FWIW Residency Expansion and Job Market Panel at ARRO Seminar

[medgator]

'radiation OR oncologist OR central OR pennsylvania/harrisburg OR pa OR STATECODE:"PA"' Jobs | ASTRO Radiation Oncology Career Center

1,685 'radiation OR oncologist OR central OR pennsylvania/harrisburg OR pa OR STATECODE:

careers.astro.org

Will consider 2020 radiation oncology residency and fellowship graduates for candidacy

There you have it folks.... Residents are officially competing with non acgme fellowship trained grads for a hospital-based general practice job.

May the odds be ever in your favor

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[xrthopeful]

That’s been the case ever since rad onc fellows have existed, lol?

 

[medgator]

That’s been the case ever since rad onc fellows have existed, lol?

Have non academic/community general practice jobs listings been posting that they have been looking for fellows all that time? Try to be honest about things.

Do you think the fellowship trained individual applying for this job will:

1). Use their fellowship training in that position?

And/or

2). Get extra pay because they did that nonaccredited fellowship?

 

[RadOncDoc21]

I see, there is a separation now. It used to not be acknowledged but this is the first time I’ve seen it advertised.

 

[medgator]

I see, there is a separation now. It used to not be acknowledged but this is the first time I’ve seen it advertised.

And if it comes down to 2 applicants equal on paper and the interview, except one is "fellowship-trained" who do you think will get the job?

 

[xrthopeful]

 

[xrthopeful]

The entire thread of replies is well worth a read by anyone interested in the residency expansion/match story.

 

[SubserviantToABR]

The entire thread of replies is well worth a read by anyone interested in the residency expansion/match story.

Oy... to some (but not all, to be fair) of the responses on that thread. That is the problem. These people in academics live in their bubbles, completely closed off from the realities of the real world. It is extremely disingenuous to say "A lot of it was based on misinformation and unrealistic fear of the job market. However it’s our job to correct those" OR "Unfortunately the decline in numbers of applicants is not based on facts"

Well then, correct it. Where are the jobs? More specifically and importantly, where are the jobs where you will be treated fairly, either as an employee or a partner? The gall of people like that, one of whom is at a program proliferating satellites all across Pennsylvania and the other is babysitting at a Memorial satellite located 30 miles away (by car) from the main Manhattan center.

To those on the thread that wrote this stuff, things are fine if you want to do academics and don't care where you go and believe whatever BS you want from your Ivory Tower. But for the majority of those, who are talented, compassionate physicians, we expect to be treated and reimbursed fairly, to work in an environment where we can actually be physicians, instead of being puppets to the chair or administration. This is what med students are hearing because that is what the recent grads/senior residents are seeing for their futures.

I hope Trevor is right in that the larger programs are considering contraction...but I'm not holding my breath.

In the words of James Carville, [it's] the economy, stupid.

 

[xrthopeful]

I think most of the replies from all of
The academics in the thread were reasonable and spot on.

Dr. Tsai seems To be a bit out of the loop

 

[xrthopeful]

 

[deleted941485]

Let’s not fool ourselves, these academic medical centers are making a big play into the healthcare business with these satellites.

The incentives are so perverse now and so entrenched that I don’t even see how voluntary contraction would even be tolerated in a system that relies on screwing the physician.

 

[deleted941485]

To Goodman’s point, I’d like to think that these PDs and chairs can see the light and the adverse implications it has, but money, ambition, and coercion are powerful motivators.

Unfortunately, the path of least resistance seems to prevail.

 

[deleted956486]

Let’s not fool ourselves, these academic medical centers are making a big play into the healthcare business with these satellites.

The incentives are so perverse now and so entrenched that I don’t even see how voluntary contraction would even be tolerated in a system that relies on screwing the physician.

I'd bet my career that contraction will be irrelevant. Why? Even if they do, unless all programs contract it wouldn't work. Let's play it out. Harvard, MD Anderson and 5 other programs contract. Meanwhile you can still be a rad onc if you go to Allegany or Northwestern. After a few years Allegany is milking the system while Harvard is paying for it. What happens? Harvard expands again. It's all a ruse.

Good news is these academics and their chairs are in the same position as their graduating residents...having to scrounge for leftovers. KARMA

 

[xrthopeful]

I’m just happy multiple PDs in that thread - Rush, Vanderbilt, CCF, UPMC are on board with not SOAP-ing any Tom, Dick, or Harry

In fact, UPMC proved it last year, they did not SOAP

 

[GapCalc]

I'll admit, I'm happy to see some acknowledgement of this issue that has literally been discussed here for 6 years. Now, maybe 7 years later, some action? I won't hold my breath. That being said, a few Tweeters are are saying that this is an overcorrection, or that the issue is not based in fact.

