How well does the doom/gloom job market in RO translate to graduates of top residency/fellowship programs?

[JivTor]

I have a strong interest in onc and will be entering clerkship next year, so rad onc is still something I am at least considering for now (maybe I'm stupid for that idk).

It's painfully obvious from lurking on this forum that the job market is abysmal and is likely to not change or maybe even get worse when I will be applying to staff positions in like ~8-9 years. My question is, if you are a graduate of a top residency/fellowship program like HROP/MSKCC/MDACC, is your job outlook significantly better than the avg applicant? Intuitively, I want to think that even with limited jobs, if you are among the very top among the applicant pool, you should still be able to get those limited positions, but I'm unsure of whether this is empirically true.

I am projecting that I will have about 13 peer-reviewed pubs (10 first-author) and about 8 presentations at national and international conferences (incl. ASTRO, CARO and ESTRO) by the application deadline. If I am able to get into a top residency program, it would also enable me to be very productive during that time and vie for top fellowship spots. Given that the demand for rad onc has dropped significantly due to the job market being poor, my chances at getting into a top residency may be better than ever.

This is all still speculation, but theoretically, if I do score a spot at a top program, should that be enough for me to overlook the poor job market?

Edit: might also relevant to add that I'd be willing to do up to two fellowships if that meant I could secure a good job.

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[thecarbonionangle]

one thing that i want you to consider is that you will not only he competing with your class and those “average” and “low tier” graduates. There are many good rad oncs out there from the golden age with 5-15 yrs of experience, board certified with an excellent record and references. You will be competing with them too. A few years ago i heard about a job in a “top” city. One that you would think under your assumption may have gone to a graduate of a “top” place. Maybe they interviewed them or maybe they did not. You know who got the job? Someone with 15 yr experience, BC, who cares where they trained. What a crappy job market does is you are not only competing with your own class but with a decade of classes who took jobs who don’ fit their ideal situation. Nobody can guarantee you anything. I feel like you want us to tell you it will be fine. Maybe it will, maybe not. All we can do is hope for the best and plan for the worst.

 

[elementaryschooleconomics]

I have a strong interest in onc and will be entering clerkship next year, so rad onc is still something I am at least considering for now (maybe I'm stupid for that idk).

It's painfully obvious from lurking on this forum that the job market is abysmal and is likely to not change or maybe even get worse when I will be applying to staff positions in like ~8-9 years. My question is, if you are a graduate of a top residency/fellowship program like HROP/MSKCC/MDACC, is your job outlook significantly better than the avg applicant? Intuitively, I want to think that even with limited jobs, if you are among the very top among the applicant pool, you should still be able to get those limited positions, but I'm unsure of whether this is empirically true.

I am projecting that I will have about 13 peer-reviewed pubs (10 first-author) and about 8 presentations at national and international conferences (incl. ASTRO, CARO and ESTRO) by the application deadline. If I am able to get into a top residency program, it would also enable me to be very productive during that time and vie for top fellowship spots. Given that the demand for rad onc has dropped significantly due to the job market being poor, my chances at getting into a top residency may be better than ever.

This is all still speculation, but theoretically, if I do score a spot at a top program, should that be enough for me to overlook the poor job market?

Edit: might also relevant to add that I'd be willing to do up to two fellowships if that meant I could secure a good job.

Nothing will enable you to "overlook" the poor job market. The Big 3, on balance, does provide advantages compared to not being at The Big 3.

You're Canadian, yes? What does a "good job" look like to you?

 

[medgator]

Perhaps, in academics and some PP. Crapshoot in much of smaller pp

 

[JivTor]

one thing that i want you to consider is that you will not only he competing with your class and those “average” and “low tier” graduates. There are many good rad oncs out there from the golden age with 5-15 yrs of experience, board certified with an excellent record and references. You will be competing with them too. A few years ago i heard about a job in a “top” city. One that you would think under your assumption may have gone to a graduate of a “top” place. Maybe they interviewed them or maybe they did not. You know who got the job? Someone with 15 yr experience, BC, who cares where they trained. What a crappy job market does is you are not only competing with your own class but with a decade of classes who took jobs who don’ fit their ideal situation. Nobody can guarantee you anything. I feel like you want us to tell you it will be fine. Maybe it will, maybe not. All we can do is hope for the best and plan for the worst.

