Do u predict an increase or decrease in number of applicants this year?
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I think there will be a decrease as the canaries have sung and decrease in non virtual elective time. However, I do not want to underestimate the ability of PDs to SOAP their way into full resident complements despite their rhetoric to the contrary.
- Oct 10, 2011
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There will be an increase of applicants compared to last year.
That increase will be driven by IMGs, FMGs, and anybody with a pulse who has a USMD or USDO after their name but otherwise horrible stats, but there will be an increase.
I guarantee you that prospective residency applicants would rather work in a low-tier rad onc residency than go unemployed.
That increase will be driven by IMGs, FMGs, and anybody with a pulse who has a USMD or USDO after their name but otherwise horrible stats, but there will be an increase.
I guarantee you that prospective residency applicants would rather work in a low-tier rad onc residency than go unemployed.
My prediction: fewer applicants, 100 US MD.
Until programs contract or agree to avoid the SOAP, rad onc will fill with unmatched students. These future residents will not have a real interest in cancer care but will be glad to be employed. Bad prognosis.
Until programs contract or agree to avoid the SOAP, rad onc will fill with unmatched students. These future residents will not have a real interest in cancer care but will be glad to be employed. Bad prognosis.
Bingo. I suspect numbers will be stableish.... Less US MD applicants, more FMGs/IMGs
The most important metric to judge the "health" of the specialty is the number of US Medical School Seniors that apply.
This number has been plummeting for the last two years
I second the rapper's prediction of 100 US Seniors. The IMG and SOAPers are harder to predict but these numbers will fall as well. This may leave a dozen or so programs that don't fill even after SOAP.
This number has been plummeting for the last two years
I second the rapper's prediction of 100 US Seniors. The IMG and SOAPers are harder to predict but these numbers will fall as well. This may leave a dozen or so programs that don't fill even after SOAP.
Fewer total applicants. Will probably fill through soap, but TBH I'm not sure what insanity COVID has caused that might prevent the IMG hoard from applying
- Nov 2, 2019
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Decrease in US MD/DO applicants, similar to increased FMG applicants, all or almost all spots filled after SOAP.
However bad the match is this year, it may have been even worse without the pandemic. Medstudents wont be able to physically meet/bond with residents who can speak to them confidentially.
I say ultimately decrease...but I actually think this is a more layered question than most people realize as there are competing factors at play.
Factors deterring application: Rad Onc employment crisis, hypofx & changing reimbursement models, lack of understanding of field, etc.
Factors encouraging application: COVID-induced Zoom interviews and diminished competitiveness of field making it much more easy for anyone to shotgun apply to multiple Rad Onc programs in a "safety/backup" fashion in case they do not match to first choice specialty
Factors deterring application: Rad Onc employment crisis, hypofx & changing reimbursement models, lack of understanding of field, etc.
Factors encouraging application: COVID-induced Zoom interviews and diminished competitiveness of field making it much more easy for anyone to shotgun apply to multiple Rad Onc programs in a "safety/backup" fashion in case they do not match to first choice specialty
What's the source of that graph? I agree that the preferences of US MD students are the bellwether for the field with a 5-8 year time horizon.
Unfilled Positions in the 2020 Radiation Oncology Residency Match: No Longer an Isolated Event - PubMed
Unfilled Positions in the 2020 Radiation Oncology Residency Match: No Longer an Isolated Event
pubmed.ncbi.nlm.nih.gov
ASTRO ROHub trying to con URMs again into the specialty
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At this point, ASTRO is trying to con anyone who may pay some dues at some point in the future.
Perverse incentives all around.
Perverse incentives all around.
I vote decrease in spots but they will all be filled through SOAP with IMGs/FMGs and rejects from other specialties. So in the end, nothing will have changed. Honestly, I hope incoming residents/residents to/from bottom of the barrel programs (about 15-20 of them) go unemployed. Maybe that will make CMS realize that their funding is going to waste and will shut down these useless programs.
