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

[medgator]

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.

39% of them thought the job market was tougher than they expected so it could be a reset of expectations here

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[elementaryschooleconomics]

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.

This is exactly what I want to look at right now, as we continue to see the product of the expansion pipeline. I agree, this metric isn't perfect - opinion on "toughness" is like when we ask patients about their quality of life and make treatment decisions based on those findings. It's not perfect, but sometimes, it's the best we have.

As I said previously, what I really want to know is the "behind the scenes" to the binary metric of "yes employed/no employed", and how that has changed over time. If people are working 5x as hard to get a job in 2019 compared to 2010, that's a valuable metric. This is the only thing that comes close to that right now.

Is it spin to see 70% are neutral-to-negative about their experiences in the job market and think that's bad? If you think it's spin I obviously can't change your mind. I'm not excited about that data, personally.

 

[Krukenberg]

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.

Agree with this post. 90% satisfied is hard to argue with. But I can accept that the #s look good now but could/will get worse in the future.

Anecdotally, most of the current PGY5s I keep up with have signed or are close to signing already. Several told me that multiple of their co-residents have also signed. I anticipate that this year will end up looking pretty good too. All jobs are in geographic areas they prefer, but it’s key to keep in mind that not everyone wants to be in a big coastal city.

 

[RickyScott]

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.

I agree with your post except for the fact that the job market was always tough. It wasn’t, and why field became white hot in early 2000s.

These surveys remind me of old quality of life survey in NCI sarcoma limb preservation study. No difference in pt satisfaction between amputation and xrt/limb sparing arms. Pts were just happy to be alive.

 

[radiation]

This is exactly what I want to look at right now, as we continue to see the product of the expansion pipeline. I agree, this metric isn't perfect - opinion on "toughness" is like when we ask patients about their quality of life and make treatment decisions based on those findings. It's not perfect, but sometimes, it's the best we have.

As I said previously, what I really want to know is the "behind the scenes" to the binary metric of "yes employed/no employed", and how that has changed over time. If people are working 5x as hard to get a job in 2019 compared to 2010, that's a valuable metric. This is the only thing that comes close to that right now.

Is it spin to see 70% are neutral-to-negative about their experiences in the job market and think that's bad? If you think it's spin I obviously can't change your mind. I'm not excited about that data, personally.

I don't think this data is meant to be exciting or even forward predicting. Its a snapshot of class that had a lot going against it in a pretty strange year.

 

[elementaryschooleconomics]

I don't think this data is meant to be exciting or even forward predicting. Its a snapshot of class that had a lot going against it in a pretty strange year.

Fair point! I guess I'm just looking for the magic study/number/p-value that swings Chairs and ASTRO/ABR/ACGME out of their "everything is fine" stance to do something about Radiation Oncology. It's exhausting hearing "but no graduate is unemployed on the survey data!" as a counter-argument, that's literally the lowest bar possible.

 

[Mandelin Rain]

I've said it before, I think the current job market is better than oft portrayed here, but the future (say 5-year horizon) will be much worse than most are predicting.

Just my thoughts.

 

[elementaryschooleconomics]

So to clarify, Terry Wall stepped down and Trevor Royce did the practice entry survey presentation. I was trying to figure out why the PowerPoint slides were COMPLETELY different. This is sad, I always enjoyed Terry Wall's years and years of resident quotes and the general format of his presentation (not knocking Royce at all, he did great).

This slide wasn't very encouraging:

Basically, while our median salary is still high compared to other specialties, we are DEAD LAST for income growth over the last 10 years. Obviously this is completely in line with the downward pressure on our field that has nothing to do with residency expansion (although, per Hallahan, perhaps this is, in part, a reflection on increased supply reducing demand).

 

[seper]

How do guys you reconcile these data: 40 fellowship positions but only 2 graduates going into fellowship per ARRO?

 

[Mandelin Rain]

How do guys you reconcile these data: 40 fellowship positions but only 2 graduates going into fellowship per ARRO?

Either data is bad (likely) and/or filling with foreign docs looking to come to America (also likely). Can’t imagine you go through the trouble of arranging and advertising a fellowship if there’s a 5% chance it fills.

 

[radiaterMike]

some options
- FMGs taking fellowships
- those who reported having 'contracts' actually had fellowship contracts
- those who took a fellowship declined to fill out the survey

 

[radonc17]

How do guys you reconcile these data: 40 fellowship positions but only 2 graduates going into fellowship per ARRO?

Hi,

This is a limitation of my fellowship project. I've analyzed how many open positions there are.

Working on finding out how many are filled or have been filled, and by whom

Historically, there have been ~7 US grads/year going into fellowship (Mohamad IJROBP 2018)

RE ARRO data: remember there were 11 ppl that did not respond. Theoretically, that could swing the numbers significantly

-Mudit

 

[thecarbonionangle]

fellowships would not be such a bad thing if they actually provided value. I know some here have suggested the idea of a systemic therapy fellowship is “ridiculous” but i just disagree. Let it be an option for those who want it. If neurologists can do it why can’t we? i love neurologists and they sure are great at calling things “interesting” but with our knowledge and more training we could give systemic therapy very competently.

 

[Mandelin Rain]

Problem with a systemic therapy fellowship is "who teaches it" and "who accepts it as valid"?

The answer to both HAS to be med oncs, but they seem the least likely to do either.

