Guessing # unmatched spots

[deleted947887]

Congrats to all those who didn't match into rad onc today. For those who matched, don't worry the guys on top are fixing everything . They're gonna make radonc great again! They have a great plan to hustle next year's medical students--I mean, increase visibility.

(HonestIy, do not despair, you can still switch out during your intern year).

Congrats!

---

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[metallica81788]

There is data published in JAMA that married physicians with highly educated spouses are less likely to work in a rural area (PMID: 26934264). Younger, female, black, and hispanic physicians are less likely to take rural positions. Unfortunately, this is a major problem for our field with it's strict geographic limitations as more women enter the specialty, since women are far less likely to have a stay at home spouse than men are. I don't know of any evidence regarding location of residency training and rural practice; that would be a good project for someone to tackle.

This is such a key point and one that is consistently ignored. Personally true for many that I know.

This is also personally true for me. There are lots of challenges for the above mentioned groups in rural areas, but it’s a difficult problem to address.

Very good points. It's even true for married people with stay-at-home spouses. Even if the physician wants to work in a rural area, many spouses may not want to relocate to rural areas if they are at home with less options and activities to occupy the time for themselves and/or children and family, whether that is true or perceived. That could lead to isolation and depression issues.

 

[Lamount]

Congrats to all those who didn't match into rad onc today. For those who matched, don't worry the guys on top are fixing everything . They're gonna make radonc great again! They have a great plan to hustle next year's medical students--I mean, increase visibility.

(HonestIy, do not despair, you can still switch out during your intern year).

Congrats!

This is a bitter and inappropriate comment on match day. Just because things didn't turn out the way you would have wanted, it doesn't mean that all will share your fate. Today isn't about you and your problems.

 

[RANDO_Phantom]

Someone is going to be hurt no matter what. I hope whatever happens, we make sure the current residents are not hurt and bigger programs step up and absorve them. The ABR leadership is disgusting, arrogant, out of touch, corrupt, criminal. Anything associated with their views is repulsing to me at this point.

Does anyone have any deets/money facts for ABR, esp. in light of this lawsuit?

 

[RickyScott]

Very good points. It's even true for married people with stay-at-home spouses. Even if the physician wants to work in a rural area, many spouses may not want to relocate to rural areas if they are at home with less options and activities to occupy the time for themselves and/or children and family, whether that is true or perceived. That could lead to isolation and depression issues.

The fluffers on twitter would have you believe, that to be "worthy," you must sacrifice everything for your true xrt "passion," whether that mean moving to BFE or a multi year fellowship in lung stereo at Stanford. Somehow what gets lost is that there are multiple interesting dynamic fields and you likely, will end up engaged with a life-long interest in whatever specialty you end up in.

 

[TDDro]

Hey guys, just a small request:

Don't use the google spreadsheet Match List to snipe at people (Kachnic, Wallner). Beyond the fact that it's a small-minded move on an important day for a lot of people, you're using a program for the butt of your joke. Someone matched there, and they don't think it's a joke. Don't be a dick.

Dunno if it's anyone here doing it, just figured I'd spread the plea.

 

[deleted947887]

Agree. Kachnic and Wallner should be admired. They pulled off something magnificent.

Hey guys, just a small request:

Don't use the google spreadsheet Match List to snipe at people (Kachnic, Wallner). Beyond the fact that it's a small-minded move on an important day for a lot of people, you're using a program for the butt of your joke. Someone matched there, and they don't think it's a joke. Don't be a dick.

Dunno if it's anyone here doing it, just figured I'd spread the plea.

 

[TDDro]

Whatever your beef with them, that's not the forum. It's a real dick move to crap on someone's match day to take a shot at someone else who doesn't even see it.

 

[deleted947887]

Whatever your beef with them, that's not the forum. It's a real dick move to crap on someone's match day to take a shot at someone else who doesn't even see it.

100%. No cyberbullying.

 

[RickyScott]

Does anyone have any deets/money facts for ABR, esp. in light of this lawsuit?
View attachment 253959

is there a chairman of radiology at any major academic center or employed in a large health care system that earns anything close to this?

 

[deleted947887]

is there a chairman of radiology at any major academic center or employed in a large health care system that earns anything close to this?

