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

[DrfluffyMD]

You have some free time, right? PLAY VIDEO GAMES. PLAY EXTRA FOR ME, BRO, I'M M1 AND I DON'T GOT NO TIME. Especially MMORPGs. Check out Guild Wars 2. If you're console player, check out Skyrim then add on allllllllll the mods people offer and then replay Skyrim.

Thanks for posting this.

OP probably stopped playing way back in M1 to focus on research, and that’s how he/she got into rad onc with all those sweet research gig.

Now years of trying to get into one of the most competitive specialty has left the OP unable to game properly because it’s been so long.

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[evilbooyaa]

Is anyone going to ACRO this weekend? Are these issues being addressed there?

There was a discussion with the residents (like 40-50 total) with couple of big names during the resident portion (including one chairman). Job market could've been discussed there, but the PGY-5s wanted to talk about oral boards for an hour and half, the attendings wanted to hear and discuss amongst themselves about their histories and the spiraling job market was never brought up. Disappointing as usual at this point - PGY-5s don't want to ask about the job market and risk alienating these attendings that they may be contacting or networking through to find jobs. Everybody (including the residents in a position to discuss the matter openly with minimal retribution) wants theirs, and aren't going to stick their neck out for "the future of this field".

Regardless, the advice from every attending I've discussed the topic with is "Just keep networking, be open geographically, and you'll get a job that you want", so it unfortunately seems that everyone has their head in the sand still.

 

[kristofer]

Disappointing as usual at this point - PGY-5s don't want to ask about the job market and risk alienating these attendings that they may be contacting or networking through to find jobs. Everybody (including the residents in a position to discuss the matter openly with minimal retribution) wants theirs, and aren't going to stick their neck out for "the future of this field".

Ridiculous that there's this idea that you can't discuss the problem without fear of pissing somebody off and not getting a good reference. Residents need to be more brave. You are not going to get non-renewed for saying you are concerned about the overtraining in the field and diminishing job opportunities. How selfish of us to care about things like finding a job and earning a living instead of focusing on getting grants and writing trials.

 

[berag]

Fwiw, my program never knew my login for my account, so not sure how these programs are checking these things weekly or whenever

PDs have their own ACGME log ins and can see their residents' case logs.

 

[hbosch]

Ridiculous that there's this idea that you can't discuss the problem without fear of pissing somebody off and not getting a good reference. Residents need to be more brave. You are not going to get non-renewed for saying you are concerned about the overtraining in the field and diminishing job opportunities. How selfish of us to care about things like finding a job and earning a living instead of focusing on getting grants and writing trials.

But the fear is based on truth. Non-renewal is unlikely mostly because most resident programs are way too lazy to deal with the paperwork and subsequent search for another resident. But there are many behind the scenes way they can punish a resident. In fact, some jobs require nonsense paperwork to be filled out by the residency programs of recent graduates (literally 3-5 years out of residency). What if you've pissed off your program by non-anonymously arguing against expansion knowing your program wants to expand? The whole hierarchical system of medicine (not just rad onc) is predatory, which is why programs can actually get away with frank and florid abuse, and not just job placement issues.

I agree with you 100% that people should speak up, because how else will anything change? But unless every single resident in a program shows a solid front to their residency director or chairman, just a few residents doing it will risk being labeled as "non-cooperative" and being punished in a myriad of ways. Residents rarely show a solid front because in every program the ultra-competitive don't want to cooperate with their fellow residents because they know they will get more for themselves (ie by pleasing attendings) by not cooperating with their fellow residents. I can't even throw all the blame on the ultra-competitive because even the supposedly "nice" residents don't want to be called "trouble makers." How many times have you seen residents look the other way while something ****ty is happening? All the time, constantly. Residents are not rule breakers, residents are not the type of people who invoke change, not in their residency program, not in society, not in life. They play the game and wait for a reward.

And honestly, residents showing a solid front is not going to help the current situation. All the programs have to say is we're not doing anything illegal. No one is doing anything illegal. I do a agree with a national organization separate from ARRO, ACRO, ASTRO (all of which is run by the exact same group of people with the same goals of expansion). But is it going to be the new grads or the people > 5 years out who hope to not see falling incomes become the norm because of over-supply. (And no, it's not the norm currently; at least I don't think it is). There really needs to be MASSIVE solidarity in order for people to not be put on a "troublemaker" list. We're not running for president. We're doctors, doctors are not rewarded for being "troublemakers." I know this attitude sounds depressing. I do think there is a real solution, just the solution requires a massive movement of solidarity. I think it's awesome that we are openly discussing this and at least talking about starting a new "movement/organization."

