FUTURE RESIDENT, DO NOT BECOME A RADIATION ONCOLOGIST!!!

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hbosch

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UNLESS YOU CAN MATCH INTO A TOP 3 PROGRAM.

I will share my experience of job finding so that prospective applicants and medical students have a clear understanding of “job opportunities” in radiation oncology when you graduate from a mediocre/nobody program. I graduated from a small program with no name recognition. It was essentially a private practice group with a university name backing it up, that had somehow tricked the ACGME into giving them a program. They had little to no connection to potential work places, and on top of that, showed no interest in helping you find a job (which actually is more common across the nation than you may suspect despite their warm smiles during residency interview days. They got what they wanted of you- what happens afterwards is of no concern to them). In a 4 year period of graduating residents, not one person got a job in a reasonable metropolitan area. In fact, one of the people graduating after me couldn’t even find a job in a largely homogenous, unexciting, culturally devoid area of American society, which is even sadder because you would think it shouldn’t be so hard to find a job there. She didn’t even get interviews in the area and she wasn’t dumb or awkward, and she was chief! She had to go to another unexciting area, one farther away from her family. Two others quit their first jobs suddenly because it was so bad.

I applied to over 50 jobs in every part of the country. I got 3 interviews. I interviewed in one place in a remote town on the east coast. The town was very small but the landscape was beautiful, so I figured I could live with a small town as long as I could walk among the beautiful landscape. I did not get that job.

My second interview was in a larger metropolitan area in the Midwest (not Chicago), but the group was kind enough to make it clear that my work hours would be 6:30-7 am (tumor boards) to 7pm-8 pm, with multiple inpatient consults per week, and covering multiple facilities, and a starting salary of 220k. I don’t actually care about only 220k but I went into radiation oncology because I do care about my personal life. Most importantly, I know that I get tired after 8-9 hrs of work, and 12 hrs would lead to burnout fast. While the city was larger, it was definitely not my ideal location. I could not imagine being a pleasant doctor to my patients feeling burnt out so early on in my career. While it may be easy for some to poo poo those of us who care about our schedule, I would assume that the majority of radiation oncology applicants apply to rad onc because of both the actual job and the promised work schedule. There were multiple other specialties I would have liked but this one won out because I liked the combination of content and lifestyle (including potentially living in AWESOME locations!)

I was offered an interview at a place (4 hrs from Minneapolis, 3 hrs from an airport) where the recruiter on the phone literally told me that my salary was guaranteed for 2 years, after which I would have to come up with a “creative” solution to supporting my salary. Was I going to sell cupcakes?

The last place (and current job) I interviewed at, I ONLY got the interview because of a connection (not through residency). The recruiter told me he got hundreds of applications (many from new grads) and the only reason he interviewed me was because he recognized the name of the person/connection. I actually love my job and co-workers. What I don’t love, and can be extremely depressing is the location. It has one of the highest rates of poverty and violence for a town of its size (it’s not big). The strip malls are becoming empty and closing down. There are many small depressing gambling places with slot machines and strip bars with neon signs with red legs that criss cross (they’re not even a sleek strip bars). There are parks where people flash you (yes, they pull their pants down) as you are taking a stroll, enjoying the flowers, and you hear conversations in the distance consisting of “Don’t do it, don’t do it” and the response “But I don’t want to live anymore.” It’s not funny. It’s sad. The school system is atrocious. The same bank got robbed 3 times in 6 months by a guy on foot (no getaway car) and a knife (no gun). Property taxes are high because the town has no economy. Buying property is a sure way to lose money and good luck trying to sell it a few years later. The closest reasonable city is 90-120 min away. The only reason people live here is because they are too poor to move. It is one of those towns that the New Yorker does a story on because of how depressed it is- the anguish of non-urban middle of nowhere America.

While I actually like my job, if I die in 5-10 years and I have spent every day of the last 5-10 years of my life in this town, I may on my death bed wonder why didn’t I die before radiation oncology residency, or even before medical school? I gave up so much of my life trying to build a dream that is not remotely attainable, and it wasn’t something absurd like “I want to be a rock star, or actor and live in a penthouse in Tokyo.” Medicine is supposed to be dependable and open up opportunities not limit your life drastically. That is why we make such a huge sacrifice with regards to our time and money. I not only wanted one job opportunity in a great location with good hours but RATHER (gasp! Oh my!) I wanted multiple options from which I could choose. That is every intelligent hardworking person’s expectation. That is why we work hard. That after years and years of studying and accumulating debt you have multiple opportunities, not worsening limitations. I got an MD and went into radiation oncology. I did not get a PhD in medieval art history.

Even if you don’t live in an impoverished area, you probably will end up in a mediocre area at best where the most exciting store is a Barnes and Noble. The majority of 21 year olds who take on medical school debt, and the majority of 25 years graduating with 120K (probably more like 200k) of debt never say, "I want to live in a place where Barnes and Noble is the hot spot in town." The once a month coupon I get for a free latte for being a B&N member doesn’t cut it for me. That was not my dream. It is still not my dream. I still look out for jobs in reasonable locations (like suburbs of a large metropolis, I would accept a 220k salary, but I can’t work 12-13 hr days).

You know what I dream of? I dream of living in a community where people read and have intellectual discussions and are cultivated and interested in things beyond sports and hunting. I dream of school systems that produce educated children. I dream of neighborhoods that are actually lovely. I dream of parks where I won’t be flashed. I dream of a town where the best restaurant is not Paneras and the most interesting store is not Micheals. I dream of banks that get robbed by men (or women) with guns and getaway cars. I truly with all of my heart when I applied to residency did not think this was a wild dream- apparently it is a wild farfetched dream.

Those of you who are guaranteed entry into MSK, MD Anderson and Harvard- by all means, apply! Because you probably will get your (esp non-academic) dream job. You can get a job in Hawaii, in California, in New York City, in Boston, in the DC area and in Sedona. These programs do have amazing opportunities. BUT MOST OF YOU ARE NOT GOING TO GO THERE FOR RESIDENCY. For the rest of you, especially ones who are going to match in middle of the road to unheard of programs (the vast majority despite the empty promises at interview time), you will not capture the life you have imagined.

I remember when I was an intern and like a dumba**, thought to myself, I am so much better than these people going into internal medicine. Those people live in San Francisco, New York, and the DC area with good schedules and decent salaries (not 500k, but above 200). They have awesome personal lives! They are laughing at me. Actually, they are not thinking of me because they have better things to do, such as take part in the liveliness of their communities. I could never find a job that pays over 200k with a decent schedule in those areas- absolutely NEVER. Can Harvard grads? Yes. But not me nor my kind.

I actually considered aerospace medicine but I didn’t apply (not sure I would’ve gotten in) because the job opportunities were limited to maybe 3 cities. I couldn’t commit to that. I feel like I ended up with worse.