MOC was designed to keep grandfathered chairs in place. Look at rad onc. How many chairs in rad oncs are grandfathered in. Take a look. You will be surprised. Then you will begin to understand why nothing was done about the ABR fiasco...can't bite the hand...

 

[deleted947887]

ARRO/ASTRO Bulletin Board for Residency/Fellowship Openings

Ha. ARRO throwing shade at SDN.

 

[DebtRising]

There's a large and inconceivable disconnect between a field that focuses on data minutiae, and even takes pride in it, but then has a collective melt down to analyzing the data about jobs and future employment.

SDN didn't publish the projection that we are training more residents than needed. It can be argued that projections are not facts. This is true. However that same methodology was the bedrock of expansion, as blessed by ACGME, SCAROP, ASTRO, and all other organizations who want to take responsibility sometimes, but only when it suits them. None were excising caution about expansion of 50% of slots when based on only a projection.

Similarly, SDN did not expand fellowships from the teens to mid 20s-30s in a few years. At least I don't think we did. It is a curious piece of data that programs were able to open more fellowships, which do not provide any new or unique skills, if the job market was so robust.

Did SDN have 50% of the practicing workforce fill out their surveys to say 'oversupply' was the main concern of the field? I wonder.

There are hard and soft data points. Employment is difficult to get a good handle on. There was one PRO report that for 1 year the job posting matched the number of new residents as the only data point in the affirmative. Hypofraction is less treatment - can be a wonderful thing for patients, should be encouraged, but someone has to explain this math to me how it magically equals more patients. The only firm data point about hypofractionation is that we are treating less.

SDN is great for bringing perspectives otherwise not allowed to be said. The rise of the satellite job - private practice work for academic pay and bureaucracy for instance - which otherwise has no way of filtering to medical students and is a very real and poor change for the field (poor in the sense is it limits advancement and opportunities compared to the generation who came before, whether it was there overt intent or not).

This forum and it's discussions are worth defending, and even with the emotion and derision no one on the ASTRO forums or twitter have taken any significant stab at addressing the above points.

 

[deleted947887]

Only reason twitter tools hate sdn is because it chips away at their control. This is the one place chair=PD=junior faculty=resident = medical student.

It's hard to let go of power. I mean, look at the ABR.

There's a large and inconceivable disconnect between a field that focuses on data minutiae, and even takes pride in it, but then has a collective melt down to analyzing the data about jobs and future employment.

SDN didn't publish the projection that we are training more residents than needed. It can be argued that projections are not facts. This is true. However that same methodology was the bedrock of expansion, as blessed by ACGME, SCAROP, ASTRO, and all other organizations who want to take responsibility sometimes, but only when it suits them. None were excising caution about expansion of 50% of slots when based on only a projection.

Similarly, SDN did not expand fellowships from the teens to mid 20s-30s in a few years. At least I don't think we did. It is a curious piece of data that programs were able to open more fellowships, which do not provide any new or unique skills, if the job market was so robust.

Did SDN have 50% of the practicing workforce fill out their surveys to say 'oversupply' was the main concern of the field? I wonder.

There are hard and soft data points. Employment is difficult to get a good handle on. There was one PRO report that for 1 year the job posting matched the number of new residents as the only data point in the affirmative. Hypofraction is less treatment - can be a wonderful thing for patients, should be encouraged, but someone has to explain this math to me how it magically equals more patients. The only firm data point about hypofractionation is that we are treating less.

SDN is great for bringing perspectives otherwise not allowed to be said. The rise of the satellite job - private practice work for academic pay and bureaucracy for instance - which otherwise has no way of filtering to medical students and is a very real and poor change for the field (poor in the sense is it limits advancement and opportunities compared to the generation who came before, whether it was there overt intent or not).

This forum and it's discussions are worth defending, and even with the emotion and derision no one on the ASTRO forums or twitter have taken any significant stab at addressing the above points.

 

[KHE88]

There is data published in JAMA that married physicians with highly educated spouses are less likely to work in a rural area (PMID: 26934264). Younger, female, black, and hispanic physicians are less likely to take rural positions. Unfortunately, this is a major problem for our field with it's strict geographic limitations as more women enter the specialty, since women are far less likely to have a stay at home spouse than men are. I don't know of any evidence regarding location of residency training and rural practice; that would be a good project for someone to tackle.

