msnbc2020

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2001-2002: 468
2002-2003: 507
2003-2004: 518
2004-2005: 534
2005-2006: 540
2006-2007: 565
2007-2008: 589
2008-2009: 595
2009-2010: 615
2010-2011: 612
2011-2012: 666
2012-2013: 676
2013-2014: 705
2014-2015: 721
2015-2016: 733
2016-2017: 749
2017-2018: 767
2018-2019: 774
2019-2020: 771
2020-2021: 772 Down 2 residents from peak of 774 in 2018-2019

LOL. Wasn't there a pledge not to fill slots in the scramble? I guess that pledge went out the window.

Number of accredited programs:
2001-2002: 77
2002-2003: 78
2003-2004: 77
2004-2005: 78
2005-2006: 81
2006-2007: 79
2007-2008: 80
2008-2009: 81
2009-2010: 81
2010-2011: 84
2011-2012: 87
2012-2013: 87
2013-2014: 88
2014-2015: 89
2015-2016: 91
2016-2017: 92
2017-2018: 94
2018-2019: 94
2019-2020 91
2020-2021: 91

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1598187641206.png
 
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2001-2002: 468
2002-2003: 507
2003-2004: 518
2004-2005: 534
2005-2006: 540
2006-2007: 565
2007-2008: 589
2008-2009: 595
2009-2010: 615
2010-2011: 612
2011-2012: 666
2012-2013: 676
2013-2014: 705
2014-2015: 721
2015-2016: 733
2016-2017: 749
2017-2018: 767
2018-2019: 774
2019-2020: 771
2020-2021: 772 Down 2 residents from peak of 774 in 2018-2019

LOL. Wasn't there a pledge not to fill slots in the scramble? I guess that pledge went out the window.

Number of accredited programs:
2001-2002: 77
2002-2003: 78
2003-2004: 77
2004-2005: 78
2005-2006: 81
2006-2007: 79
2007-2008: 80
2008-2009: 81
2009-2010: 81
2010-2011: 84
2011-2012: 87
2012-2013: 87
2013-2014: 88
2014-2015: 89
2015-2016: 91
2016-2017: 92
2017-2018: 94
2018-2019: 94
2019-2020 91
2020-2021: 91

View attachment 316696
View attachment 316697

The most stunning part of seeing the numbers like this is:

2010 = 612 residents
2013 = 705 residents

A jump of almost 100 additional residents/year in 3 years is insane. With the 5 year training lag, it's probably why people are finally willing to be more vocal about the supply issue. In 2013, it was "bloodbath" math but folks weren't feeling the effects yet, just predictions. Now the jobs crunch is really cranking up - too bad we have a thousand new residents already in the pipeline...
 
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CaesarRO

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The most stunning part of seeing the numbers like this is:

2010 = 612 residents
2013 = 705 residents

A jump of almost 100 additional residents/year in 3 years is insane. With the 5 year training lag, it's probably why people are finally willing to be more vocal about the supply issue. In 2013, it was "bloodbath" math but folks weren't feeling the effects yet, just predictions. Now the jobs crunch is really cranking up - too bad we have a thousand new residents already in the pipeline...
Feel free to correct me if I'm wrong, but I think these are total # of residents, not residents per year. So it's an increase of 100 in the 5 yr pipeline, not per year.

Point still stands. Definitely a jarring jump to see I'm just a few years.
 
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Feel free to correct me if I'm wrong, but I think these are total # of residents, not residents per year. So it's an increase of 100 in the 5 yr pipeline, not per year.

Point still stands. Definitely a jarring jump to see I'm just a few years.

Whoops you're totally correct, definitely not per year. But yeah, same sentiment regardless.

I desperately wish we had the inverse stat of "number of people leaving per year". You'd think a specialty that has board exams which explicitly test on decay kinetics would understand that if the half-life of the daughter (practicing RadOncs) is significantly longer than the parent (resident RadOncs), you're gonna get an unbalanced equation...
 
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scarbrtj

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Whoops you're totally correct, definitely not per year. But yeah, same sentiment regardless.

I desperately wish we had the inverse stat of "number of people leaving per year". You'd think a specialty that has board exams which explicitly test on decay kinetics would understand that if the half-life of the daughter (practicing RadOncs) is significantly longer than the parent (resident RadOncs), you're gonna get an unbalanced equation...
EVERY equation balances. Eventually.
 
