Is Rad Onc Going down?

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[The wise one]

Super hard!

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[Lebron's hairline]

Super hard!

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Could you elaborate?

 

[slowthai]

Just go to the rad onc forum and look at the first like, 10 threads. They are begging all med students to avoid the field at all costs.

 

[altblue]

there are areas outside of those cities that exist with ample things to do and a better cost of living. you'd probably be able to find a job in those places.

east and west coast Zoomers are convinced that no other region of the country exists.

 

[bigindian4891]

Do you want to work hard to have no say about where you live and have a difficult time finding a job? Avoid Rad onc and possibly EM. Talk to the people looking for jobs, and realize its going to get worse every year as more people graduate.

 

[7331poas]

there are areas outside of those cities that exist with ample things to do and a better cost of living. you'd probably be able to find a job in those places.

east and west coast Zoomers are convinced that no other region of the country exists.

Nah, from what I have heard finding jobs even in the flyover states is hard.

 

[eyejust]

Do you want to work hard to have no say about where you live and have a difficult time finding a job? Avoid Rad onc and possibly EM. Talk to the people looking for jobs, and realize its going to get worse every year as more people graduate.

EM??

 

[slowthai]

EM??

Yes, it's going down in flames. Just head over to the EM forums. Malignant residency expansion is such a specialty killer.

 

[Splenda88]

Hey, M1 here interested in radiaiton oncology. I thought it was a super interesting field after seeing what rad oncs do when my grandpa got cancer. After doing some research into the field, I cam across a huge thread of someone on sdn who went on a tirade of why rad onc is going downhill. To any Radiation oncologists, is the job market in radiaton oncology really bad or is this just more of the same sdn/reddit fearmongering? Like are radiaiton oncology residents forced to go work out in the boonies somewhere after graduating or is it just that getting a good job in a big metro area like NYC/LA/Chicago is hard?

It's not fear-mongering... My friend who is graduating next year is having a tough time getting anything going as far as job offers.

He told me one person in his program jump off the ship after 1st year.

 

[slowthai]

It's not fear-mongering... My friend who is graduating next year is having a tough time getting anything going as far as job offers.

He told me one person in his program jump off the ship after 1st year.

Hooolee crap, I hope you mean left the program, not committed suicide

 

[7331poas]

Hooolee crap, I hope you mean left the program, not committed suicide

I would hope his residency program is not on a cruiseship sir.

 

[Splenda88]

Hooolee crap, I hope you mean left the program, not committed suicide

Left the program and went into IM with the hope of doing Heme/Onc

 

[CyrusHabs7695]

crazy that this was one of the most competitive specialties a few years ago and now programs are going unfilled. such a shame, seems like a super cool field

 

[Splenda88]

crazy that this was one of the most competitive specialties a few years ago and now programs are going unfilled. such a shame, seems like a super cool field

At the end of the day, the $$$ and job security matter no matter what premeds and some med student say...

Even my friend acknowledged that he made a big mistake but he was already a PGY4...

 

[deleted985251]

Any actual rad onc residents/attending want to chime in, not people who have friends in the field?

 

[slowthai]

Any actual rad onc residents/attending want to chime in, not people who have friends in the field?

@evilbooyaa

 

[Splenda88]

Any actual rad onc residents/attending want to chime in, not people who have friends in the field?

Go to the rad-onc forum. That forum along with the pathology forum are the saddest forum in SDN... However, if radonc is the only specialty you can see yourself into, do NOT go there.

Rad Onc Twitter

Getting annoying because of the sycophants. We all are on here posting. We can do the same thing on twitter. Use your SDN name, post, and we can All retweet each other to make the salient points more prominent to push back on the nonsense and garbage being spewed. I’m getting fatigued of...

forums.studentdoctor.net

 

[Goro]

Is this because the field is saturated, or that technology/medical advances have made less useful in Oncology?

 

[deleted985251]

Is this because the field is saturated, or that technology/medical advances have made less useful in Oncology?

From what I’ve heard in around 2010 they increased the number of residency spots by a lot and completely flooded the market.

 

[dieABRdie]

Any actual rad onc residents/attending want to chime in, not people who have friends in the field?