And yeah program directors can and are allowed to see your cases. Keeping track of numbers is for your own graduation. All a program has to do to prove numbers is show the number of sims that the department had in a year. The department has an easy list for that as they keep track of it for billing. They don't need the resident list at all.

And yeah, I no longer know how to play video games . I'm far behind. But you're right, I have all the time in the world to catch up.

 

[TomatoMan]

There really needs to be MASSIVE solidarity in order for people to not be put on a "troublemaker" list. We're not running for president. We're doctors, doctors are not rewarded for being "troublemakers." I know this attitude sounds depressing. I do think there is a real solution, just the solution requires a massive movement of solidarity. I think it's awesome that we are openly discussing this and at least talking about starting a new "movement/organization."

I concur that residents, no matter how much they try, will not be able to effect any significant change towards curbing the over-supply. As you say, it will require a true show of vocal solidarity among practicing radiation oncologists, including community and academic physicians (there have to be some junior "academics" who aren't yet beholden to hospital administrators, and even some senior ones who might just decide to do what's right for the field). I know on-line petitions have been used for this purpose before. Does anyone on this board have any experience with this or know someone who does?

 

[Neuronix]

But the fear is based on truth. Non-renewal is unlikely mostly because most resident programs are way too lazy to deal with the paperwork and subsequent search for another resident. But there are many behind the scenes way they can punish a resident. In fact, some jobs require nonsense paperwork to be filled out by the residency programs of recent graduates (literally 3-5 years out of residency).

I didn't think this was real. But now I know three people from two different residency programs who had this happen to them. The program was not happy with them, but rather than actually fire them the chair and program director let them graduate but refused to give any positive evaluations thereafter. This cost all three of them jobs. Two of them were essentially forced to do a fellowship to get a recommendation there and one still found a job in academics that didn't care.

Residents are not in a position to speak out. Neither are junior faculty for that matter. We're all easily replaceable in this job market. The will of the chair is what matters--and they are rewarded for expansion (satellites, residents, etc).

 

[TomatoMan]

Residents are not in a position to speak out. Neither are junior faculty for that matter. We're all easily replaceable in this job market. The will of the chair is what matters--and they are rewarded for expansion (satellites, residents, etc).

Well said. I couldn't agree more.

 

[Reaganite]

I didn't think this was real. But now I know three people from two different residency programs who had this happen to them. The program was not happy with them, but rather than actually fire them the chair and program director let them graduate but refused to give any positive evaluations thereafter. This cost all three of them jobs. Two of them were essentially forced to do a fellowship to get a recommendation there and one still found a job in academics that didn't care.

Residents are not in a position to speak out. Neither are junior faculty for that matter. We're all easily replaceable in this job market. The will of the chair is what matters--and they are rewarded for expansion (satellites, residents, etc).

I won't get into the details, but I'll just say you always have the option of burning such programs anonymously on this board . Trust me, there are repercussions to the program when you point out legitimate concerns here.

 

[RickyScott]

I dont want to be subversive, but a lot of chairs are now paid around a million- you can often look up their salary on guidestar: GuideStar nonprofit reports and Forms 990 for donors, grantmakers, and businesses

For example, the chair of moffit (an institute not known to pay faculty well) earns 900,000+ in 2015 prior to being named physician in chief.


search moffitt and then look at pdf of tax return (form 990) for this entity: H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer SCRN Ctr Inc

Check it out- here it is:
http://www.guidestar.org/FinDocuments/2016/593/238/2016-593238640-0e2f5cfc-9.pdf

 

[medgator]

Harrison made $870K in W-2 and $42K in "other" per that form.

 

[kristofer]

I won't get into the details, but I'll just say you always have the option of burning such programs anonymously on this board . Trust me, there are repercussions to the program when you point out legitimate concerns here.

Agree. There are legitimate reasons for giving less-than-positive references after graduation. For instance, someone who is clinically competent but awkward or creepy around patients, can't take negative feedback, etc. Because the chair had a personal problem or disagreed with the opinion of the resident is not one. Tanking a new physician's career from the start because they didn't suck up to the chair is not ok, and programs like this should be called out so that med students know to avoid them and so this petty nonsense stops. To be fair, rad onc overall seems fairly benign compared to the level of sadism in surgical residences (I'm reminded of this thread), but that doesn't make it ok to exercise personal vendettas to the point where one's only option to make a living after graduation is fellowship.