The friends I know, none of whom went to top 3 programs, all have mediocre jobs at best- by no means a dream job. Either the location is terrible or the work load is insane, often coupled with an internist salary (like 250k max).

I don’t understand the legal details of why we are in this situation. The reasons why it’s happening is not at ALL remotely important to those of you who are applying to rad onc residency right now. What is important is that this is the reality, and that it is extremely unlikely to change soon as no one is working on a solution. And you deserve to know (as I severely wish I had known) before you throw away the rest of your life.

This is my day: I wake up, I go to work, arriving at 7:45 to 8 am, and I leave around 5 pm. I read, watch tv, and/or do some “hobby” to pass the time. I have no friends outside of work. There are no restaurants that are exciting. There are no cultural events. There is zero reason to leave my apartment other than to put gas in my car or go to the grocery store. The closest Whole Foods and Trader Joes are more than an hour away. Sometimes I play the lottery to throw excitement into my life. I don’t win. My most interesting thoughts this winter have been 1.) in response to seeing rabbit tracks in the snow, “Oh my. A bunny has passed this way.” And 2.) in response to the light pattern cast by the sun through the cheap plastic blinds on my beige apartment wall, “Well, isn’t the morning light lovely today.” These thoughts are only truly exciting if you are Beatrix Potter or a 17th century Dutch master painter who specializes in light and shadow.

My bank account is growing and growing but it does not make me happy because I have nothing to spend it on. Seriously, the money is not even exciting because I have nothing to spend it on. Married physicians leave town within 2-3 years because the spouses get depressed or the children need to actually go to decent schools.

My only goal (because doubtful in 7 – 10 years, I’m going to find a good job because contrary to popular belief the market will not fix itself) is to save aggressively and “retire” in 10 years (and live frugally), and say good bye to radiation oncology (not even because I hate it- I don’t hate the job itself, but because I simply can’t find a job in a good enough location, and money is not the end all of my life). Do I want to retire early? No, I wanted to have a long fulfilling career which includes a cultivated personal life. I can’t get that, and so therefore, I’m just going to “transition” out. I will be the unemployed physician, the physician no longer using their MD.

No matter how kind and wonderful of a human being you are, no matter how much you love radiation oncology (and it is interesting but so are other specialties, and so are other non-medical fields), it is extremely difficult to live in a depressing town. That is why depressing towns have lower life expectancies- it takes its toll on you.

My other option is to do locums- but that’s not a great way to start your career and obviously not stable. Perhaps I could do a “fellowship?” Absolutely not. Fellowships are jokes and in my opinion delays your growth as a physician because you just continue to be the baby doctor. And I’m not even sure it would have helped.

Please be wise. Looking back on it, after not having matched in a top program, I wish I had dropped out of radiation oncology all together and done some other field with much better living opportunities. Just rank the programs whose alumni do have amazing jobs. Don’t be fooled by promises at interviews from smaller institutions. If they tell you people have great jobs, they are lying to you. Alumni who graduated even 4 years ago don’t count. Be wise, prudent and suspicious; be wary that some people say they are part of a larger system in a big city but in reality work in the middle of nowhere at a satellite facility, making half of what the main institution makes. Only accepting residency in a top tier program is sort of like the people who apply to law school, but will ONLY go to law school if it’s a top 5-10 program esp when the economy was bad- those people were brilliant. They didn’t want to graduate from a medicore law school and end up in the middle of nowhere just so they could have a job and pay off their debt and catch up on retirement saving. Our problem is not even related to the S&P 500 index.

The moral obligation falls on the residency programs. I don’t know the details of anti-trust laws but do know Congress often grants lobbyists from various industries exemptions. Are the people who benefit from residency expansions going to spend time lobbying Congress to stop it? Of course not. Not to mention it is usual that a group of supposedly intelligent human beings are approaching a problem in such an uninspiring manner- basically saying there is no solution. There is alway a solution- you just have to work on it. Even if it is basically impossible to fix this situation, the exact reasons why we can’t fix the problem are not at all important for the prospective applicant. The only thing that is important is that a deplorable job market is the reality, and going into radiation oncology limits your life opportunities, rather than expanding it. It is sad and hard to say this but it is true. Radiation oncology for me has been more of a prison rather than an expansion of my life.

The problem is that people want you to be grateful for an opportunity that you never wanted. We are all intelligent- we never had to go into this field, but they want us to be relieved just to get a job, no matter where it is. We are not unskilled laborers- our prospects should not be poor. As intelligent human beings with aspirations, we SHOULD expect jobs in nice areas as we DO deserve it. If that is not available, then the FUTURE applicants should clearly know this. We should not present them with false hope. That’s immoral.

I wanted to live in a real metropolitan area- that was a basic need for me. The FUTURE should look for other opportunities when they don’t match somewhere that will provide them with hopeful opportunities, and the very basics for their life goals.

Seriously, PROSPECTIVE APPLICANTS, if you don’t match into a top program, don’t bother doing it. It is NOT worth it. There are ways to have back-up specialties. Someone from my med school applied to both plastic surgery and family medicine- she was a great applicant- nobody had an issue with it. Another applied to both orthopedics and derm- no one had an issue with him either. It is POSSIBLE and REASONABLE and INTELLIGENT to have multiple interests and end up with the residency program that gives you the BEST opportunity to live the life you want, including your personal life. That is how I would have done it on retrospect. Or just apply to rad onc and if you don’t match to an awesome program, re-apply to a different specialty the next year.

I'm not just disgruntled. I’m massively disappointed in myself that I did not have a better understanding of what I accepted several years ago. I feel tricked, but mostly I feel stupid. How could I have been so foolish? I was an adult yet so blind to my future. I feel ashamed for not being able to project myself far enough into the future to understand how little control I would have over my occupation (including the where) and how much it would affect my daily life. I’m ashamed that I allowed my debt to accumulate and my retirement goals to be ignored for this career that is essentially a prison, that now I have no choice but to stay in this job for another 10 years just to catch up on repaying debt and saving for retirement. I can’t just walk away now because I have no other skills. Dr. Zeitman has hope for the future because he does not have to feel the pain of the present, nor do his residents. I wish the best for Dr. Zeitman but far more importantly, I wish the best for our current young future, who should not make the same mistake I made or many others of us have made. We should not lie to them about their future. Going to a top 3 institution may still get you an amazing job in an ideal location (esp non-academic); going to a nobody institution gets you misery.

