Columbia

[Conn Seannery]

Just wondering - is Columbia a good program?

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[medgator]

No

 

[metallica81788]

In past few years personally knew of a resident transfer to a now well-known hellpit program in a "less desirable" location (to them at least) from Columbia so that should say a lot

 

[fiji128]

My personal ranking of nyc programs in terms of quality/training experience:

MSKCC
NYU
Mt Sinai
Columbia
Montefiore
SUNY Downstate
Methodist

Compared to other programs in the US, Columbia is probably equivalent to a third tier type of place. Program was chronically on probation for years with the acgme. Newish chair Lisa Kachnic would be a huge minus for me. Program has recently expanded from like to 6 to 8 residents. If you have to be in New York City its an option.

 

[medgator]

My personal ranking of nyc programs in terms of quality/training experience:

MSKCC
NYU
Mt Sinai
Columbia
Montefiore
SUNY Downstate
Methodist

Compared to other programs in the US, Columbia is probably equivalent to a third tier type of place. Program was chronically on probation for years with the acgme. Newish chair Lisa Kachnic would be a huge minus for me. Program has recently expanded from like to 6 to 8 residents. If you have to be in New York City its an option.

Honestly, top 3 prob ok to rank, wouldn't even interview at the others in this day and age

 

[RickyScott]

Honestly, top 3 prob ok to rank, wouldn't even interview at the others in this day and age

I would rank Einstein/montefiore above Columbia. Historically, einstein has been a decent program. Columbia chair has a highly malignant reputation and has bounced around a lot.

 

[medgator]

I would rank Einstein/montefiore above Columbia. Historically, einstein has been a decent program. Columbia chair has a highly malignant reputation and has bounced around a lot.

Just don't see the point of going anywhere outside of NYU or Sloane in this day and age.... NYC needs a real culling of programs

 

[seper]

Montefiore >> Columbia and MS

 

[metallica81788]

Just don't see the point of going anywhere outside of NYU or Sloane in this day and age.... NYC needs a real culling of programs

As long as trainees want to go to NYC, they will exist in perpetuity

 

[elementaryschooleconomics]

Totally agree, Monte > Columbia, otherwise it's a solid list.

 

[speakeroftruth]

Columbia is an absolute joke of a program and terrible place to receive radiation oncology care. I can't even bring myself to call it a department. What an embarrassment to our field that it is now responsible for the education and training of 8 residents after expanding in the era of massive residency overexpansion. And to top it off, you have Lisa "residents are f*cking" stupid" Kachnic as your chair? Might as well go punch a baby in the face and you will still be a better person and radiation oncologist than Lisa Kachnic. Anyone who ranks Columbia should not be surprised having to beg for a horrible job with low pay and high RVU requirements in an area far away from their family.

If you are an applicant that is at serious risk for having to match at Columbia in the era where even good programs can barely fill and medical students with criminal records are matching at high rates as programs try to avoid the SOAP, you are probably a perfect fit for rad onc now but please, save yourself.

 

[deleted1111261]

What year did they expand?

No self regulation or “peer review”. Think any of these PDs or chairman would give Dr. K a call and say, “Hey, you really think this is a good idea?” Nah.. it’s just a bunch of backslapping people, liking each others’ posts, never offering honest criticism (unless you’re inferior to them in some way), and certainly not trying to improve the situation.

What a joke. 8 years and counting to give back to the field with a FTE … it’s the least I can do.

 

[RickyScott]

What year did they expand?

No self regulation or “peer review”. Think any of these PDs or chairman would give Dr. K a call and say, “Hey, you really think this is a good idea?” Nah.. it’s just a bunch of backslapping people, liking each others’ posts, never offering honest criticism (unless you’re inferior to them in some way), and certainly not trying to improve the situation.

What a joke. 8 years and counting to give back to the field with a FTE … it’s the least I can do.

I think they expanded last year.

 

[fiji128]

What year did they expand?

No self regulation or “peer review”. Think any of these PDs or chairman would give Dr. K a call and say, “Hey, you really think this is a good idea?” Nah.. it’s just a bunch of backslapping people, liking each others’ posts, never offering honest criticism (unless you’re inferior to them in some way), and certainly not trying to improve the situation.

What a joke. 8 years and counting to give back to the field with a FTE … it’s the least I can do.