Oh absolutely not. I want to hear the straight truth of it, and I appreciate your candor. I asked because I'm not as familiar with the nuances of this situation as those of you who are actually out there working in the trenches. If the situation really is so grim that even graduates of the top RO programs will have to scrap and claw for mediocre jobs then it certainly pushes me towards med onc instead. Definitely a shame though as RO seemed like a great fit for me.

Edit: grammar

 

[JivTor]

Nothing will enable you to "overlook" the poor job market. The Big 3, on balance, does provide advantages compared to not being at The Big 3.

You're Canadian, yes? What does a "good job" look like to you?

The ideal job to me would mean average pay in a large city (no preference for academic vs. community as of yet).

I'm also very much on the younger side compared to my classmates so it's not like I mind moving around, working late hours, or have any plans to settle down/start a family anytime soon. So, if it takes me working like crazy during residency to publish and be excellent clinically, and doing multiple fellowships after that, I can live with that sacrifice.

But at the end of the day, if despite doing all of that, it's likely that I will still have to accept working locum in the middle of nowhere--that is something I cannot accept.

 

[drewdog1973]

People are getting jobs NOW, but that is uninformative. The concern is the future. Do not confuse weather with climate. This is where ASTRO/ARRO misleads. “96% employment” and other blather.

- they are more likely to be hospital employees
- academic satellite jobs are very common, offering the pay of academics with the workload of private practice
- true partnership positions continue to diminish
- partnership salaries are decreasing
- the mean and median of starting salaries are higher than before, but they tend to max out rapidly
- before, fresh grads were not at a disadvantage, but this is changing - many jobs want experience now

Be careful. That’s the main point. You have all the information you need. So, if you choose to join us, don’t be surprised if things don’t play out in your favor.

 

[yesmaster]

There will always be fellowships open to you in major cities.

Graduating from a top 3 program will not help in looking for jobs. Your publications will help even less. A top 3 program will do much to indoctrinate you in the Koolaid of ASTRO, which posits that we can "innovate" our way out of the basic labor market economics.

 

[elementaryschooleconomics]

The ideal job to me would mean average pay in a large city (no preference for academic vs. community as of yet).

I'm also very much on the younger side compared to my classmates so it's not like I mind moving around, working late hours, or have any plans to settle down/start a family anytime soon. So, if it takes me working like crazy during residency to publish and be excellent clinically, and doing multiple fellowships after that, I can live with that sacrifice.

But at the end of the day, if despite doing all of that, it's likely that I will still have to accept working locum in the middle of nowhere--that is something I cannot accept.

Ah OK - if, even now, so early in this process, you know you want to be in a large city, you need to avoid RadOnc.

I'm someone in the job market right now, and I can assure you that EASILY the most limiting desire is geography - because this has always been the case, even in the better days. Most people want to be in "large cities". If you abandon geographic preference, there are still some jobs out there (today - I don't know what things will be like when you finally get to that point).

I also strongly agree with everything that has been posted above. Just do MedOnc, it's a no-brainer. It's what I would do if I had a time machine.

 

[JivTor]

Ah OK - if, even now, so early in this process, you know you want to be in a large city, you need to avoid RadOnc.

I'm someone in the job market right now, and I can assure you that EASILY the most limiting desire is geography - because this has always been the case, even in the better days. Most people want to be in "large cities". If you abandon geographic preference, there are still some jobs out there (today - I don't know what things will be like when you finally get to that point).

I also strongly agree with everything that has been posted above. Just do MedOnc, it's a no-brainer. It's what I would do if I had a time machine.

That makes sense. One of the things I was told by many people about rad onc is that because of the expensive and clunky equipment needed to give radiation therapy, rad onc positions are concentrated in large centres that have sufficiently high patient loads to make it economical. But I guess if there's a massive oversupply of ROs, it makes no differences since there won't be positions available regardless.

I read one of your previous posts where you said "Many, many fields outside of medicine face these issues, but the opportunity cost is SO HIGH for us (in medicine) that there should be some sort of guaranteed career at the end – as it used to be." This is exactly my mentality. Truly hope you have some luck in your job search though.

