I just couldn't help myself....

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dieABRdie

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Check this out.... 7th post down: Confused and devastated without a match

"I got a SOAP offer from a rad onc program. I ended up turning it down because I just don’t know the field at all. Maybe that was dumb of me, but I ultimately couldn’t do it. "

Open spot in the SOAP? How about a medical student who wants to be a psychiatrist and has never stepped foot into a radiation oncology department!

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Check this out.... 7th post down: Confused and devastated without a match

"I got a SOAP offer from a rad onc program. I ended up turning it down because I just don’t know the field at all. Maybe that was dumb of me, but I ultimately couldn’t do it. "

Open spot in the SOAP? How about a medical student who wants to be a psychiatrist and has never stepped foot into a radiation oncology department!

Let’s see:

1) A number of Rad Onc PD’s indicated that they wouldn’t SOAP unless the candidate had shown or demonstrated a strong sense of interest in the field- BullSh—-t.

2) A med student chose psych over rad onc. Let this one sink in for a moment. I have nothing against psych but when I was applying, anybody could walk right into psych and you needed a MD/PhD or significant research to get into rad onc.

3) I stated I would not complain about our field for awhile so instead I will make a plea to anyone who is a rad onc to stop thinking of themselves or their situation and reflect on where we are now.
 
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From discussing with students recently, supposedly psych becoming more of an attractive field and thus becoming more competitive
 
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It is a good time to reflect. Three students, all third years, asked me this week about the field given how many people soap'ed in this year. Their two concerns were: 1. if people with low step scores would be able to get in and 2. if salaries at mgma medium were common.

For all the talk about how students with an interest in oncology are self-selecting, it seems there is soon going to be a significant group of less able applicants looking for an easy way into a high-paying field.
Vast majority of students who match today will only have job options in rural locations where Im/er type specialties would probably pay them more and require less training.
 
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From discussing with students recently, supposedly psych becoming more of an attractive field and thus becoming more competitive

Psych has definitely gotten more competitive. There are good reasons.

1. Mostly outpatient, at least in private practice. Its pretty much academics only that work in ERs and take call.
2. Can get a job in any city.
3. Can set up your own practice and take cash only if desired.

I would have definitely done it if I didn't like working with cancer patients and dislike working with psych patients so much. But then again if you set up your own practice you can see the patients you want.
 
It is a good time to reflect. Three students, all third years, asked me this week about the field given how many people soap'ed in this year. Their two concerns were: 1. if people with low step scores would be able to get in and 2. if salaries at mgma medium were common.

For all the talk about how students with an interest in oncology are self-selecting, it seems there is soon going to be a significant group of less able applicants looking for an easy way into a high-paying field.

Any student with an interest in cancer patients who doesn't want to do surgery should consider heme/onc. I don't think medical students get good exposure since most heme/onc rotations are inpatient in which the patients who are doing poorly are concentrated. During my rotation I spent one day at clinic instead of on the floor and 100% of the patients there were NED. With the rapid expansion of indications for systemic therapy the future is rosy. The lifestyle isn't so bad as much of the load is carried by NPs... although I think that might be the biggest threat going forward once they are completely independent and admins realize they can just have them give chemo. It will most likely be some time before patients accept cancer therapy without a physician... but that's what anesthesiology said.
 
From discussing with students recently, supposedly psych becoming more of an attractive field and thus becoming more competitive
Increasing salaries, widespread demand geographically over the last several years. Basically the opposite of what is happening in RO

It's become much more competitive to match into psych per my discussion with a couple of academic faculty i know at different programs. I am sure we will see a higher FMG/DO % in rad onc vs psych soon if it hasn't happened already. And I'm sure the radoncrocks twitterati will tell us how much better that is for the specialty
 
LMAO hilarious. A psych warm body offered a spot by the pigs and he just could not STOMACH IT. WOW. Let that sink in. Guy would rather be UNMATCHED!!!
 
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Any student with an interest in cancer patients who doesn't want to do surgery should consider heme/onc. I don't think medical students get good exposure since most heme/onc rotations are inpatient in which the patients who are doing poorly are concentrated. During my rotation I spent one day at clinic instead of on the floor and 100% of the patients there were NED. With the rapid expansion of indications for systemic therapy the future is rosy. The lifestyle isn't so bad as much of the load is carried by NPs... although I think that might be the biggest threat going forward once they are completely independent and admins realize they can just have them give chemo. It will most likely be some time before patients accept cancer therapy without a physician... but that's what anesthesiology said.