I know that a lot of people convince themselves by trite sayings, “but still we are aren’t in internal medicine, “ “hey, there’s still nothing else better out there,” but, yes, there are better things out there and they do provide a better tomorrow. Many people just do not want to admit to themselves that they made a mistake. It is extremely hard to tell yourself you made a mistake by choosing this field. It makes you feel like your entire essence is a failure, that all your hard work and rationality was a mistake and a failure, but I did make a mistake and I want you, the future applicant to know this. For those of who us who did not go to Harvard/MSK/MDAnderson, we don’t want to call ourselves stupid and makes ourselves feel bad compared to them, so we pep talk ourselves in all sorts of ways so that we can keep on with our lives…whatever, future applicant, don’t make the same mistake we did.

I may love radiation oncology, I may enjoy my actual job, but every time I drive home and pass the neon criss-crossing legs, I do recognize I made a massive mistake and it will affect the remainder of my future. If you all are okay with living 2 hrs outside of Saint Louis, 90 min outside of Kansas City, 2hrs outside of Cincinatti, 2 hours outside of Indianopolis, somewhere in Nebraska or Abilene, TX, by all means become a radiation oncologist! (And I’m not EVEN sure I saw jobs in these locations). Otherwise, do not be lured by the money. It’s not worth it.

Best wishes to all of you. With all of my heart, I hope everyone ends up with a well rounded wonderful life. May your local bank robberies not be successful with just a knife and shoes. (By the way, there are plenty of guns here, but not everyone can afford them).

I will now return to convincing myself that bunny tracks in the snow are mind blowing.

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Thank you so much for sharing this, I have heard of similar situations, which for obvious reasons aren't
publicized.
"Two others quit their first jobs suddenly because it was so bad." This is what really concerns me. Residents are being placed in positions where they may have to make choices that are morally dubious in order to earn a living or remain close to their families. I know of a position - that filled! for a radiation oncologist to babysit mobile hdr units that travel from nursing home to nursing home delivering skin brachy to basal cells on demented 90 year olds.
 
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Thanks for sharing your experience. I've always wondered why there are few posts, if any, by residents describing their job search struggles, especially after they have completed their job search. I wonder if it is partly a little embarrassing for them to talk about their struggles after being so successful in every way until that point.
 
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Thank you for the post. For what it's worth, I control several practices in one of the areas you mentioned, and I promise you no resident from Harvard, MSKCC, or MD Anderson will ever sniff a job in my neck of the woods ;).
 
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Thanks for sharing your perspective. It's too late for me but maybe not for others reading. I myself, really liked a few other fields but ultimately chose rad onc, I have very happy friends in other fields and painfully share your perspective. I wish you were trolling because it was a depressing read but you're likely not. I have friends with lower scores, lower ranks, who went into "less competitive" specialties and are now very happy in a top location making pretty good money (250K+), and i honestly feel foolish.

I will dispute the suggestion, however, that the job placement at "top" programs is significantly better. I have personal knowledge of multiple of these programs (top 10) and I can tell you it is not true that these places have a choice to where they want to be. If you want to end up in one of the top 5 cities in this country by population (top California, Northeast, Texas, top Florida, top Midwest cities), you have to have connections. Believe it or not, the connection and networking opportunities at some of the "top ten" programs are underwhelming. When you interview, pay attention to the cities people are ending up, ask about the cities, This will tell you what kind of opportunities the residents have. There are multiple middle of the road programs out there with actually pretty good job placement in competitive markets. Some of the "top" programs also have a reputation among some PP hiring guys(obviously always a subjective thing) of producing not the best CLINICALLY READY trained doctors and this limits their opportunities despite their "chiefs" having 20+ red journal pubs. People talk about the three As..... its a real thing.
 
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Assuming this is not a very well written parody, it is a bit depressing living in smaller towns. But even more so than that is the utter, sheer boringness (if that's a word) of radiation oncology in a small town. The rationale of having a legal requirement for a radiation oncologist to be present when 180 cGy of X-ray is passed into a small area of the body, versus zero legal requirement for an MD to be present when 10 cGy is passed into the entire thorax e.g. (ie a non-contrasted CT) is goofy, silly, quixotic, kafkaesque, and inexplicable. The MD has, for almost all intents and purposes, zero interaction of any sort with the passage of that 180cGy on a routine basis because obviously 1) it isn't clinically required, and 2) nothing acutely clinically infaust (save the machine banging into the patient's head) can happen from the passage of those X-rays (whether it's 180cGy or twice that). I'm not looking for an argument about why this requirement is in place; I'm simply saying that there comes a point in the small clinic radiation oncologist's life that he or she is wasting away his or her Good Brain Years. I have a colleague in New Zealand who always laughs, "For us, there is no concept of direct supervision; therapists are highly trained after all." I think if that aspect--the radiation oncologist becoming a neutered, passive, zero-interaction baby-sitter of sorts--were more apparent to med students, there'd be less desire to "risk" becoming that sort of doctor. This is a career where you become on many days just a warm body... who in their right mind would ever want that? I don't think Tim Cook, Kanye, Obama, or Selena Gomez would ever put up with that :)
 
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Im not in rad onc but this is why I get mad when AAMC, other med organizations, or media say there is a huge shortage of doctors and will only increase when really all the decent liveable areas are saturated and the places with jobs are all middle of no where hospitals.
 
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Wow, this is a great thread. I hope you eventually make peace or sense of it in your own way. Thank you all for your candour.
 
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Thank you for the post. For what it's worth, I control several practices in one of the areas you mentioned, and I promise you no resident from Harvard, MSKCC, or MD Anderson will ever sniff a job in my neck of the woods ;).
So true.... I'll take the 3As all day over pedigree*. And someone who's efficient. Spending time in a lab for a year or on the breast service with 5 attendings isn't going to help someone work in a competitive full-spectrum pp environment.

Personally, I would bet that the busy mid-tier places probably train the best private practitioners. And along with others in this thread, dispute the OPs assertion that the top 3 programs get the best jobs. Definitely not true, at least not in PP in the Southeast. Connections and 3As are way more important imo. Carbonionangle really nailed in that post

*-I've heard MSK is a gauntlet so respect for that
 
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. The rationale of having a legal requirement for a radiation oncologist to be present when 180 cGy of X-ray is passed into a small area of the body, versus zero legal requirement for an MD to be present when 10 cGy is passed into the entire thorax e.g. (ie a non-contrasted CT) is goofy, silly, quixotic, kafkaesque, and inexplicable.
I agree with what you posted, but imo IGRT is a different issue. The problem is that most patients are getting igrt with their treatment and Medicare says someone "capable" needs to be available to "furnish assistance with the procedure" if need be. Also there can be questions regarding electron setups etc. Both of those can require direct supervision in the building. Therapists can and do have igrt questions during the day
 
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I am sorry to say, but I think that hbosch has more problems with his personal life than with his work. Assuming that living in a wealthier, nicer city is going to fix your life and all your problems, is simply not true.

The lack of "exciting restaurants" and the "beige walls" in your appartment can be fixed. Go take cooking lessons and cook for yourself, you may even meet someone to cook with/for. And go redecorate, your bank account can afford it.
 