I take some issue with that.

“Brave” members of the “No Questions, Please” job panel at ASTRO this year referred to a paper evaluating job offers amongst recent graduates. The FIFTEEN authors evaluated satisfaction of applicants as they related to three factors: location, metro size (population), and job type (academic vs private). Lo and behold, most received at least one if not more of their preferred factors in their job offer. Over half received an offer with all 3!

There are numerous reasons why citing this paper is a Bad Decision when it comes to arguing that things are all right with the job market. First, it examines job application patterns, not actual job taken. If you got that private practice offer but they low-balled you, then you technically counted as 'getting what you wanted' in this survey even if you didn't sign the contract. Second, 'geographic location' was defined by US census regions. I don't know about you, but just about 0% of the residents I know are looking for a job in a US census region. They are looking for a job in a city, or maybe even a state. Third, they make no mention if the 'academic' positions are truly academic with protected time and research support or satellite jockeys AKA Academic In Name Only (AINO). Fourth, and perhaps most damning, is that somewhere around 17% of job applicants did not get a single job offer that matched any of their 3 categories (census region, practice type, or metro size).

Would you take a 1 in 6 chance of ending up in a job that didn't meet any of three overly-broad criteria? If not, why would you ever choose radiation oncology?

 

[deleted956486]

Would you take a 1 in 6 chance of ending up in a job that didn't meet any of three overly-broad criteria? If not, why would you ever choose radiation oncology?

1 in 6 chance for 5 years of wasted time when you could have a guarantee in 3 years.

 

[scarbrtj]

"Unfortunately the decline in numbers of applicants is not based on facts"

(Not directed to you @Subserv. Btw, discussing on twitter is unfruitful w/ its character limits, and I'm paid by the character.) What I would hope--and shame on me if not--is that I have never put forth anything re: the rad onc job market that was not objectively verifiable. It's just too easy to prove someone wrong when they're wrong nowadays. I have previously in this forum went into some detailed exposition about the number of radiation oncologists in the US over the last ~15 years (a detailed exposition that's just impossible to do on twitter). In brief, the number of academic MDs has increased even more so than residency expansion, and the academic expansion predated the residency expansion just a bit. The recent ASTRO workforce study showed that private practice is rapidly dwindling and academic/employed is increasing. It's a Will Rogers-ing/zero-summing where the academics (honestly) see a growing job market (more satellites e.g.), increased "work" (hence needing residents, hence starting new residency programs etc.) while in reality the demand for radiation oncology itself has remained stable or decreased (hypofx e.g.). So there's been a shortsighted, insular burgeoning of the rad onc supply without attendant demand increases and now... well, now is now. If the academics cut residents they will cut their coverage; minor decreases in their QOL but decreases nonetheless. It will make these presently bearable hemi-AINO (@GapCalc) situations into uber-AINOs. Tenable in the long-term? What we are talking about is a group of humans willingly inflicting pain on themselves. Typically, humans do not do that.

 

[deleted573262]

We are certainly in for an intriguing year. This year we've got about 200 spots. Taking 1/6 spots away puts us around 160 spots. I still think the market could contract a little more to 150 or so. 1/4 decrease in size and instead of 52% of people getting their preferred jobs will increase to closer to 2/3. That's a good number. I hope these big programs buck up and don't match as many and I hope smaller programs do the same. Although, I fear the bigger programs will collect all of great applicants and the smaller, pseudo-PP residencies will find a warm body in the SOAP.

 

[xrthopeful]

Anyone applying this year posting here? If you have reasonable stats and rad onc experience you’re prob gonna have a sick match.

 

[Krukenberg]

I'd bet my career that contraction will be irrelevant. Why? Even if they do, unless all programs contract it wouldn't work. Let's play it out. Harvard, MD Anderson and 5 other programs contract. Meanwhile you can still be a rad onc if you go to Allegany or Northwestern. After a few years Allegany is milking the system while Harvard is paying for it. What happens? Harvard expands again. It's all a ruse.

Good news is these academics and their chairs are in the same position as their graduating residents...having to scrounge for leftovers. KARMA

It’s the programs that have a reasonable chance of not filling that should contract (and would be smart to contract).