So if "younger, female, black, and Hispanic physicians" are truly more likely to gravitate to oversaturated markets in coastal cities and less likely to take rural positions that have been desperately trying to hire anybody for years, then how do we solve the maldistrubtion problem and lack of quality oncology care in rural areas?

Surely you're not suggesting we focus on recruiting more older white christian males right from rural red states to enter the field over younger black and Hispanic females? Write that up and submit it to the NEJM and see how that goes. Hell, just propose that study and see what happens to your career.

The solution to the maldistrubtion problem in rural America is clear: Shut down the small midwestern program with <6 residents and increase the spots in the big cities. They have inferior rad bio training anyway.

 

[KHE88]

Congrats to all those who didn't match into rad onc today. For those who matched, don't worry the guys on top are fixing everything . They're gonna make radonc great again! They have a great plan to hustle next year's medical students--I mean, increase visibility.

(HonestIy, do not despair, you can still switch out during your intern year).

Congrats!

Dude, your trolling is getting out of hand and making those of us with legitimate gripes look bad. This is a really really mean-spirited comment aimed at innocent med students. You want to launch backhanded personal insults at the ABR, be my guest. But not against a handful med students on the worst day of their lives.

A sarcastic/snarky/angry comment here and there is one thing (I've certainly done it) but it's literally all you post.

You complain, complain, complain and scream that everyone need to file lawsuits, telling everyone to switch to med onc, etc. Put your money where your mouth is, file a lawsuit, and switch to med onc. Otherwise stop with the over-the-top do-as-i-say-not-as-i-do hyperbole.

 

[thecarbonionangle]

It is an interesting issue in all of medicine. Females work part time more, practice medicine less, and go to less under-served areas. So do minorities. There are obvious reasons for some of these things. Rad onc has a lot of ethnic minorities (mostly asian) and with the increase of females as well, our rad onc workforce is more diverse etc. People want to be near their people. People are tribal, they want to be near their food, religious centres, etc. I mean can you really blame an ethnic minority for not being too happy about practicing in an area where multiple people show up in MAGA hats for treatment? Hispanics and AA are absolutely the most underrepresented in rad onc and places like that may be scary for them.

 

[thecarbonionangle]

Only reason twitter tools hate sdn is because it chips away at their control. This is the one place chair=PD=junior faculty=resident = medical student.

It's hard to let go of power. I mean, look at the ABR.

Where do we go from here though? Snowflakes and fluffers pander, cant call spade a spade. There doesn’t seem to be anything changing. This SOAP issue is the best thing to happen to the field recently. Multiple FMGs matched this year, congrats to them. it will get worst and maybe once places in the bubble struggle to fill, things will change. Look at path, even in “big name places” mostly FMGs.

I’m not feeling positive. Even if my own personal fortunes remain ok, i have a terrible taste in my mouth about the leaders in the field and the malaise i feel. It disgusts me. I need leaders to inspire me and snap me back

 

[scarbrtj]

Does anyone have any deets/money facts for ABR, esp. in light of this lawsuit?
View attachment 253959

For the psychiatrists this looks like a case of classic transferrance.

Transferrance of money from the physicians’ wallets into the wallets of those at the psych board.

Ain’t nobody at the ABR making close to a million. They’re doing ok but not a million. If they were there’d be mass rebellion. As sanctimoniously ossified and tone-deaf Wallner is, for him it’s not about money. It’s just about being drunk with what little power he has, and like an MLB umpire, never never never never ever being able to admit a mistake.

 

[ranson]

Official Match Data: https://mk0nrmpcikgb8jxyd19h.kinsta...oads/2019/03/Advance-Data-Tables-2019_WWW.pdf

2019:
Unfilled programs: 21
Applicants: 192 (163 US seniors)
192 positions offered, 86 programs
No. of matches: 163 (147 US seniors)

2018:
Unfilled programs: 5
Applicants: 222 (194 US seniors)
177 positions offered, 85 programs
No. of matches: 172 (162 US seniors)

Number of applicants dropped by 30, # of programs were the same, yet number of positions increased (probably due to expansion of existing residency programs).

