Chirag/Royce Editorial, Goodman Article, Potters Response on Job Market 031121

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drewdog1973 said:
Tulane is not the Nola program that’s considering to open.
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The only other one would be Ochsner hospital, which probably could except for the required research component. But still nothing on the Acgme website for the state of Louisiana.
 
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It would be Ochsner maybe partnering w LSU for science part. That’s what I heard
 
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I have heard this same rumor for a few years, and from people who would be "in the know."

I mean, Louisiana's 3rd most prominent city with protons... if anything screams poorly managed modern rad onc, it's starting a training program there. So, I'll be 0% surprised when it inevitably happens in the next 3-5 years.
 
GapCalc said:
I have heard this same rumor for a few years, and from people who would be "in the know."

I mean, Louisiana's 3rd most prominent city with protons... if anything screams poorly managed modern rad onc, it's starting a training program there. So, I'll be 0% surprised when it inevitably happens in the next 3-5 years.
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They drew inspiration from the Baylor Scott and white radonc program in temple,tx
 
If any swampy place (and i like swamps), protons or not, tries to open up a program, I sure hope this is absolutely blocked. Don’t have too much faith in “leaders”.
 
xrt123 said:
Is there a short summary for those that refuse to give money to ASTRO/red journal?
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Parisian mathematician Jules Henri Poincare is credited with identifying fundamental concepts that established chaos theory, which describes dynamic systems wherein small differences in initial conditions can lead to widely diverging outcomes. The phenomenon is often called the “butterfly effect,” conjuring an image of an insect in China flapping its wings, possibly triggering a cascade of meteorologic events that ultimately cause a tornado in Texas. 1 For the record, we know of no actual Asian lepidopteran that has ever affected Panhandle weather, intentionally or otherwise.

As for the fluttery initial conditions that led eventually to the current chaotic state of affairs in radiation oncology residency applications, we offer a Nymphalidae candidate from the past not considered by Maas et al 2 as they sought to explain the recent drop off in applicants to radiation oncology residency programs. Was it Dr Joseph Gerstein blowing the whistle that alerted authorities to the infamous TAP Pharmaceuticals scandal? For those too young to remember: In the 1990s, many urologists supplemented their incomes by liberally prescribing leuprolide under an arrangement with the manufacturer, TAP Pharmaceutical Products, which supplied the drug to urologists at a steep discount, whereupon the urologists billed Medicare the full price—a fraudulent practice eventually halted via litigation that obliged TAP and other pharma companies to pay over $1 billion in penalties. Carreyrou and Tamman 3 connected the dots between the abrupt loss of this source of revenue and the sudden birth of urologist-owned intensity modulated radiation therapy centers, exploiting a freshly minted well-reimbursed treatment modality 4and ushering in a new era of unbridled entrepreneurialism in the field, coinciding with a steadily upward salary trend for radiation oncologists all around, attracting more and more applicants to the field.

Was it surprising that this bubble would eventually burst? Along the same lines, was it surprising that many rockstar MD PhDs who entered the field—to the chest-thumping delight of those already there, who felt smarter by association—would, upon finally finishing a decade or more of postgraduate education in their late 30s with a heavy burden of accumulated debt and often a young family to support, veer toward substantially higher-paying community jobs rather than toil away as physician-scientists at the mercy of unstable research funding support for a fraction of their potential annual income outside of academia?

The retrospectoscope might also show us other sneaky Pieridae who flittered around and set the maelstrom in motion, but enough nostalgia: Now is the time to plan a better future. We hereby issue a call to action to the American Society for Radiation Oncology (ASTRO), the American Board of Radiology (ABR), academic department chairs, residency program directors and faculty, and everyone in the radiation oncology community.