Programs to have officially increased spots from 2019 to 2021; Loma Linda 5 to 6, Case Western Reserve 6 to 7, Columbia 6 to 8, Northwestern 8 to 9, Thomas Jefferson 9 to 11, Duke 13 to 14.

List from ACGME with search done on 2/23/2021 and previously on 3/14/2019.
ACGME - Accreditation Data System (ADS)

 

[medgator]

Programs to have officially increased spots from 2019 to 2021; Loma Linda 5 to 6, Case Western Reserve 6 to 7, Columbia 6 to 8, Northwestern 8 to 9, Thomas Jefferson 9 to 11, Duke 13 to 14.

List from ACGME with search done on 2/23/2021 and previously on 3/14/2019.
ACGME - Accreditation Data System (ADS)

LL, Columbia and TJU have no business expanding.

 

[seper]

No legit avenue for "pruning" of RadOnc programs is deserved locations

 

[thecarbonionangle]

very well known terrible hellpit place. Look at hellpit thread

 

[medgator]

Just wondering - is Columbia a good program?

Maybe they should look for a vice chair first before they look for a resident or fellow

Associate/Professor of Radiation Oncology (Physician Leader, Vice Chair of Clinical Operations) in New York, NY for Columbia University Irving Medical Center

Exciting opportunity in New York, NY for Columbia University Irving Medical Center as a Associate...

careers.astro.org

 

[fiji128]

Maybe they should look for a vice chair first before they look for a resident or fellow

Associate/Professor of Radiation Oncology (Physician Leader, Vice Chair of Clinical Operations) in New York, NY for Columbia University Irving Medical Center

Exciting opportunity in New York, NY for Columbia University Irving Medical Center as a Associate...

careers.astro.org

I wonder what something like that pays and the number of hours per week you would be working. Basically sounds like you're the functional chair.

 

[medgator]

I wonder what something like that pays and the number of hours per week would you be working. Basically sounds like you're the functional chair.

The technical term is the chair's b****

 

[Neuronix]

I wonder what something like that pays and the number of hours per week you would be working. Basically sounds like you're the functional chair.

What I've seen is that the vice chair position pays little more in money or protected time per rank, and people do it to get promoted from associate to full professor or as a stepping stone to chair or division lead somewhere else.

Seems like a lousy job. Being clinical director is thankless. You're basically the physician police with little power to change anything. Heaven help you at a malignant shop--nothing you can do but tell people to shut up and get to work. If you like having power over other physicians, maybe that's a perk of the job?

 

[seper]

Doubt the vice chair will get out of seeing inpatient consults at Presbyterian
By all accounts (I interviewed their physicists who wanted to switch jobs) it is not a nice place to do RadOnc.
But hey, it is in NYC

 

[Mandelin Rain]

Maybe they should look for a vice chair first before they look for a resident or fellow

Associate/Professor of Radiation Oncology (Physician Leader, Vice Chair of Clinical Operations) in New York, NY for Columbia University Irving Medical Center

Exciting opportunity in New York, NY for Columbia University Irving Medical Center as a Associate...

careers.astro.org

"integrating operations of all areas managed through matrix relationships"

At least the expectations are clear.

 

[TheWallnerus]

Just wondering - is Columbia a good program?

Photoshop skills questionable.

 

[yesmaster]

LL, Columbia and TJU have no business expanding.

Case Western, Northwestern, and Duke also have no business expanding.

Disclosure: I have no current or prior affiliation with any of these institutions. I did buy a Columbia hoodie once upon a time because NYC was FREEZING.

 

[OTN]

Case Western, Northwestern, and Duke also have no business expanding.

Disclosure: I have no current or prior affiliation with any of these institutions. I did buy a Columbia hoodie once upon a time because NYC was FREEZING.

No one has any business expanding.

No one has any business staying the same size they are.

Everyone should be in the business of contracting.

 

[Gfunk6]

Everyone should be in the business of contracting.

They are in the business of contracting - with HMOs/PPOs to push their technical reimbursement to 700% of Medicare.

 

[evilbooyaa]

No one has any business expanding.

No one has any business staying the same size they are.

Everyone should be in the business of contracting.

They are in the business of contracting - with HMOs/PPOs to push their technical reimbursement to 700% of Medicare.