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RickyScott

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Just need enough employed/non partner/non tenure track positions and unaccredited fellowships to pick up the slack
Will follow grads of mskcc/mdacc etc in 4-5 years. Am convinced some will be in fellowships or awful satellite junior faculty positions after going through a “hunger games” type residency experience in which they compete for the 1-2 spots in their own networks.
 
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msnbc2020

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Whoops you're totally correct, definitely not per year. But yeah, same sentiment regardless.

I desperately wish we had the inverse stat of "number of people leaving per year". You'd think a specialty that has board exams which explicitly test on decay kinetics would understand that if the half-life of the daughter (practicing RadOncs) is significantly longer than the parent (resident RadOncs), you're gonna get an unbalanced equation...
The inverse stat can be roughly inferred by using the number of practicing radiation oncologists per year.
Number of practicing radiation oncologists
2000: 3560 (1 per 79213 people)
2008: 4209 (1 per 71661 people)
2012: 4459 (1 per 69309 people)
2014: 4682 (1 per 67520 people)
2015: 4845 (1 per 66299 people)
2017: 5029 (1 per 64768 people)

The data shows that MD Anderson is full of sh$t

Results
Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand.
Conclusion
Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

Imo a conservative estimate would put the number of radiation oncologists in 2020 at 5300
With current population of 328,000,000: 1 per 61887 people
 
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The inverse stat can be roughly inferred by using the number of practicing radiation oncologists per year.
Number of practicing radiation oncologists
2000: 3560 (1 per 79213 people)
2008: 4209 (1 per 71661 people)
2012: 4459 (1 per 69309 people)
2014: 4682 (1 per 67520 people)
2015: 4845 (1 per 66299 people)
2017: 5029 (1 per 64768 people)

The data shows that MD Anderson is full of sh$t

Results
Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand.
Conclusion
Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

I'm sure @scarbrtj already did the math on this and I missed it, but basically:

2008 to 2012 = increase of 250 (~62 per year)
2012 to 2014 = increase of 223 (~110 per year)
2014 to 2015 = increase of 163
2015 to 2017 = increase of 184 (~92 per year)

Is it safe to assume we're creating an excess of at least 100 Radiation Oncologists a year now?
 
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scarbrtj

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The inverse stat can be roughly inferred by using the number of practicing radiation oncologists per year.
Number of practicing radiation oncologists
2000: 3560 (1 per 79213 people)
2008: 4209 (1 per 71661 people)
2012: 4459 (1 per 69309 people)
2014: 4682 (1 per 67520 people)
2015: 4845 (1 per 66299 people)
2017: 5029 (1 per 64768 people)

The data shows that MD Anderson is full of sh$t

Results
Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand.
Conclusion
Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

Imo a conservative estimate would put the number of radiation oncologists in 2020 at 5300
With current population of 328,000,000: 1 per 61887 people
To their credit (I guess), the Ben Smith et als came out later and said "we were wrong and full of sh$t"
 

scarbrtj

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The inverse stat can be roughly inferred by using the number of practicing radiation oncologists per year.
Number of practicing radiation oncologists
2000: 3560 (1 per 79213 people)
2008: 4209 (1 per 71661 people)
2012: 4459 (1 per 69309 people)
2014: 4682 (1 per 67520 people)
2015: 4845 (1 per 66299 people)
2017: 5029 (1 per 64768 people)

The data shows that MD Anderson is full of sh$t

Results
Between 2010 and 2020, the total number of patients receiving radiation therapy during their initial treatment course is expected to increase by 22%, from 470,000 per year to 575,000 per year. In contrast, assuming that the current graduation rate of 140 residents per year remains constant, the number of full-time equivalent radiation oncologists is expected to increase by only 2%, from 3,943 to 4,022. The size of residency training classes for the years 2014 to 2019 would have to double to 280 residents per year in order for growth in supply of radiation oncologists to equal expected growth in demand.
Conclusion
Demand for radiation therapy is expected to grow 10 times faster than supply between 2010 and 2020. Research is needed to explore strategies to enhance capacity to deliver quality radiation therapy despite increased patient loads.