A Call to Action to ASTRO​

ASTRO, interpreting antitrust laws against collective market action, has historically steered clear of acting upon the issue of a potential oversupply of radiation oncologists. Nevertheless, as the leading US professional organization of our specialty, for the benefit of present and future members, ASTRO should initiate a formal objective assessment of the radiation oncology job market in the United States, ideally enlisting an outside consulting agency to perform this service, given the essential need to avoid bias in the analysis.
There is a precedent for this initiative. In the early 1990s, after a perceived deficiency of radiation oncologists in the prior decade, the ASTRO Committee on Human Resources took on this responsibility, stating that it “is certainly appropriate that ASTRO evaluate the manpower issue because it will have significant effect on quality, efficiency, and cost issues.” 5 Ultimately, the Society of Chairs of Academic Radiation Oncology Programs (SCAROP) was charged with operationalizing the information. 6 Informed by public discussions on this issue, 7 we also fear that there is a widening generational divide between more senior members of ASTRO and recent residency graduates entering the workforce. The European Society for Radiotherapy and Oncology (ESTRO) has a Young ESTRO committee to ensure that the “voices of the next generation of researchers and practitioners are heard” and to “secure a high level of relevance of ESTRO for young members.” We call upon ASTRO to establish a similar committee with board of director representation because we believe that it would be a win-win for ASTRO to engage younger members to help guide the society into the future.

A Call to Action to the ABR​

In the painful aftermath of the 2018 physics and radiation biology examinations, trainees were increasingly distrustful of the ABR. To its credit, the ABR has since responded to input from many stakeholder groups including Association of Residents in Radiation Oncology, Association for Directors of Radiation Oncology Programs, American Association for Women in Radiology, the AAWR, and others on several important issues. Residents and junior faculty can now sit for their boards remotely, with earlier examination dates for initial certification examinations, and a generous parental leave policy during residency training has been endorsed.

Although these changes are steps in the right direction, radiation oncology residents remain burdened with 3 qualifying examinations, more than all other specialties.8,9 Now is the time to condense these examinations into a single one, focusing more on clinically relevant material that will maintain a high level of skill and knowledge in the field.

A Call to Action to Academic Chairs​

Programs have steadily added residency positions over the past 10 years. However, now that applicant numbers are down and a large number of programs are unfilled in the primary match (32 in 2020 and 35 in 2021), many programs have elected to fill slots with applicants who were unmatched after applying to another field of medicine via the Supplemental Offer and Acceptance Program (SOAP). 10 A 2020 plea from a number of program directors to avoid using the SOAP and allow a natural market correction to occur 11 had minimal impact.

The result is that 15% of our incoming class in 2021 and 25% in 2022 will be hastily recruited students who found out a day or 2 before signing up for a career in radiation oncology that they had not matched in their preferred specialty. We believe that there is an escalated risk of discontent in this cohort for numerous reasons, notably job opportunity concerns and lack of inherent interest in the subject matter, compounded by the aforementioned complex qualifying examination structure. In 1998, when the supply of radiation oncologists exceeded anticipated demands, SCAROP led the charge to decrease the number of residency positions to decrease the graduating pool each year. 6 We need SCAROP now to cease residency program expansion—indeed, preferably to contract program sizes—and to normalize not using the SOAP to fill unmatched positions.

A Call to Action to Program Directors and Faculty​

The Accreditation Council for Graduate Medical Education has proposed new program requirements to ensure that residents are being trained in an atmosphere where they are exposed to multidisciplinary oncologic care, see adequate numbers of patients, and receive appropriate supervision. These new rules will be out for public comment and, if approved, enacted in 2022. The goal is to reduce the number of residents at programs where the residents are employed primarily as clinical workhorses without sufficient learning opportunities. Program directors need to look critically at their programs and evaluate how many residents they should be training, and faculty might have to adjust expectations about the percentage of cases covered by residents.

A Call to Action for Everyone​

We believe that the vast majority of practicing radiation oncologists feel privileged to render care to their patients and enjoy their chosen career path in medicine. We also believe that the overwhelming majority of stakeholders in the field are acting in good faith to provide high-quality care now and ensure that in the future patients will continue to have access to an important modality of our cancer-fighting armamentarium. Furthermore, we believe that our field's ongoing success hinges on the intellectual agility to find creative solutions and abandon outmoded dogmas when appropriate. Now is the time for the entire community to come together to optimize trainee numbers and improve the climate in radiation oncology.
 