 

[OTN]

Ok, so let's call them out. Which programs did this? I don't know of any or I would go first.

 

[noobsauce]

As an applicant of this cycle, the original post and the discussion afterward were every interesting and helpful (and a little depressing). Thank you.
I too seemed to have been idealistic. In terms of job prospect, this is what I got out of this thread:

75% chance of getting a job that I can live with = connections^4 + "triple A" + (residency program where people place well)/2

I married a physician, so hopefully I won't starve if all else fail.

 

[RickyScott]

wanted to post an old article about 21C, but one of the most insightful and prescient about our field, and it is really worth re-reading today: the university complexes have picked up where 21 century left off: Beams and Schemes

I am starting to believe that the high technical fees in radiation oncology actually end up hurting a lot of radoncs and poisoning the job market.

"In 2002 cancer doctors began prescribing a new service called intensity-modulated radiation therapy. IMRT is an impressive innovation, able to blast tumors with the precision of a Waterpik showerhead versus the garden-hose approach of older external beam therapy. Medicare pays $700 per IMRT session, compared with $100 for external beam. They take the same amount of effort to administer. Some in the profession grouse that IMRT is overprescribed--and some doctors who have parted ways with Dosoretz say the company promotes higher IMRT use by offering bonuses for meeting higher revenue targets. The generous reimbursement rates explain why Dosoretz's company can run its expensive IMRT machines at 50% capacity yet remain highly profitable.

"Many communities have five radiation centers that should have one or two," says Kevin Gross, president of Universal Health Services , a national hospital chain that also provides radiation therapy.

In many markets competition has intensified for access to the profession's lifeblood: referrals. Because radiation oncologists do not diagnose cancer, they rely on referring physicians such as surgeons, urologists and gynecologists. A single referral can lead to a course of 40 treatments, or $25,000, and double that with facility fees. It's illegal under federal law to pay doctors directly for referrals or to refer to a clinic in which a doctor has a financial stake, so Dosoretz has been busy buying practices outright, which is fine by regulators as long as he does not overpay. But absent a buyout, there are plenty of contorted ways to get referrals anyway."

 

[RollTideRadOnc]

I wanted to offer a little bit of a dissenting opinion:

Working at an academic satellite may not be a bad option for many graduating residents.

Granted, if you do so you're going to make a lot less money than you would elsewhere (even compared to being an employee of other major hospital systems). You're also going to be permanently on the bottom of the totem pole. You'll always be a "second class" attending in your department and looked down upon.

That being said -- if your ego and wallet can handle the above -- you'll get job security and stability (much more so than in non-academic positions), good proximity to cities, access to clinical trials, and access to the expertise of your department.

Considering how unstable the radonc job market is, this is not a half bad deal...

 

[RickyScott]

I wanted to offer a little bit of a dissenting opinion:

Working at an academic satellite may not be a bad option for many graduating residents.

Granted, if you do so you're going to make a lot less money than you would elsewhere (even compared to being an employee of other major hospital systems). You're also going to be permanently on the bottom of the totem pole. You'll always be a "second class" attending in your department and looked down upon.

That being said -- if your ego and wallet can handle the above -- you'll get job security and stability (much more so than in non-academic positions), good proximity to cities, access to clinical trials, and access to the expertise of your department.

Considering how unstable the radonc job market is, this is not a half bad deal...

unfortunately, this is where everything is headed, and why programs expand residency slots, and quite honestly what ASTRO is all about. Now even a satellite in most major cities is difficult to get.
I think the only way to brake the cycle is to push for lower technical reimbursements- to get the greedy hands of ASTRO out of the community. The sole intention of the satellite facilities in community hospitals is to drive up health care costs.

 

[seper]

Also, a few academic departments I''m familiar with have a "pathway" for a young satellite attending to work his/her way back to the main center.

I wanted to offer a little bit of a dissenting opinion:

Working at an academic satellite may not be a bad option for many graduating residents.

Granted, if you do so you're going to make a lot less money than you would elsewhere (even compared to being an employee of other major hospital systems). You're also going to be permanently on the bottom of the totem pole. You'll always be a "second class" attending in your department and looked down upon.

That being said -- if your ego and wallet can handle the above -- you'll get job security and stability (much more so than in non-academic positions), good proximity to cities, access to clinical trials, and access to the expertise of your department.