I just happened to pass by so I'll chime in real quick. If geographic flexibility is what you desire by any measure then do not go into this specialty. I looked back at all the residents who graduated from our program in the last 5 years and 50% of them have taken jobs in "rural" areas... no exaggeration. I would have to define rural... as I know some people consider towns like Nashville rural. These are towns of approximately 30,000 - 50,000 people that are 1.5 to two hours from a small, regional airport (not a major airport). I would say the "ranking" of our program would be solidly mid-tier and has no reputation for being a poor training program. Of course some of our graduates might disagree but I can say that even when I practiced in a town of 50K by myself there was nothing I saw in adult radiation oncology that I was uncomfortable treating.

I had complete flexibility in my geographic area if I desired. I actually received 5 offers in either private practice or non-academic hospitals over the year and a half I was searching but all of them had some form of fatal flaw. These included things like horribly dated equipment with no interest in upgrading to modern technology, predatory employment with no path to partnership, or poor compensation relative to other similar positions. One joker actually lied to me about the possibility of a future position. Without any other options I held out for it for several months... only to find out he was lying to me about his group's future and it never happened. I did do locums work at several very rural places and those jobs weren't too bad.... but they were across the country from my family and I completely underestimated how that would wear on me. I know many other residents who interviewed with similar geographic flexibility and were only offered 1-2 interviews so they took what they could get.

In the end... holding out for me worked out because I landed a fantastic opportunity... but it was completely luck. If you couldn't tell me I landed where I did; there is no circumstance that I would have chose this again. One saving grace of Rad Onc used to be that no matter what there would always be a job in BFE paying well north of median MGMA... but this year they removed the CMS requirement for on site supervision of radiation therapy. The hospital that owned the equipment required our presence in order to collect the technical revenue from CMS (which represents 80% of the billing). Because of this policy change over the last year I personally witnessed jobs that were perpetually available due to rural location be removed from posting. The hospital administrators realized they could pay someone 1-2 days per week instead. Of course this was falsely propping up the job market so it is normalizing to what it should have been... but its among many of the other reasons for a worsening market.

Those other reasons are nearly the only thing discussed in the Rad Onc forum. You will hear a different tune from people in academics because the leaders benefit from the supply and the young ones are afraid speaking out will affect their promotion.... or in many cases they have always been sheltered from reality in their academic bubble. They've labeled posters here as "misanthropes" and blame them for the poor job market. But take a look at those forums where there is a known problem with the job market (i.e. pahtology or pharmacy), then take a look other forums for medical specialties. Do you think this is just a farce perpetuated by a handful of people... or could there truly be an issue? My experience is that Rad Onc is moving beyond a geographically restricted field to one where employment at all is a very real risk.

 

[eyejust]

Hooolee crap, I hope you mean left the program, not committed suicide

... You really needed someone to clarify this for you?

 

[evilbooyaa]

Current rad onc attending, fresh residency graduate. dieABRdie has summarized it quite well.

In brief, there are too many residents graduating every year and not enough good jobs for them. Getting a job in major cities (NYC/LA/SF/Chicago) was always a struggle year to year, although you'd maybe be able to. Nowadays, getting a job in something that would be considered a city in any part of the country is difficult, solely because of the competition. There will be some rural jobs (towns with < 50 or 100k population) that are currently available. Whether those will still be present when you, as a current MS1, graduate a 5-year residency (8-9 years into the future) is to be determined.

The main issue for this is an increase from ~100ish residency graduates per year to ~200 per year over a 10 year period, thus massively increasing supply. In addition, Radiation Oncology is a field that can be done until physicians are in their 70s or 80s... or in at least one academic institution, until the physician literally passed away from old age, while he was still working. Some would argue that old-timers, who have been 'grandfathered' into board certification and have no requirements to ensure they are 'keeping up with current literature' treat using archaic techniques and dosing, and are literally incapable of doing more advanced treatments. Some proportion of this is at academic institutions, with multiple institutions (that I have personally interacted with) having a scenario of "a certain older attending is unsafe unless a resident is on their service to ensure that things are done somewhat within reason"

There are significant downward pressures on the demand for radiation oncologists - more regimens are being done in less treatments, meaning less weekly evaluations, with physicians able to see more consults to prop up their salaries (currently revenue is driven, in part, on a per treatment basis, although this is in the process of being revamped by the alternative payment model, which is a disaster as currently designed).