SubserviantToABR said:
Parisian mathematician Jules Henri Poincare is credited with identifying fundamental concepts that established chaos theory, which describes dynamic systems wherein small differences in initial conditions can lead to widely diverging outcomes. The phenomenon is often called the “butterfly effect,” conjuring an image of an insect in China flapping its wings, possibly triggering a cascade of meteorologic events that ultimately cause a tornado in Texas. 1 For the record, we know of no actual Asian lepidopteran that has ever affected Panhandle weather, intentionally or otherwise.

As for the fluttery initial conditions that led eventually to the current chaotic state of affairs in radiation oncology residency applications, we offer a Nymphalidae candidate from the past not considered by Maas et al 2 as they sought to explain the recent drop off in applicants to radiation oncology residency programs. Was it Dr Joseph Gerstein blowing the whistle that alerted authorities to the infamous TAP Pharmaceuticals scandal? For those too young to remember: In the 1990s, many urologists supplemented their incomes by liberally prescribing leuprolide under an arrangement with the manufacturer, TAP Pharmaceutical Products, which supplied the drug to urologists at a steep discount, whereupon the urologists billed Medicare the full price—a fraudulent practice eventually halted via litigation that obliged TAP and other pharma companies to pay over $1 billion in penalties. Carreyrou and Tamman 3 connected the dots between the abrupt loss of this source of revenue and the sudden birth of urologist-owned intensity modulated radiation therapy centers, exploiting a freshly minted well-reimbursed treatment modality 4and ushering in a new era of unbridled entrepreneurialism in the field, coinciding with a steadily upward salary trend for radiation oncologists all around, attracting more and more applicants to the field.

Was it surprising that this bubble would eventually burst? Along the same lines, was it surprising that many rockstar MD PhDs who entered the field—to the chest-thumping delight of those already there, who felt smarter by association—would, upon finally finishing a decade or more of postgraduate education in their late 30s with a heavy burden of accumulated debt and often a young family to support, veer toward substantially higher-paying community jobs rather than toil away as physician-scientists at the mercy of unstable research funding support for a fraction of their potential annual income outside of academia?

The retrospectoscope might also show us other sneaky Pieridae who flittered around and set the maelstrom in motion, but enough nostalgia: Now is the time to plan a better future. We hereby issue a call to action to the American Society for Radiation Oncology (ASTRO), the American Board of Radiology (ABR), academic department chairs, residency program directors and faculty, and everyone in the radiation oncology community.

A Call to Action to ASTRO​

ASTRO, interpreting antitrust laws against collective market action, has historically steered clear of acting upon the issue of a potential oversupply of radiation oncologists. Nevertheless, as the leading US professional organization of our specialty, for the benefit of present and future members, ASTRO should initiate a formal objective assessment of the radiation oncology job market in the United States, ideally enlisting an outside consulting agency to perform this service, given the essential need to avoid bias in the analysis.
There is a precedent for this initiative. In the early 1990s, after a perceived deficiency of radiation oncologists in the prior decade, the ASTRO Committee on Human Resources took on this responsibility, stating that it “is certainly appropriate that ASTRO evaluate the manpower issue because it will have significant effect on quality, efficiency, and cost issues.” 5 Ultimately, the Society of Chairs of Academic Radiation Oncology Programs (SCAROP) was charged with operationalizing the information. 6 Informed by public discussions on this issue, 7 we also fear that there is a widening generational divide between more senior members of ASTRO and recent residency graduates entering the workforce. The European Society for Radiotherapy and Oncology (ESTRO) has a Young ESTRO committee to ensure that the “voices of the next generation of researchers and practitioners are heard” and to “secure a high level of relevance of ESTRO for young members.” We call upon ASTRO to establish a similar committee with board of director representation because we believe that it would be a win-win for ASTRO to engage younger members to help guide the society into the future.