Imo a conservative estimate would put the number of radiation oncologists in 2020 at 5300
With current population of 328,000,000: 1 per 61887 people
I'm sure @scarbrtj already did the math on this and I missed it, but basically:

2008 to 2012 = increase of 250 (~62 per year)
2012 to 2014 = increase of 223 (~110 per year)
2014 to 2015 = increase of 163
2015 to 2017 = increase of 184 (~92 per year)

Is it safe to assume we're creating an excess of at least 100 Radiation Oncologists a year now?
Correct by you both. NB: We were producing about 100/year in 2000 when there were about 3500 rad oncs nationally. We are at ~5000 now and should hit ~6000 by 2025. There is no "right number" I suppose. But could 3500 radiation oncologists handle all of America's rad onc work now and for the next ~5 years? Yes.
 
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Correct by you both. NB: We were producing about 100/year in 2000 when there were about 3500 rad oncs nationally. We are at ~5000 now and should hit ~6000 by 2025. There is no "right number" I suppose. But could 3500 radiation oncologists handle all of America's rad onc work now and for the next ~5 years? Yes.

It's unfortunate these elementary school calculations aren't enough for certain chairs of certain institutions in certain states named Kentucky, or his buddies.
 
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metallica81788

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The amount of spots increased by ~70 between when I applied for residency (in the ~3-4 year window of it's "peak competitiveness") and when I finished. Wow.
 
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This thought occurred to me reading this forum...

I completed residency within the past few years, as I am sure many others here did as well. If not for expansion, would I have matched? It would be nice to think that I was a “core” applicant and that added spots just made room for other people... but who knows. I think this thought is why I have always approached this topic with reluctance and humility.
 
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qwerty89

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Emergency Medicine:
2005-2006: 4256
2007-2008: 4546
2010-2011: 5190
2014-2015: 5941
2020-2021: 8389

97% increase in 15 years

Radiology:
2005-2006: 4303
2007-2008: 4427
2010-2011: 4584
2014-2015: 4676
2020-2021: 4492 (DR) + 21 (IR-Independent) + 427 (IR Integrated) = 4940

14.8% increase in 15 years

Dermatology:
2005-2006: 1052
2007-2008: 1110
2010-2011: 1172
2014-2015: 1275
2020-2021: 1589

51% increase in 15 years

Radiation Oncology:
2005-2006: 540
2007-2008: 589
2010-2011: 612
2014-2015: 721
2020-2021: 772

43% increase in 15 years

Now some of the increase for EM can be explained because old DO programs are now under the umbrella of the ACGME. Not so much for Rads and Derm which had very few DO spots in the first place. I don't think RadOnc had any osteopathic residencies. Either way that is massive expansion.

Derm is also undergoing expansion of private equity at the moment. I would imagine their landscape will look very different in 10 years, at least in the big cities.
 
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CaesarRO

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This thought occurred to me reading this forum...

I completed residency within the past few years, as I am sure many others here did as well. If not for expansion, would I have matched? It would be nice to think that I was a “core” applicant and that added spots just made room for other people... but who knows. I think this thought is why I have always approached this topic with reluctance and humility.
I have definitely had this thought many times.

When I matched I knew spots were increasing and factored it in my favor for matching, but did not think of the broader implications of the trend continuing. I think the only literature at the time was the original Ben Smith publication and I rationalized that the demand was expected to increase with the aging population, etc.
 

scarbrtj

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Emergency Medicine:
2005-2006: 4256
2007-2008: 4546
2010-2011: 5190
2014-2015: 5941
2020-2021: 8389

97% increase in 15 years

Radiology:
2005-2006: 4303
2007-2008: 4427
2010-2011: 4584
2014-2015: 4676
2020-2021: 4492 (DR) + 21 (IR-Independent) + 427 (IR Integrated) = 4940

14.8% increase in 15 years

Dermatology:
2005-2006: 1052
2007-2008: 1110
2010-2011: 1172
2014-2015: 1275
2020-2021: 1589

51% increase in 15 years

Radiation Oncology:
2005-2006: 540
2007-2008: 589
2010-2011: 612
2014-2015: 721
2020-2021: 772

43% increase in 15 years

Now some of the increase for EM can be explained because old DO programs are now under the umbrella of the ACGME. Not so much for Rads and Derm which had very few DO spots in the first place. I don't think RadOnc had any osteopathic residencies. Either way that is massive expansion.