Considering how unstable the radonc job market is, this is not a half bad deal...

 

[scarbrtj]

Also, a few academic departments I''m familiar with have a "pathway" for a young satellite attending to work his/her way back to the main center.

Is it the Holman pathway?

Thanks, I'll be here all week.

 

[Mandelin Rain]

Is it the Holman pathway?

Thanks, I'll be here all week.

I think they have renamed that pathway the "Bridge to Nowhere."

 

[firewicket]

I feel like the FAQs section of SDN needs to be updated (5 years old) to reflect all this job shortage stuff/declining utilization of RT/residency expansion/decrease in competitiveness of applicants.

This is one of the first places medical students go to learn about the field and unless you are sieving through the threads you don't know about it all.

 

[DukeNukem]

Good news everyone--our department where I'm training is expanding its residency program. Also good news for those looking for jobs--our chair recognizes the difficulties with the job market and will be hiring instructors for the coming satellite positions. I think he means instead of professors. What's the difference?

The faculty are all going under a new pay system and they think it means pay cuts for them too. At least the fellows and instructors won't be cut, I think? So those are the best jobs.

Went 15 miles down the road to a large hospital/private practice to look for a job. They also are going to be opening up instructor positions maybe next year and their own private practice residency program in the next few years.

Why worry? Sounds like plenty of radiation oncologists in the future.

 

[PruritisAni]

Good news everyone--our department where I'm training is expanding its residency program. Also good news for those looking for jobs--our chair recognizes the difficulties with the job market and will be hiring instructors for the coming satellite positions. I think he means instead of professors. What's the difference?

The faculty are all going under a new pay system and they think it means pay cuts for them too. At least the fellows and instructors won't be cut, I think? So those are the best jobs.

Went 15 miles down the road to a large hospital/private practice to look for a job. They also are going to be opening up instructor positions maybe next year and their own private practice residency program in the next few years.

Why worry? Sounds like plenty of radiation oncologists in the future.

I really hope the 3rd paragraph is hyperbole. But the rest sounds about right. Afterall, instructors are the millenial version of the hospital employee.

 

[deleted18755]

I

I really hope the 3rd paragraph is hyperbole. But the rest sounds about right. Afterall, instructors are the millenial version of the hospital employee.

That’s definitely a joke (I’m almost certain that a residency program needs not only physics but radiobiologists as well); however, private practices can and do offer ridiculous “fellowships” that are whatever they want them to be since they aren’t accredited so they are allowed to do so.

FWIW I was discussing the deteriorating job market with some old friends/colleagues and anecdotal second hand information: for whatever reason the rural Midwest and even some medium sized cities there have some decent and high paying jobs (for how long who knows). The people and culture are apparently laid back and friendly/welcoming. Forget about Chicago or even Detroit though.

 

[DukeNukem]

That’s definitely a joke (I’m almost certain that a residency program needs not only physics but radiobiologists as well); however, private practices can and do offer ridiculous “fellowships” that are whatever they want them to be since they aren’t accredited so they are allowed to do so.

It's not a joke. I'm not going into details so I don't lose my anonymity. But, they have plans to do that, and they have ways to pull that off.

 

[OTN]

Scott + White in Temple, Tx is not an academic institution and has residents. Opened in 2010 or 2011 I believe.

 

[medgator]

Scott + White in Temple, Tx is not an academic institution and has residents. Opened in 2010 or 2011 I believe.

Scott and white sounds like the teaching hospital of Texas A&M

Scott & White Medical Center - Wikipedia

 

[RickyScott]

It's not a joke. I'm not going into details so I don't lose my anonymity. But, they have plans to do that, and they have ways to pull that off.

your chairman sounds like a real POS... I had just posted a link to "beams and schemes" This sounds radical, but when enough people are hurt by this type of greed and behavior, I think it will resonate more: we need to lobby for lower technical fees in radiation. Also consider, posting names to shame these chairs...

 

[fiji128]

Actually the place I am currently working, its basically a large private hospital system with a main hospital and several satellites with some ACGME residency positions in other sub specialties, is thinking about opening a residency program in radiation in maybe like 5 years in the future. I really hope that doesn't happen as its totally not needed in our geographic area but its a little disconcerting that the higher up are sort of discussing it.

Bottom line for those second and third year medical students is don't go in radiation oncology if you want any say over where you live, especially so if you want to live in a population center where most of the rest of the country also lives.