ABC
Always Be Contracting
The rub, as pointed out above, is the difference in which definition of contracting to use.

 

[DHorowitz]

I’m not one to hide behind pseudonyms or anonymity, so let me be up front about who I am. I’m David Horowitz, the program director for the Columbia University radiation oncology residency. I’ve been in this position for the past year. I’m not here to defend the department against people’s perceptions about what it was in the distant past, or even to try to change anyone’s mind, but I do want to talk about who we are as a program and our vision for the future.

I’m doing this job because I care about our residents; I want to help them to develop into the physicians and people that they want to be. We talk a lot at Columbia about training the next generation of leaders, but to be frank it’s about working with residents to recognize within themselves what they’re truly passionate about, and supporting them as they develop those passions. Those interests go in many directions--whether it’s lab research that we’re supporting with the Holman pathway, NIH-funded work like the intersection of FLASH and immuno-oncology, pursuing a master’s degree in bioethics during their research year, or pursuing a commitment to diversity, equity and inclusion with local, regional and national leadership roles, just to name a few. I think that recognizing and supporting the diverse interests of residents as they develop their true passions have unquestionably paid dividends, with Columbia rad onc residents awarded over $200,000 in grants last year, garnering leadership roles in ARRO, as well as having multiple oral presentations at the upcoming ASTRO meeting.

To be honest, though, I’ve been most influenced by the experience of a resident who instead of pursuing grants and academic plaudits, was truly passionate about being the best damn doctor at treating prostate cancer. Through his incredible devotion and focus, he chose to do additional rotations in prostate brachytherapy, and finished residency training with more than 100 implants. The commitment and leadership that he demonstrated is no less worthy than another resident who received an NIH grant; it just helps to demonstrate the need for genuine support of whatever really makes that resident tick. I feel like it’s my job to try to think differently about what it means to excel in a radiation oncology residency, and make sure that future residents have the support that they need. It’s also about enabling people to take risks, to try new things, without fear of failure causing paralysis.

My commitment to the people who come through the Columbia rad onc residency is that I will work with them as they develop their interests into passions, which will naturally help them become leaders not just as radiation oncologists, but as oncologists who have a seat in the larger medical and scientific community. Because of the diversity of interests we want to continue to foster, we’ve had to completely rethink our mentorship program to be more comprehensive and intentional. Good mentorship is hard, but our associate program director, Fred Wu, has been incredible in developing a mentorship program that takes a holistic view of the residents and works to create a network of both local and national mentors that helps to develop the potential of each individual resident.

We’ve been getting hate for expanding the residency program, and here’s what I’ve got to say about that. While the decision to expand the program predates my tenure as program director, I own it. I think that we provide our residents training that we can be proud of, and I don’t think that we should cede that to other programs just because they decided to expand earlier. But what I won’t do is take residents who aren’t committed to radiation oncology, and that means no SOAPing. If that means we don’t match, so be it. I also think that it speaks to our interest in expanding radiation oncology’s seat at many tables, not just trying to cram more seats into our small table.

Maybe some of you have opinions about my chair, Lisa Kachnic. She doesn’t need to me to defend her or explain her actions. All I’m going to say is this: it is clear to me that she cares deeply about the success of the residents and faculty in her department, and works to bring about that success. More than that, what I’ve seen from her during the worst of the early COVID pandemic in New York City made it 100% clear to me that she cares even more deeply about who we are as people, not just as staff.

I have to admit that it bothers me when the Columbia haters come out on SDN. I don’t care if you mockingly put up a photo of me out with my colleagues (if you want to know which one is me, I’m the good looking one), but I do care about the environment created for residents and students whose “colleagues” disdain them and their place of work. So please, consider having a little empathy.

I’ll be the first to say that we’re far from perfect at Columbia--I certainly have made and will continue to make plenty of mistakes. But there’s room to try new things within radiation oncology training without totally abandoning the successes of the past. So I want to listen to what you have to say. I’m not really one for message board debates, so I’d like to invite anyone who is interested in talking about the good, bad, and ugly of rad onc training (at Columbia or in general) to join me for a zoom chat on Friday, 9/3/21 from 4-5 p.m EDT.