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This is one of the better troll posts I’ve really ever seen. The park with nonstop flashing and overheard suicide conversations was funny to think about, and the mention of an hour-long drive to Whole Foods or Trader Joe’s was a nice touch. “Neon criss-crossing legs,” brilliant. The all caps title was a little much, though. In any case, Kudos.
 
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Sure some of the op's points seem like hyperbole. The references to drugs, depression, gambling, and sexualization really detract from the main point of the post and make it easy to write off by those who would otherwise like to.

But much of it rings true to me. We're to the point that graduating residents need to be prepared to take a job anywhere. Within a few hours from a major airport is the current goal for my graduating friends.

Even then you may not find a quality full-time position. I have plenty of stories over the past few years of people forced into bad positions (high hours, low pay), forced into fellowship (and then not even using their fellowship training), or forced into part-time work.

Plenty of MDs and MBAs are aware of the job crunch and waiting to take advantage of you. Plenty of academics are happy to turn a blind eye and keep expanding their residencies.

I'm always surprised at how the junior or mid career guys also ignore this problem. Working docs are more and more expendable. It's not like if your job turns into a nightmare or you're taking something temporary you can just move somewhere else later.

There are success stories too. There may still be maybe 100* decent jobs that become available every year. Will you be in that group? There are a number of factors-- program, connections, luck... I don't know when or if this situation will turn around. As it stands, it just gets worse every year. At some point I fully expect that we will hit a crisis where some percentage of graduating rad onc residents will have no job availability like pathology or nuc med. How bad it will get and for how long are the main questions in my mind.

*100 is a totally made up number.
 
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I'm simply saying that there comes a point in the small clinic radiation oncologist's life that he or she is wasting away his or her Good Brain Years.

If the direct supervision rule went away, a lot of jobs would go away. Whether that would translate into fewer, busier, higher paying jobs or fewer, busier jobs for the same pay I'm unclear at this point.
 
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I remembered when I was applying, rad onc applicants made fun of rad applicant who made fun of medicine applicants for their lack of competitiveness

Five years later, the medicine guys are living it up in the SF bay area making 220k, the rad applicants are forced to go to a smaller metro for 300k and the rad onc applicant is making 220-250 in the BFE?
 
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Yes,
If the direct supervision rule went away, a lot of jobs would go away. Whether that would translate into fewer, busier, higher paying jobs or fewer, busier jobs for the same pay I'm unclear at this point.
That would be devastating for the field. Imagine the urorads practices...
 
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I am sorry to say, but I think that hbosch has more problems with his personal life than with his work. Assuming that living in a wealthier, nicer city is going to fix your life and all your problems, is simply not true.

The lack of "exciting restaurants" and the "beige walls" in your appartment can be fixed. Go take cooking lessons and cook for yourself, you may even meet someone to cook with/for. And go redecorate, your bank account can afford it.

Thank you for your advice. I also never thought about spicing my life up by eating cake, but now I will go eat cake for breakfast. You seem to think interior decorating and cooking classes can somehow make up for not being in a metropolitan area, but read on and I will address your "points."

Yes, I do have issues with my personal life. There is none outside of work. You are also making the assumption that I was equally unhappy when I lived in larger areas. I was not. I had a personal life. I had things to do outside of work, and friends outside of work.

I think you missed the part where I said the area has a high rate of turnover for even married individuals (who supposedly have something to come forward to, like a spouse and kids). They also get depressed and leave. The first thing my very first patient said to me was not "hi", it was "You're never staying here." It is extremely hard for people who have not lived in towns like this to understand the dearth of available "entertainment" and what metropolitan areas take for granted (whether you think that's superficial or not is a whole different debate). For example, we have one movie theater that is 30 min from where I live.

There are no cooking classes in my town. I actually checked. Don't worry- I bought a vitamix. Now I make smoothies. There are no interior decorators in my town. There are 3 furnitiure stores in town- like Quality Furniture. I have driven 1.5 hrs to better furniture stores and they won't deliver to me. While some companies online are happy to drop off furniture in front of my apartment (which actually can get stolen), I have not yet a found a company that is willing to deliver furniture for me on the weekends because I'm outside their weekend delivering areas, meaning I would have to use PTO to accept a furniture delivery. I would rather use PTO to go out of town.

I took a water color class- the average age of the person there was 72, mostly in their 80s, one in her sixties, and me- a total of 6 of us.

The other point is- perhaps you are able to tolerate living in an area like this. Perhaps you fully understand what it's like to live here and can tolerate it. Perhaps you are also happy with 12 hr days. But the point is, many people can't and don't want to and they should know what it's like before they gamble with their future.

I understand that if you have not lived here as an individual in your 30s, you have zero conception of what it is like, and therefore, very easy to mock the writer (me) and assume exaggeration. None of what I wrote was an exaggeration. I did hear an unfortunate conversation and the point of the strip bar is to emphasize that there aren't exciting bars and restaurants (which is generally considered a basic aspect of a city). The 2nd closest bank to me has been robbed 3x times, the same way. It's all true. On the larger national conversation, this is exactly why the people who live in these towns feel so sore about the "coastal" towns or "metropolitan" areas because what they see on TV does not remotely correlate to their own reality. That is why they feel "behind" and are extremely unhappy (not just the doctors, the entire community, including my patients). Over and over again, this past 2 years we have heard of large swaths of poor white people who feel behind compared to the rest of the country- this is where they live! They are unhappy and they are suffering, and it's worse when someone who gets to live in a better area mocks them by telling them to take a cooking class. It's this "let them eat cake" attitude that makes people angry. People make lives for themselves everywhere, but most people if they can afford it will leave communities like this. I'm lucky because once I'm financially stable (not rich), I can leave. I realize every day that as soon as I have finances in decent shape- I can leave. My patients can never leave.

In ANY CASE, I'm not writing this to convince someone who already has a rad onc job and a life they enjoy. I clearly wrote that I made a mistake and because I would have wanted someone to forewarn me. It is extremely unfair to current applicants to have a misinformed view of the job market. Even if 70% of people (which is not the case) end up with jobs in decent places, what if you fall in the 30%? That's not good odds.

I wanted to paint a clear picture of what life in these middle of nowhere towns are. People can easily fantasize some sort of bucolic life for themselves and convince themselves that the money is worth it. That's not the case, and they should know.

Please don't be needlessly dismissive towards others, assuming they're bratty and superficial. It does not help the conversation. I don't feel just pain for myself, I feel pain for these towns, but fixing these towns is outside of my hands and was not a part of my career ambitions.