 

[kristofer]

Actually the place I am currently working, its basically a large private hospital system with a main hospital and several satellites with some ACGME residency positions in other sub specialties, is thinking about opening a residency program in radiation in maybe like 5 years in the future. I really hope that doesn't happen as its totally not needed in our geographic area but its a little disconcerting that the higher up are sort of discussing it.

Bottom line for those second and third year medical students is don't go in radiation oncology if you want any say over where you live, especially so if you want to live in a population center where most of the rest of the country also lives.

There is a very large number of programs trying to expand their residencies currently, typically using satellite volume as a rationale. Not surprisingly they also want to offer "fellowships." This is under the guise of increased academic productivity. I think what we are seeing is a fast track pipeline of cheap labor through increased competition. If these expansions and new programs go through, I honestly would not be surprised to see the number of graduates to double in the next 10 years. Yes, there seem to be plenty of high paying non-academic jobs in rural middle America. Will there be in 10 years? The problem then might evolve from being one of not being able to live near a metro area to one of the specialty as a whole being on the low end of compensation compared to other specialties. Medical students are taking notice as evidenced by posts on their forum, and while I don't think we've seen the effect yet this cycle, I think we will in the next 2-3 cycles with reduced applicant number and quality.

 

[nkmiami]

There will come a time when payment reform/hypofractionation will make it economically non viable to have a linac with less than 25-30 patients (just like in the rest of the world) When that happens, the job market will be totally f'd.

 

[OTN]

The aging baby boomer demographic will help with total patient numbers, but with the inevitable reimbursement reduction/hypofractionation push needed per patient to treat the "grey tsunami" and not bankrupt the program, I agree that it will not translate into increased demand for radonc services.

However, I disagree that 30 patients is going to be the "break-even" number for patients. The US is different than Europe, in that we're much more spread out. Making it economically viable to have 20ish patients on a machine makes sense, as it would allow for all patients to be treated across the country, even ones in smaller cities. Maybe I'm being naive, but requiring 30 patients just to break even seems like a move too far in the wrong direction to me.

 

[Haybrant]

There will come a time when payment reform/hypofractionation will make it economically non viable to have a linac with less than 25-30 patients (just like in the rest of the world) When that happens, the job market will be totally f'd.

this right here is one of the most important posts. if you're even thinking about going into rad onc, you're not thinking clearly. Still time to get out even for the PGY-1's. W the way job restriction is I was seriously thinking if it was feasible for me to go back for a primary care residency. Would not have even dreamed of that before.

 

[medgator]

this right here is one of the most important posts. if you're even thinking about going into rad onc, you're not thinking clearly. Still time to get out even for the PGY-1's. W the way job restriction is I was seriously thinking if it was feasible for me to go back for a primary care residency. Would not have even dreamed of that before.

Not sure I'd sound that kind of alarm.... if you're ok with the rural/midwest locales, there are decent jobs still out there. But yes, if you want populated/desirable/coastal areas, it's looking bleak for the future.

 

[Phantom1]

Honestly I think this thread has run its course. It is an inflammatory title and is biased by people who like to complain due to their situation. There are tons of happy rad oncs in the country who never post on this site because they are busy and happy with their lives. If you read the OP seems pretty lazy, and had job offers in better places but “didn’t want to work 12 hours”.

Hybrant, if you want to go back in to primary care, feel free, and watch your salary cut in half. Yes there are future issues with jobs, but these issues are overstated here and trying to dissuade good residents to go into rad onc is counterproductive and destructive. If anything residents need to work a little harder to be competitive for the good jobs.

Moderators, this thread title is inflammatory and again biased either by trolls who have only ever posted 1-2 times on this board or by those few who expected the world but didn’t want to work hard for it, just like the OP...

 

[nkmiami]

Not sure I'd sound that kind of alarm.... if you're ok with the rural/midwest locales, there are decent jobs still out there. But yes, if you want populated/desirable/coastal areas, it's looking bleak for the future.

The aging baby boomer demographic will help with total patient numbers, but with the inevitable reimbursement reduction/hypofractionation push needed per patient to treat the "grey tsunami" and not bankrupt the program, I agree that it will not translate into increased demand for radonc services.

However, I disagree that 30 patients is going to be the "break-even" number for patients. The US is different than Europe, in that we're much more spread out. Making it economically viable to have 20ish patients on a machine makes sense, as it would allow for all patients to be treated across the country, even ones in smaller cities. Maybe I'm being naive, but requiring 30 patients just to break even seems like a move too far in the wrong direction to me.