 

[deleted573262]

It’s the programs that have a reasonable chance of not filling that should contract (and would be smart to contract).

Programs taking 1 applicant aren't suddenly going to see this decrease in applicants and decide it's time to close shop.

 

[deleted956486]

I don't see the sweet side of matching to your number one if the field is collapsing. Unless of course you're trying to get a green card. Then it's a win-win. Get your greencard and probably will make more money than wherever you're from-even as a fellow. US grads? Any way you spin it, it's a loss.

 

[medgator]

It’s the programs that have a reasonable chance of not filling that should contract (and would be smart to contract).

Correct. Honestly, the Arkansas, Mayo Scottsdale's, WVUs and LIJs of the country should just disappear. They honestly haven't been open that long to begin with and are the most visible symptom of the problem

 

[xrthopeful]

 

[Lamount]

How does this work now? Are there places that are going to rely on SOAP to fill all of their spots?

 

[deleted774703]

How does this work now? Are there places that are going to rely on SOAP to fill all of their spots?

 

[deleted774703]

Above is the fear if All these programs keep soaping just for free labor

 

[deleted774703]

I think most of the replies from all of
The academics in the thread were reasonable and spot on.

Dr. Tsai seems To be a bit out of the loop

Yeah agree. After reading through the threads, Tsai is batty

 

[deleted573262]

“There’s no problem here”
It’s not like everyone halfway considering applying to radonc doesn’t know there was a ASTRO panel this year in which Duke PD, UCLA chair, ACGME vice chair and Ben Falit agreed that there was a serious problem...
Does she think some med student is gonna read her twitter and be like oh well I guess it’s all peachy then?

it sounds like residency expansion is a problem which is recognized on sdn and #radonc. we will see how this year plays out with SOAP or no SOAP.

 

[RadOncMegatron]

I think for the most part I was encouraged by the thread. A lot of people came on acknowledging the issue. The problem is real and solutions need to come, but wonder if Zeitman was right and that the market has corrected itself via applicants fleeing? Hopefully, programs will not fill their slots on SOAP as alluded to, but I need to see it to believe it. Alas, the people have spoken and hopefully residency contraction will commence.

 

[MegaVoltagePhoton]

Don't be too hopeful. This is going to be the narrative



(i.e., the "We might get less qualified applicants, but who cares, we should never have cared about scores" response)

 

[deleted774703]

Don't be too hopeful. This is going to be the narrative



(i.e., the "We might get less qualified applicants, but who cares, we should never have cared about scores" response)

Never trust someone from MSKCC or MDACC on residency issues

 

[medgator]

Never trust someone from MSKCC or MDACC on residency issues

Or Mayo for that matter

 

[medgator]

Don't be too hopeful. This is going to be the narrative



(i.e., the "We might get less qualified applicants, but who cares, we should never have cared about scores" response)

Wow..... Huge denial/reality distortion going on over there, along with some gaslighting.

Rad onc as specialty was in a tough place in the mid 90s. Programs closed and training was extended by a year during that time to deal with all the people who couldn't find jobs

 

[xrthopeful]

Who the hell is going to willingly choose Rochester MN over other great locations that have good programs this year

 

[utubefan]

Correct. Honestly, the Arkansas, Mayo Scottsdale's, WVUs and LIJs of the country should just disappear. They honestly haven't been open that long to begin with and are the most visible symptom of the problem

Hold up. Just because a program is new doesn't mean it should disappear.

I can attest at least one of the above programs was created for educational good and not for coverage (some of my attendings are probably more efficient without a resident and have to slow down to teach us), matched last year despite other several more established regional institutions not matching (and those other established institutions, some of which do need the warm bodies, then SOAPed residents who didn't match into ENT and Derm), and its grads are kicking butt as attendings (moderating ASTRO panels, jobs at top institutions, etc.).

Kudos to Tendulkar, Beriwal, etc. Let's keep this field to people who actually want to do it/worked hard to get into it in the first place and let them go where they want to go, including the new places, if they attract them. These new residencies may be creating some good for the future of rad onc with some applicants who wanted to go to those places/ranked them highly (like me!). I agree more with not opening up the field to any warm body by not SOAP-ing, which my PD is actively considering as well.

 

[medgator]

Hold up. Just because a program is new doesn't mean it should disappear.