 

[DebtRising]

The biggest evaluation point is the rigors to which rad onc is trying to make itself disappear. There is continuous research in “non inferiorty” trials to set targets of “it’s not worse by more than 10%” as justification to decrease radiation utilization.

May be great for society - and/or insurance carriers. But will radiation be in 10 years - single fraction breast, 5 fraction prostate, single fraction srs brain, 2-3 fraction body SBRT? Who cares where you graduate from if you learn a tool that’s continually working to prove itself as short and niche as possible with thousands of excess grads ahead of you?

 

[Ray D. Ayshun]

Just base your decision re specialty on the sdn ratio.

If #threads centered on what a dumpster fire the specialty is/#threads discussing clinical decisions > 1, look elsewhere.

 

[JivTor]

Also, my understanding is that the Canadian market is not amazing, but still a lot better than the US situation. Is there any red tape that's preventing US grads from pursuing licensure in Canada? I know that on average you'd make a lot less in the public healthcare system but making $375-$475 is better than not having a job at all, no?

 

[RickyScott]

Let’s say you beat the odds and land a job as a satellite monkey near some large city. Your problems are not over. You will have a hard time with professional advancement, getting raises etc. what if you have a difficult chairman at some point in your career?

 

[medgator]

.

But at the end of the day, if despite doing all of that, it's likely that I will still have to accept working locum in the middle of nowhere--that is something I cannot accept.

You might have to until your preferred job/geographic locale opens up

 

[medgator]

Let’s say you beat the odds and land a job as a satellite monkey near some large city. Your problems are not over. You will have a hard time with professional advancement, getting raises etc. what if you have a difficult chairman at some point in your career?

Bingo.... Even those of us with good-ish jobs now, where do we lateral to?

 

[scarbrtj]

One of the things I was told by many people about rad onc is that because of the expensive and clunky equipment needed to give radiation therapy, rad onc positions are concentrated in large centres that have sufficiently high patient loads to make it economical.

My question is, if you are a graduate of a top residency/fellowship program like HROP/MSKCC/MDACC, is your job outlook significantly better than the avg applicant?

In the "old days," 10-15 patients under treatment a day made things economical enough. But 10-15 patients under treatment per day meant ~3 new patient consults a week. Now those 3 new patients per week will put you under 10 on daily treatment (because fraction reduction... if you're halfway up-to-date/ethical), and it's not so economical anymore.

Keep in mind that for a split second all the 2020 MDACC grads went from offers to unemployed (essentially). COVID context, etc etc, but let that sink in... all the MDACC grads suddenly were aboard the HMS Titanic until lifeboats came by and they were rescued. The only way there's not outright incontrovertible crazy horrible bad job market stories right now is: academics has artificially been propping up the job market for at least 5 years now. Most rad oncs in America now fall under an academic umbrella, satellite or other. The non-academic market is anemic, or bad, or whatever adjective you want. It's going to get that way in academics, too, eventually. Why? Math. Math is really real; rad onc world is active in cutting its own reimbursement (and govt world is trying to help them), non-rad onc world is actively cutting down on outright per-patient utilization, and cancer incidences are not growing near what was predicted 10y ago or so. (The latter has not affected med onc because the "chronicity" of their care has skyrocketed, quite in contradistinction to rad onc.) The "job outlook," realistically, has to be first an academic jobs outlook. Will those academic jobs be there at the level they have been over the last 5 years 10 years from now? I predict: no. Not to toot my own horn, but I have been making prett-ay accurate predictions the last few years.

 

[medgator]

. Why? Math. Math is really real; rad onc world is active in cutting its own reimbursement (and govt world is trying to help them), non-rad onc world is actively cutting down on outright per-patient utilization, and cancer incidences are not growing near what was predicted 10y ago or so.

You forgot the other side of the equation....

 

[scarbrtj]

You forgot the other side of the equation....

Totally. Yet to the uninitiated, this doesn't look like anything but natural, organic growth in supply. This is the one that scares me.