Derm is also undergoing expansion of private equity at the moment. I would imagine their landscape will look very different in 10 years, at least in the big cities.
This is all numerator data (supply). Missing is denominator data (demand). Let's take a stab at derm e.g. This is useful because derms actually deliver more radiation therapy for skin cancer than rad oncs do. The derms say "Dermatologists alone have been unable to meet increasing patient demand for dermatologic services." (And in 1970 a first year derm salary was $12-24K?!?) There are about 20K derms in the U.S. About 10% (or more) of the U.S. population sees a derm per year (about 33 million people per year), and their estimated office visits are ~45 million a year. "Office visits" are an unclear metric in rad onc. But let's be real generous and say the average rad onc course is 4 weeks for 6 visits per patient per year (consult, 4 OTVs, and a followup), and we will let that include retreats etc. for a per year basis. About 600K/year get radiation in their first course, but let's again be very generous and guess that there's a 50% re-tx rate and that occurs a year later so we will say rad oncs have access to 900K patients/year (this is very high side, suspect number but let's go with it). And let's assume there are only 5000 rad oncs right now (there's probably more). My point is we should look at patients/year, and office visits. Office visits probably give a good idea about "amount of work per patient."

Run a little Excel....



... and it shows how rad onc might be ~2.5-9x oversupplied versus derm, even though derm has expanded at same rate as rad onc and there are ~4x as many derms.

Derm's got big denominators. Notice I have tried to positively/helpfully overestimate on rad onc side and underestimate on the "versus derm" side. So the numbers could be worse. E.g., it's been cited that the average dermatologist sees 5000 patients/year. The average rad onc sees... 250/year? And again that is probably very high. But looking at this metric, rad onc could be 20x oversupplied versus derm.
 
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qwerty89

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This is all numerator data (supply). Missing is denominator data (demand). Let's take a stab at derm e.g. This is useful because derms actually deliver more radiation therapy for skin cancer than rad oncs do. The derms say "Dermatologists alone have been unable to meet increasing patient demand for dermatologic services." (And in 1970 a first year derm salary was $12-24K?!?) There are about 20K derms in the U.S. About 10% (or more) of the U.S. population sees a derm per year (about 33 million people per year), and their estimated office visits are ~45 million a year. "Office visits" are an unclear metric in rad onc. But let's be real generous and say the average rad onc course is 4 weeks for 6 visits per patient per year (consult, 4 OTVs, and a followup), and we will let that include retreats etc. for a per year basis. About 600K/year get radiation in their first course, but let's again be very generous and guess that there's a 50% re-tx rate and that occurs a year later so we will say rad oncs have access to 900K patients/year (this is very high side, suspect number but let's go with it). And let's assume there are only 5000 rad oncs right now (there's probably more). My point is we should look at patients/year, and office visits. Office visits probably give a good idea about "amount of work per patient."

Run a little Excel....



... and it shows how rad onc might be ~2.5-9x oversupplied versus derm, even though derm has expanded at same rate as rad onc and there are ~4x as many derms.

Derm's got big denominators. Notice I have tried to positively/helpfully overestimate on rad onc side and underestimate on the "versus derm" side. So the numbers could be worse. E.g., it's been cited that the average dermatologist sees 5000 patients/year. The average rad onc sees... 250/year? And again that is probably very high. But looking at this metric, rad onc could be 20x oversupplied versus derm.

Oh I agree. I didn't take into account demand.

But I didn't fully take into account supply either.
"Research shows that almost 40% of women physicians go part-time or leave medicine altogether within six years of completing their residencies."

Derm is female dominated and if a higher % of them go part time or leave altogether then you have an even better outlook. RadOnc is male dominated and most of those are looking for full time work, which makes oversupply even worse.
 
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StIGMA

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This is all numerator data (supply). Missing is denominator data (demand).
Many caveats of course. One thing 'protecting' us a bit, like surgical specialties or radiology, is only we can do what we do. I don't ever expect to see an APP to administer radiotherapy in my lifetime (the only way that starts is if we begin that training ourselves, which we shouldn't... and if this happens it would be driven by lazy academics offloading as much work as possible to anyone else). However APPs are all over the place in derm, ED, primary care, etc. I wouldn't be surprised if APPs are primary on delivering heme/onc care paths in the future, though.
 