I think predicting whats going to happen in 6 years for heme/onc is really hard. Increasing indications for systemic therapy doesn't necessarily tie to reimbursement, they are at the whim of policymakers just like we are. Remember med students have to think about 3 years internal med + 3 years heme onc (very few people do the fast track, which is research heavy). A lot can change in 6 years, we are the best example of that.

Agree the fact that this student got a SOAP offer is a poor reflection of whatever program that offered
 
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Agree the fact that this student got a SOAP offer is a poor reflection of whatever program that offered

You think only that program is the problem? You know what they say when you see one rat/cockroach...

Plenty of mid/bottom tier cockroach rad onc programs matched SOAP applicants this year, many of whom were likely in that same position
 
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These guys just don't care.

Just hire scribes for Christ's sake. They are (barely) cheaper than residents, and you don't have to pretend to educate them.

Like seriously, is there no consideration of self reflection? Can people not stop to see how their actions are ruining/have ruined the field? Is it that important to have another PGY2 resident at OSU? Math denying in rad onc is like science denying in the current administration. Except with even less ambiguity and uncertainty.
 
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My guess is someone that was supposed to start decided to stay in their medicine program.

How do you guys know this is an expansion?

If it is an expansion, yes they should be shamed.
 
My guess is someone that was supposed to start decided to stay in their medicine program.

How do you guys know this is an expansion?

If it is an expansion, yes they should be shamed.
It. Doesn't. Matter.

The canary spoke. Don't fill it.
 
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Psych has definitely gotten more competitive. There are good reasons.

1. Mostly outpatient, at least in private practice. Its pretty much academics only that work in ERs and take call.
2. Can get a job in any city.
3. Can set up your own practice and take cash only if desired.

I would have definitely done it if I didn't like working with cancer patients and dislike working with psych patients so much. But then again if you set up your own practice you can see the patients you want.

it’s also one of the few fields left where you can graduate, hang up a shingle, and start seeing patients away.

To start a private practice in almost any other field you need a fair amount of capital and will likely be cash flow negative for some time. Plus unless you’re in a really sparse market you’ll get offered peanuts from insurance. For psych you can rent a one room office (or even use your living room), charge cash, and be busy quickly since there is so much demand. Even in the ramp up you can make money since expenses can be so low.

Of course the downside is you have to like psych and dealing With psych patients. Not my cup of tea, but if you can stomach or enjoy it, it’s a great gig.
 
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For psych you can rent a one room office (or even use your living room), charge cash, and be busy quickly since there is so much demand. Even in the ramp up you can make money since expenses can be so low.
Perhaps why the infrastructure of modern medicine is driving good people to a specialty like psych that def has pluses and minuses but now the minuses getting vastly outweighed by the potential pluses as you mention. The ability to rent an office and get to work is something every professional (attorney, architect, real estate agent, psychic, etc) should have the right to pursue in this country IMHO.
 
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Perhaps why the infrastructure of modern medicine is driving good people to a specialty like psych that def has pluses and minuses but now the minuses getting vastly outweighed by the potential pluses as you mention. The ability to rent an office and get to work is something every professional (attorney, architect, real estate agent, psychic, etc) should have the right to pursue in this country IMHO.

Any ideas how this could work in rad onc though?
 
Hcc
Perhaps why the infrastructure of modern medicine is driving good people to a specialty like psych that def has pluses and minuses but now the minuses getting vastly outweighed by the potential pluses as you mention. The ability to rent an office and get to work is something every professional (attorney, architect, real estate agent, psychic, etc) should have the right to pursue in this country IMHO.

Completely agree. One of the prior perks of being a physician was autonomy/ability to be your own boss...and after 9+ years of post college education/training, well deserved imo. Now the majority of us work for a corporate behemoth( I would include most academic centers in this category). There are lots of reasons I’ll probably advise my own kids not to pursue an MD, but this is the biggest.
 
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It can't. We are married to multimillion dollar capital investments and we are commoditizing our labor through shameless residency expansion

Couldn’t multiple rad oncs lease a machine, each with their own independent office spaces? You ‘rent’ therapy services and physics services?