Additionally, the changes in supervision requirements detailed above are relevant - historically Rad oncs needed to 'babysit' a machine while it was treating in all but the most rural (critical access) locations. That requirement has gone away and some places have responded in kind.

Similarly, many radiation trials going forward are trying to figure out how to give less radiation, or no radiation. A few investigators are looking for more indications for radiation, but giving more treatments of radiation is not of significant interest to 99% of academics.

Radiation oncology is also a downstream referral specialty, so many patients get treated (potentially inappropriately depending on clinical scenario) without ever meeting a radiation oncologist, but that's essentially the same as it's always been.

Currently, a graduating resident has been told by the president of our national society, ASTRO, to be happy with A job, ANY job that they receive. I (and many others on this forum) worry about what that will be in 5 years. I can't imagine where we will be at in 9 years, although whether we will continue on this current trajectory is TBD. This is why the field this year, for ~200 spots, has ~100 US MDs applying.

There are less people that have applied to rad onc this year (at least on day 1 ERAS, across USMD, USDO, and IMGs/FMGs) than there are available spots in residency. Many lower-quality programs seem happy to SOAP or take any warm body that applies rather than consider going unmatched.

Current academic attendings in ivory towers are well insulated from all of this. They are also reliant on residents, not only for clinical work, but for prestige and ability to recruit good quality attendings to their institution (the carrot of 'resident coverage' is a big selling point for many prospective radiation oncology attendings).

If you are truly interested in the field, talk to current residents or recent graduates (within the past 2-3 years). Tenured professors have zero direct knowledge of the job market and most will likely claim it is better than the 'misanthropes' on SDN would want you to believe.

If you are willing to pursue the field despite all these issues, then more power to you. While many on the Rad Onc forum have regret, I personally know that the clinical work and use of technology is amazing, and that I would not be nearly as happy in any other field as I am in this one. That being said, if I was a MS4 now, I'd probably still go for it, but really try to get into a top program, but I can't recommend that for anyone who likes other fields of medicine as much as they like Rad Onc.

 

[slowthai]

... You really needed someone to clarify this for you?

I'll admit, wasn't one of my finest moments, but my brain was running on empty at the time. But thanks for highlighting this, much appreciated

 

[Matthew9Thirtyfive]

I'll admit, wasn't one of my finest moments, but my brain was running on empty at the time. But thanks for highlighting this, much appreciated

Nothing better than public humiliation.

 

[sloh]

What you call fearmongering is what we at SDN call “get your head out of the sand.”

 

[efle]

I have no personal experience with this but here's what NRMP data captured in recent years:

Match Data to RadOnc for US MD Seniors:

2020: 192 positions, 122 applied, 121 matched
2018: 194 positions, 190 applied, 176 matched
2016: 186 positions, 186 applied, 169 matched
2014: 186 positions, 188 applied, 168 matched
2011: 171 positions, 181 applied, 154 matched
2009: 156 positions, 155 applied, 134 matched
2007: 142 positions, 152 applied, 124 matched
2006: 137 positions, 149 applied, 115 matched

So the number of positions exploded +40%, and while applicant volume was keeping pace for a while, it suddenly fell off in the last couple years. Now there's only enough US MD Seniors to fill ~2/3 spots so it has a ~100% matchrate for warm bodies. Definitely looks like a previously hot specialty that has suddenly lost its appeal due to overexpansion

 

[Neopolymath]

hope those old guys are rich af and happy that they screwed all the young guns. Hope it was worth it to work a little less hard for a little more money after already being quite well compensated.

Guys, for the love of God don't go into corporate practice and don't fall for this shortage of doctors BS that even med students keep saying just so some boomer jerk can make even more money

 

[The wise one]

@Neopolymath what's the alternative? Corporate medicine is the future.

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[Neopolymath]

@Neopolymath what's the alternative? Corporate medicine is the future.

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Feel free to proverbially roll over and die if you want to. You have options.