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RickyScott

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Regarding number of docs leaving specialty per year- It is going to be around 100 or less where it was in early 2000s. The newly minted bubble of radoncs wont be retiring for 30+ years.
 
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Regarding number of docs leaving specialty per year- It is going to be around 100 or less where it was in early 2000s. The newly minted bubble of radoncs wont be retiring for 30+ years.

Plus the new ones are making less money, getting less reimbursements, won't have nice cushy pensions or practice sell-offs, and have enormous student loan debts to pay. Only way now to FIRE in RadOnc is too have zero living expenses, have a high earning spouse, or get a job in the boonies making as much as you can saving 80%+ of your income for 10-15 years.

But hey at least we don't have to spend all that money traveling for conferences now am I right
 
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The “leadership” in this field continues to show moral, intellectual, unimaginative willful midgetry. May God help us all, folks! For the breadlines are a-coming
 
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Ok, now that I have crashed this forum I should probably post something serious.

I think Scar makes some good arguments. Some disciplines are better able to absorb (and even needed) a near doubling of residency spots over a 20 year period.

Im not quite as doom and gloom as some people here. We are clearly facing a problem and have issues with over saturation. I wouldn’t want to be just starting out right now and I am down right sad to see how far we have fallen in terms of appeal and generally having our [email protected] together. But for the last 30 years there have been so many existential threats that were going to end the field and yet here we are. There will be pain. But the one advantage of the idiocy of rapid expansion is we are now bottom heavy and after some pain the old guard will be replaced by people who get it. I’ve given up on anything substantial happening in the near term.
 
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Ok, now that I have crashed this forum I should probably post something serious.

I think Scar makes some good arguments. Some disciplines are better able to absorb (and even needed) a near doubling of residency spots over a 20 year period.

Im not quite as doom and gloom as some people here. We are clearly facing a problem and have issues with over saturation. I wouldn’t want to be just starting out right now and I am down right sad to see how far we have fallen in terms of appeal and generally having our [email protected] together. But for the last 30 years there have been so many existential threats that were going to end the field and yet here we are. There will be pain. But the one advantage of the idiocy of rapid expansion is we are now bottom heavy and after some pain the old guard will be replaced by people who get it. I’ve given up on anything substantial happening in the near term.

This used to give me hope (and somewhat still does), but the timeframe you're thinking about here is longer than most people think. Many, many senior academic attendings have been in the game for 30+ years (some, like Wallner, much longer). I definitely agree that the people who have come out of residency in the past decade or so are amazing and give me hope - however, it will be at least 10-15 years before they assume many positions of power, and then it will take several more years to enact positive change.

No one can see the future, I certainly can't. But given the people who are currently in power and the field's trajectory over the past 5-10 years, I would be SHOCKED if we start to see meaningful change prior to 2030. That was a similar time frame for Radiology, right? Things started going south in the early 2000s and are just now bouncing back?
 
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StIGMA

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Also, be wary how soon a recent grad turns into a replica of the old guard. There’s a strong incentive to maintain status quo coming from above. Not many people will want to stick their necks out especially with so few other opportunities available.
 
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Lamount

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Our field is at a bit of a crossroads... and frankly, it’s not clear that anyone here really knows what the ideal future looks like for rad onc.

Everyone agrees that we should residency expansion.

Everyone agrees that increase in fellowships indicates a tighter job market.

But how does the field get better? -not the job market, the field.
If we want to maintain/increase compensation, we have to improve value. How are we improving value?

the conventional criticism of academia is that hypofx is killing the field... but if results are the same, then there really isn’t a reasonable argument for charging more money when the same thing can be done more cheaply. If we want to charge more money for a treatment, it has to be better.

Limiting residency expansion is important for the job market, but doesn’t do much for the field. If you want the field to improve, support research into new technologies and indications for RT. Don’t throw stones at trials evaluating protons. Don’t be nihilistic when someone dares to increase indications for RT. Celebrate innovative research and stop eating our own.
 