 

[Ray D. Ayshun]

if you're halfway up-to-date/ethical

Apologies for going tangential, but I often "err" on the side of more fractions, even as a new grad from a program that very aggressively hypofractionated. Why? It's the most ethical choice in my mind. Based on the structure of my contract and the hit covid has caused, the more professional billing I do, the less I get paid, so there's a disincentive to draw things out. On the other hand, the more billing i do, the more apt i am to get what i want from a staffing, capital, etc, POV. IOW, keeping the doors open seems the most ethical. Sure, it may cost the patient more out-of-pocket, but it also might not, and the financial overlords are more apt to overlook certain approaches to billing and collections if the bottom line looks good enough,

 

[scarbrtj]

Totally. Yet to the uninitiated, this doesn't look like anything but natural, organic growth in supply. This is the one that scares me.

And to explicate just a little more. About 1.8 million people a year are diagnosed with cancer. This graph doesn't show that ~1 million people ayear out of the newly diagnosed 1.8 million get XRT per year; i.e., XRT doesn't have a ~56% utilization rate. It has, at best, about a 25-30% utilization rate (and falling). That 1 million comprises retreats, people failing long (>1y) after initial diagnosis, etc.

As far as outright new patients getting XRT early in their diagnosis, it's about ~600K per year (an overestimate, very very likely, but go with me), which means ~110 de novo new dx patients per rad onc per year. (But the number of "new to the practice" patients will obv be higher.) But the number of "truly new" patients per rad onc per year has likely fallen under 200 for the first time in history since rad onc became a specialty.

 

[Ray D. Ayshun]

Totally. Yet to the uninitiated, this doesn't look like anything but natural, organic growth in supply. This is the one that scares me.

if you zoom out on that and use the same x-axis, it's really NBD...

 

[JivTor]

In the "old days," 10-15 patients under treatment a day made things economical enough. But 10-15 patients under treatment per day meant ~3 new patient consults a week. Now those 3 new patients per week will put you under 10 on daily treatment (because fraction reduction... if you're halfway up-to-date/ethical), and it's not so economical anymore.

Keep in mind that for a split second all the 2020 MDACC grads went from offers to unemployed (essentially). COVID context, etc etc, but let that sink in... all the MDACC grads suddenly were aboard the HMS Titanic until lifeboats came by and they were rescued. The only way there's not outright incontrovertible crazy horrible bad job market stories right now is: academics has artificially been propping up the job market for at least 5 years now. Most rad oncs in America now fall under an academic umbrella, satellite or other. The non-academic market is anemic, or bad, or whatever adjective you want. It's going to get that way in academics, too, eventually. Why? Math. Math is really real; rad onc world is active in cutting its own reimbursement (and govt world is trying to help them), non-rad onc world is actively cutting down on outright per-patient utilization, and cancer incidences are not growing near what was predicted 10y ago or so. (The latter has not affected med onc because the "chronicity" of their care has skyrocketed, quite in contradistinction to rad onc.) The "job outlook," realistically, has to be first an academic jobs outlook. Will those academic jobs be there at the level they have been over the last 5 years 10 years from now? I predict: no. Not to toot my own horn, but I have been making prett-ay accurate predictions the last few years.

Sorry, I'm totally out of the loop, what is the situation at MDACC? Essentially they had a hiring freeze and people who were going to have staff positions are being made to do fellowships instead?

 

[mavrik13]

Also, my understanding is that the Canadian market is not amazing, but still a lot better than the US situation. Is there any red tape that's preventing US grads from pursuing licensure in Canada? I know that on average you'd make a lot less in the public healthcare system but making $375-$475 is better than not having a job at all, no?

My perspective is that, currently, the US job market is better than the Canadian job market (as a Canadian). Still an oversupply, and the issue probably won't be resolved for another 5+ years (until people stop working into their mid 70's). It sounds like that may change in the future. A fellowship is the norm after residency, and even then, not a guarantee. You might get scooped up by somewhere like PMH if you are a bench researcher. Also, within reason, jobs are preferentially given to Canadian citizens (per employment rules).

The bottom line is that it doesn't matter about number of publications, or where you do your residency. You need to develop a skill set that is marketable. There will always be jobs out there, just not enough to go around for everyone

 

[elementaryschooleconomics]

My perspective is that, currently, the US job market is better than the Canadian job market (as a Canadian). Still an oversupply, and the issue probably won't be resolved for another 5+ years (until people stop working into their mid 70's). It sounds like that may change in the future. A fellowship is the norm after residency, and even then, not a guarantee. You might get scooped up by somewhere like PMH if you are a bench researcher. Also, within reason, jobs are preferentially given to Canadian citizens (per employment rules).