 

[Kardio]

@Neopolymath PLEASE go into MedEd or MedPolitics

 

[cookiegrub]

Is this because the field is saturated, or that technology/medical advances have made less useful in Oncology?

It's because the technology is available in big city academic centers (think proton therapy). The rule of thumb is to be at a top 3 program to ensure employment wherever you can imagine.
Research is HUGE, so if you can do a concurrent PhD at a top institute and weasel your way in, this field is probably much more interested in # publications. This field is really cool and if you want to go for it, residency wise it's super nice. Just make sure to put you foot in the right doors to end up at the right location. It'll take a lot of sacrifice though. That being said, things change overnight so keep your eyes open and get on that publication train now!

 

[Neuronix]

Yes job market is a bit better for top tier grads, but it is still tough. Going to a top residency program does not create you a position in an area that is not hiring that year. Not all practices care about academic prestige--some even look down on it (top program grads too spoiled, not clinical enough). Having too many papers is a red flag to many private and hospital employed jobs that don't offer research. Many practices are more interested in someone who they know who is tied to the area rather than a top tier grad unknown person.

Do not waste your time getting a PhD for rad onc unless that's something you seriously want to do. Clinical publications are easy to get in a few months or a year, and you can rack up just as many clinical papers in numbers as a PhD who spends years in a lab on basic research. Also there are very limited and very competitive options for research for MDs in rad onc outside of clinical research.

Finally, technology is available all over the place, but also major city academics does not guarantee tech. For example, there are 34 proton radiation centers in the usa now per wikipedia. Sloan Kettering just recently went online with protons, about 20 years late to the party.

 

[Lucca]

hope those old guys are rich af and happy that they screwed all the young guns. Hope it was worth it to work a little less hard for a little more money after already being quite well compensated.

Guys, for the love of God don't go into corporate practice and don't fall for this shortage of doctors BS that even med students keep saying just so some boomer jerk can make even more money

there is no practice that isn't corporate in the us. Academia is as corporate as corporate, just focuses on different metrics but ultimately its the same economics. That doesnt mean we should tolerate a work environment that doesnt value us or makes us sacrifice patient care for some meaningless number on a yearly report, js.

I also came into med school very interested in rad onc from prior experience. Very cool field. But will most likely be avoiding it even if the market is better *today* for top residency grads. There are just too many other options to do research in cancer biology and take care of cancer patients.

 

[Neopolymath]

there is no practice that isn't corporate in the us. Academia is as corporate as corporate, just focuses on different metrics but ultimately its the same economics. That doesnt mean we should tolerate a work environment that doesnt value us or makes us sacrifice patient care for some meaningless number on a yearly report, js.

I also came into med school very interested in rad onc from prior experience. Very cool field. But will most likely be avoiding it even if the market is better *today* for top residency grads. There are just too many other options to do research in cancer biology and take care of cancer patients.

Uhhhhhhhhm? Are you referring to specifically this field or making some semantic distinction that all small democratic PP groups are structured as corporations or ???

 

[Chartreuse Wombat]

Any actual rad onc residents/attending want to chime in, not people who have friends in the field?

I am a Radiation Oncology faculty member at top 10 institution. I trained 30 years ago. I have a son who is M3. I have encouraged him NOT to pursue RadOnc. It is a great field but so many trends combining to make the job market poor. We have overtrained (Increased residency positions by nearly 100% in last 15 years) as reimbursement, indications are falling.

 

[medgator]

crazy that this was one of the most competitive specialties a few years ago and now programs are going unfilled. such a shame, seems like a super cool field

That's what doubling spots in a small specialty will do to a field

 

[medgator]

It's because the technology is available in big city academic centers (think proton therapy). The rule of thumb is to be at a top 3 program to ensure employment wherever you can imagine.
Research is HUGE, so if you can do a concurrent PhD at a top institute and weasel your way in, this field is probably much more interested in # publications. This field is really cool and if you want to go for it, residency wise it's super nice. Just make sure to put you foot in the right doors to end up at the right location. It'll take a lot of sacrifice though. That being said, things change overnight so keep your eyes open and get on that publication train now!