Join our Cloud HD Video Meeting

Meeting ID: 958 0694 6413

Passcode: 369108

One tap mobile

+16465588656,,95806946413# US (New York)

+13017158592,,95806946413# US (Washington DC)


I’m also always happy to chat at 212-305-7077 or by email at [email protected]



David

 

[deleted1111261]

Dr. Horowitz,

It’s so nice to see you participate! People usually come on SDN to play defense and that’s fair.

I would love to debate, but I fear this will become about your residents (who I have zero issue with). What this has always been about is the wisdom of maintaining and then expanding programs in light of reality.

If you’re open to talking about your expansion and expansion, in general, that would be an interesting conversation. I don’t think most of us have any doubt that your residents themselves are excellent and you’re trying your best to educate them. I’m sure someone as passionate as you will do an amazing job.

I’m not sure the “if I didn’t train them, someone else would have” argument is that strong. But, certainly something to consider.

So, interested in talking about expansion? Let me know, and I’ll be there next Friday!

Simul

(I like the pic. You guys look like a fun crew!)

 

[communitydoc13]

I also think that it speaks to our interest in expanding radiation oncology’s seat at many tables, not just trying to cram more seats into our small table.

I am not a Columbia hater (I know nothing about the program and have never criticized it online). Your response above is thoughtful, hyperarticulate, and the type of exposition that would make me want to apply to your program. It is also representative of an overwhelming attitude in academic radonc that will never let us meaningfully address oversupply of residents or a bad job market. Namely, that our particular institution offers such tremendous value in training that it would be immoral to reduce residency spots in the setting of job market concerns.

The rub is in in your above statement. How do we meaningfully expand radonc's seat at many tables? I have heard this idea wistfully bandied about by academics since I was in residency. But our identity is strictly associated with delivering radiation (functionally a single drug with varying delivery techniques). This is in the setting of an almost exponentially expanding pharmaceutical armamentarium, a better understanding of cancer biology (biology is king), and decades old and maturing initiatives in both evidence based medicine and personalized medicine that will only reduce the number of patients being treated with radiation long term. In my roughly 10 years in independent practice, I have seen a significant decrease in the fraction of patients referred for radiation that come into my community cancer center (as well as the number of fractions of radiation delivered). Most importantly, this decrease in general is representative of more thoughtful, less wasteful, less toxic and equally efficacious care over all.

I personally believe that the natural evolution of oncology overall will mean a general reduction in administration of radiation. (This is not really a bad thing. It is just a real thing and it is our perverse incentive to increase radiation treatments). A radiation oncologist that does not deliver radiation is not a radiation oncologist by today's definition. Our leaders should acknowledge this and be willing to make the hard decisions necessary to integrate what have historically been radiation oncology programs into what is likely to be the future of oncology. IMO this is not training potential leaders in basic or translational science, health disparities, health equity or bioethics. There is nothing intrinsic to radiation oncology training that makes becoming a leader in these fields more likely. (If anything, I suspect it's the converse). The number of people with the intrinsic interest and technical makeup to do the hard work of things like FLASH research (actually intrinsic to radonc) is vanishingly small compared to a residency cohort.

By the present definition of radiation oncology, I believe all programs should assess the need for clinical radiation oncologists in their region as the main data point for determining class size. (Unfortunately for Columbia, this may mean a very small number of residents). They should also be looking for ways to integrate their programs into new definitions of either "solid tumor oncology" or "thereapeutic radiology/radiation oncology" that will make their residents uniquely positioned for the future of the field.

 

[RickyScott]

Harvard and MDACC both cut spots and both could offer better justifications for expansion.

 

[medgator]

Harvard and MDACC both cut spots and both could offer better justifications for expansion.

@DHorowitz please consider the above. We simply have zero proof that your programs' expansion fulfilled a need either in NYC or the field in general. As an example, i am sure Mayo Jacksonville and Scottsdale provide great training too. They simply aren't needed societally. Have you looked at the job market in the sunbelt lately? It's saturated

Please consider ending your unaccredited inpatient palliative fellowship as well, if it still is in existence. It really gives your program a bad look

 

[SubserviantToABR]

I’m not one to hide behind pseudonyms or anonymity, so let me be up front about who I am. I’m David Horowitz, the program director for the Columbia University radiation oncology residency. I’ve been in this position for the past year. I’m not here to defend the department against people’s perceptions about what it was in the distant past, or even to try to change anyone’s mind, but I do want to talk about who we are as a program and our vision for the future.