 

[RSAOaky]

fellowships would not be such a bad thing if they actually provided value. I know some here have suggested the idea of a systemic therapy fellowship is “ridiculous” but i just disagree. Let it be an option for those who want it. If neurologists can do it why can’t we? i love neurologists and they sure are great at calling things “interesting” but with our knowledge and more training we could give systemic therapy very competently.

I do think some fellowships provide value (brachy, peds, protons) but at the same time, we already spend 4 years in radonc training and I think there should be more opportunities for people who have those specific career goals to wrap them into residency training.

 

[thecarbonionangle]

Problem with a systemic therapy fellowship is "who teaches it" and "who accepts it as valid"?

The answer to both HAS to be med oncs, but they seem the least likely to do either.

anybody familiar with how neurologists started the neuro-onc fellowships allowing them to give systemic therapy?

did med oncs teach gyn oncs?

 

[OTN]

anybody familiar with how neurologists started the neuro-onc fellowships allowing them to give systemic therapy?

did med oncs teach gyn oncs?

One of the first chemotherapies developed was for choriocarcinoma, so the GynOncs naturally kind of came first there. They're also the first to see the patients and control their referral patterns.

I don't think medonc has been too unhappy to allow the neuro-oncologists to treat GBM. Every medonc I know has been perfectly fine referring those patients to neuro-onc, and we always pontificate about how treating only that disease (essentially) all day every day would be no fun.

The best models for radoncs giving systemic therapy of course comes from other countries like Germany, where they give systemic therapy concurrently with radiation all the time. They leave systemic therapy for metastatic disease up to the medoncs, of course.

I can't see, politically, that medical oncology would allow radiation to attack their turf in this country.

 

[thecarbonionangle]

One of the first chemotherapies developed was for choriocarcinoma, so the GynOncs naturally kind of came first there. They're also the first to see the patients and control their referral patterns.

I don't think medonc has been too unhappy to allow the neuro-oncologists to treat GBM. Every medonc I know has been perfectly fine referring those patients to neuro-onc, and we always pontificate about how treating only that disease (essentially) all day every day would be no fun.

The best models for radoncs giving systemic therapy of course comes from other countries like Germany, where they give systemic therapy concurrently with radiation all the time. They leave systemic therapy for metastatic disease up to the medoncs, of course.

I can't see, politically, that medical oncology would allow radiation to attack their turf in this country.

ok but they already allowed neurology to do it so any insight into how this is achieved?

 

[Mandelin Rain]

anybody familiar with how neurologists started the neuro-onc fellowships allowing them to give systemic therapy?

did med oncs teach gyn oncs?

I don't really know the history of those sub-specialties, but my impression is that they started prescribing chemos as they were developed for the malignancies they "own". Those sites/drugs were never really exclusive domain of med oncs, so they were never really "stealing" business from them, nor did they have any say in the matter. And of course, they just train the next generation of neuro/gyn-oncs themselves.

 

[MegaVoltagePhoton]

I would love to give concurrent chemo for my cervix cancer patients but i know it will never happen. one thing i did think about though was coming at it from the access point of view and the admin, rather than med onc, point of view. basically make the argument that it speeds up care for patients thus improving patient satisfaction. frees up the gyn onc too and allows them to not hire so many np/pas since another physician can actually give and manage the chemo. my gyn oncs actually don't even want to give chemo, they would rather be in the or be seeing new consults that will lead to being in the or. however i work in a psuedoacademic center (ok, it is really an academic center, just not a main one) and the docs are salaried.

 

[deleted605854]

One of the first chemotherapies developed was for choriocarcinoma, so the GynOncs naturally kind of came first there. They're also the first to see the patients and control their referral patterns.

I don't think medonc has been too unhappy to allow the neuro-oncologists to treat GBM. Every medonc I know has been perfectly fine referring those patients to neuro-onc, and we always pontificate about how treating only that disease (essentially) all day every day would be no fun.

The best models for radoncs giving systemic therapy of course comes from other countries like Germany, where they give systemic therapy concurrently with radiation all the time. They leave systemic therapy for metastatic disease up to the medoncs, of course.

I can't see, politically, that medical oncology would allow radiation to attack their turf in this country.

I think it's easy to convince med onc to give up the concurrent part. None of the money is there unless RT-IO concurrent takes off big-time.

But there's one caveat. You'll have to admit your own patients. No more admissions to "heme/onc" or you could pay for a hospitalist type of service to take care of that.

So, convince them now. Deal with inpatients and you will be rewarded when it's concurrent RT-IO for everyone.

You know this to be true

 

[RadOncDoc21]

I think it's easy to convince med onc to give up the concurrent part. None of the money is there unless RT-IO concurrent takes off big-time.

But there's one caveat. You'll have to admit your own patients. No more admissions to "heme/onc" or you could pay for a hospitalist type of service to take care of that.

So, convince them now. Deal with inpatients and you will be rewarded when it's concurrent RT-IO for everyone.

You know this to be true

The systems I been at over the past couple of years have used hospitalist and many of the med oncs don’t even see inpatients anymore!

 

[deleted605854]

The systems I been at over the past couple of years have used hospitalist and many of the med oncs don’t even see inpatients anymore!

Some hospitals are like that. Especially with med onc being so flush. Hospitalists ,PAs, Scribes , APNs. No wonder Vinay is against useless fellowships. I have a feeling soon enough med oncs will be doing some of those because there's no reason to hire that many med oncs with all the support that's going on for the existing ones.

So take away the concurrent part and pay into the pot that goes for the hospitalist's keep. Done