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RickyScott

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Our field is at a bit of a crossroads... and frankly, it’s not clear that anyone here really knows what the ideal future looks like for rad onc.

Everyone agrees that we should residency expansion.

Everyone agrees that increase in fellowships indicates a tighter job market.

But how does the field get better? -not the job market, the field.
If we want to maintain/increase compensation, we have to improve value. How are we improving value?

the conventional criticism of academia is that hypofx is killing the field... but if results are the same, then there really isn’t a reasonable argument for charging more money when the same thing can be done more cheaply. If we want to charge more money for a treatment, it has to be better.

Limiting residency expansion is important for the job market, but doesn’t do much for the field. If you want the field to improve, support research into new technologies and indications for RT. Don’t throw stones at trials evaluating protons. Don’t be nihilistic when someone dares to increase indications for RT. Celebrate innovative research and stop eating our own.
the conventional criticism of academia is that hypofx is killing the field... but if results are the same, then there really isn’t a reasonable argument for charging more money when the same thing can be done more cheaply. If we want to charge more money for a treatment, it has to better
if you want to charge more, you charge more because you can ie are an academic monopolistic system. Hypofract is almost always more expensive at academic centers than conventional fract at freestanding. How much do you think sbrt prostate is at Mskcc?
In terms of expanding indications for xrt- there may or may not be indications out there. And lastly protons- protons are just not profitable without prostate and it this point anyone who has been around the block can recognize protons probably worse in prostate. “Eating our own” - academic center owns this phrase .
 
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OTN

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Our field is at a bit of a crossroads... and frankly, it’s not clear that anyone here really knows what the ideal future looks like for rad onc.

Everyone agrees that we should residency expansion.

Everyone agrees that increase in fellowships indicates a tighter job market.

But how does the field get better? -not the job market, the field.
If we want to maintain/increase compensation, we have to improve value. How are we improving value?

the conventional criticism of academia is that hypofx is killing the field... but if results are the same, then there really isn’t a reasonable argument for charging more money when the same thing can be done more cheaply. If we want to charge more money for a treatment, it has to be better.

Limiting residency expansion is important for the job market, but doesn’t do much for the field. If you want the field to improve, support research into new technologies and indications for RT. Don’t throw stones at trials evaluating protons. Don’t be nihilistic when someone dares to increase indications for RT. Celebrate innovative research and stop eating our own.

The whole "community docs say hypofractionation is killing the field" is a canard. The Twitter crowd loves to claim that all community docs hate hypofx, but in reality all we've tried to do the whole time is to get academia to recognize the very, very simple fact (insert scarb data here) that hypofractionation will lead to a decrease in demand for radoncs.

I also strongly disagree with "limiting residency expansion is important for the job market, but doesn't do much for the field." We want good medical students to apply to radonc to help push the field forward. Look at what's happening now with the "leadership" that got into the field when it was easy.
 
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scarbrtj

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The Twitter crowd loves to claim that all community docs hate hypofx, but in reality all we've tried to do the whole time is to get academia to recognize the very, very simple fact (insert scarb data here) that hypofractionation will lead to a decrease in demand for radoncs.
Academia would've "hated" hypofrac too if they'd have seen reimbursement declines trending with the number-of-treatments or patients-on-treatment declines. But they didn't, so reality hasn't come at them hard (yet). The chickens are coming home to roost though.

Maybe we want new, great med students to "push the field forward"... maybe we don't? I wonder. I think all of these omit-RT-in-breast trials have rad oncs as PIs. We can only take so much pushing forward until... you know. All this wonderful, laudable progress is killing us!

 

Lamount

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The whole "community docs say hypofractionation is killing the field" is a canard. The Twitter crowd loves to claim that all community docs hate hypofx, but in reality all we've tried to do the whole time is to get academia to recognize the very, very simple fact (insert scarb data here) that hypofractionation will lead to a decrease in demand for radoncs.

I also strongly disagree with "limiting residency expansion is important for the job market, but doesn't do much for the field." We want good medical students to apply to radonc to help push the field forward. Look at what's happening now with the "leadership" that got into the field when it was easy.