When I started residency, we used to leave the computer on all night just to perform one optimization iteration for IMRT and there were all sorts of time consuming qas-
It took significant resources, and justified the high reimbursement that cms awarded at the time. Today, in many cases, IMRT is more efficient than 3d. However, the original, -very high reimbursements- have continued, and present reimbursement does not reflect how efficient and easy IMRT has become. As someone posted in that beams and schemes article, this drove the expansion of 21C and academic sattelites.

If CMS ever catches on, I expect that there will be a contraction of centers. Regarding jobs, I believe there will continue to be jobs on the coasts in major cities, but they will be exploitative, low paying and suck. We will see more fellowships in subjects like "palliative and stereotactic radiation," and maybe even one in mastering documentation and dictations.

 

[evilbooyaa]

Honestly I think this thread has run its course. It is an inflammatory title and is biased by people who like to complain due to their situation. There are tons of happy rad oncs in the country who never post on this site because they are busy and happy with their lives. If you read the OP seems pretty lazy, and had job offers in better places but “didn’t want to work 12 hours”.

Hybrant, if you want to go back in to primary care, feel free, and watch your salary cut in half. Yes there are future issues with jobs, but these issues are overstated here and trying to dissuade good residents to go into rad onc is counterproductive and destructive. If anything residents need to work a little harder to be competitive for the good jobs.

Moderators, this thread title is inflammatory and again biased either by trolls who have only ever posted 1-2 times on this board or by those few who expected the world but didn’t want to work hard for it, just like the OP...

I personally disagree. I think open information regarding the opinions (even of a 'disgruntled' few) about the state of our field (both now and what it might become in the future) is not worth closing down discussion. You're certainly welcome to post your own opinions, either here, or in a separate thread if you would like. In regards to the bolded, I think this forum is the only place (at least that I'm aware of) that is willing to say that Rad Onc isn't all sunshine and rainbows, and IMO that's something for medical students to consider as they choose their future careers.

 

[nkmiami]

Honestly I think this thread has run its course. It is an inflammatory title and is biased by people who like to complain due to their situation. There are tons of happy rad oncs in the country who never post on this site because they are busy and happy with their lives. If you read the OP seems pretty lazy, and had job offers in better places but “didn’t want to work 12 hours”.

Hybrant, if you want to go back in to primary care, feel free, and watch your salary cut in half. Yes there are future issues with jobs, but these issues are overstated here and trying to dissuade good residents to go into rad onc is counterproductive and destructive. If anything residents need to work a little harder to be competitive for the good jobs.

Moderators, this thread title is inflammatory and again biased either by trolls who have only ever posted 1-2 times on this board or by those few who expected the world but didn’t want to work hard for it, just like the OP...

Residency slots in such a small field have more than doubled in 15 years (that has to be totally unprecedented), and continue to expand, the growth of hypofractionation... (which in a lot of surveys has not even been widely adopted in breast) residents and medstudents should not be concerned? I have a job that I love as well and work 12 hours a day happily, but am very pessimistic about the future of the field ... the evidence here is more compelling than global warming.... Also, your suggestion that if all the residents just work harder, that will somehow increase the supply of good jobs is very concerning...

 

[shogun0660]

Moderators, this thread title is inflammatory and again biased either by trolls who have only ever posted 1-2 times on this board or by those few who expected the world but didn’t want to work hard for it, just like the OP...

 

[deleted18755]

When I started residency, we used to leave the computer on all night just to perform one optimization iteration for IMRT and there were all sorts of time consuming qas-
It took significant resources, and justified the high reimbursement that cms awarded at the time. Today, in many cases, IMRT is more efficient than 3d. However, the original, -very high reimbursements- have continued, and present reimbursement does not reflect how efficient and easy IMRT has become. As someone posted in that beams and schemes article, this drove the expansion of 21C and academic sattelites.

If CMS ever catches on, I expect that there will be a contraction of centers. Regarding jobs, I believe there will continue to be jobs on the coasts in major cities, but they will be exploitative, low paying and suck. We will see more fellowships in subjects like "palliative and stereotactic radiation," and maybe even one in mastering documentation and dictations.

What is more concerning and possibly economically devastating for a practice is when CMS adjusts the wRVU for IGRT (which I understand is in the works) . . . it will flip the books on most practices overnight.

