does anybody know if other fields are more specific in their case requirements? For example, does general surgery specify how many open vs lap procedures vs robotic, how many cholecystecomies, how many bowel resections, etc etc. does ENT say you have to do these many neck dissections, these many sinus surgeries etc? or is this a general blanket like "abdominal surgeries" or "head and neck surgeries". Our requirements are way too general. We should absolutely specify minimal requirements to achieve competency in every subsite (from Peds to lymphoma, to SRS/SBRT (within SBRT, must have a broad experience including liver, etc etc), to T&O and interstitial gyn, HDR/LDR prostate etc etc). I undestand why this is not done, because of politics. Some supposedly "good programs" have low brachy volumes and send their residents for like 1-3 month externships to get some GYN, prostate brachy at places like Wash U and others. There are some already very bad no good programs which would not meet enough cases in specialized things like lymphoma. There are places that barely see prostate!
I feel like this seriously needs to be looked at. This will hurt some or many programs. In the grand scheme of things, most of these programs shouldn't exist. There are just so many bad programs out there. Some supposedly "good programs" which are not quite as good as people say. I don't understand why they don't just tighten the requirements and shut them down. They started with good idea of increasing requirements but it eventually got so watered down it did absolutely nothing.
I now believe nothing will change or be done, unless things get so bad that truly "breadlines" happen for our field. Im talking about like a plurality of people without a job like Nuc Med,and "big name" places having their own be unemployed (not enough satellites to place them, not enough secret hand shake to place them),and people having to do multiple useless "fellowships" with Miami Mehta Proton center and ANOVA. Until this happens, nothing is going to change.
I'm not even going to discuss the board issue. Paul Wallner says we must thank him for elevating rad onc. Nothing changing.
So we find ourselves in this unfortunate position with no end in sight and only signs that things are likely to get worst. The match gets worst and worst every year. I review applications being in review committee, and they get worst every year. They may be very good people, the best people, but they are objectively less qualified than years prior.
Speaking broadly, our generation has been now through two terrible financial crisis. We had no capital or liquidity to ride the stock market wave the past 10 years. We have no savings, and a lot of debt, and we are entering a job market with declining prospects with market forces that decrease utilization, decrease need for presence (warm body nearby), decrease fractions in a model where you get paid per fraction, decreased lowered ceiling in terms of pay (rarity of these golden goose jobs that offer 800K+ partnership, etc), and our very own cannot think fast enough for more ways to eliminate our modality etc etc. Anybody going into rad onc now, needs to seriously consider these issues. If you are early in your training, it is not too late to get out. People in my situation are stuck, we are going nowhere, but you still have time!
There is no free lunch in medicine, but some lunches are better than others.
For those looking for a job or looking next year, my advice is to sign the first "good" "decent" contract you get, if you're lucky, and never look back.
