If we are truly undesirable, and you truly have empathy for the rural patients, then why would you even want them to be treated by "undesirable" (ie bad) doctors like me? However, the point of the thread is not that rural people don't deserve care. They are human beings- of course they deserve care.
I don’t agree with people who call those who live in rural areas as “crawling from holes,” that was an unfortunate use of words by an exasperated person. People who were unfortunately born here cannot suddenly fix a bad economy and shouldn’t be branded as awful. The reason the whole city is not moving to better places is because they can’t afford it. My patients tell me all the time they would love to live elsewhere but they can't.
However, when everyone in this field meets a certain level of intelligence and ability, to just say future medical students who could potentially fall in your “undesirables” category should be the ones stuck in locations that severely affect their personal lives is ridiculous. Those medical students are not stupid, are not evil ogres with food stuck in their beards/hair, and are currently deciding if this field will give them the opportunities they hope for. Someone should treat the rural patients, but that is not a burden that needs to fall on the shoulders of medical students who never said they want to go to rural areas…and there are med students who want to go to rural areas, but the ones that do not should make a prudent decision regarding their career. There are subsections of some medical school slots meant only for people who plan on working in rural areas- those people can foresee themselves in these areas whether because they love rural life or they want to help underserved areas.
Of course, people who live in rural areas deserve healthcare.
The point of this thread is not that those jobs should not exist (although some of them actually are truly not economically feasible and were opened in a time of excess and greed). The point of this thread is to forewarn the current batch of medical students (not the current batch of residents or attendings or private practice doctors) that if you are interested in geography, it is difficult to find a job in high population areas. I can tell you at 18 and in my mid-20s I would have no interest in Bern, NC, or even Phoenix (which obviously is a big city). I wanted a level of flexibility that simply does not exist in this field, and I was foolish and did not know that. Literally we are expanding our definition of desirable location to include towns that in our early 20s we (some of us) would never consider but now that we have done the training and committed our lives to this job, we have to. Those medicals students have not yet done the training. These medical students should understand the geographical restrictions, so that in 5 years so they are not surprised. I don’t think college towns (at this point, I would take a job in a college town) are interesting and many people who are currently considering career options are still at the fork in the road and would appreciate knowing which direction is flexible.
The point is we sell to them that radiation is interesting (true), that you have great hours (with some new jobs, it’s not always the case- I do know people who get home late, weekends are generally free though), that the money is great (compensation is decreasing because of oversupply but still pretty great) and you will find great job opportunities in desirable areas.
Let’s say that even 60-70% (and I’m being very generous- both by percentage number and definition of “good area”- which includes Cleveland) of people find jobs in good high population areas, that means 30-40% are not finding jobs in those areas. If you are a candidate good enough to get into rad onc, then likely you would be an excellent candidate for many other fields. Then you as a potential candidate have to decide whether the odds of “being a desirable human being” and “getting a desirable job” in radiation oncology is worth it. Or would you rather go to internal medicine and be sure you end up where you want?
The only reason I picked off the top 3 because it’s pretty obvious to everyone outside of the field (ie med students) that those are top 3, and it’s easier to assume that you will have better odds of finding a good job coming out of there. It’s easy for a med student to bank on the quality of those programs. Let’s say they even know what top 10 is or top 15. After top 15, how is a student supposed to figure out which smaller, lesser known residency programs end up with good jobs, hope they match there, and then hope that in 5 years they too will end up with good jobs? In one interview day? Everything here is anonymous, they certainly won’t figure it out from this thread. The SDN residency ranking? No.
Let’s say that if they can’t get into top 15, then we tell them, okay med student, pick now where you want to be and match there. What if they don’t match there? What if they do match there and in 5 years the job market is even worse? Let’s say they match there, and they end up married to someone who needs a different location?
Let’s just even assume that the character attacks are true- I’m stupid; I’m lazy; I don’t know how to network; I’m not polished; I lack confidence; I’m a bad doctor; I don’t know how to please my referring physicians- how are the potential applicants supposed to look themselves in the mirror and know that they are not like me? You think people have that much self awareness? Nobody looks in the mirror and says, “Yes, I am stupid, lazy, lack social skills, unkempt, lack confidence and generally just suck at not just my job but existence. So as an undesirable human being, I deserve to be in Lalaville, flyover state, USA. I will choose radiation oncology even though other specialities, like medicine, might offer me, the undesirable lout, a job in a better place…BUT as an undesirable I must be true to my undesirable state and end up in Lalaville, so I will choose rad onc.” And again- why do the poor rural citizens deserve such a monster as their physician? (And so much of these character judgements are subjective- there is no objective scale of "polished.")
II’ve arbitrarily picked the “top 3” because that is the best odds because I can say with almost (not quite) certainty I’m not closing doors to them. That a large portion of America will still be available to them. They can probably figure out the next 15 great residencies, but afterwards, how are they supposed which small programs are reliable and keeps doors open vs unreliable ones that closes doors. As someone mentioned, in medicine, very few residencies close doors for private practice in desirable locations.
And clearly, how will they know if they will be able to network and will be able to find out about all those non-posted jobs that everyone else knows about?
You are now sending the potential applicant who could go into a different field and have much more flexibility through a series of smaller and smaller hoops to make sure they don’t fall in the 35% of people who end up in bad locations. And they STILL won’t have multiple options, even if they get one job offer in a good place. However, if they go into internal medicine, they might have multiple officers approaching similar pay, and their geographic future looks brighter.
I may have to accept my job and treat my patients with joy (and I do- I don’t treat them poorly just because I hate the surrounding town). However, they are early enough in their careers to be wary of empty promises and to choose their occupation and future flexibility wisely. Even the dumbest and laziest among them are intelligent and competent and have other career opportunities right now. Just because they care about geography, doesn't mean they act entitled. It means they are human beings.
It doesn’t make you a horrible person to not want to live in a small town. If you have a family, you have to think about how it affects your family. People want good school systems, and some people want more diversity of both people and cultural opportunities because they prefer that life for themselves and their children. A single person has difficulty here because of lack of cultural opportunities (and also want diversity of people) and it’s near impossible to date someone (and therefore difficult to build a family).
If you love rural areas (and there are many who do), then you are lucky because almost any field will provide you the opportunity to build the life you want.
Again, the post is for future applicants to make a prudent decision. I'm not threatening the current rad ones by stating that I feel so entitled I should get your job. I wish you the best in your job, and will not presume to make broad generalizations about your character or whether or not you are deserving of it.