A Call to Action to the ABR​

In the painful aftermath of the 2018 physics and radiation biology examinations, trainees were increasingly distrustful of the ABR. To its credit, the ABR has since responded to input from many stakeholder groups including Association of Residents in Radiation Oncology, Association for Directors of Radiation Oncology Programs, American Association for Women in Radiology, the AAWR, and others on several important issues. Residents and junior faculty can now sit for their boards remotely, with earlier examination dates for initial certification examinations, and a generous parental leave policy during residency training has been endorsed.

Although these changes are steps in the right direction, radiation oncology residents remain burdened with 3 qualifying examinations, more than all other specialties.8,9 Now is the time to condense these examinations into a single one, focusing more on clinically relevant material that will maintain a high level of skill and knowledge in the field.

A Call to Action to Academic Chairs​

Programs have steadily added residency positions over the past 10 years. However, now that applicant numbers are down and a large number of programs are unfilled in the primary match (32 in 2020 and 35 in 2021), many programs have elected to fill slots with applicants who were unmatched after applying to another field of medicine via the Supplemental Offer and Acceptance Program (SOAP). 10 A 2020 plea from a number of program directors to avoid using the SOAP and allow a natural market correction to occur 11 had minimal impact.

The result is that 15% of our incoming class in 2021 and 25% in 2022 will be hastily recruited students who found out a day or 2 before signing up for a career in radiation oncology that they had not matched in their preferred specialty. We believe that there is an escalated risk of discontent in this cohort for numerous reasons, notably job opportunity concerns and lack of inherent interest in the subject matter, compounded by the aforementioned complex qualifying examination structure. In 1998, when the supply of radiation oncologists exceeded anticipated demands, SCAROP led the charge to decrease the number of residency positions to decrease the graduating pool each year. 6 We need SCAROP now to cease residency program expansion—indeed, preferably to contract program sizes—and to normalize not using the SOAP to fill unmatched positions.

A Call to Action to Program Directors and Faculty​

The Accreditation Council for Graduate Medical Education has proposed new program requirements to ensure that residents are being trained in an atmosphere where they are exposed to multidisciplinary oncologic care, see adequate numbers of patients, and receive appropriate supervision. These new rules will be out for public comment and, if approved, enacted in 2022. The goal is to reduce the number of residents at programs where the residents are employed primarily as clinical workhorses without sufficient learning opportunities. Program directors need to look critically at their programs and evaluate how many residents they should be training, and faculty might have to adjust expectations about the percentage of cases covered by residents.

A Call to Action for Everyone​

We believe that the vast majority of practicing radiation oncologists feel privileged to render care to their patients and enjoy their chosen career path in medicine. We also believe that the overwhelming majority of stakeholders in the field are acting in good faith to provide high-quality care now and ensure that in the future patients will continue to have access to an important modality of our cancer-fighting armamentarium. Furthermore, we believe that our field's ongoing success hinges on the intellectual agility to find creative solutions and abandon outmoded dogmas when appropriate. Now is the time for the entire community to come together to optimize trainee numbers and improve the climate in radiation oncology.
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Great editorial. It succinctly says what exactly needs to be done. I hope it does not fall on deaf ears.
 
medgator said:
Nice op ed and call to action from Drs Fields and Kavanagh

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Absolute fire. Anyone clinging to the status quo of RadOnc from pre-2018 needs to internalize these words deep into their soul.

I can't wait to read Ralph's tone-deaf opinion:

1630437351339.png
 
TheWallnerus said:
Lol. Ken said "farts."

xqN8dxW.png
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Ken Olivier has absolutely no backbone. He had all of the chances in the world with his involvement at ADROP to lead the charge, and he absolutely nothing with that opportunity. Now, we sing the praises for Emma Fields and Brian Kavanagh but not KO. He too could’ve been bold AF.
 