 

[medgator]

Official Match Data: https://mk0nrmpcikgb8jxyd19h.kinsta...oads/2019/03/Advance-Data-Tables-2019_WWW.pdf

2019:
Unfilled programs: 21
Applicants: 192 (163 US seniors)
192 positions offered, 86 programs
No. of matches: 163 (147 US seniors)

2018:
Unfilled programs: 5
Applicants: 222 (194 US seniors)
177 positions offered, 85 programs
No. of matches: 172 (162 US seniors)

Number of applicants dropped by 30, # of programs were the same, yet number of positions increased (probably due to expansion of existing residency programs).

Hopefully this will be a turning point, not holding my breath though.

What awful numbers compared to last decade.

 

[PhotonBomb]

Hopefully this will be a turning point, not holding my breath though.

What awful numbers compared to last decade.

you mean compared to last year? there were more applicants than spots last year. this is the year that was a shift.

think it's important people keep in mind that this isn't a trend, yet. This was one year. Will be really interesting to see what happens this next year.

 

[Chartreuse Wombat]

Official Match Data: https://mk0nrmpcikgb8jxyd19h.kinsta...oads/2019/03/Advance-Data-Tables-2019_WWW.pdf

2019:
Unfilled programs: 21
Applicants: 192 (163 US seniors)
192 positions offered, 86 programs
No. of matches: 163 (147 US seniors)

2018:
Unfilled programs: 5
Applicants: 222 (194 US seniors)
177 positions offered, 85 programs
No. of matches: 172 (162 US seniors)

Number of applicants dropped by 30, # of programs were the same, yet number of positions increased (probably due to expansion of existing residency programs).

I think it is worse than that.

The total number of positions offered is higher, over 200 total. PGY-1 (6 programs, 15 positions) and PGY-2 (86 programs, 192 positions).

Total positions 207

Forty more positions than US Seniors. I am pretty confident that the 10% rate of unfilled positions is a record.

Another metric...US Seniors are filling less than 80% of positions offered. That number has been over 90% (even >95% in some years) for the last decade.

Nothing to see here; move along. /sarc

 

[medgator]

I think it is worse than that. The total number of positions offered is higher, over 200 total. PGY-1 (6 programs, 15 positions) and PGY-2 (86 programs, 192 positions).

Forty more positions than US Seniors. I am pretty confident that the 10% rate of unfilled positions is a record.

Nothing to see here; move along. /sarc

IGRT babysitters are going to be cheap in 2025+

 

[deleted947887]

Not exactly sure what you are basing this on. The field went from top 3 competitive specialty to a backup specialty in the span of 8-10 years. If that's not a trend, I dont know what is. SMH*

*I just realized you're a junior resident. Keep convincing yourself that this isn't that bad. It keeps the demons away at night.

I love how the former ASTRO president uses the argument that we can't limit supply because of the law, to defend promoting a dead specialty to medical students. I'm pretty sure the law doesn't want people to waste 5 years training for a specialty with plenty of providers. Rather than promoting this dying field, why not just let the market work? Oh wait, I forgot, Colorado needs scribes and junior faculty babysitters. The icing on the cake? The canaries leading other canaries to the coal mine.

Alright folks, as much as I've enjoyed this dance, I have more important things to tend to. It was great. Hopefully, I'll meet some of you in person at the unemployment office, or we'll hate each other while trying to skim referrals from real oncologists, or we'll bump into each other while begging for junior faculty positions that pay less than midlevel providers make in rural America. Until then, good luck with everything!

you mean compared to last year? there were more applicants than spots last year. this is the year that was a shift.

think it's important people keep in mind that this isn't a trend, yet. This was one year. Will be really interesting to see what happens this next year.

 

[PointA]

you mean compared to last year? there were more applicants than spots last year. this is the year that was a shift.

think it's important people keep in mind that this isn't a trend, yet. This was one year. Will be really interesting to see what happens this next year.

I disagree that this is a one year aberration. Zietman has presented data showing the field was at peak competitiveness around 2011-2013 with >1.4 applicants per position. We have been on a downward trajectory ever since. Yes, the bottom fell out this year but it is consistent with the overall trend. I don't think the appropriate response is to "see what happens next year." Leadership should be proactive to address the concerns of the rank and file so we can hopefully come up with some constructive changes. This is a great field and we must work to save it.