CMS is not funding any new program's positions. My guess would be the CMS funds ~30% of rad onc positions.
- Nov 2, 2019
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Details here. Part of the Balanced Budget Act of 1997
US Residency Training Before and After the 1997 Balanced Budget Act
Context Graduate medical education (GME) determines the size and characteristics of the future workforce. The 1997 Balanced Budget Act (BBA) limited Medicare funding for additional trainees in GME. There has been concern that because Medicare is the primary source of GME funding, the BBA would...
jamanetwork.com
Initially part of HillaryCare that was to determine the number of positions according to need (i.e. train lots of generalists and reduce training of (expensive) proceduralists)
ASTRO not very woke trying to funnel URMS into dead end jobs with low pay. The old white chairmen will be quite happy. They care about diversity folks!
- Nov 2, 2019
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Hmm yes I thought of ASTRO when I saw this Tweet which had nothing to do with RadOnc Twitter:
Its overall a problem with medicine hierarchy which is basically an old white patriarchy. Lots of lip service paid to “diversity” but what are people actually doing to promote them besides tricking them into a dead end job? the funny things many of these departments are totally white elitist havens. These same guys match their sons and daughters and place them into jobs. There is no wokeness, just a bunch of liars and cheats who just want people to know their place, and keep their head down, you best scratch my back and i will scratch back, maybe.
Applicant here, from attending many meet and greets across the board. General Decrease:
- The same 40-50 USMD/DO students are attending those. (Top 5 programs attracted the most by #) (add to that 20,30 students, heck double that you are at a 100 but I really really doubt 50 students are NOT attending since this might be the only way to get info this year and they are advertised pretty well compared to other specialities)
- A handful (10 at most) of really interested FMG/IMGs attended those M&Gs with genuine interest and physically located in the US. Now add the current pandemic, NBME/ECFMG ruckus this year is a difficult one for IMGs in terms of getting the required USMLEs and VISAs(ban+other political aspects). + based on the # applied and matched last year I think at most 20-30.
Total: 80-90 applicants - Total best case scenario: 130-150 Both ways it will be a fun year.
- The same 40-50 USMD/DO students are attending those. (Top 5 programs attracted the most by #) (add to that 20,30 students, heck double that you are at a 100 but I really really doubt 50 students are NOT attending since this might be the only way to get info this year and they are advertised pretty well compared to other specialities)
- A handful (10 at most) of really interested FMG/IMGs attended those M&Gs with genuine interest and physically located in the US. Now add the current pandemic, NBME/ECFMG ruckus this year is a difficult one for IMGs in terms of getting the required USMLEs and VISAs(ban+other political aspects). + based on the # applied and matched last year I think at most 20-30.
Total: 80-90 applicants - Total best case scenario: 130-150 Both ways it will be a fun year.
This will be a banner year (compared to next/subsequent) for programs due to the COVID situation which precludes medstudents interacting with current residents, who are very down on the field in private, (but willing to be cheerleaders on social media to help them get a job). Most would communicate real opinion confidentially to a medstudent who they got to know during a physical rotation.
it will be interesting to see the match results this year. Last year, the SOAP was mostly not surprising. However, some pretty bad programs matched which should have ended up on SOAP. What this means is these places are scraping the very bottom of the pot and casting a wide net for any warm body. As my chairman told me recently, “we just have to fill”. How long can this strategy guarantee ANY match/warm body? Time will tell. rad onc is still seen as very appealing by FMGs who would rather take 300k “middle of nowhere” rather than being a PCP in a rural town making nothing. The field used to be mostly FMGs not too long ago. It may take an even worsening of the market for things to reach the level that places cannot fill with ANYBODY.
many places already believe “residents should teach themselves” , so they do not care who they match. Anybody can write a note and contour. Cheap labour is always an incentive. Current residents are incentivized to continue to draw suckers. Current faculty are incentivized to collect more souls and pump out useless papers on the backs of these poor souls. I would take what many residents and faculty say these days with a grain of salt. Focus on the fundamentals and stick to good programs.