I can attest at least one of the above programs was created for educational good and not for coverage

The bottom line is, we don't need to be educating as many radiation oncologists no matter how great your program is. It's a waste/maldistribution of societal resources/Medicare gme funding and is actively hurting the specialty

Personally, I'd be fine with every new program/expanded slot this decade being nixed to bring us back down to <130 slots/year. That's as many rad oncs as we need honestly.

This whole expansion thing started as a way for academic chairs to reduce salaries for academic ROs. Time to put a stop to that

Kudos to Tendulkar, Beriwal, etc. Let's keep this field to people who actually want to do it/worked hard to get into it in the first place and let them go where they want to go, including the new places, if they attract them. These new residencies may be creating some good for the future of rad onc with some applicants who wanted to go to those places/ranked them highly (like me!). I agree more with not opening up the field to any warm body by not SOAP-ing, which my PD is actively considering as well.

Programs that actively SOAP on an annual basis should be publicly shamed here and on Twitter imo

 

[Lamount]

Perhaps this a reasonable way to limit residency expansion. As a requirement of accreditation, every program needs to get at least one applicant through the match every year. I can’t imagine that would violate anti-trust laws as the free “market” of applicants would ultimately determine the number of programs.

 

[deleted941485]

The bottom line is, we don't need to be educating as many radiation oncologists no matter how great your program is. It's a waste/maldistribution of societal resources/Medicare gme funding and is actively hurting the specialty

Personally, I'd be fine with every new program/expanded slot this decade being nixed to bring us back down to <130 slots/year. That's as many rad oncs as we need honestly.

This whole expansion thing started as a way for academic chairs to reduce salaries for academic ROs. Time to put a stop to that



Programs that actively SOAP on an annual basis should be publicly shamed here and on Twitter imo

We don’t need to train that many rad oncs even if we have the capacity not only because it’s a waste of CMS funds but more importantly because it’s clearly becoming a waste of time and money for medical students whose time and effort could be better spent in another area.

 

[seper]

Program directors working for hospitals are rightfully worried. I know firsthand that some of the people mentioned above are evaluated based on the overall health of their residency program, which of course includes filling the spots.

 

[TheIllusionist]

I am double applying, leaning hard on medicine for now. Only will rank elite tier of rad onc, if I get interviews. Have 4-5 ranked 25-50 programs on Doximity so far for IM, so not the best, but strong ones nonetheless. Did a Heme Onc rotation and enjoyed it a lot.

Again stats wise, all clinical honors, high 240s step1, low 260s step2ck, no AOA, 4 abstracts, 1 poster, 1 oral, 1 translational paper all rad onc specific. Some unique med policy leadership and ECS.

 

[TheIllusionist]

I think this is a strategy many should follow. Many apply IM prelim anyway so you will effectively have an IM application prepared. Just rank top radonc programs and below that top IM categoricals and plan on doing a medonc fellowship.

I just recommend getting letters early. I had to get 9 total- 4 rad onc, 4 medicine, 1 prelim rad onc medicine letter (my other medicine letters read as categorical and heme onc intending, as relayed to me by the writers).

 

[scarbrtj]

I am double applying, leaning hard on medicine for now. Only will rank elite tier of rad onc, if I get interviews. Have 4-5 ranked 25-50 programs on Doximity so far for IM, so not the best, but strong ones nonetheless. Did a Heme Onc rotation and enjoyed it a lot.

Again stats wise, all clinical honors, high 240s step1, low 260s step2ck, no AOA, 4 abstracts, 1 poster, 1 oral, 1 translational paper all rad onc specific. Some unique med policy leadership and ECS.

If I truly truly truly loved rad onc and wanted to do nothing else... I’d go do medicine for three years. So you can be ABIM and have a lifetime of potential options. Then go and do rad onc. On one hand it’s three years of life wasted. On the other hand, maybe not. To paraphrase Billy Joel slow down you crazy child rad onc waits for you. (Don’t you love it when randos offer major life advice.)

 

[deleted573262]

Actually only two years wasted since you’d have to do prelim intern year anyway. Also PGY-3 IM is a bit of a cakewalk compared to 1-2 so it’s really only one extra hard year and might save your future if/when radonc truly implodes.

pgy3 IM residents work less than pgy2-5 rad onc residents. no question.

 

[medgator]

pgy3 IM residents work less than pgy2-5 rad onc residents. no question.

I get the sense that pgy2 is by far the toughest year.... You're responsible for checking up the on interns and making sure everything gets caught and the service runs.