While this may be true, the downturn in radiation oncology so oft lamented here happened while it was recruiting most competitive residents. Thus, I think it’s foolish to assume the field will turn around AFTER the rad onc residency becomes more competitive.

my point is not that PP are the only ones complaining about hypofx... my point is that money follows values, and now that we know that more fx does NOT necessarily equal more value, it behooves everyone to support the research that might identify places where we can provide higher value treatments.

have you ever heard a med onc hate on an immunotherapy trial?
 
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scarbrtj

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While this may be true, the downturn in radiation oncology so oft lamented here happened while it was recruiting most competitive residents. Thus, I think it’s foolish to assume the field will turn around AFTER the rad onc residency becomes more competitive.

my point is not that PP are the only ones complaining about hypofx... my point is that money follows values, and now that we know that more fx does NOT necessarily equal more value, it behooves everyone to support the research that might identify places where we can provide higher value treatments.

have you ever heard a med onc hate on an immunotherapy trial?
Hypofractionation is/was a signal outside our field that radiotherapy had lower value than was previously perceived (overt and/or tacit). That horse can't be put back in the barn. What's done is done and all. "Value" is a very, very subjective term. There's "microvalue" and "macrovalue." With the rise in hypofractionation, there's been a decline in community rad onc and ease-of-access to RT for many patients. That's a form of low value care.
 
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Lamount

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Academia would've "hated" hypofrac too if they'd have seen reimbursement declines trending with the number-of-treatments or patients-on-treatment declines. But they didn't, so reality hasn't come at them hard (yet). The chickens are coming home to roost though.

Maybe we want new, great med students to "push the field forward"... maybe we don't? I wonder. I think all of these omit-RT-in-breast trials have rad oncs as PIs. We can only take so much pushing forward until... you know. All this wonderful, laudable progress is killing us!


It’s the lack or progress that is killing us... and one of the major obstacles is that many don’t want us looking.

hypofx happened because society wanted cheaper treatments and it turns out that, a lot of times, we can get away with fewer fx.

if we had better treatments that were more expensive (like immunotherapy for med onc),society may be willing to pay a higher price. I would argue it is in all of our interest to focus our energy on supporting innovative research into higher quality treatments (particle therapy, FLASH, radiosensitizers, cardiac radioablation, SRS for movement/psych disorders etc...). There is some really cool stuff out there. .. and this needs to be the focus of academics and PP alike.
 
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seper

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I don't like what I see in the field. "People who get it" are the new grads who chase every singe wRVU (or 0.85) and don't care about things like patient's well being and program building.

Ok, now that I have crashed this forum I should probably post something serious.

I think Scar makes some good arguments. Some disciplines are better able to absorb (and even needed) a near doubling of residency spots over a 20 year period.

Im not quite as doom and gloom as some people here. We are clearly facing a problem and have issues with over saturation. I wouldn’t want to be just starting out right now and I am down right sad to see how far we have fallen in terms of appeal and generally having our [email protected] together. But for the last 30 years there have been so many existential threats that were going to end the field and yet here we are. There will be pain. But the one advantage of the idiocy of rapid expansion is we are now bottom heavy and after some pain the old guard will be replaced by people who get it. I’ve given up on anything substantial happening in the near term.
 

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I don't like what I see in the field. "People who get it" are the new grads who chase every singe wRVU (or 0.85) and don't care about things like patient's well being and program building.

I think we are referring to different people. Sadly, though, what you are describing is a predictable consequence of saturation. If you put three hamsters in a cage with no food, before long you will only have two hamsters, even if they were all chummy to start with.
 
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thecarbonionangle

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I agree. In gradschool, working with rats and mice was very edifying. Rodents are very much like people. You put A few in a cage and next day you see they ate their friend. The mom ate the babies. Similarly lots of rats in this field. They like to eat the young too. All that is left is the carcass of our field. The smell of rat urine fills the air. Now i got to take a shower mayne. Too much RO for the day. Hopping into swamp for the weekend.
 
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msnbc2020

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"The Radiation Oncology Residency accepts one resident a year. As of July 2021, a fourth resident will begin training."
Good to know that more programs are opening to help alleviate the shortage of radiation oncologists! (sarcasm font off).
 
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msnbc2020

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771 residents in 2019-2020 ---> 772 residents in 2020-2021
Still wondering what happened to all the pledges not to fill in SOAP or post-SOAP.
 
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