 

[taserlaser]

I disagree that this is a one year aberration. Zietman has presented data showing the field was at peak competitiveness around 2011-2013 with >1.4 applicants per position. We have been on a downward trajectory ever since. Yes, the bottom fell out this year but it is consistent with the overall trend. I don't think the appropriate response is to "see what happens next year." Leadership should be proactive to address the concerns of the rank and file so we can hopefully come up with some constructive changes. This is a great field and we must work to save it.

Assuming we will in fact continue no changes prior to next year’s match, what are people’s guesses for unmatched positions for next year? 30? 50?

 

[deleted947887]

Assuming we will in fact continue no changes prior to next year’s match, what are people’s guesses for unmatched positions for next year? 30? 50?

Depends on many things.
ABR screwup 2.0 -----> 50
SDN 2.0>>twitter 2.0--->50
Both--->70
None-->40

 

[Ray D. Ayshun]

Assuming we will in fact continue no changes prior to next year’s match, what are people’s guesses for unmatched positions for next year? 30? 50?

Probably fewer than this year. The secrets out, you don't have to be a competitive candidate to match somewhere.

 

[KHE88]

Probably fewer than this year. The secrets out, you don't have to be a competitive candidate to match somewhere.

Yep, the applicant pool will be inundated by candidates in the bottom half of their class who would otherwise do IM, ob/gyn, etc. but are attracted by the prospect of making the same $250k salary for an 8-5 M-F essentially office job with minimal call and no rounding. Eager to sign up for linac babysitting gigs. We already had people barely passing USMLE matching this year. But it was still mostly self-selected and programs were still trying to be picky and look what happened. There will be more bottom tier, DO, and FMG applicants, and they will all get interviewed and ranked going forward.

Self-selection out of rad onc is dead. This field is wide open to anybody with a pulse and a pass on step 1.

Can't wait until ASTRO this year when instead of talking about these problems we get to gather in a big room with thousands of our peers and collectively look at pictures of the president's family, exotic vacations, and cocktail parties at his mansion.

It's like the band continuing to play as the Titanic sinks. Ahhh....

 

[Xander Cruz]

Probably fewer than this year. The secrets out, you don't have to be a competitive candidate to match somewhere.

I would agree. I'll call it now - next year, most (savvy) programs (save for HROP/MSKCC/Anderson) will adjust and interview more candidates than in previous years, thus creating deeper rank lists, and avoid going unfilled. The optics of next year's match will be superficially much better than this year's, which furthers the Old Guard's™ narrative that nothing needs to change.

 

[xrthopeful]

Yep, the applicant pool will be inundated by candidates in the bottom half of their class who would otherwise do IM, ob/gyn, etc. but are attracted by the prospect of making the same $250k salary for an 8-5 M-F essentially office job with minimal call and no rounding. Eager to sign up for linac babysitting gigs. We already had people barely passing USMLE matching this year. But it was still mostly self-selected and programs were still trying to be picky and look what happened. There will be more bottom tier, DO, and FMG applicants, and they will all get interviewed and ranked going forward.

Self-selection out of rad onc is dead. This field is wide open to anybody with a pulse and a pass on step 1.

Can't wait until ASTRO this year when instead of talking about these problems we get to gather in a big room with thousands of our peers and collectively look at pictures of the president's family, exotic vacations, and cocktail parties at his mansion.

It's like the band continuing to play as the Titanic sinks. Ahhh....

there data on this?

 

[metview]

I know a quite a few people who got into "top 10 programs" with average stats for Rad Onc. This would have NEVER happened over the past 10 years. It's really shocking how things changed just over 1 YEAR.

Once the word is out (probably is by now), every FM, OB, Peds, DO, FMG applicant is gonna apply next year! Gonna be fun!

 

[KHE88]

there data on this?

Anecdotal seeing a handful of people with low 200 scores apply. I'm sure there were a couple in the 190s who got in. Would have to wait for charting outcomes to prove it. I would expect the numbers of applicants in these categories to go up dramatically in the coming years.