"...The Accreditation Council for Graduate Medical Education has proposed new program requirements to ensure that residents are being trained in an atmosphere where they are exposed to multidisciplinary oncologic care, see adequate numbers of patients, and receive appropriate supervision. These new rules will be out for public comment and, if approved, enacted in 2022..."

If this is enacted, then I think many programs that started in the last ~ 15-20 years will have to close. There are a few exceptional programs that were started in the last 15-20 yrs that should continue operating:
- UCSD...outstanding job starting something from scratch.
- UTSW...also outstanding.
- UC Davis is also good.
- OK also decent.

I can't think of any other programs from the last 15-20 yrs that are up there.
Some are "OK", good "average" programs...these you can argue that should stay open vs closed.
There are definitely programs that sit at the bottom, these programs should "be gone with the wind"...
 
Radonc90 said:
"...The Accreditation Council for Graduate Medical Education has proposed new program requirements to ensure that residents are being trained in an atmosphere where they are exposed to multidisciplinary oncologic care, see adequate numbers of patients, and receive appropriate supervision. These new rules will be out for public comment and, if approved, enacted in 2022..."

If this is enacted, then I think many programs that started in the last ~ 15-20 years will have to close. There are a few exceptional programs that were started in the last 15-20 yrs that should continue operating:
- UCSD...outstanding job starting something from scratch.
- UTSW...also outstanding.
- UC Davis is also good.
- OK also decent.

I can't think of any other programs from the last 15-20 yrs that are up there.
Some are "OK", good "average" programs...these you can argue that should stay open vs closed.
There are definitely programs that sit at the bottom, these programs should "be gone with the wind"...
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Not sure Davis any better than Mayo Scottsdale or moffitt. Honestly i would argue all of them should go. They simply aren't needed
 
Radonc90 said:
There are definitely programs that sit at the bottom, these programs should "be gone with the wind"...
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I agree but I still feel really sad for the 1st and 2nd years sitting in these programs now. There's a special sort of weirdness I am sure one feels when one has graduated or attended a residency program that no longer exists. Very unlikely any will go the way of, say, Vandy, which shut down for several years in the 1990s only to be Hallahanically resurrected in 2001.
 
Wait, which years were Vandy shut down, I am curious? And why...
 
Radonc90 said:
Wait, which years were Vandy shut down, I am curious? And why...
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I think it was ACGME related. Standards went down and what not. I think the chair left (before Hllahan) and faculty number got low. Needless to say reputation was not great and hand it to Hallahan he got them back in the game. They were residency-less from around 95 or 96 to 2001.
 
It’s a great editorial. Yet, it’s what has been said here for decades. We’ve said this in many ways and have insulted and have been shot down. “Where’s the data?” “The surveys say people finding jobs.” “We need more evidence before we consider contraction.”

It was thrilling to read that The Establishment - in the Establishment Journal - is now in agreement with #cutthespots and contraction. At the same time, it took two horrendous matches and humiliation academia cocktail parties to consider contraction.

Let’s see what actions are taken. People are still expanding with no shame and no social pressure is ever used. People still considering opening programs. Crappy fellowships and even crapper rationale for their existence remain.

I’m pessimistic because most people aren’t BK or EF. They are the exception, rather than the rule. Can you imagine Dr. Kachnic or Dr. Randall writing something so profound and channeling the vox populi?
 
This is just "feel-good editorial" in RedJ.

I had dinner with a Prog Director at a Midwest program that did not match in March 2021.
After dinner, the PD acknowledged that they called a med student who rotated with them but did not match into ? Derm or ? Radiology or something like that. "Interestingly", the student agreed to SOAP into radonc...

I am waiting for when the "rubber meets to road". In other words, I am waiting for when the contraction actually happens.
Even if contraction happens tomorrow, this oversupply problem will not be corrected until 10-15 yrs from now, unless the establishment retires...
 
Radonc90 said:
This is just "feel-good editorial" in RedJ.