I’m doing this job because I care about our residents; I want to help them to develop into the physicians and people that they want to be. We talk a lot at Columbia about training the next generation of leaders, but to be frank it’s about working with residents to recognize within themselves what they’re truly passionate about, and supporting them as they develop those passions. Those interests go in many directions--whether it’s lab research that we’re supporting with the Holman pathway, NIH-funded work like the intersection of FLASH and immuno-oncology, pursuing a master’s degree in bioethics during their research year, or pursuing a commitment to diversity, equity and inclusion with local, regional and national leadership roles, just to name a few. I think that recognizing and supporting the diverse interests of residents as they develop their true passions have unquestionably paid dividends, with Columbia rad onc residents awarded over $200,000 in grants last year, garnering leadership roles in ARRO, as well as having multiple oral presentations at the upcoming ASTRO meeting.

To be honest, though, I’ve been most influenced by the experience of a resident who instead of pursuing grants and academic plaudits, was truly passionate about being the best damn doctor at treating prostate cancer. Through his incredible devotion and focus, he chose to do additional rotations in prostate brachytherapy, and finished residency training with more than 100 implants. The commitment and leadership that he demonstrated is no less worthy than another resident who received an NIH grant; it just helps to demonstrate the need for genuine support of whatever really makes that resident tick. I feel like it’s my job to try to think differently about what it means to excel in a radiation oncology residency, and make sure that future residents have the support that they need. It’s also about enabling people to take risks, to try new things, without fear of failure causing paralysis.

My commitment to the people who come through the Columbia rad onc residency is that I will work with them as they develop their interests into passions, which will naturally help them become leaders not just as radiation oncologists, but as oncologists who have a seat in the larger medical and scientific community. Because of the diversity of interests we want to continue to foster, we’ve had to completely rethink our mentorship program to be more comprehensive and intentional. Good mentorship is hard, but our associate program director, Fred Wu, has been incredible in developing a mentorship program that takes a holistic view of the residents and works to create a network of both local and national mentors that helps to develop the potential of each individual resident.

We’ve been getting hate for expanding the residency program, and here’s what I’ve got to say about that. While the decision to expand the program predates my tenure as program director, I own it. I think that we provide our residents training that we can be proud of, and I don’t think that we should cede that to other programs just because they decided to expand earlier. But what I won’t do is take residents who aren’t committed to radiation oncology, and that means no SOAPing. If that means we don’t match, so be it. I also think that it speaks to our interest in expanding radiation oncology’s seat at many tables, not just trying to cram more seats into our small table.

Maybe some of you have opinions about my chair, Lisa Kachnic. She doesn’t need to me to defend her or explain her actions. All I’m going to say is this: it is clear to me that she cares deeply about the success of the residents and faculty in her department, and works to bring about that success. More than that, what I’ve seen from her during the worst of the early COVID pandemic in New York City made it 100% clear to me that she cares even more deeply about who we are as people, not just as staff.

I have to admit that it bothers me when the Columbia haters come out on SDN. I don’t care if you mockingly put up a photo of me out with my colleagues (if you want to know which one is me, I’m the good looking one), but I do care about the environment created for residents and students whose “colleagues” disdain them and their place of work. So please, consider having a little empathy.

I’ll be the first to say that we’re far from perfect at Columbia--I certainly have made and will continue to make plenty of mistakes. But there’s room to try new things within radiation oncology training without totally abandoning the successes of the past. So I want to listen to what you have to say. I’m not really one for message board debates, so I’d like to invite anyone who is interested in talking about the good, bad, and ugly of rad onc training (at Columbia or in general) to join me for a zoom chat on Friday, 9/3/21 from 4-5 p.m EDT.

Join our Cloud HD Video Meeting

Meeting ID: 958 0694 6413

Passcode: 369108

One tap mobile

+16465588656,,95806946413# US (New York)

+13017158592,,95806946413# US (Washington DC)


I’m also always happy to chat at 212-305-7077 or by email at [email protected]



David

Hi David,
Thank you for coming onto SDN. You sound like a solid guy, and I hope you have success in your career.

But...