The bad test takers, DOs, and FMGs will end up at the non-elite programs in the locations nobody wants. They will fail the ABR's "minimum competence" cancer bio and physics exams, and these programs will eventually get shut down. The elite coastal programs will expand and continue to remain exclusive due to reputation and location and will eventually train the majority of rad oncs. The maldistribution problem will worsen. This process will happen over the next 5-10 years.

This is exactly what Paul Wallner apparently wants to happen if you go back and read his opinion pieces.

 

[xrthopeful]

Can someone give me a summary on the Gran Unified Theory of Conspiracy?

Is the end goal to expand the residency spots such to have cheap labor for all the fat cats or is the theory that the end goal of the shadowy cabal is to close all the small programs down. real confusing.

Think of the medical students reading this - if I'm confused, they must be too.

 

[Burt Radnolds]

Agree that programs will fill next year, how could they not as the rad onc twitter crew is all over this. By increasing awareness of our field and educating medical students on the false extremist views of SDN, next years match will be filled with warm bodies, followed by a round of back patting and a cocktail celebration at ASTRO. The fact that the caliber of applicant may have shifted dramatically will be an inconsequential detail.

Never fear though, the Angoff method will save us all and these poor souls will be filtered out after serving their 4 years of being dictation/contour monkeys.

 

[SneakyBooger]

if I'm confused, they must be too.

1st stage of dementia

Or is it? I can't remember.

I am too old.

LOL

 

[thecarbonionangle]

Anecdotal seeing a handful of people with low 200 scores apply. I'm sure there were a couple in the 190s who got in. Would have to wait for charting outcomes to prove it. I would expect the numbers of applicants in these categories to go up dramatically in the coming years.

The bad test takers, DOs, and FMGs will end up at the non-elite programs in the locations nobody wants. They will fail the ABR's "minimum competence" cancer bio and physics exams, and these programs will eventually get shut down. The elite coastal programs will expand and continue to remain exclusive due to reputation and location and will eventually train the majority of rad oncs. The maldistribution problem will worsen. This process will happen over the next 5-10 years.

This is exactly what Paul Wallner apparently wants to happen if you go back and read his opinion pieces.

I reviewed most applications and interviewed most applicants. This is true. Numerous people in 190s-low 200s range all matched and some in “pretty good programs”. Multiple FMGs, also matched. This cannot be good for our field. These are our future colleagues. I guess as long as Kachnich has a warm body at Vandy, or insert any greedy expanding chair, all things are good. Knock knock. Who thur? Path. Ok open the door. We here!

 

[thecarbonionangle]

you mean compared to last year? there were more applicants than spots last year. this is the year that was a shift.

think it's important people keep in mind that this isn't a trend, yet. This was one year. Will be really interesting to see what happens this next year.

Fluffer alert!!!

 

[SneakyBooger]

Knock knock. Who thur? Path. Ok open the door. We here!

OMG. Too funny.

#TheTruthHurtsSometimes

 

[scarbrtj]

Can someone give me a summary on the Gran Unified Theory of Conspiracy?

Is the end goal to expand the residency spots such to have cheap labor for all the fat cats or is the theory that the end goal of the shadowy cabal is to close all the small programs down. real confusing.

Think of the medical students reading this - if I'm confused, they must be too.

No Grand Unified Theory (GUT). To have a GUT takes BRAINS. Brains imply an ability to react intelligently to the environment as it changes, threatens. This is no conspiracy story. More like a story of the Incas, or the Kryptonians. Simply a failure of foresight (dramatic culling of the rad oncs’ tx numbers, existential threats) and planning (oversupply of rad oncs). Radiation exposure produces cataracts, you “see”...

 

[SneakyBooger]

Where do we go from here though?

Lawsuits have been filed regarding MOC. There will be a lot of discovery in the coming years. Some of it may shed light on issues such as those discussed on this platform.

Surprised there is no thread regarding the lawsuits against the ABR in the rad onc forum.

 

[RANDO_Phantom]

For the psychiatrists this looks like a case of classic transferrance.

Transferrance of money from the physicians’ wallets into the wallets of those at the psych board.

