MDACC:
Details: Fantastic combination of international reputation, impressive faculty, supportive culture, clinical training, basic and clinical research opportunities, every technology under the sun, and beautiful facilities. The focus here is squarely on education, since when you have 24 residents and 60+ faculty with 1-to-1 resident-to-attending coverage (on 2-month rotations), most faculty/services know how to function independently of residents, since they also employ a ton of NPs/PAs. Thus the attendings are very actively involved and you only have to do the educational stuff for the most part, and non-doctorly scutwork is very minimal (though I've heard not all services are as smooth as others). About 60% of the patients come outside Houston, which is good because you see the coolest cases around the world, but could be bad since you're being seen often as a second/third/tenth opinion, and you may be actually treating/simming fewer patients than you actually do H&Ps for (since they'll often go home to get treated when they realize that RT techniques don't vary too much among major academic centers around the country). This would also happen at big-name cancer centers like MSKCC/DFCI/Mayo/Hopkins, etc. Hands down most impressive hospital and medical center… absolutely gorgeous and HUGE (like everything else in Texas), including a fully equipped gym for staff members. Call is one week out of every 5 for your first year, with no call at all after that (could be good or bad depending on your preferences), and you'll often get called in a couple nights and one weekend day per week, as well as having to be present from 6 am til 10 pm for the on-treatment patients (yes they treat for 16 hours a day). Luckily you're not covering the proton center on call (attendings are), otherwise it'd be a lot worse. All in all, seems like workload is more than most programs, but not overwhelming. Research is only 8 months protected but can get up to 12 months if you want. Morning conference can also be pretty intense, as residents present often and get picked on a lot, but at least there's a lot of attending buy-in and the room is packed with 40+ people every day. Other didactics in radbio and physics tend to be in two-week protected blocks and not longitudinal, as far as I understand. If you get an interview here, definitely go, since they put you up for THREE nights in a very nice one-bedroom suite near the medical center, giving you a full extra Saturday to explore the city and see that Houston isn't all that awful (especially in the winter and if you have a car), since it has a ton of sports/arts/restaurants/etc, and cost of living is great. 6 residents/year.
Perfect if: looking for unparalleled clinical and academic exposure; willing to work hard but with minimal scutwork, value excellent mentorship and teaching; wanting a lot of space to rent/buy on a resident's salary, especially if you're living with partner/family
MSKCC:
Details: From day 1, you will get an incredible load of responsibility and patient numbers. This is phenomenal for some people and awful for other people. Though these patients will teach you a lot, some may argue that you go well beyond the point of diminishing returns, many residents say they learn much more from their co-residents than their attendings, since there's very little time for 1-on-1 teaching. Seems like the reason for such high volume is that there really aren't that many faculty members for the amount of patients come through the cancer center, so each faculty member (and by extension the residents) has to handle a load much heavier than MD Anderson or Harvard. More important than the actual number of hours is the intensity of the hours, since you're constantly getting paged with new consults left and right (more on some services than others). You learn to be efficient, but at the cost of reading and doing research during your clinical rotations unless you're willing to do work way beyond 80 hours a week (which most of their residents seem very willing to do). Full year of research during third year, though the chair expects that you outline your work very carefully beforehand and justify yourself often especially if you choose to do clinical research during that time, which he frowns upon but will begrudgingly support in the end. Though most attendings seem pretty cool overall, there are apparently a few that routinely beat up (verbally) on their residents and can really ruin morale throughout a 2-3 month rotation. Residents seem to bond pretty well, and are generally a pretty young and energetic group that enjoys working hard and playing hard. This is probably the most polarizing program, where some residents couldn't imagine life/training any other way, and others could seriously drown in misery (similar to the distribution in general surgery programs, though to a lesser degree). New York has its obvious perks and downsides, as there's so much fun/cultural stuff going on there, but is also high-paced, fairly impersonal, and very expensive, though the subsidized housing makes things much more reasonable (plus the salary is probably the highest in the country). 5 residents/year.
Perfect if: looking for the most clinical volume and autonomy/responsibility of any program; are OK with minimal 1-on-1 teaching, dealing with the occasional adversarial attending, and living in a constantly high-paced and occasional frenetic work environment; want to be actively recruited by every top-notched private practice in the East Coast; are single or at least without kids, love big and exciting cities, and value camaraderie with your generally young and energetic co-residents.
