Many are setting themselves up for serious unhappiness. Embrace it, there is no escaping it.

Considering that most US big cities don't have good lamb biryani those folks are indeed set up for unhappiness.

There's burgers and fries and burgers and fries. Enjoy!

 

[radonc17]

are the marks supposes to represent metros of over 250k people? Or where people got jobs?

Each mark represent a unique job, which I have prospectively logged for over 4 years

White Mark: academic employer

Red Mark: non-academic employer

I wasn't tech savvy enough to make a heat map for free and I didn't want to pay for it since still resident

-Mudit

 

[FrostyHammer]

Hi all,

Thanks so much for your support in general as well as your feedback to the project!

I agreed that overall region is very broad. I lumped it together due to small numbers in individual subregions.

I also attempted a subset analysis based on Sub-Regions, but the numbers are so small it's hard to make anything of it "stats wise"

It does show there is a big difference intuitively: for example in the West, big difference in desire going to California vs Wyoming etc

I'm attaching it here for convenience. Of note, I removed the ppl who said they had "no regional preference"

Thanks!

-Mudit

I have to say this...thank you for not putting your personal picture on this particular poster.

 

[radonc17]

I have to say this...thank you for not putting your personal picture on this particular poster.

@FrostyHammer really is very frosty

 

[evilbooyaa]

I have to say this...thank you for not putting your personal picture on this particular poster.

Dang why you gotta be a hater, dude/dudette?

 

[DireMoose]

Each mark represent a unique job, which I have prospectively logged for over 4 years

White Mark: academic employer

Red Mark: non-academic employer

I wasn't tech savvy enough to make a heat map for free and I didn't want to pay for it since still resident

-Mudit

Again, very well done!

So these are jobs that people actually received over the course of 4 years? Per one earlier discussion, does there exist postings correlating with any of these jobs? Would be interesting to see how many postings are for show and were already filled. Obviously not easily obtainable data, but could be bantered about on a site like this.

 

[radonc17]

Again, very well done!

So these are jobs that people actually received over the course of 4 years? Per one earlier discussion, does there exist postings correlating with any of these jobs? Would be interesting to see how many postings are for show and were already filled. Obviously not easily obtainable data, but could be bantered about on a site like this.

Thanks! Each mark represents a job opening, not necessarily filled job

I have had to manually check websites to see if they are filled (def a limitation) and have had moderate success with that

Safe to assume that jobs which continuosly repeat every month or so AND do not update their website have not been filled (again I acknowledge limitation)

I have the data for repeat job postings, just not enough time to write it up recently...

-Mudit

 

[elementaryschooleconomics]

I've glanced at the ARRO/Terry Wall practice entry slides, nothing earth-shattering since ARRO's Tweet several weeks ago. I (sadly) have actual work to do, so if someone wants to throw some of the granular details up that'd be great, otherwise I'll try to get to it after I cure some cancer.

 

[Chartreuse Wombat]

I've glanced at the ARRO/Terry Wall practice entry slides, nothing earth-shattering since ARRO's Tweet several weeks ago. I (sadly) have actual work to do, so if someone wants to throw some of the granular details up that'd be great, otherwise I'll try to get to it after I cure some cancer.

Posted behind the firewall

 

[deleted605854]

I've glanced at the ARRO/Terry Wall practice entry slides, nothing earth-shattering since ARRO's Tweet several weeks ago. I (sadly) have actual work to do, so if someone wants to throw some of the granular details up that'd be great, otherwise I'll try to get to it after I cure some cancer.

Radiation cures cancer! Holy smokes. I thought it was this pesky thing that people wanted omitted.

Maybe there is hope....not!

 

[elementaryschooleconomics]

Radiation cures cancer! Holy smokes. I thought it was this pesky thing that people wanted omitted.

Maybe there is hope....not!

I prowl around the infusion floors at the mothership, handing out my card going "when y'all fixin' to get serious about curing this, call me".

Those chemotherapists give me some nasty glares lemme tell ya.