Ain’t nobody at the ABR making close to a million. They’re doing ok but not a million. If they were there’d be mass rebellion. As sanctimoniously ossified and tone-deaf Wallner is, for him it’s not about money. It’s just about being drunk with what little power he has, and like an MLB umpire, never never never never ever being able to admit a mistake.

How much is "ok"? 1/4 of a mil? 1/2 a mil? 1/10 of a mil? Paid for what?

 

[deleted947887]

How much is "ok"? 1/4 of a mil? 1/2 a mil? 1/10 of a mil? Paid for what?

$300,000 for 5 hours of work a week is ok. That's the threshold.

 

[theabr4trump]

The more money--The Better.

 

[evilbooyaa]

If you don't like the idea to close small programs, that is OK and there are valid criticisms of that approach, but there is no solution that will make everyone happy. Rather than just critiquing, please provide an alternative solution.

Mandate that attendings are not allowed to have 24/7 resident coverage. Shrink programs accordingly to fit this mantra.
Mandate a maximum number of separate facilities residents can be sent to (I propose 2-3) during residency for residents to meet their numbers.
Increase educational requirements across the board, including for all brachy and peds. Mandate requirements for definitive EBRT compared to palliative.

 

[Mandelin Rain]

Site specific requirements should be easy enough to accomplish. You don't want someone coming out having treated 4 head and neck in 4 years, or not prostates because the urorads in town. Brachy numbers should go WAY up. Again, a mix of prostate LDR/HDR, T&O, Cylinder. Obviously SBRT/SRS cases should double or triple. Not sure about unsealed sources. Strikes me as an necessary add-on as some number of rad oncs will actually administer. Most will not, though.

Peds numbers should go to nil and it should be a required fellowship IMO. It is sufficiently different enough from adult rad onc that treating even twice the current number of random peds cases over 4 years is nearly useless. If you want peds as a large part of your practice, you should do a fellowship IMO.

 

[Krukenberg]

Site specific requirements should be easy enough to accomplish. You don't want someone coming out having treated 4 head and neck in 4 years, or not prostates because the urorads in town. Brachy numbers should go WAY up. Again, a mix of prostate LDR/HDR, T&O, Cylinder. Obviously SBRT/SRS cases should double or triple. Not sure about unsealed sources. Strikes me as an necessary add-on as some number of rad oncs will actually administer. Most will not, though.

Peds numbers should go to nil and it should be a required fellowship IMO. It is sufficiently different enough from adult rad onc that treating even twice the current number of random peds cases over 4 years is nearly useless. If you want peds as a large part of your practice, you should do a fellowship IMO.

I think some consideration would need to be given to the fact that some programs have a large peds volume built in because of proximity to a major children’s hospital.

 

[Mandelin Rain]

I think some consideration would need to be given to the fact that some programs have a large peds volume built in because of proximity to a major children’s hospital.

Sure. However, often these programs will also then take outside rotators from near by programs without a Childrens Hospital, thus diluting the numbers for everyone.

If you need (EDIT: looked it up) 450 beam cases for graduation, and we agree even that is not enough, you should probably do at least 100 or 150 peds cases if that is going to be an element of your practice. Numbers like that would more likely ensure an appropriate breadth of pathology and complexity of cases. I doubt even in highest volume peds centers, anyone comes close to touching that. Could be wrong though.

 

[PointA]

Mandate that attendings are not allowed to have 24/7 resident coverage. Shrink programs accordingly to fit this mantra.
Mandate a maximum number of separate facilities residents can be sent to (I propose 2-3) during residency for residents to meet their numbers.
Increase educational requirements across the board, including for all brachy and peds. Mandate requirements for definitive EBRT compared to palliative.

This is a good list. I would go so far to say patient numbers from satellite clinics should not be allowed to count towards residency expansion. As academic departments are gobbling up more and more satellites, this is becoming a bigger issue. Many of these clinics are essentially private practices with the university name on the door so it's questionable whether it is really part of the traditional "teaching hospital."

The case log requirements are a total disaster. The requirement for SBRT cases is 10, which is less than the requirement for pediatrics! All radiation oncologists will perform SBRT but probably less than 5% actually treat peds. Brachy and SRS numbers are way too low also. When was the last time these case requirements were adjusted? Leadership asleep at the wheel... and then they why wonder why so many of us are upset and medical students are running for the exits.