The bottom line is that it doesn't matter about number of publications, or where you do your residency. You need to develop a skill set that is marketable. There will always be jobs out there, just not enough to go around for everyone

Yeah, I think the US market is still "better" than the Canadian market, but that's like saying it's better to die of a stroke in your sleep than drowning - why even bother making the comparison, it's bleak no matter what.

Sorry, I'm totally out of the loop, what is the situation at MDACC? Essentially they had a hiring freeze and people who were going to have staff positions are being made to do fellowships instead?

MDACC hired 7 folks from the Class of 2020. COVID hit, all 7 contracts were rescinded in March/April. From March-July it sounds like there were variations in what was going to happen to each person (delayed starts, fellowship/instructor positions, etc) but 6 out of the 7 people started on-time or close to it, and one will start in early 2021.

This was more of an Anderson problem as an institution that a pure RadOnc problem...but no one is immune from the economics of healthcare in America, whatever your pedigree, whether you're doctor or patient.

 

[elementaryschooleconomics]

Apologies for going tangential, but I often "err" on the side of more fractions, even as a new grad from a program that very aggressively hypofractionated. Why? It's the most ethical choice in my mind. Based on the structure of my contract and the hit covid has caused, the more professional billing I do, the less I get paid, so there's a disincentive to draw things out. On the other hand, the more billing i do, the more apt i am to get what i want from a staffing, capital, etc, POV. IOW, keeping the doors open seems the most ethical. Sure, it may cost the patient more out-of-pocket, but it also might not, and the financial overlords are more apt to overlook certain approaches to billing and collections if the bottom line looks good enough,

I love this! This level of real-world nuance is often neglected in these discussions, I strongly agree with your viewpoint here. There's more to all this than "hypofraction is non-inferior, ergo, everyone should get as few fractions as possible" - but if you hypofractionate a linac out of business, and it's the only game in town for many miles, and that community loses a major resource - are you really doing what's best for society? I know a lot of crusty old patients who would rather let "nature take its course" than drive a long distance to my current academic center in the heart of an urban area...I personally prefer patients to live, but hey, maybe we're crazy eh?

 

[kimplera]

I've been a glass half full guy for most of this discussion (years long). however, what i would say is that, especially if you have time, be sure to carefully explore your career options. If radonc is the only field you see yourself happy in - do it and go all in. if there is another field you say you would be equally happy pursuing...
Also if "big city" means >1M then a lot more options - if you mean >10M then the pickings get slimmer and slimmer...

Personally - i love the field - if i had to sling cisplatin and ondansetron all day i think i would have retreated to my lab full time...

 

[Baws]

I've been a glass half full guy for most of this discussion (years long). however, what i would say is that, especially if you have time, be sure to carefully explore your career options. If radonc is the only field you see yourself happy in - do it and go all in. if there is another field you say you would be equally happy pursuing...
Also if "big city" means >1M then a lot more options - if you mean >10M then the pickings get slimmer and slimmer...

Personally - i love the field - if i had to sling cisplatin and ondansetron all day i think i would have retreated to my lab full time...

What city in America has a population of more than 10 million?

 

[Chartreuse Wombat]

What city in America has a population of more than 10 million?

According to Wikipedia (err..)

None

 

[elementaryschooleconomics]

According to Wikipedia (err..)

None

View attachment 324156

He's a glass half full guy! He's rounding up!

(just jokes!! )

 

[Ray D. Ayshun]

Has nobody been paying attention? If there's one thing we can't do, it's properly count people, particularly in cities.

 

[RadOncDoc21]

Has nobody been paying attention? If there's one thing we can't do, it's properly count people, particularly in cities.

Or number of Rad onc residents needed.

 

[deleted941485]

In the "old days," 10-15 patients under treatment a day made things economical enough. But 10-15 patients under treatment per day meant ~3 new patient consults a week. Now those 3 new patients per week will put you under 10 on daily treatment (because fraction reduction... if you're halfway up-to-date/ethical), and it's not so economical anymore.