Pedigree doesn't matter nearly as much for private practice, it's really a combination of luck in finding open positions in the areas your are looking for a job. Personality and connections far more important imo. In fact, networking has been proposed by many in our specialty to solve the tough job market. Unfortunately, they aren't sharp enough to figure out this won't actually increase the supply of jobs...

 

[The wise one]

With pedigree comes connection and personality

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[medgator]

With pedigree comes connection and personality

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Definitely can be a negative on the second..... Honestly the best places for PP imo are solid mid and upper mid tier programs that keep you clinically busy with a full spectrum of cases

 

[bluelamin]

is there a similar trend happening for DR? NRMP shows high % match rate....and assuming this has been the case for 5+ years....wont that also lead to job saturation at some point given the rise in # grads?

 

[medgator]

is there a similar trend happening for DR? NRMP shows high % match rate....and assuming this has been the case for 5+ years....wont that also lead to job saturation at some point given the rise in # grads?

DR has seen a big growth in imaging which should help demand.

 

[slowthai]

is there a similar trend happening for DR? NRMP shows high % match rate....and assuming this has been the case for 5+ years....wont that also lead to job saturation at some point given the rise in # grads?

Though there are a lot of programs (and not much relative interest in the field, which explains the match rate), DR hasn't expanded anywhere close to the rate of rad onc or EM. Plus the demand for imaging is exponential at this point, like medgator said.

 

[bluelamin]

Though there are a lot of programs (and not much relative interest in the field, which explains the match rate), DR hasn't expanded anywhere close to the rate of rad onc or EM. Plus the demand for imaging is exponential at this point, like medgator said.

phew! that's a relief...

 

[bubbachuck]

New rad onc attending. I've been following the SDN for several years. We're definitely overtraining (attributed to weak national leadership) but I have yet to personally know of someone who hasn't landed somewhere they're happy with, though maybe not straight out of residency. Rad onc definitely has issues with national organizations, but there's good people coming up the ranks that are more motivated whereas the boomers are thinning out. I also think supply/demand is cyclical and it's impossible to prognosticate the future more than 5 years. I wouldn't go into rad onc unless you feel like it's right fit (do rotations in med onc, rad onc, maybe surgery), but if you feel like it's the right fit, it's a good time to go in since you won't have to compete with as many people who are going in for the $/lifestyle/competitiveness.

Ultimately, SDN skews to extremes and there's few "calming voices". So I would recommend supplementing by talking to residents in an informal setting. I would also try to talk to new attendings to ask them how the job process went. In general, reality is more moderate than SDN will portray.

 

[Matthew9Thirtyfive]

New rad onc attending. I've been following the SDN for several years. We're definitely overtraining (attributed to weak national leadership) but I have yet to personally know of someone who hasn't landed somewhere they're happy with, though maybe not straight out of residency. Rad onc definitely has issues with national organizations, but there's good people coming up the ranks that are more motivated whereas the boomers are thinning out. I also think supply/demand is cyclical and it's impossible to prognosticate the future more than 5 years. I wouldn't go into rad onc unless you feel like it's right fit (do rotations in med onc, rad onc, maybe surgery), but if you feel like it's the right fit, it's a good time to go in since you won't have to compete with as many people who are going in for the $/lifestyle/competitiveness.

Ultimately, SDN skews to extremes and there's few "calming voices". So I would recommend supplementing by talking to residents in an informal setting. I would also try to talk to new attendings to ask them how the job process went. In general, reality is more moderate than SDN will portray.

Totally agree that SDN can be polarizing and go to extremes, but I don’t think residents and academic attendings are the best people to talk to about the job market. Academic pathologists have been out of the loop in the path job market for years and are still saying it’s good.

 

[Cognovi]

is there a similar trend happening for DR? NRMP shows high % match rate....and assuming this has been the case for 5+ years....wont that also lead to job saturation at some point given the rise in # grads?

High match rate is not equivalent to expansion of positions.

 

[jhmmd]

Rad onc is like interventional rads. Anyone who says differently is selling something.

 

[Cognovi]

Rad onc is like interventional rads. Anyone who says differently is selling something.

In what way?

 

[jhmmd]

In what way?

The market is booming