Make it so that nearly everything is remote, and you go to the linac once a week to see patients while they are there? And in future APM world where we don’t bill for OTV, you won’t even need to do that
 
Couldn’t multiple rad oncs lease a machine, each with their own independent office spaces? You ‘rent’ therapy services and physics services?

Make it so that nearly everything is remote, and you go to the linac once a week to see patients while they are there? And in future APM world where we don’t bill for OTV, you won’t even need to do that

Could in theory work in a geography with existing practitioners with developed referral bases who decide to consolidate and share overhead. Practically speaking, though, in most cases these guys have probably been competing and ****-talking each other for years, will be hard-headed boomers who will want everything their respective ways which means they will never come to an agreement, and more likely than not have plans to just sell their practices to the highest bidding hospital.

Coming out of residency, it wouldn't make much sense to try to collaborate with multiple other rad oncs because then you'd be competing for the professional cut. Better to bring on non Rad onc investors and keep the prof cut for yourself.

The reality is the best people to open XRT centers are not rad oncs...if not private equity or a hospital, it's gonna be urologists and med oncs.
 
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Couldn’t multiple rad oncs lease a machine, each with their own independent office spaces? You ‘rent’ therapy services and physics services?

Make it so that nearly everything is remote, and you go to the linac once a week to see patients while they are there? And in future APM world where we don’t bill for OTV, you won’t even need to do that
Irrelevant if we are producing more graduates than is needed.

We were in a better place pre hypofx and APM graduating 120/year last decade.... It doesn't work in the hypofx/APM era graduating more than that
 
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Check this out.... 7th post down: Confused and devastated without a match

"I got a SOAP offer from a rad onc program. I ended up turning it down because I just don’t know the field at all. Maybe that was dumb of me, but I ultimately couldn’t do it. "

Open spot in the SOAP? How about a medical student who wants to be a psychiatrist and has never stepped foot into a radiation oncology department!

Well, you are a very intelligent grownup and you had better figure out what in the hell will make you happy. At least you don’t have to decide if you want to spread the asphalt or roll it. You have ZERO sympathy from me.


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Well, you are a very intelligent grownup and you had better figure out what in the hell will make you happy. At least you don’t have to decide if you want to spread the asphalt or roll it. You have ZERO sympathy from me.


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Context is important here. There was an article in our society journal with pledges from many rad onc program directors that they would not take SOAP candidates with no demonstrated interest in the field.

And yet there are stories like this that popped up.
 
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Not every program signed the pledge. And only 3 programs that signed the pledge had to fill through SOAP. And demonstrated interest is loosely determined, sure 1 rotation 1 LOR, but I've heard one soaper scrambling in from a different field said other stuff like "relative had radiation" still contributed in addition to 1 month 1 letter in the SOAP interviews.

Some programs, the ones that didn't sign the pledge may have been more focused on finding warm bodies to fill quick compared to the ones that signed the plege

And the programs that avoided the SOAP, some might have interviewed (I know for sure at least 1 program did that) and ranked every single applicant, even the step 200 MD, the unqualified FMG/DOs - some FMG/DOs are excellent but there are some awful ones out there
 
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Apart from the pledge, feel free to pull aside Louis potters and James Bonner at Astro and politely ask them to explain themselves.
 
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Apart from the pledge, feel free to pull aside Louis potters and James Bonner at Astro and politely ask them to explain themselves.

Not the best time to bug Potters. I wonder if they started furloughing attendings in his Department.


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Not the best time to bug Potters. I wonder if they started furloughing attendings in his Department.


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He's got plenty of time to give multi page updates on ROhub several times a week talking about how much their volume has dropped, so i am going to guess yes
 
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Not every program signed the pledge. And only 3 programs that signed the pledge had to fill through SOAP. And demonstrated interest is loosely determined, sure 1 rotation 1 LOR, but I've heard one soaper scrambling in from a different field said other stuff like "relative had radiation" still contributed in addition to 1 month 1 letter in the SOAP interviews.

Some programs, the ones that didn't sign the pledge may have been more focused on finding warm bodies to fill quick compared to the ones that signed the plege

And the programs that avoided the SOAP, some might have interviewed (I know for sure at least 1 program did that) and ranked every single applicant, even the step 200 MD, the unqualified FMG/DOs - some FMG/DOs are excellent but there are some awful ones out there

this is true. I know of multiple aweful No good programs who literally interviewed as many people as possible and ranked every warm body, truly aweful applicants. Some very low quality applicants matched this year, some of you may want to hire soon. It worked for these aweful programs because they matched. We still know who you are, the word Got out quick, these are very leaky places! And i suspect ultimately these aweful places will go unmatched.
 