Keep in mind that for a split second all the 2020 MDACC grads went from offers to unemployed (essentially). COVID context, etc etc, but let that sink in... all the MDACC grads suddenly were aboard the HMS Titanic until lifeboats came by and they were rescued. The only way there's not outright incontrovertible crazy horrible bad job market stories right now is: academics has artificially been propping up the job market for at least 5 years now. Most rad oncs in America now fall under an academic umbrella, satellite or other. The non-academic market is anemic, or bad, or whatever adjective you want. It's going to get that way in academics, too, eventually. Why? Math. Math is really real; rad onc world is active in cutting its own reimbursement (and govt world is trying to help them), non-rad onc world is actively cutting down on outright per-patient utilization, and cancer incidences are not growing near what was predicted 10y ago or so. (The latter has not affected med onc because the "chronicity" of their care has skyrocketed, quite in contradistinction to rad onc.) The "job outlook," realistically, has to be first an academic jobs outlook. Will those academic jobs be there at the level they have been over the last 5 years 10 years from now? I predict: no. Not to toot my own horn, but I have been making prett-ay accurate predictions the last few years.

Break even use to be 10-15. I mean what I see now as a COG who is a slave to the academic satellite paymasters is more like 15-20 now. Thats only gonna get worse.

 

[frijoles]

Just do MedOnc, it's a no-brainer. It's what I would do if I had a time machine.

No way. Med onc training (6 yrs mostly inpatient) brutal. Still have inpatient service as attending. Maybe I’m biased, but at my hospital med oncs are worked like dogs with terrible support. They constantly complain about how they’re drowning.... meanwhile rare for our group to stay past 5pm and hardly ever have to work weekends

Would’ve probably done derm or rads if not rad onc I guess but I’m happy with my job 🤷‍♂️

 

[RadOncMegatron]

No way. Med onc training (6 yrs mostly inpatient) brutal. Still have inpatient service as attending. Maybe I’m biased, but at my hospital med oncs are worked like dogs with terrible support. They constantly complain about how they’re drowning.... meanwhile rare for our group to stay past 5pm and hardly ever have to work weekends

Would’ve probably done derm or rads if not rad onc I guess but I’m happy with my job 🤷‍♂️

Are there med oncs who wish they were rad oncs?

 

[frijoles]

Are there med oncs who wish they were rad oncs?

At my hospital, yup. Good friends with a few of them and they talk pretty openly about it. I think they’re short staffed compared to us and just always getting crushed tho. Not just limited to MDs, the RNs all want to work for us too. We just stole their best RN . I’m sure there are better med onc gigs out there though, realize this is just my system. Although, from what I recall in training too, Med oncs always seemed stretched thin. Definitely don’t view it as a “lifestyle” specialty.

 

[elementaryschooleconomics]

No way. Med onc training (6 yrs mostly inpatient) brutal. Still have inpatient service as attending. Maybe I’m biased, but at my hospital med oncs are worked like dogs with terrible support. They constantly complain about how they’re drowning.... meanwhile rare for our group to stay past 5pm and hardly ever have to work weekends

Would’ve probably done derm or rads if not rad onc I guess but I’m happy with my job 🤷‍♂️

Oh yeah from a lifestyle perspective RadOnc will probably usually beat MedOnc - but the degree of that difference will likely vary from institution to institution or practice to practice.

My statement comes from 1) I surprisingly loved my traditional, preliminary Internal Medicine intern year and 2) I personally value the more flexible employment options that come with pursuing MedOnc. I don't think anyone questions that there are many happily employed Radiation Oncologists - the issue is the 1) lack of employment options for new and upcoming RadOncs and 2) lack of lateral movement options for currently employed RadOncs.

Have you ever looked into going elsewhere? If so, were you ever given a firm contract offer or was it vague platitudes by those in charge?

 

[frijoles]

Oh yeah from a lifestyle perspective RadOnc will probably usually beat MedOnc - but the degree of that difference will likely vary from institution to institution or practice to practice.

My statement comes from 1) I surprisingly loved my traditional, preliminary Internal Medicine intern year and 2) I personally value the more flexible employment options that come with pursuing MedOnc. I don't think anyone questions that there are many happily employed Radiation Oncologists - the issue is the 1) lack of employment options for new and upcoming RadOncs and 2) lack of lateral movement options for currently employed RadOncs.