For example: as recently as last year the wRVU (NOT including technical) for checking a single daily CBCT is literally slightly above a level-3 follow-up for a PCP that is scheduled in a 15 appointment (but I'm sure routinely last longer). Does anybody really think their 10-30 second verification of the therapist's alignment of a CBCT while sipping coffee at their desk is worth more than a 15-20 minute follow-up of a primary care physician?

PS: If you're already a practicing radiation oncologist of course you would be crazy to switch to primary care, even if you didn't have to do any additional training, right now if it's for compensation/quality of life reasons but who knows 3-5 or more realistically 10-15 years from now?

 

[MDACCRules]

Seems like the thread-cycle is something like this...

Good case -> Question about getting in -> Complaints about the job market being horrible -> Complaints about hypofractionation and residency growth -> Minority defense of people just needing to live in smaller non-coastal towns and suck it up and work harder -> Someone explaining that they scour the hospital and get their own referrals by befriending pulmonologists or doing prostate biopsies or stealthily reading mammograms and doing own wire loc biopsies -> Someone disputing that this strategy would work in certain geographic areas -> More complaining about hypofractionation and residency growth -> Some Harvard/MDACC/Sloan resident explaining they had no problem getting a great job in LA or SF or Manhattan -> Someone else complaining that it's harder for the residents from flyover country to get a job -> More complaining about hypofractionation -> Good case ... and cycle repeats.

Still fun to watch! Keep up the great work!

 

[seper]

Cone beam reviews literally print RVUs... lots of people will miss them.

 

[scarbrtj]

Moderators, this thread title is inflammatory

You're inflammatory!

 

[Tigerstang]

I have not posted on this forum in years but cannot thank the OP enough for posting this. I am guessing most folks disagreeing must be residents and have not yet felt the gravitas and reality of what the OP is saying. If you talk to literally any practicing radiation oncologist, they would agree with the general points made. Our field is in its death throes. The money is gone, the jobs are gone, and it's getting worse by the day. If you're smart, go into derm or plastic surgery. If you're not, go be a hospitalist and make radonc money but have better control over your schedule and your city. If you're really smart, get out of medicine while you can.

 

[Fpg1245]

I have not posted on this forum in years but cannot thank the OP enough for posting this. I am guessing most folks disagreeing must be residents and have not yet felt the gravitas and reality of what the OP is saying. If you talk to literally any practicing radiation oncologist, they would agree with the general points made. Our field is in its death throes. The money is gone, the jobs are gone, and it's getting worse by the day. If you're smart, go into derm or plastic surgery. If you're not, go be a hospitalist and make radonc money but have better control over your schedule and your city. If you're really smart, get out of medicine while you can.

I just wish I could get these points through to the residents and even the interviewing med students. They are literally being fed lies about this field by their mentors. Makes me sick. I told a guy a few weeks ago who “had to make the tough decision between ophthalmology and Rad Onc”. I cleared the air on that real fast. Hopefully he listened. Residents should really consider their options and even if they are advanced. they should seriously consider jumping ship for greener pastures. I mean doing another residency is probably more palatable than finishing up and scrounging around for a stable job the rest of your life. Right?

The fact that this is one of the longest running top posts on the forum should speak volumes to anybody.

 

[kristofer]

Moderators, this thread title is inflammatory and again biased either by trolls who have only ever posted 1-2 times on this board or by those few who expected the world but didn’t want to work hard for it, just like the OP...

Seriously? You are requesting that moderators censor the title of this thread because you don't like the content and opinions expressed? Really? Yes, the OP doesn't come off as particularly stable and appears to have numerous personal issues, but it's an important topic and shouldn't be swept under the rug because it's inconvenient. If we can't openly discuss things like the job market without people calling for censorship, that speaks to an even bigger problem in the culture.

 

[Sheldor]

I have not posted on this forum in years but cannot thank the OP enough for posting this. I am guessing most folks disagreeing must be residents and have not yet felt the gravitas and reality of what the OP is saying. If you talk to literally any practicing radiation oncologist, they would agree with the general points made. Our field is in its death throes. The money is gone, the jobs are gone, and it's getting worse by the day. If you're smart, go into derm or plastic surgery. If you're not, go be a hospitalist and make radonc money but have better control over your schedule and your city. If you're really smart, get out of medicine while you can.