 

[deleted573262]

I get the sense that pgy2 is by far the toughest year.... You're responsible for checking up the on interns and making sure everything gets caught and the service runs.

Totally. I think pgy2 is the most difficult regardless of the specialty. For rad onc, it is a foreign topic and steep learning curve. For IM, it is being in charge of a small team while still making sure the ship is orderly when the attending comes around.

 

[evilbooyaa]

PGY-3 IM is certainly more difficult than PGY-5 Rad Onc... and definitely more difficult than the research 6-12 months built into a rad onc residency.

Let's not hyperbole by saying that our residency is MORE difficult than even IM. They have overnight calls, nights, etc. They may get 6 or 9 months of elective but we get 12 months of elective (in regards to not requiring weekend rounds/notes/etc.)

Dr. Tendulkar was right last year. I hope he's right this year. I hope that programs would rather take nobody than fill up on derm/ophtho rejects. Maybe the secret will get out to DOs and IMGs next year.

This will be a golden opportunity to rid the radonc world of malignant programs. Scut factories are on notice.

Ask questions, applicants. You are in the driver’s seat this year. Just because a program ranks highly on Doximity doesn’t mean you won’t be miserable there and it certainly doesn’t mean they will support you getting a good job.
Are you expected to provide cross coverage? Are rotations designed around educational yield or around providing attending coverage? Have you ever broken ACGME case limits? Are you encouraged to record your cases honestly? Do you have 100% resident-led didactics (I.e little faculty teaching) Are there any faculty that residents do not enjoy working with (don’t ask for specific names)? Have faculty been active in helping residents secure jobs? These are legitimate questions that you can ask more or less directly.

But really the key question you need to determine is this: did the program director coach residents to misrepresent the program or are they able to talk freely about it? Residents will not answer this directly (and it’ll make you look bad to ask it), but there are ways you can get at it:

1) Damning by faint praise. If people give vague or less than enthusiastic answers, it’s likely that they are trying to avoid saying things they are not “supposed” to say.

2) Repetitive answers - if you hear the same line from many residents in a way that sounds plagiarized, it’s likely they were coached to say it.

3) Saying nothing bad at all. All programs have issues. If nobody can bring up or honestly discuss a negative issue, it’s because they are afraid to and it’s an oppressive environment. Good programs identify issues and fix them promptly.

4) Use the spreadsheet. If you have information about a program (good or bad), SHARE IT!

This is an opportunity to put the squeeze on abusive programs and improve resident education and quality of life across the board in radonc! Programs must provide value to their residents or go unfilled.

Absolutely correct. As a current resident, I ALWAYS talk about the weaknesses of my program. We had a year where the scheduling was rough and we told people about it. We have not had a year since inception (AFAIK) that we have not fully filled in the match. I've had applicants come up to me afterwards and thank me for being willing to say anything beyond just "it's all great you should totally come here please".

I'm going to take the same approach this year - med student applicants, let me sell you on why our program is so great. I'm tempted to incorporate bits and pieces of the above quoted post on a flash card so I can address all these questions directly during the resident/applicant alone time that is built into the residency day.

 

[medgator]

PGY-3 IM is certainly more difficult than PGY-5 Rad Onc... and definitely more difficult than the research 6-12 months built into a rad onc residency.

Let's not hyperbole by saying that our residency is MORE difficult than even IM. They have overnight calls, nights, etc. They may get 6 or 9 months of elective but we get 12 months of elective (in regards to not requiring weekend rounds/notes/etc.)

Speak for yourself. Those of us that went to high volume mid tier places at smaller academic centers had to always cover attendings, even cross cover and got more like 3-6 months out of clinic for electives/research, if that.

My program wasn't as bad in retrospect for preparing me for a busy full spectrum clinical practice, but in the current era, I imagine they and many others may have trouble filling...

 

[evilbooyaa]

Speak for yourself. Those of us that went to high volume mid tier places at smaller academic centers had to always cover attendings, even cross cover and got more like 3-6 months out of clinic for electives/research, if that.

My program wasn't as bad in retrospect for preparing me for a busy full spectrum clinical practice, but in the current era, I imagine they and many others may have trouble filling...

Yes but consider the fact that what we call a regular clinic rotation (even with clinic cross-coverage, as painful as that is) is what IM residents call an elective month. No call, no weekends? That's our life most of the 365 days in a year.

And yes, the amount of research time is variable and I question the utility of it rather than just letting me graduate a year early, but I certainly think 3 months is not sufficient to expect any sort of actual research output.