what i would say to applicants is be very careful about going to a bad place. Probably 20-30 places that are worth a damn. Others are total trash, some stinkier than others. There is a crisis in this field of huge asymetry in the quality of residency programs and it is far bigger than just “a few” places.
many places already believe “residents should teach themselves” , so they do not care who they match. Anybody can write a note and contour. Cheap labour is always an incentive. Current residents are incentivized to continue to draw suckers. Current faculty are incentivized to collect more souls and pump out useless papers on the backs of these poor souls. I would take what many residents and faculty say these days with a grain of salt. Focus on the fundamentals and stick to good programs.
what i would say to applicants is be very careful about going to a bad place. Probably 20-30 places that are worth a damn. Others are total trash, some stinkier than others. There is a crisis in this field of huge asymetry in the quality of residency programs and it is far bigger than just “a few” places.
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- Mar 30, 2009
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80-90 would be bad. In my program (medium sized) we may not even have enough applicants to interview comfortably.
I think programs in the US need to grow up and realize that this is the inevitable course of things. Canada had the same thing years ago. Programs contracted massively. Some programs didn't fill up completely despite the contraction (yes, even the one you're thinking about).
Life went on. Canadian RO grads are still doing 1-2 year fellowships and the job market is a little bit better. Anything beyond 0 is better though.
Life went on. Canadian RO grads are still doing 1-2 year fellowships and the job market is a little bit better. Anything beyond 0 is better though.
there has been much “piping” done to this field already. Now i am no prude, so i an not anti-piping, but Lots of healing needs to take place before we can move on
Current resident here. Most (pretty much all) med students who rotate through are locked and loaded into rad onc (or urology/radiology/etc) - I have never seen a med student who rotates through "trying things out" to help them decide which specialty they will go into. I know med students have to get their start somewhere, I just don't think it is with the residents. How do residents tell med students the truth during the critical decision-making time if we don't see them until long afterwards?
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Yup, just join the conversation here, this is what a lot of students use to get into medical school in the first place and continue to use it to figure out their specialty.
Fourth year medical student here. I was originally set on RadOnc when I started medical school due to previous undergraduate research in radiation biology (that I randomly applied to through work study and found very stimulating). However, after following this forum throughout medical school and meeting students/residents/attendings at conferences (ASTRO, ACRO, etc.), I've decided to pursue a different specialty altogether (for other reasons as well).
My conversations with residents at my home institution who I have known for quite some time have been actually contrary as they tried to convince me to stay in the field. After talking to them ad nauseam about concerns with APM, hypofx, residency expansion, etc., the best I could get out of them was that the job market wasn't as good as before, but that the past several years have been decent. This was particularly heartbreaking as these were some of the brightest and hardest working people I know. Perhaps they're in too deep and would prefer to stay in a state of denial. The sunk cost fallacy is too real.
It's truly a shame that the leadership continues to bury its head in the sand. This field has so many incredible physicians doing incredible things for their patients. Nevertheless, a big thank you to the forum for being honest and best of luck to you all (and to the greater field of radiation oncology).
I remember being in the resident room and participating in residency interviews with that same state of denial. I think its harder to accept the realities than just deny that they exist. The other issue is that these problems developed very quickly over the past few years and it will take time for all the issues you mentioned to trickle into residency education and expectations.
I commend you on the wise and thoughtful decision to go into another field. Now if you can spread that around to all these other medical students who don't seem to get it....
I commend you on the wise and thoughtful decision to go into another field. Now if you can spread that around to all these other medical students who don't seem to get it....
- Nov 2, 2019
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You are unusually wise.
As @Grubbe-a-dub-dub mentioned, there's a dose of "head in the sand" denial. Whether or not we want to admit it, the VAST majority of us tie our self esteem and self worth to our jobs. A LOT of people went into RadOnc at big name places, in part, because it made us feel good. We felt the prestige.