For what it's worth, historians agree Marie Antoinette never said, "Let them eat cake." But someone did write "take a cooking class" and "go redecorate.' (By the way, I'm not allowed to paint my walls. I rent.). Also, you missed the part where I said I can't spend my money on anything because there is nothing here. Believe, I've tried figuring out how to have an exciting life. Once again, I have "hobbies." However, no one, including the current applicants, want to spend days and months trying to figure out how to pass their time because the town they live in has nothing to offer. They deserve better, whether or not you think so.
 
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If you dont end up where you want you need to do more than just try to blame the field. Did you work your ass off in college to get into a good med school? Did you work your ass off in med school to get into a good residency? Did you work your ass off in residency to be a more competitive job applicant? Rad Onc is an Awesome competitive field. Work hard, party hard.
 
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If you dont end up where you want you need to do more than just try to blame the field. Did you work your ass off in college to get into a good med school? Did you work your ass off in med school to get into a good residency? Did you work your ass off in residency to be a more competitive job applicant? Rad Onc is an Awesome competitive field. Work hard, party hard.

Thank you for understanding my point. I repeatedly stated in my first post that it was MY mistake. I did not get into a good residency, and therefore, I am suffering. That people in GREAT residencies do probably get good jobs, but people should perhaps stay away from mediocre programs especially if geography is important. I am very happy that you are doing well and I wish you the best in both working and partying.

I also over and over and over said I love radiation oncology and my current job, just not where I live. Thank you so much for reading closely and agreeing with all of my points. In short, rad onc is not a geographically flexible field for people who don't get into good programs. However people like to construe my post, I am not asking advice about how to change my life. I have already made a decision about my future. I am forewarning others what their possible future could turn into.
 
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Future Resident, This is what a Disgruntled Non-Radiation Oncologist Troll (Who has only ever posted 3 times on this board) looks like. Dont become this guy!!!
 
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people in GREAT residencies do probably get good jobs, but people should perhaps stay away from mediocre programs especially if geography is important.
Repeating a lie over and over doesn't make it true. People should stay away from mediocre training programs so to as avoid mediocre training and the need for a "fellowship" to make up for a deficiency in training.

Plenty of people in FL, CA, TX, WA, OR etc. do have great jobs in great locations with great hours. And they didn't train at MSKCC/MDACC or Harvard. That doesn't mean that the job market is in good shape. It's not. Maybe instead of throwing a pity party for yourself when you trained at Mediocre U, it probably would have behooved you to make connections in your desired geographic locale before you got to the end of your residency (assuming you aren't trolling this forum)
 
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The post provides a good contrast to the ASTRO piece by the chief resident of Harvard. Sure, some of the extra details may be considered a bit histrionic, but as pointed out most residents do not got to top tier programs and I would argue this post is more germane to their experience. Yes, there are self pity elements here, and incorrect and bitter assumption that midlevel program completely closes door to desirable job/loaction, but there is more truth and substance here than in ASTRO propaganda: THE MAJORITY OF GRADUATING RESIDENTS WILL NOT FIND A POSITION IN A DESIRABLE LOCATION, AND THE ONES THAT DO may be exploited.

At our annual meeting, almost no focus is devoted to this issue -that may be the most important one facing the field. Plenty of seminars with guys who remind me of this man making inane proclamations such as "we need a robust social media platform and robust quality matrix to robustly address quality and safety, new technologies..."
 
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I would just like to share that while my overall job satisfaction is good I do not find the OP's comments to be trolling or hyperbole. I took a job in an economically depressed area with a large portion of the populace coming from coal country. I probably have lower standards of living the the OP but I would just like to say that if you find this to be trolling then maybe you do not have a good idea of what life is like in "the fly over states". I would like to share the there are no neon lights on the strip club I drive past every day, I am not sure if it is actually still open since there are no windows or lights. If you however think that this language is trolling do yourself a favor and go to Google Maps and type in radiation oncologist. Place the map over Appalachia. Take the yellow human stick figure and put it on some of the stand alone facilities and get a ground view of the world at that facility. I request this because I appreciate where the OP is coming from. I personally am happy in this environment (mainly because my wife could get a job in this area and that is important for our quality of life).

I am personally somewhat acquiescent about the whole job situation since I did an MD PHD starting in 2004 and watched expansion of the MD PHD programs and a rapid decline in NIH funding in 2008 when I was applying for fellowship grants. At the time I was very upset that by 2011 almost all of the R01s and R21s in radiobiology were at a top 5 program or Yale. I went on interviews saying I wanted to do research however it is very difficult to hope to pursue a career where there is no opportunities. I gave up on the idea of being a physician scientist which was emotionally difficult since I felt invested after so many Western blots and colony forming assays. The academic leadership has done a very poor job of addressing why 20% of residents are MD PhDs and yet there is no avenue for the even a small percentage of which to obtain a faculty position in which you can justify your salary with extramural funding. The only publication that I am aware of on where funding in radiation biology was located and the quantity of NIH grants was published in 2011 and Lynn Wilson was a coauthor. Reading was depressing in terms of the number of funded grants. A specific example in regards to the job search I and a coworker experienced is that if you email 44 "academic centers" in regards to scientific job opportunities you will get 3 replies. Not offers for interviews, replies.

After it became clear academics was a poor outlook for me, my family pursued job opportunities in more rural areas. Life is slower and there is definitely less cultural activities to pursue. Drugs gambling and addiction are a huge problem in my patient's lives (the plus side is that I was given a bottle of blackberry moonshine by a patient last week as a sign of appreciation!). If I were single I would have a lot of the same sentiments that the OP has shared. My best friend is a subspecialty surgeon who has a great personality but works in a similar geographical area. He may have said many of the same things the OP wrote and I would not blame the things in his personal life for his situation or outlook. Dating in a small town is tough when everyone with near his level of education is tough when almost all of the possible candidates are coworkers. Living in rural areas is a reality many of us in Radonc will face.

I do not want to tell anyone to not go into this field. Its an interesting field and I am not educated enough about whats going on in other subspecialties to say what is better and who has the best ten year outlook. However if you are interested in benchtop research you need to understand that a lot of medical funding now mostly comes from industry. I would strongly urge people that since Varian and Elekta are not handing out a ton of money where as Pfizer and Merck are able to align their interests with your research ideas that you consider medical oncology as a specialty instead.

I wanted to support the OP in that I appreciate that SDN can be therapeutic and we should emotionally support each other as well as share some of my experience. If you disagree and think this was trolling and hyperbole, go to google maps and then come up with a reply to my post.
 
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Arguably, going into any field with the expectation of being a fully funded physician scientist without having a truly outstanding record in your PhD and matching into a residency where that would be supported is foolish and overly romantic. Those concerns are not new at all especially in radiation oncology.
 
Arguably, going into any field with the expectation of being a fully funded physician scientist without having a truly outstanding record in your PhD and matching into a residency where that would be supported is foolish and overly romantic. Those concerns are not new at all especially in radiation oncology.
Sure, but how about the expectation that you could live near a moderate sized city if you so desired? I wouldnt call that "romantic" or unrealistic expectations.
 