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He's got plenty of time to give multi page updates on ROhub several times a week talking about how much their volume has dropped, so i am going to guess yes

He is probably right to complain, as his radonc network is the most affected in the North America. I’m just very curious to see of they are continuing to pay base salaries to their attendings and which personnel cost cutting measures are in place.


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He is probably right to complain, as his radonc network is the most affected in the North America. I’m just very curious to see of they are continuing to pay base salaries to their attendings and which personnel cost cutting measures are in place.


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Just use the residents to run everything...
 
Just use the residents to run everything...

:) well, for hospital-based centers, he hardly needs physician presence now. Just condense all billable sims and new starts into 1-2 days. The problem is the bottom line on professional side and that’s what he is trying to convey.


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this is true. I know of multiple aweful No good programs who literally interviewed as many people as possible and ranked every warm body, truly aweful applicants. Some very low quality applicants matched this year, some of you may want to hire soon. It worked for these aweful programs because they matched. We still know who you are, the word Got out quick, these are very leaky places! And i suspect ultimately these aweful places will go unmatched.
Many programs cashing in on the stimulus checks of continued residual med student interest in rad onc.
But even that money will dry up in future for some programs once ACGME comes collecting over poor inservice scores/board pass rates.
 
Many programs cashing in on the stimulus checks of continued residual med student interest in rad onc.
But even that money will dry up in future for some programs once ACGME comes collecting over poor inservice scores/board pass rates.

Assuming the RO residency grad breadlines starting in July don't do it first
 
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A392A816-750A-4F44-81C8-81A3F7A4D81D.jpeg
 
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Assuming the RO residency grad breadlines starting in July don't do it first
Don’t be confrontational about it. Would just ask him why a doubling of residency numbers would be expected to work out? He should be able to answer that politely. Obviously don’t accuse him of being greedy etc. the point is this should not be an abstract decision for him. Real faces need to ask him point blank for his rational.
 
Many programs cashing in on the stimulus checks of continued residual med student interest in rad onc.
But even that money will dry up in future for some programs once ACGME comes collecting over poor inservice scores/board pass rates.
I do worry for the IMGs who aren't extremely proficient in English passing the orals. I'm a native speaker and found my self going in circles at times. Tough test for anyone. Having a language barrier added on will make it even more difficult.
 
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He's got plenty of time to give multi page updates on ROhub several times a week talking about how much their volume has dropped, so i am going to guess yes

Anyone else have volume that has been unaffected, but by minimizing staff and ridiculous amount of administrative duties from COVID feel overwhelmed like me? I have been crazy buzy for the past month.
 
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Anyone else have volume that has been unaffected, but by minimizing staff and ridiculous amount of administrative duties from COVID feel overwhelmed like me? I have been crazy buzy for the past month.
I've gotten very few bread and butter cases. Lately everything is diagnosed through ED, so even a few cases can eat up a lot of time.
 
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Anyone else have volume that has been unaffected, but by minimizing staff and ridiculous amount of administrative duties from COVID feel overwhelmed like me? I have been crazy buzy for the past month.
Me too. There's a lag obviously, see a ton of consults a few weeks ago and they make it through to sim and machine now. I am sure a month from now will be different
 
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I do worry for the IMGs who aren't extremely proficient in English passing the orals. I'm a native speaker and found my self going in circles at times. Tough test for anyone. Having a language barrier added on will make it even more difficult.

i'll go ahead and say it because many of you are thinking it. The history of oral boards is racist. It was a final "let me lay eyes on you before I let you into this club". It may not be inherently racist now. It may be. Nobody really knows, but many are saying it. There's a reason why literally most fields got rid of it, including the ABR with radiology.
 
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i'll go ahead and say it because many of you are thinking it. The history of oral boards is racist. It was a final "let me lay eyes on you before I let you into this club". It may not be inherently racist now. It may be. Nobody really knows, but many are saying it. There's a reason why literally most fields got rid of it, including the ABR with radiology.
Probably true, although there are some idiots that are really good at MC exams that get exposed during orals....
 