It's very hard to let that go. I decided a few years ago that being a doctor, being a Radiation Oncologist, was not how I was going to define my self and my life. Breaking free of that, the issues in this field are disgustingly obvious. But medicine is a cult, academia is a cult, we are tribes of animals at our core.
No one wants to admit they bought high and sold low.
status anxiety is palpable, and probably worsens impostor syndrome.
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Med students are smart. They're not going to gamble all their hard work on poor job prospects. The talent drain will come back to hurt our specialty and we'll all feel it when the referrals start drying up.
- Dec 18, 2015
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Relative to 2000, the referrals have already started drying up. Hugely. Totally untalked about by ASTRO or leaders. Instead they keep reciting the “two thirds of the 1.8 million cancer patients per year will get radiation therapy” talking point. As if it’s immutable. As if 20 years ago it didn’t used to be 1/2 instead of 2/3 they now say. The referrals are going up! Don’t believe your eyes or the plethora of data.
Ding, ding, ding! We have a winner.
Congratulations on keeping both your eyes open and relying on data-driven decision making, you will be better off.
Maybe we should advise the surgeons and med oncs to also keep both their eyes open and use data-driven decision-making too. Seems all they do is keep one eye closed and cut/give immunotherapy. Who cares about data?
Do we demand too much data to our own detriment? Does everything need a RCT? When RCT comes out in esophagus for naysayers and it is written off as “too complicated” and “nobody understands this!” is this consistent? Do we have anything to learn from the enviable success of med onc and surgeons? Discuss
Absolutely we do. I dont know if it's some weird form of overcompensation but rad oncs are their own biggest critics. yes, med onc has people like vinay prasad. but if vinay prasad given keynotes?
and i will say this forum can be guilty of some this. something like mri guided therapy being actually good/better would be important for our specialty. we need a shiny new toy (that works) too. but a bunch of dogpiling on it already. Very odd, self cannabilizing specialty.
I get your point - this is our crutch for being "too evidence based" because of course we can just "radiate first, think later" just like surgeons "cut first, think later" and med oncs give "immunotherapy first, think later"
But when costs for your modality are far outstripped by that of med onc (immuno) and surgery (a procedure + associated costs), it's not financially that big of a deal (exception to this is protons, which admittedly are still not in the same stratosphere as the costs of immunotherapy). It's great to have an RCT but it's not as essential for us as it is for others, where one non-evidence-based decision literally costs an arm and a leg (ours costs only part of an arm).
There is a medical student interested in RO at my program. I told him if you would rather do RO in Kansas than IM anywhere you like in the country, you should do RO. He got the message, still applying RO. Basically that was my rationale as well, couldn't do anything else in medicine. Informed consent is important folks!
When I hear anecdotes about a medstudent who loves the field so much, he is willing to practice anywhere or that Astro/ABR/Neha are taking steps to address situation, I guess the “humanist” in me (for lack of better word) applauds them. In reality, I know that this is not about practicing in Kansas- some residents will just not find any job! Even with a total resident freeze for 10 years (which will never happen) we would still have an oversupply in 2030s. Unprecedented problem here.
( a key figure is how many radoncs retire from the workforce/year. Based on my being in field for 15 years and trying to extrapolate anecdotally across our specialty it is quite a bit less than 100/year. We are already at excess, and the 1000+ committed radoncs produced over next 5-6years will not be offset by those who retire over the next 10!)
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Let me throw in an analogy...
If you love aviation so much and your dream is to become an airline pilot, would you spend years/money to become an airline pilot, given what is going on in the world now?
At least half of your dream comes true, bc you will be a pilot but you have no job.
If you love aviation so much and your dream is to become an airline pilot, would you spend years/money to become an airline pilot, given what is going on in the world now?
At least half of your dream comes true, bc you will be a pilot but you have no job.
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