 

[elementaryschooleconomics]

@frijoles just posted the relevant ARRO Tweets in the Twitter thread, I particularly enjoyed this one:

A whooping 39% agreed the job market was tough, with an additional 31% opting to be neutral. Only 30% didn't think the job market was tough last year.

This is the metric I'm concerned about. When the unemployment stat begins to appear we will be beyond saving. This is climate change data. Don't deny climate change until coastal cities are underwater.

ASTRO: "we can't ask the oil companies to reduce emissions, that would be collusion, the sea turtles won't go completely extinct, population-level disasters are cyclical! Why, when I first heard about climate change 30 years ago..."

 

[FrostyHammer]

Dang why you gotta be a hater, dude/dudette?

No malicious intent and everyone knows it. Relax!

 

[thecarbonionangle]

This always has driven me nuts about the geography metric.

From this other Mudit poster (I swear to God I'm not Mudit Chowdhary secretly promoting his own work):
View attachment 321509

This is the classification of "Region", from the US Census Bureau:

View attachment 321508

If you're interested in the Northeast:

View attachment 321510

Say you're from Pittsburgh, that's where all your family is.

A job was recently posted in Presque Isle, Maine. Say you get that job (if you're lucky):

View attachment 321511

That's a 15+ hour drive between the two...but by all these surveys, you got your region of choice! Huzzah for you!

one thing i was thinking looking at this map further: there is a lot of elitism on here regarding location and the term “desirable” and “undesirable” is dropped often, this often means big cities, the majority on the coasts with some exception. Believe it or not people live in these “god forsaken” places and are happy and have a good life. Even these “undesirable” places in that map did not have that many job postings in the past four years. Some of this is less population, etc, but some of these states are actually saturated as well, from talking to people about it. So when people say “dont worry you will get A job”,its hard to have any idea where this will be. On any given year nothing is guaranteed (there could be zero jobs for years in an “undesirable” place, that happens to be close to family). Is there other specialties where there is this level of uncertainty?

 

[medgator]

one thing i was thinking looking at this map further: there is a lot of elitism on here regarding location and the term “desirable” and “undesirable” is dropped often, this often means big cities, the majority on the coasts with some exception. Believe it or not people live in these “god forsaken” places and are happy and have a good life. Even these “undesirable” places in that map did not have that many job postings in the past four years. Some of this is less population, etc, but some of these states are actually saturated as well, from talking to people about it. So when people say “dont worry you will get A job”,its hard to have any idea where this will be. On any given year nothing is guaranteed (there could be zero jobs for years in an “undesirable” place, that happens to be close to family). Is there other specialties where there is this level of uncertainty?

There hasn't been a job in my MSA (>500k population, 1 hour from a major metro) since 2015. Have definitely gotten several emails the last few years looking for jobs though. A Hospital job finally opened this year and was snatched up almost immediately, despite the administration being incompetent and malignant

 

[radiation]

@frijoles just posted the relevant ARRO Tweets in the Twitter thread, I particularly enjoyed this one:

View attachment 321553

View attachment 321554

A whooping 39% agreed the job market was tough, with an additional 31% opting to be neutral. Only 30% didn't think the job market was tough last year.

This is the metric I'm concerned about. When the unemployment stat begins to appear we will be beyond saving. This is climate change data. Don't deny climate change until coastal cities are underwater.

ASTRO: "we can't ask the oil companies to reduce emissions, that would be collusion, the sea turtles won't go completely extinct, population-level disasters are cyclical! Why, when I first heard about climate change 30 years ago..."

I disagree, the most important metric is job satisfaction and the class of 2019 did well for themselves. The job market for rad onc has always been tough, 9% change in a COVID year is not nearly as bad as it could've been. People feelings on job market is not really a reliable metric of the future, especially during a pandemic. 90% of people being satisfied with jobs is great and a reasonable number in any specialty. This doesn't mean there isnt an oversupply or that we shouldn't be concerned. But to try to spin this survey to make it bad year for residents is not really accurate. These are reasonable numbers for this class- let this data stand on its own and use the plethora of other data to make your other points.