There's a lot of opinions regarding Columbia and Lisa Kachnic. I'll be honest, I did not know too much about Lisa Kachnic before 2018 and had no opinion one way or another.

It is hard for me to understand how Lisa Kachnic, the chair of Columbia, is supportive of residents, when she has actively worked against their best interests.

Despite being at peak rad onc, her belief (her words) is that the quality of residents has trended downwards: "Fourth, generally available National Residency Match Program data suggest that, during the past decade, regardless of a belief within the radiation oncology community, trends in the quality of residents accepted for training have been drifting slightly downward." (source: Commentary on: Thoughts on the American Board of Radiology Examinations and the Resident Experience in Radiation Oncology - PubMed).

It is hard to see a comment like that and believe that the figurehead of the Columbia rad onc department is supportive of residents. Telling current residents that they suck is pretty demoralizing, especially during the peak of radiation oncology competitiveness and applicant quality.

Second, by her own admission, programs less than 6 perform poorly on ABR initial certification exams (source: Kachnic's own presentation at ASTRO/ARRO 2018):

If a program is underperforming (not even considering the impact on future job prospects), why was there expansion of Columbia's program from 6 to 8? Did their education get better, meriting an increase in number of trainees? Maybe, but I suspect, like most programs, they expanded, not because of the quality of education increased but rather, the desire for cheap labor. You can offer a high quality of education, without the need to expand.

Reputation of a program goes a long way, and the others here can comment on it. But, to be truly supportive of residents is to provide a high quality education and a bright, satisfying, long lasting career. Given how the market is since these statements from Kachnic, we are not sure Columbia can deliver on that promise.

 

[thecarbonionangle]

Man classic post. Pretty much illustrates what is wrong with our field. Complete head in sand. We will expand because we are just that good and I am just that good looking. Good luck in the match, total hellpit

 

[SubserviantToABR]

For those curious how Kachnic and the ABR responded to the 2018 exams, Kachnic (in front of hundreds of residents) said there was no irregularities in their scoring in 2018 and that she was bummed that she was getting cyberbullied.

The next year, the pass rate miraciously increased:

Maybe it is because all the ABR did was add large textbooks to their study guide:

Was it because every single resident the year after read Khan in its entirety or did they realize they screwed up Angoff scoring and change the cut point? Did the dog wag the tail or did the tail wag the dog?

 

[DHorowitz]

Hi Simul,

I really appreciate the response, and would love to talk with you about the effect of residency expansion and contraction. I think it's debatable about the effect of individual residency expansion at the margin on the overall rad onc job market, but something that I'm glad we're getting more data about and can have collegial discussion. I'm also not saying that "if I didn't train residents, someone else would have." I'm saying that given a finite supply of radiation oncology applicants, there are good reasons why people would want to do their training at Columbia compared to another program. It's supporting our residents as they decide what is right for them to be doing with their careers--connecting them with alumni in private practice across the country to learn what that's actually all about, mentoring them as they write grant applications if their passions are in academic medicine, supporting efforts to improve their abilities as educators, etc.

I've got to push back on your comment that this has always been about residency expansion, though. Just look higher up in the thread to see real vitriol about Columbia. Or look at the picture of three human skulls and then a Neanderthal skull labeled "Columbia," and think about the dehumanizing effect it might have.

As much as I'd like to talk about the merits of residency expansion, I'd also really like to listen to people who think that our training is lacking, because what I really care about is the quality of the training that our program provides for our residents. No lie, I'd honestly appreciate hearing from our critics, because while I've got a bunch of ideas for ways to change the way we approach residency training, I definitely don't have a monopoly on them.

So if you and any of our colleagues in rad onc are able to, I'd love to talk with you on Zoom on Friday. Or let's find another time to talk. I'd appreciate hearing more of your perspective. And please, call me David. My colleagues at CU all do that, and we’re all colleagues here hoping to improve rad onc as a field.

Thanks,

David

 

[Neuronix]

David, all programs should contract. There are too many trainees, and it has destroyed the job market for radiation oncologists.

It doesn't matter if your program does a good job training or not. The fact that your program recently expanded and now you will not contract means that you are part of the overexpansion problem. Every program says that theirs should not be the one to contract. It doesn't matter. If you don't contract, you're part of the problem.