I actually agree with nearly everything in this thread, but this seems a little extreme. People I talk to mention that job market not being open in big cities, but no one I talk to thinks the field is in its death throes. During my job search I got more interviews that I could go on, all in locations I loved, all for great money. Maybe it just doesn't jive with my personal experience, but for the record, not all residents this last year had a hard time finding jobs. Many I know are quite happy with where they are going and are making double/triple what you would make as a hospitalist.

 

[deleted18755]

I actually agree with nearly everything in this thread, but this seems a little extreme. People I talk to mention that job market not being open in big cities, but no one I talk to thinks the field is in its death throes. During my job search I got more interviews that I could go on, all in locations I loved, all for great money. Maybe it just doesn't jive with my personal experience, but for the record, not all residents this last year had a hard time finding jobs. Many I know are quite happy with where they are going and are making double/triple what you would make as a hospitalist.

I agree as well but as exaggerated as it may have been the OP's intent (or what I think the take away from this thread should be) was not to say how bad things are now or for practicing radiation oncologists to leave their jobs try to switch to become a hospitalist (which would be insane) but to make it clear that the finances of such a small field with relatively limited services can change literally overnight (a single change in compensation for something like IMRT planning, or especially IGRT review, on treatment weekly management, etc) or more slowly but surely and cumulatively over the course of a few years on a fundamental level with less treatments per patient (hypofractionation) AND less payment per treatment in a fee for service model right when a tsunami of new residents are graduating with no end in sight.

For a student with 2-3 years left of school plus maybe a research year plus 5 years residency and maybe even a fellowship the entire game can easily change in 7-10 years with decreased patient volume, decreased compensation per patient, and literally another few thousands residents entering the work force between now and when the medical student graduates (200-250 residents per year x 7-10 years = terrifying and game changing) with nowhere near that number retiring.

Most medical students who seek guidance and advice are probably talking with their academic adviser who has advised thousands of students but like mine had <1% of them go into radiation oncology and had no idea what he was talking about or just basing everything a few random students who matched 5-7+ years before me or a radiation oncologist in an academic center who has been practicing for a decade and may be well intentioned but is somewhat insulated from all of this and is likewise providing information that is outdated by a decade instead of giving a reasonable forecast for a decade from now. . . I'm afraid current medical students are going to enter the workforce in 2028 not only shocked that it isn't like it was in 2018 but having expected it to be like their advisers described it was in 2008!

 

[nkmiami]

I agree as well but as exaggerated as it may have been the OP's intent (or what I think the take away from this thread should be) was not to say how bad things are now or for practicing radiation oncologists to leave their jobs try to switch to become a hospitalist (which would be insane) but to make it clear that the finances of such a small field with relatively limited services can change literally overnight (a single change in compensation for something like IMRT planning, or especially IGRT review, on treatment weekly management, etc) or more slowly but surely and cumulatively over the course of a few years on a fundamental level with less treatments per patient (hypofractionation) AND less payment per treatment in a fee for service model right when a tsunami of new residents are graduating with no end in sight.

For a student with 2-3 years left of school plus maybe a research year plus 5 years residency and maybe even a fellowship the entire game can easily change in 7-10 years with decreased patient volume, decreased compensation per patient, and literally another few thousands residents entering the work force between now and when the medical student graduates (200-250 residents per year x 7-10 years = terrifying and game changing) with nowhere near that number retiring.

Most medical students who seek guidance and advice are probably talking with their academic adviser who has advised thousands of students but like mine had <1% of them go into radiation oncology and had no idea what he was talking about or just basing everything a few random students who matched 5-7+ years before me or a radiation oncologist in an academic center who has been practicing for a decade and may be well intentioned but is somewhat insulated from all of this and is likewise providing information that is outdated by a decade instead of giving a reasonable forecast for a decade from now. . . I'm afraid current medical students are going to enter the workforce in 2028 not only shocked that it isn't like it was in 2018 but having expected it to be like their advisers described it was in 2008!

Thank you. I keep repeating the same thing over and over again. Major supply and demand issues here, and a professional society whose short sighted self interests diverge from its members. Residency positions in this once tiny field have more than doubled and continue to expand, yet some question "wheres the evidence that this (more residents/less fractions) will affect the job market." Such extreme evidence-based-idiocy logic should only be used to make really bad decisions about patient care at a tumor board, not on something vital to our livelihood.

 

[Neuronix]

During my job search I got more interviews that I could go on, all in locations I loved, all for great money.

I'd be curious to talk offline about where you were looking. My job search was not like this at all.