Have you ever looked into going elsewhere? If so, were you ever given a firm contract offer or was it vague platitudes by those in charge?

Yeah that’s fair. Thankfully haven’t had to move yet, but sounds rough out there.

 

[kimplera]

ok - so i don't have a good sense of city size - coming from my view - anything over 500K is large and >1M is very large...

 

[RSAOaky]

This is all still speculation, but theoretically, if I do score a spot at a top program, should that be enough for me to overlook the poor job market?

Edit: might also relevant to add that I'd be willing to do up to two fellowships if that meant I could secure a good job.

I remember in med school when people would say don't do a surgical residency unless you can't see yourself doing anything else. As we all know, far more surgeons than would care to admit went into a surgical specialty for ego reasons and many of them are miserable.

I think this really applies to radonc as well nowadays. Don't go into the field unless you can't see yourself doing anything else. Most of us love what we do but don't love the endless uncertainty about the field. The bar keeps getting set lower and lower as to what we should be happy with when we get out of residency. Right now you either get paid well working in the middle of nowhere or you get lucky working in or around a reasonably sized city for an average salary. It's anyone's guess what the situation will be in 5 years time.

You asked if you'd have better luck going to HROP, MSKCC, MDACC. You'd have better luck than someone going to West Virginia, but don't forget that there are a lot of really highly regarded top to mid-tier programs as well that you're still competing with, and I don't really think you have much of a leg up on any of them unless you do residency in the city you want to practice. If you want to go into academics then perhaps you'll have a greater advantage.

 

[RadOncDoc21]

I hear that a palliative fellowship trained rad onc can break through all those barriers more easily. Okay, I’ll stop now.

 

[Ray D. Ayshun]

I hear that a palliative fellowship trained rad onc can break through all those barriers more easily. Okay, I’ll stop now.

I've been an attending now for a few months. Kinda getting tired of some of the responsibilities. You wouldn't happen to know who I could get in touch with to see about starting a palliative RT fellowship here?

 

[RadOncDoc21]

I've been an attending now for a few months. Kinda getting tired of some of the responsibilities. You wouldn't happen to know who I could get in touch with to see about starting a palliative RT fellowship here?

To be honest it’s likely easier then starting a new residency program which appears to be easy. I guess adding residents to an existing program is by far the easiest thing to do.

Just be aware that having a rad onc fellow “weighs you down” in the clinic. They need your guidance on when to use 30/10 vs 20/5 and the extremely special 8/1 which takes years to master!

I would just have them dictate notes, do contours, etc to start out.

 

[McConaughey]

I would just have them dictate notes, do contours, etc to start out.

I read this too fast at first and took it seriously. What a bummer the field has become for the current residents, recent graduates. I’m sure the expectations are not clear, as in, if you are a good fellow you might get to stay here with a real job?

 

[RickyScott]

I remember in med school when people would say don't do a surgical residency unless you can't see yourself doing anything else. As we all know, far more surgeons than would care to admit went into a surgical specialty for ego reasons and many of them are miserable.

So much is dependent on situation. I was viscerally disgusted with Internal medicine during med school (intellectually and socially), but loved it during internship. Was really tempted at the time to forego xrt and stay in IM
A lot to do with the people, institution and geography.

 

[90sportsfan]

Oh yeah from a lifestyle perspective RadOnc will probably usually beat MedOnc - but the degree of that difference will likely vary from institution to institution or practice to practice.

My statement comes from 1) I surprisingly loved my traditional, preliminary Internal Medicine intern year and 2) I personally value the more flexible employment options that come with pursuing MedOnc. I don't think anyone questions that there are many happily employed Radiation Oncologists - the issue is the 1) lack of employment options for new and upcoming RadOncs and 2) lack of lateral movement options for currently employed RadOncs.

Have you ever looked into going elsewhere? If so, were you ever given a firm contract offer or was it vague platitudes by those in charge?

I'm still a medical student, but was thinking about pursuing RadOnc, but am leaning more towards Radiology. I would think a big benefit for MedOnc over RadOnc is having the Internal Medicine training. In a worst case scenario if you are struggling to find a job or need to be in a specific city, Internal Medicine would open the door for tons of options, even as a hospitalist or shift work, that could be temporary until the right MedOnc job comes around.