I had dinner with a Prog Director at a Midwest program that did not match in March 2021.
After dinner, the PD acknowledged that they called a med student who rotated with them but did not match into ? Derm or ? Radiology or something like that. "Interestingly", the student agreed to SOAP into radonc...

I am waiting for when the "rubber meets to road". In other words, I am waiting for when the contraction actually happens.
Even if contraction happens tomorrow, this oversupply problem will not be corrected until 10-15 yrs from now, unless the establishment retires...
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Still, at least it's a first step compared to the other crap coming from people like Louis Potters, Dr Randall etc
 
Mandelin Rain said:
Was there anything “bold” let alone “bold af” in that op-ed?

We have a problem, let’s try to fix it. That’s just good common sense anywhere but rad onc, where that notion is somehow "bold af".
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thecarbonionangle said:
damning for our field when telling the truth is considered some amazing act of courage by “leaders”. Hopefully something is done.
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Yeah, sadly, observing and reporting reality in an establishment journal by establishment people is a big step for us.

It just all goes back to how tiny we are in the grand scheme of medicine, the cliques, and how if you upset the wrong person just once your career can be seriously damaged. We just can't get out of our own way most of the time.
 
thecarbonionangle said:
the best thing these guys can do is retire. All of these guys in their 60s. You had a good run. Let people with skin in the game fix this field and YOU please gtfo of the way! Go sip or smoke a lil somethin’ with all the money you pillaged.
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That would be the only thing that could go a long way toward fixing things in the short term
 
VCU program director is trying to teach OB GYN classes to recruit students to radonc and get face to face time with them. This is because they have trouble filling the spots because everyone sees the market crumbling. When program directors get this desperate I doubt it means they are trying to willingly contract.
 
xrt123 said:
VCU program director is trying to teach OB GYN classes to recruit students to radonc and get face to face time with them. This is because they have trouble filling the spots because everyone sees the market crumbling. When program directors get this desperate I doubt it means they are trying to willingly contract.
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Uhhh did you read her recent op ed?
 
I'm obviously a fan of directing ire where ire is due - but Emma Fields and Brian Kavanagh are on the right side of history. Brian voluntarily contracted spots at Colorado, Emma has not SOAP'ed anyone despite VCU not Matching students for a few years...and they published this editorial in the Red Journal, which highlights all the problems facing the field that other folks want to deny.

I think they're actually trying to lead us out of the darkness.
 
elementaryschooleconomics said:
I'm obviously a fan of directing ire where ire is due - but Emma Fields and Brian Kavanagh are on the right side of history. Brian voluntarily contracted spots at Colorado, Emma has not SOAP'ed anyone despite VCU not Matching students for a few years...and they published this editorial in the Red Journal, which highlights all the problems facing the field that other folks want to deny.

I think they're actually trying to lead us out of the darkness.
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That seems to be beside the point for a distinct group of people. Which is fine - the field continues to burn us in a myriad of way. What’s unique is that editorial literally says what we’ve been asking people to address, and still it draws ire.
 
I am not directing ire. Tons of respect for both and appreciate there work/values. We have limited people in academics to even broach the topic of contraction of residency spots, but even with a few speaking out there is still a drive for these programs to bring people in and fill what they can. Emma and Brian, if your reading this, I love you both! If you start a kickstarter/Gofundme to contract residency slots I will be the first to ante up. If you need me to support a month coverage of your own NP instead of a resident I can probably swing that too.
 
Has anyone heard that the spring oral boards pass rate was 88% for first time takers? (Some people said I the Wallnerus have said it?)

88% is concerning IMHO in a "are they up to shenanigans again?" kind of way. Especially given previous shenanigans, and COVID.
 
I haven't heard a number yet, and nothing has been posted on the ABR website about the 2020 exams, let alone 2021. I have anecdotally heard the pass rates for the writtens were very high, and have also heard tales of specific people who failed orals in the spring, but not the overall pass rate. Isn't 90% consistent with historical pass rates for first-time test takers for orals?
 
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