There are many other issues specifically with Columbia that others are pointing out: chair who failed 40% of rad onc trainees one year in their board exams and still defends it, unaccredited palliative fellowship, no need for more rad oncs particularly in critically oversaturated NYC, etc.

ABC (always be contracting) until the job market improves. Your lengthy posts dance around this simple issue. Medical students should be very wary of choosing radiation oncology as a specialty due to the oversupply of radiation oncology residents. They will be doubly wary of a program that has continued to expand despite the issues mentioned, no matter how you try to spin it.

 

[elementaryschooleconomics]

I have asked many Chairs and academic department faculty over the last couple years, in face-to-face conversation, on their opinions about the number of residents we're training. While in the beginning there was straight denial, as interest in the specialty crashed, the response universally became "programs should definitely contract, but not my program, because we provide excellent training".

I find this entirely hypocritical, for a specialty where most of our research is geared towards cutting down treatment times for radiation, or omitting radiation altogether, "for the greater good". Do as I say, not as I do, right?

After the Twitter debate on breast radiation this week, and thinking about these contraction arguments, I have a hypothesis: the people beating the drum regarding omission of radiation for breast cancer would not choose to omit radiation for themselves or a family member, using similar arguments.

"Contraction is for other people, not for us, we're special"

"Omission is for other people, not for me, I'm special"

Perhaps I'm wrong, as Harvard and Anderson have walked the walk recently (though perhaps not entirely voluntarily, but the ends justify the means).

Regarding Columbia, regardless of David's thoughtful posts (which I appreciate you coming here!): Lisa Kachnic has worn her opinion on her sleeve about residents for years. She's leading the department, and thus setting the culture. I wouldn't want to be a part of that institution the same way I wouldn't want to be involved with Chicago.

But what do I know, I was one of those kids who matched in the decade when quality was trending downward. I somehow managed to pass my boards on my first try, so maybe there's hope for me after all!

 

[RickyScott]

Expanding in this market -while Soaping 100% of entering class- doesn’t comport with dedication to residents and their ultimate well being. Nor does claiming 40% of “AOA -types”are not fit to practice radonc, but then 100% Soaping…

 

[radiation]

The cognitive dissonance of SDN is always funny to me. Here we have posters calling out a program director for not personally stopping residency expansion at his institution when its likely he has had very little influence on the matter. On the other hand, we have the same people who think they are holier than thou because they have even less influence on residency expansion but they have hundreds of post on a niche forum so they must be helping solve overexpansion problem way more than he is!

 

[thecarbonionangle]

The cognitive dissonance of SDN is always funny to me. Here we have posters calling out a program director for not personally stopping residency expansion at his institution when its likely he has had very little influence on the matter. On the other hand, we have the same people who think they are holier than thou because they have even less influence on residency expansion but they have hundreds of post on a niche forum so they must be helping solve overexpansion problem way more than he is!

I agree that there is nothing we can do and we are doomed. The “leadership” is like the red head in titanic holding Leo’s hand saying i’ll never let you go! While ignoring that there is plenty of room to help and do something about it. In the end, the sharks feast on all our carcasses and the “leadership” will be ok. They know that and they do not care.

 

[SubserviantToABR]

The cognitive dissonance of SDN is always funny to me. Here we have posters calling out a program director for not personally stopping residency expansion at his institution when its likely he has had very little influence on the matter. On the other hand, we have the same people who think they are holier than thou because they have even less influence on residency expansion but they have hundreds of post on a niche forum so they must be helping solve overexpansion problem way more than he is!

First, we did not call out David Horowitz. He came to the forum and posted. Many of us expressed our opinions. If he thought we were just a niche forum, why would he come here to expression his own opinion? I did not know who Horowitz was until this morning.

Second, many of us, including myself, are at academic programs. We express opinion freely and outwardly here on the forum, but we do work at places where we are trying to make change locally. Without giving away my own identity, I can tell you that we are slowly and quietly attempting to contract the number of residency positions. I am not a program director, but we have been applying pressure to leadership to make change happen. It is hard for a lot of reasons, but we are attempting to do our own part, as small as it is. It is nerve-wracking to see senior residents go through the job hunt, especially after going through it myself less than 3 years ago.

Third, this forum is influential in many ways. Many of the topics and opinions discussed here are also supported by the onslaught of new and fascinating papers, led by fantastic people like Chirag, Mudit, Chelain, and Trevor (there are many, many more!), quantifying the concerns regarding the job market and residency overexpansion.