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Probably true, although there may some idiots that are really good at MC exams that get exposed during orals....

I suppose you're right
im having a hard time though picturing how someone can be graduated from a residency, not know a single thing, then pass boards which are hard and then somehow stumble in orals because someone tricked them during the breast section? (supposedly one of the most failed sections, seriously?). Oral boards is an outdated system completely open to all sorts of conscious and unconscious biases. The example was brought up of someone having an accent and how that may affect them negatively during boards. Most specialties who don't have them are able to produce competent doctors. Its also a huge waste of time and money.

The current crisis has only exposed how redudant things are. the ACGME is even saying, hey it doesn't matter if you don't get all your cases, just graduate if your PD/Program is OK. This makes sense because the program should know if you're ready, but it exposes the sillyness of their requirements. Rather than using this as an opportunity to get rid of FOUR board exams we have to take, they do nothing.
 
I suppose you're right
im having a hard time though picturing how someone can be graduated from a residency, not know a single thing, then pass boards which are hard and then somehow stumble in orals because someone tricked them during the breast section? (supposedly one of the most failed sections, seriously?). Oral boards is an outdated system completely open to all sorts of conscious and unconscious biases. The example was brought up of someone having an accent and how that may affect them negatively during boards. Most specialties who don't have them are able to produce competent doctors. Its also a huge waste of time and money.

The current crisis has only exposed how redudant things are. the ACGME is even saying, hey it doesn't matter if you don't get all your cases, just graduate if your PD/Program is OK. This makes sense because the program should know if you're ready, but it exposes the sillyness of their requirements. Rather than using this as an opportunity to get rid of FOUR board exams we have to take, they do nothing.
Agree with all of that, although in the era of expansion, might be good to dump some of the writtens and keep the oral, esp when any place can open or expand a program these days without regard to quality/breadth etc
 
Anyone else have volume that has been unaffected, but by minimizing staff and ridiculous amount of administrative duties from COVID feel overwhelmed like me? I have been crazy buzy for the past month.

My volume has started to really really come down last couple of weeks...but with telehealth and taking me out of my normal routine, less staff, and TONS of meetings/webEx...I've been working more hours.

Crazy.
 
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I suppose you're right
im having a hard time though picturing how someone can be graduated from a residency, not know a single thing, then pass boards which are hard and then somehow stumble in orals because someone tricked them during the breast section? (supposedly one of the most failed sections, seriously?). Oral boards is an outdated system completely open to all sorts of conscious and unconscious biases. The example was brought up of someone having an accent and how that may affect them negatively during boards. Most specialties who don't have them are able to produce competent doctors. Its also a huge waste of time and money.

The current crisis has only exposed how redudant things are. the ACGME is even saying, hey it doesn't matter if you don't get all your cases, just graduate if your PD/Program is OK. This makes sense because the program should know if you're ready, but it exposes the sillyness of their requirements. Rather than using this as an opportunity to get rid of FOUR board exams we have to take, they do nothing.

This whole residency and board exam system is supposedly in place to protect the public from incompetent doctors. However, now we have:

1) The ACGME coming out and repeatedly saying case load doesn't matter, just the subjective judgement of the PD/CCC.
2) Written boards postponed.
3) Oral boards postponed.

- but -

4) Everyone will seemingly be allowed to move forward with their careers unhindered.

I know, I get it - extraordinary circumstances. However, would a commercial airliner be allowed to fly with passengers if it didn't pass a final safety inspection? I'm going to go out on a limb here and say no. That final safety inspection is essential. Someone who survives 4 years of medical school and 5 years of residency doesn't need all these hoops - and most specialties seem to recognize that.

FOUR board exams is ridiculous. Do PGY-2 Internal Medicine residents have to take board exams where the mechanisms of fluoroquinolone Q-T prolongation are tested? Are they studying cutaway diagrams of ventilators and their mechanical parts? Being asked about the historical materials used to build a chest tube? What would be the reaction if this was proposed?

At a minimum, this should be an opportunity to do away with RadBio/Physics and roll a few small, key concepts from those exams into a single exam taken at the end of residency. The relative merits (or lack thereof) of oral boards is a whole different debate that also deserves attention, but still.

Come on, ABR. This is your chance to embrace change and save face while doing it.
 
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