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Arguably, going into any field with the expectation of being a fully funded physician scientist without having a truly outstanding record in your PhD and matching into a residency where that would be supported is foolish and overly romantic. Those concerns are not new at all especially in radiation oncology.


In the early 2000s it was not all that foolish or romantic to anticipate there would be a large number of physician scientist jobs available with opportunities for funding. Training requires years and again it is difficult to predict markets 13 years in the future. I did not anticipate a doubling in the size of the MDPhDs graduating just like I did not anticipate radonc slots increasing in size to this degree.

I do not regret entering the field at all but I do wish to give caution to candidates that if you think you like benchtop research or living in the city it is going to be difficult to obtain those jobs. The day to day observations of the OP are well founded and I sympathize with someone used to living in a major city who only finds work in an economically depressed, town with no stoplights.

The good news is that its not that hard to learn to enjoy moonshine!
 
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Arguably, going into any field with the expectation of being a fully funded physician scientist without having a truly outstanding record in your PhD and matching into a residency where that would be supported is foolish and overly romantic. Those concerns are not new at all especially in radiation oncology.

:laugh: I didn't even mention in my supportive reply earlier how many brilliant and tremendously qualified MD/PhDs there are in this field who are now 100% clinical either in academics or private practice.

If you're interested in basic research, you should probably pick almost any specialty but this one at this point.
 
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I wish that I had grasped the concept of an exit strategy earlier in my career. Hopefully US med grads are startingting to seeing the writing on the wall here.
 
It’s funny I was one of the first people here back in my 2nd year of residency who criticized the field and the direction things were going, I’ll have to go back and find the thread for old times sakes. I was vilified back then for it, still remember gfunk ostracizing me for my views (no hard feelings tho G!). I’m glad to see that people are finally realizing what has happened and the dignity that you have the chance of being stripped of. It’s a lonely ****ing road when you don’t have friends or community bc you had to move regardless if you’re in a small town or a big town and when you have to work with **** baby boomers (seriously the aggression some of them have while offering nothing useful makes you sick, Going to Astro is nausea inducing seeing some of these people try to soak up the limelight).

It should be apparent to all Med students if you lurk here that you should not go into rad onc, it might be good but you run the risk of ruining your life. No you won’t hear this perspective from the academics at the top that advise you, they’ll hear of these posts and have a good chuckle they’ll tell you oh they’re just bitter people at SDN. Don’t buy it, if you’re on the fence walk away from this idea that you’ll be a special radiation oncologist. Our leaders have failed us, you want no part of this
 
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It’s funny I was one of the first people here back in my 2nd year of residency who criticized the field and the direction things were going, I’ll have to go back and find the thread for old times sakes. I was vilified back then for it, still remember gfunk ostracizing me for my views (no hard feelings tho G!). I’m glad to see that people are finally realizing what has happened and the dignity that you have the chance of being stripped of. It’s a lonely ****ing road when you don’t have friends or community bc you had to move regardless if you’re in a small town or a big town and when you have to work with **** baby boomers. It should be apparent to all Med students if you lurk here that you should not go into rad onc, it might be good but you run the risk of ruining your life. No you won’t hear this perspective from the academics at the top that advise you, they’ll hear of these posts and have a good chuckle they’ll tell you oh they’re just bitter people at SDN. Don’t buy it, if you’re on the fence walk away from this idea that you’ll be a special radiation oncologist. Our leaders have failed us, you want no part of this

I imagine folks working at MSK, Stanford or UCSF just chunkle at it. Having trained in one of those areas away from the coast, I can tell you that location is far more important than money.
 
I imagine folks working at MSK, Stanford or UCSF just chunkle at it. Having trained in one of those areas away from the coast, I can tell you that location is far more important than money.

I would imagine pretty much every specialty save nucs and path are having a good laugh. I mean can we name any other specialty that’s as geographically restricting.
 
I would imagine pretty much every specialty save nucs and path are having a good laugh. I mean can we name any other specialty that’s as geographically restricting.

100% academic IR is similarly restricting, but we just went from 260 spots to 140 or so integrated spots plus unknown amount of pgy 6-7 independent spots down the road.
 
I think my PTSD flared after reading the OPs detailed account of current life in a less than desirable locale. I trained at a very similar program and our graduating residents had similar difficulties, including myself. I would warn the current residents and medical student applicants that although the post was written with prose more befitting of an SNL skit, the gist is very much closer to fact than fiction. This is a very geographically restrictive field. I don’t think anyone can argue with that. As a recent graduate, I was looking for location, compensation, and job satisfaction. In the past I heard candidates could realistically expect to compromise on one of the 3. Now the expectation is to give up on 2 or even all 3. The scary part is that it will get worse before it gets better due to apathetic leadership.
 
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People need humour. It is an adult defense mechanism. The post likely reflects the persons reality accurately, whether being flashed with balls in a park daily is a true thing or not. Anyone who has driven through the rural South or midwest knows these things too well; it can be pretty scary and sad the level of economic depression ( you see suffering in peoples faces). I have friends from rural places and have heard about the absolutely dreadful dating pool. The flickering legs is a good tool weather true or not, its symbolic of what is happening to our field. These expansions are so sickening. Another program just popped up (Arkansas and they area already looking for a resident). Last year West virginia and oh wait another nyc program popped up. Over the last few years we have seen a few nyc programs, another LA program and expansions from multiple programs. The google doc has a thread listing multiple programs which are advertising during interviews their plans for expansions.
 
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"My bank account is growing and growing but it does not make me happy because I have nothing to spend it on. Seriously, the money is not even exciting because I have nothing to spend it on."

You need to take scuba diving adventures 3-4 times per year. Go to Austrailia for a little bit. Buy a Boat.
 
Part of the challenge of working a a rural/semi-rural area is that it can be logistically challenging to take vacations. Locums coverage is frequently needed (partly due to lack of partners). Recruiting Locums people to undesirable locations is challenging.


Sent from my iPhone using SDN mobile
 
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This is an unfortunate situation and story. I think it is a true warning. We as a field need to be honest and say that there are many satisfied people, but there is a very real chance of being burned. Caveat emptor!
 
For the record, I do support moves to reduce the number of grads (or at least stabilize the number).

I just think if posting about the poor job market I would focus on the fact that it's bad for everyone, and not focus on not getting a lab job as an MD/PhD. In terms of landing a coveted basic science split position, most people are screwed from the beginning unless they are walking in with Nature pubs.
 
Also wanted to tie in diversity. It seems to me that a majority/significant portion of entering residents are people of color/minorities (Asian-American, Indian etc) or Jewish. I would think being completely detached from their communities in a small town in apalachia may be even less palatable than for others.
 