HARVARD:
Details: Incredible exposure to 4 sites (MGH, BWH/DFCI/Children's, BIDMC, and BMC) with attendings as famous as those at MD Anderson. You cover full services rather than individual attendings here (3-month blocks), but the workload still doesn't seem to be overwhelming. Each site seems to have a fairly different personality. MGH is very busy clinically, as the resident gets a lot of autonomy/responsibility and somewhat minimal one-on-one teaching (since the focus is very much on getting work done, kind of like MSKCC), while BWH/DFCI/Children's has a much more academic feel, with very intense daily morning conferences where a full command of the literature is emphasized, more one-on-one teaching, but a little less volume and autonomy/responsibility, since services there are much more attending-driven. Attendings at BIDMC usually treat multiple sites (so it won't just be one site for the full 3 months) and are typically less busy, while BMC has a patient population that tends to have a lot poorer access to healthcare, with more advanced disease presentations and often unreliable treatment compliance, and everything there is generally more disorganized (kind of like the real world). Full 12 months protected research time during third year to do anything you want in the entire Harvard community (which if you don't know, is ridiculously huge), including the possibility of going to the School of Public Health 6-week program on clinical effectiveness ($13k, entirely paid for by the rad onc program, and good foundation on statistics, etc.) or continuing to get your full MPH (an additional $30k that's out of your own pocket unless you have a fellowship). That leaves you with 12 three-month blocks to split among all these sites, with 1 block at BMC during second year, 2-3 blocks at BIDMC, 4-5 blocks at BWH/DFCI/Children's, and 4-5 blocks at MGH. Since you're spending so little time at each site, there are a couple disadvantages. One is that one site might be unquestionably the strongest in one particular area (i.e. gynecology at BWH/DFCI/Children's, CNS/peds at MGH with their protons), and you might not be assigned to work there at all during your residency, especially since you only have time to do each subspecialty once (with a couple exceptions). Another is that you won't really know the faculty as well as you might at a smaller program like Yale/Penn/MSKCC, since you won't have rotated with all of them (like at MD Anderson, attendings are assigned somewhat randomly) and since you'll disappear off their radar for 6-12 months at a time if you're not going to be assigned to their hospital for a while. New mentorship program formed to address this fragmentation, though this probably won't solve all their problems. There's also somewhat less resident camaraderie, since you don't see half your class for all of first year after the first two weeks of orientation (since you do 6 months at MGH then 6 months at Longwood, or vice versa, then second year and fourth year they're more mixed up). Boston seems like a fantastic place to live, with lots of options for living environments from downtown to nearby suburbs, though it is pretty uniformly expensive on all fronts and tends to get quite cold. 7-8 residents/year.
Perfect if: looking for broadest perspectives on clinical matters with fantastic faculty and broadest variety of research opportunities; want the opportunity to get first dibs on any academic or private practice job in the country; are truly a self-starter since no one will ever know if you're falling through the cracks, despite mentorship program; are OK with not meeting most of the faculty or being as much on their radars since you're rotating so much; prefer a very nice but expensive city with lots of suburban-like areas within walking distance or 10-15 minute drive.
YALE:
Details: Fantastic, smaller training program led by one of the most supportive PDs in the business. Like MD Anderson, a huge focus on scut-less education, so that you have more time to spend with your patients, simming, planning treatments, reading, and doing research. Brand new Smilow cancer hospital is beautiful, and even the rad onc facilities in the basement feel very bright and soothing. Covering two or three attendings of different sites at a time (3-month blocks), so each rotation is a little less focused, though this can be good so that you'll likely end up seeing each subsite multiple times. The workload isn't too intense, though, because Yale owns tons of satellites (residents only rotate at two of them), and nearly every attending spends at least 1-2 clinic days outside of YNHH, and only 1 clinic day per week at YNHH that you're responsible for. The two satellites you'll go to (Lawrence and Memorial in New London and Backus in Norwich) are about an hour away from YNHH, but are against traffic. Residents say they really like it there, since it's more of a generalist experience where they get a ton of autonomy/responsibility, but still get taught well by the Yale faculty who attend there. 12 full months of research/elective to do whatever you want (including aways), luckily doesn't have to be 12 consecutive months though it can be if you want. Downside of a smaller program like this is that you don't get as many perspectives as you would at Harvard/MSKCC, since most subsites only have one or two faculty. Parts of New Haven, especially around the medical area, are pretty ghetto, but the college campus area is only a couple blocks away and is beautiful (with tons of fantastic restaurants), and almost all the residents live in suburbs about 15-20 minutes away, which are really nice and where you can get quite a bit of space on a resident salary (plus they pay you on par with Boston despite lower cost of living). 3 residents/year.
Perfect if: looking for excellent clinical and academic training in a relatively laid-back, flexible, family-like environment; prefer having a fair amount of time available to read, do research, and have a life during clinical months; are OK with spending 9 months driving an hour each way to the satellites and OK with driving in general, since most of the nice places to live are about 15-20 minutes away; want a smallish, college-town city with good restaurants downtown and nice/inexpensive suburban-areas nearby that is within 1.5-2 hours to either NYC or Boston by car/bus/train, ideal if you have a partner/family
PENN:
Details: Rapidly expanding department led by one of the most genuine, humanistic chairs in the country. Brand new building with several floors dedicated to rad onc, including proton center, and have hired like crazy to handle the tripling in clinical volume that has occurred within just a few years. Very clinically focused department, and residents have been working quite hard to accommodate all the new attendings. Quite a bit of scut, which residents were very willing to admit, but still seems like a very positive environment with good 1-on-1 teaching, as many of the attendings are young and friendly. Though they admit that some kinks still need to be worked out, it appears the hardest part of the expansion has passed. Located right on the UPenn campus, with all the advantages of the university environment, and most residents live in Center City (lots of great restaurants and only a 15-20 walk or short drive/bus away), with some living in some nice suburbs not too far away. Research is 10 months (five 2-month blocks), which can be scheduled consecutively if you really needed. Required intern year at HUP can be a real bummer if you really want to stay where you did med school or if you want a cushy transitional year, so take that into account because you can't get around it. So-so salary for so-so cost-of-living. 4 residents/year
Perfect if: looking for great clinical exposure in a friendly environment with younger, up-and-coming attendings and phenomenal chair; are OK with a fair amount of scut in exchange while seeing lots of patients; like a city with a good mix of niceness and grit with excellent food and interesting history within 1-2 hours to NYC/Baltimore/DC by train (longer by car for some reason); not bothered by required medicine internship at Penn