ABC. Always be contracting.

 

[RickyScott]

The cognitive dissonance of SDN is always funny to me. Here we have posters calling out a program director for not personally stopping residency expansion at his institution when its likely he has had very little influence on the matter. On the other hand, we have the same people who think they are holier than thou because they have even less influence on residency expansion but they have hundreds of post on a niche forum so they must be helping solve overexpansion problem way more than he is!

Agree with you that Sdn is a reflection not a cause of the descent of radonc to the bottom of the match. We have little influence over the underlying greed that is destroying this specialty whether residency expansion or price gouging/virtue signalling, but If we can save one medstudent…

 

[medgator]

The cognitive dissonance of SDN is always funny to me. Here we have posters calling out a program director for not personally stopping residency expansion at his institution when its likely he has had very little influence on the matter. On the other hand, we have the same people who think they are holier than thou because they have even less influence on residency expansion but they have hundreds of post on a niche forum so they must be helping solve overexpansion problem way more than he is!

SDN was pretty much the only one calling it until match 2019 happened.

 

[radiation]

SDN was pretty much the only one calling it until match 2019 happened.

This is the same exceptionalism that gets projected on programs that don't contract. "Oh my program has great training so I can't be held responsible for what other programs are doing or if I cause unintended consequences for the field"

"Oh I talked about overexpansion on an internet message board in 2019, so I did my part. Everyone else better better fix this mess. It's inconceivable that I have any agency in this, if the "leaders" don't fix this mess then it's on everyone except for me"

 

[elementaryschooleconomics]

This is the same exceptionalism that gets projected on programs that don't contract. "Oh my program has great training so I can't be held responsible for what other programs are doing or if I cause unintended consequences for the field"

"Oh I talked about overexpansion on an internet message board in 2019, so I did my part. Everyone else better better fix this mess. It's inconceivable that I have any agency in this, if the "leaders" don't fix this mess then it's on everyone except for me"

I'm certain there are many of us actively working towards getting into positions to have more agency over this.

The problem being, of course, is that Radiation Oncology in America is a giant pyramid scheme. The academicians are running everything, Chairs are in power for 20-30 years, and the field is of such a size that a small cabal of the Good Ole Boys Club holds significant influence, and it's VERY hard to enact change while being "on the outside".

In the meantime, if we can challenge the information asymmetry using the internet to facilitate medical students making informed career choices, that's better than nothing at all, wouldn't you say?

 

[yesmaster]

You know, we have a global warming problem. Sure, the Pacific Northwest is burning but should investors abandon Chevron and Halliburton? If your division is well-run, full of well-intentioned people, who make state of the art drill bits for horizontal drilling and hydraulic fracking, who do research on AI enhanced discovery of oil fields, is it appropriate for anonymous Internet eco-terrorists to poo-poo your company?

It’s tough to be a PD in 2021. I don’t criticize individual programs or join in on any of that. As you can see, we don’t care whether you’re Columbia or CCF, UCI or Harvard, everyone should be contracting.

Unless a training program has opened vast new opportunities in our CLINICAL SCOPE of PRACTICE as clinicians, it should be contracting or closing. For FLASH and immunotherapy, hire postdocs or PhD scientists or support early-career physician scientist assistant professors, for bioethics, start an MPH program. They are worthy endeavors, however, wake me up when graduates of any residency program in the country can prescribe Keytruda or perform their own biopsies.

 

[yesmaster]

@radiation

What’s your point?

We’re all guilty so the Internet should stop pushing for contraction or counseling students to stay away from the field?

 

[medgator]

This is the same exceptionalism that gets projected on programs that don't contract. "Oh my program has great training so I can't be held responsible for what other programs are doing or if I cause unintended consequences for the field"

"Oh I talked about overexpansion on an internet message board in 2019, so I did my part. Everyone else better better fix this mess. It's inconceivable that I have any agency in this, if the "leaders" don't fix this mess then it's on everyone except for me"

Ok then keep doing your ostrich in sand thing. To each their own. The fact that we've had multiple academic folks come here and post and engage with us over the last few years would seem to indicate we probably have more credibility on these issues than you like to ascribe to us