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Also wanted to tie in diversity. It seems to me that a majority/significant portion of entering residents are people of color/minorities (Asian-American, Indian etc) or Jewish. I would think being completely detached from their communities in a small town in apalachia may be even less palatable than for others.

I have lived/worked and grew up in the type of place the OP describes but honestly didn’t really realize how depressing it is for many while I was growing up since it’s all I knew (the stripclubs are everywhere as are the “massage parlors” that oddly enough are often adjacent to gun shops but they definitely don’t have neon lights just no windows and no lights as somebody else describes) and it was a treat to go to the Super Kmart to look around then Denny’s for dinner. A lot of America is like this.

I did want to comment that I agree with the above point and it is definitely something to consider. For whatever reason (at least in my experiences and those of my family and friends as far as I know) most people in economically depressed towns that are 95% white, Christian, and die hard Trump supporting /overwhelmingly and openly anti-immigrant are accepting of Indian (or Pakistani with a not obvious Muslim name) doctors. If you’re a family man who is Indian and not political who at least “pretends” to be Christian by celebrating Easter and Christmas at home while giving out gifts, participate in office activities, say Merry Christmas to everybody etc it’s no big deal but if you’re openly non-Christian, liberal, or gay and/or political about it then it’s not just that you may in a place far from like minded individuals but one that is unwelcoming or even actively hostile to you.

I can’t believe how much has changed in the US in the past 10-15 years but trust me there are many places in the US where nothing has changed in decades (it may have even gotten worse recently). I love my job and most of my patients but if you can’t stand the thought of living in a place like this please seriously consider another field because it very well may be your only choice when you graduate.
 
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What I'd ask the OP, and other posters on here with experience, what tips would you offer if our goal is to NOT end up in places like this. I've talked to academic physicians who advised fellowships in order to try to get a job in a target location (e.g. do one in California if you want a job in California), but I've also heard of PP folks frowning on fellowships. Graduates from my program have been able to get jobs where they've wanted to for the most part, although one was more than happy to go to a fairly undesirable location.
 
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What I'd ask the OP, and other posters on here with experience, what tips would you offer if our goal is to NOT end up in places like this. I've talked to academic physicians who advised fellowships in order to try to get a job in a target location (e.g. do one in California if you want a job in California), but I've also heard of PP folks frowning on fellowships. Graduates from my program have been able to get jobs where they've wanted to for the most part, although one was more than happy to go to a fairly undesirable location.
Make connections early and often. I'm partnered into a practice outside of a desirable metro not far from where I grew up. It was all related to connections.

If you can make those connections early enough, offer to locums your chief year at those places as a trial on both sides for a possible job and eventual partnership.

Pedigree means very little despite what the op states, esp once you get outside of CA and the northeast. And don't be a douche, know/live/walk/breathe the 3A's. Beyond that, a little luck and serendipity helps.

And fellowships in general are going to be frowned upon in pp outside of specific circumstances (ie brachy fellowship for brachy heavy practice I suppose, or a situation where you need a extra year while spouse finishes up training) because it may come across as trying to make up for deficiencies in your training program
 
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What I'd ask the OP, and other posters on here with experience, what tips would you offer if our goal is to NOT end up in places like this. I've talked to academic physicians who advised fellowships in order to try to get a job in a target location (e.g. do one in California if you want a job in California), but I've also heard of PP folks frowning on fellowships. Graduates from my program have been able to get jobs where they've wanted to for the most part, although one was more than happy to go to a fairly undesirable location.

It might be worthwhile to start a new thread: “job search tips (post-2010)” or soMething lie that. I would imagine being flexible or starting as early as possible would be top. With regards to fellowships I have no idea but of course the academic guys are going to encourage it (since it benefits them) and everybody else is going to frown upon it since at best it’s lame and at worst it makes it seem like you did it because there is something wrong with you or your training and you had to do a fellowship to make up for your deficiencies.
 
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The post provides a good contrast to the ASTRO piece by the chief resident of Harvard. Sure, some of the extra details may be considered a bit histrionic, but as pointed out most residents do not got to top tier programs and I would argue this post is more germane to their experience. Yes, there are self pity elements here, and incorrect and bitter assumption that midlevel program completely closes door to desirable job/loaction, but there is more truth and substance here than in ASTRO propaganda: THE MAJORITY OF GRADUATING RESIDENTS WILL NOT FIND A POSITION IN A DESIRABLE LOCATION, AND THE ONES THAT DO may be exploited.

At our annual meeting, almost no focus is devoted to this issue -that may be the most important one facing the field. Plenty of seminars with guys who remind me of this man making inane proclamations such as "we need a robust social media platform and robust quality matrix to robustly address quality and safety, new technologies..."

I know the Harvard resident. Awesome guy. He didn’t get his job because he was at Harvard. He has a personal history with his new department and they know how good he is clinically. He still would have gotten the job if he went to a non top 5 program.

I went to a well regarded mid tier program and busted my ass. I had a stellar CV and I ended up with three good academic job options (east coast, west coast, and mid west). There is almost no way going to a higher tier program would have helped me do much better.

I agree with Gator that the problem with some lesser known programs is they don’t offer the best training. If you go there you will have to really bust ass and make things happen to make your CV stand out, more than you would have to at stronger program.
 
I know the Harvard resident. Awesome guy. He didn’t get his job because he was at Harvard. He has a personal history with his new department and they know how good he is clinically. He still would have gotten the job if he went to a non top 5 program.

I went to a well regarded mid tier program and busted my ass. I had a stellar CV and I ended up with three good academic job options (east coast, west coast, and mid west). There is almost no way going to a higher tier program would have helped me do much better.

I agree with Gator that the problem with some lesser known programs is they don’t offer the best training. If you go there you will have to really bust ass and make things happen to make your CV stand out, more than you would have to at stronger program.

I was an attending for a few years.
1) Training is 95% the resident and 5 % the program. Today everything is on the internet and there are video lectures, so many books,contouring sessions, internet forums etc. Every program has a trilogy/truebeam equivalent. It was not like the 90's when there were astro tapes and 2 (sic!) textbooks, and one worthwile annual meeting. Journals are online and electronic. I honestly dont get poor training- thats on the resident, who are of top ability and motivation today.

2) What are you are getting at with the "distinguish yourself" bit for jobs from a policy perspective? This is still a zero sum game! There is a constant here and it is small. Most residents, no matter how hard they work and distinguish themselves are going to end up disappointed. There are still too few jobs and too many residents, and working harder wont change that. What if all the applicants got "better", would that change anything?

You are implying that if most residents just put in extra effort and dedication, they will be rewarded. No, quite the opposite. The OPs post was wrong to state that a lesser known program virtually excludes decent job opportunities, but nails the bigger picture that MOST GRADUATING RESIDENTS ARE NOT GOING TO BE HAPPY WITH THEIR JOB. It is misleading to choose the "awesome guy" from Harvard, or a rhodes scholar, (the more awesome he is, the more nontopical his story!). His experience is simply not representative of the job search that is taking place for most residents.

The ASTRO column acknowledges there is a problem (how could it not?) washes the hands of any solution, then sanitizes and minimizes the issue by ending with the applicant finding his ideal job. Non-threatening of course, but leaves me wandering who does ASTRO represent?

(When US NEWS etc has a story about applying to college. Do they choose the valedictorian with a perfect SAT and westinghouse award and end with them going to Harvard?)
 
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It might be worthwhile to start a new thread: “job search tips (post-2010)” or soMething lie that. I would imagine being flexible or starting as early as possible would be top. With regards to fellowships I have no idea but of course the academic guys are going to encourage it (since it benefits them) and everybody else is going to frown upon it since at best it’s lame and at worst it makes it seem like you did it because there is something wrong with you or your training and you had to do a fellowship to make up for your deficiencies.

I think a thread like that would be helpful. My personal preference is that I'd like to be in a metro area of some sort (I'm single), it doesn't necessarily have to be in a given coast or city etc. My program has very strong clinical training but research is not as much of an emphasis so my CV may not cut it for many academic jobs. If a fellowship is done for geographic reasons, would that necessarily be held against a candidate?
 
Sounds exactly like pathology.
When I left residency and looked for a job I had a grand total of TWO offers, and both of them were in terrible horrible small garbage places like the OP describes.
 
Make connections early and often. I'm partnered into a practice outside of a desirable metro not far from where I grew up. It was all related to connections.

If you can make those connections early enough, offer to locums your chief year at those places as a trial on both sides for a possible job and eventual partnership.

Pedigree means very little despite what the op states, esp once you get outside of CA and the northeast. And don't be a douche, know/live/walk/breathe the 3A's. Beyond that, a little luck and serendipity helps.

And fellowships in general are going to be frowned upon in pp outside of specific circumstances (ie brachy fellowship for brachy heavy practice I suppose, or a situation where you need a extra year while spouse finishes up training) because it may come across as trying to make up for deficiencies in your training program

I'm also in a PP in a "desirable" medium-sized growing metro location (although in a flyover state, for what it's worth). Trainees would be very wise to take medgators advice during their job search. I've seen that work time and time again. I would also agree with several others posting that limiting/reducing the number of graduates is essential to the future of this specialty. Our leadership (someone else mentioned a name earlier, but he's clearly not the only one at fault) has proven that they do not represent the best interests of most practicing rad-oncs. They answer to their university higher-ups and hospital administration, both of whom benefit from the current over-supply. It would be great if ACRO or another entity that actually represents the rank-and-file is able to fill this void, but obviously I'm not optimistic about this occurring.
 
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I just want to throw my experience with this year's job search into the ring because it has been very different to the OP's. I will not harp on the fact that we have an oversupply of residents or a lack of good jobs as this has been discussed ad nauseam. I recognize that my experience is not representative of the whole much like we should all recognize that OP's is not either. It is not an easy job market and if you want a good job in a specific desirable area it will probably come down to luck, patience, timing and connections. Even then, you will need to be someone that people actually want to work with.

I come from a low-mid tier program in a large metropolitan area in the South with pretty minimal name recognition. I've had experiences at ASTRO where people quite obviously look down upon me because I'm not at a place that makes the annual med student radonc tier rankings thread. We have an excellent clinical experience, mostly self directed teaching, do minimal research, are not particularly well connected, and I didn't use any connections through the job process (I probably should have). I applied to a handful of jobs on the ASTRO site with the restriction being that I would only apply to jobs in cities I actually wanted to be in or close enough to cities I wanted to be in. I ultimately received job offers from both my interviews at ASTRO (both in the northeast and not upstate new york or western pennsylvania) and both my interviews in my current city. All 4 of these are jobs in large metropolitan areas with international airports and I would be happy with any of them. I also had a handful of interviews in places that just weren't for me and I did not pursue further.

I read all the doom and gloom. Frankly, I didn't ever consider that I would have the opportunities that I have and I feel quite lucky to be in this situation. I wrote thoughtful cover letters and made contact with the places that I was interested in which was received well. I don't have a stellar CV but I am normal, laid back, and easy to talk to. My friends from other residency programs also have opportunities they are happy with, several of them in big cities, and they run the gamut of radonc programs.

This board has become a bit of an echo chamber and while there is certainly some merit to the discontent, I think it's important to know that there are people that are not Harvard chief residents or children of distinguished radoncs getting desirable jobs in desirable areas.
 
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I was an attending for a few years.
1) Training is 95% the resident and 5 % the program. Today everything is on the internet and there are video lectures, so many books,contouring sessions, internet forums etc. Every program has a trilogy/truebeam equivalent. It was not like the 90's when there were astro tapes and 2 (sic!) textbooks, and one worthwile annual meeting. Journals are online and electronic. I honestly dont get poor training- thats on the resident, who are of top ability and motivation today.

2) What are you are getting at with the "distinguish yourself" bit for jobs from a policy perspective? This is still a zero sum game! There is a constant here and it is small. Most residents, no matter how hard they work and distinguish themselves are going to end up disappointed. There are still too few jobs and too many residents, and working harder wont change that. What if all the applicants got "better", would that change anything?

You are implying that if most residents just put in extra effort and dedication, they will be rewarded. No, quite the opposite. The OPs post was wrong to state that a lesser known program virtually excludes decent job opportunities, but nails the bigger picture that MOST GRADUATING RESIDENTS ARE NOT GOING TO BE HAPPY WITH THEIR JOB. It is misleading to choose the "awesome guy" from Harvard, or a rhodes scholar, (the more awesome he is, the more nontopical his story!). His experience is simply not representative of the job search that is taking place for most residents.

The ASTRO column acknowledges there is a problem (how could it not?) washes the hands of any solution, then sanitizes and minimizes the issue by ending with the applicant finding his ideal job. Non-threatening of course, but leaves me wandering who does ASTRO represent?

(When US NEWS etc has a story about applying to college. Do they choose the valedictorian with a perfect SAT and westinghouse award and end with them going to Harvard?)

I couldn’t agree more with this post. It’s a zero sum game. If everybody steps it up and tries to improve themselves nothing changes from the residents perspective (if anything the chairs and administrators get all the benefit since they now have even better applicants for the same crappy or non-existent jobs).

Let’s not forget that we are not talking about the average person here, even the bottom quartile radiation oncology resident did great in college, was top of the class in medical school, and spent five years in residency ... that’s a top 1 or 0.1% candidate in my book and somebody who should take their exceptional abilities/performance to another speciality where they can thrive and be rewarded appropriately rather than being told they are mediocre and should have tried harder and now be happy living like the OP.
 
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