Is rad onc job market … rebounding?

[dozitgetchahi]

San Antonio isn’t a bad city but isn’t desirable for most Millennials/Gen Z doctors completing training. Similarly, Cleveland and Columbus aren’t desirable, the other smaller places of Ohio even less so.

A Ohio cancer center was offering $650k on ASTRO job board in 2015. Glad to see our pay has kept up with inflation and COL these last 9 years.

In contrast, in heme onc:

Community Oncology | San Jose, CA | 4 Day Week | Top 100 Hospital in US - California job with Jackson Physician Search | 783340

Join a state-of-the-art, 400-bed hospital system in an outpatient Hem/Onc role. This award-winning system opened their own Cancer Center in 2007 an...

www.nejmcareercenter.org

LOS ANGELES, HEMATOLOGY/ONCOLOGY - Los Angeles, California job with Hematology-Oncology Specialists | 763023

$550,000 Starting base salary. Private Oncology Practice with multiple locations in Los Angeles area looking for BC\BE Oncologists to join our...

www.nejmcareercenter.org

When was the last time there was an open rad onc position for $550k base and $900k TC in Los Angeles or Silicon Valley, with a 4 day work week?

Tons of other heme onc jobs in desirable metros like Seattle, Denver, etc. I’m guessing these jobs aren’t exclusively available to MDA and MSKCC fellowship graduates either.

Yes, rad onc will have mgma median $600k jobs in small towns 50-200k people for the foreseeable future. Heme onc by the way is paid 2.5x our comp for these rural positions.

We’re not the same.

You lost me with “Cleveland and Columbus aren’t desirable”. I’ve lived in both and had great experiences in both, and I currently live in semi-rural Illinois and like it more than either of those cities.

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

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[Mandelin Rain]

You lost me with “Cleveland and Columbus aren’t desirable”. I’ve lived in both and had great experiences in both, and I currently live in semi-rural Illinois and like it more than either of those cities.

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

100%

 

[Doctorer]

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

On the one hand, yes. On the other hand, I'm saying this as someone who lives in a desirable metro area. I wasn't willing to put my money where my mouth is, and expecting others to do so (especially without being compensated like they were previously) is hypocritical.

To put it another way, I don't think a single person from my friend group in college lives outside of a major city. Yes, I know what that implies about me, but I'm not unique.

 

[thecarbonionangle]

You lost me with “Cleveland and Columbus aren’t desirable”. I’ve lived in both and had great experiences in both, and I currently live in semi-rural Illinois and like it more than either of those cities.

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

Yup. Unfurtunately the field attracted a lot of these people during competitive times. They thought RO was a gold mine to make millions working 3 days a week in Manhattan. They are arrogant, elitist, entitled, out of touch, etc. It is repulsing to me how many of them we have in our field. The issues with oversupply, job market, etc are a bit different. I do think the field will be better off with less of these people. I do not care that IMG/DOs will fill spots as long as we are not lowering standards to match anyone like many hellpits. Many programs should be shut down.

 

[NotMattSpraker]

You lost me with “Cleveland and Columbus aren’t desirable”. I’ve lived in both and had great experiences in both, and I currently live in semi-rural Illinois and like it more than either of those cities.

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

It wasnt for my family. I hated St. Louis. Family was very unhappy. Life is totally different in Denver... it was like a happiness switch flipped. I would not work in Cleveland for double my salary. But thats me and my family not you and yours.

I totally agree with you overall. I'd love to see the other side of this advice more often too. Rad Oncs need to stop telling people their life will be fine if they have to live somewhere they dont want to live because of our geographic restrictions.

Some people don't care where they live or can find happiness everywhere. Some people care a lot. Doctors do need to get a grip and stop acting like they have all the answers for everyone.

 

[TheWallnerus]

Doctors do need to get a grip and stop acting like they have all the answers for everyone.

The "I would not work in Cleveland" thought process engages exactly the same neurons as "Telehealth OTVs are bad care" thought process... and I wish people would realize that. I remember "The Onion" used to sell a t-shirt that said "I know what is best for everyone." I bought it, but wear it with irony.

 

[deleted1180461]

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

This ethos is very common in rad onc and other subspecialities. My guess is because they historically draw students from high socioeconomic backgrounds. It is true that rad onc used to be a very "snobby" specialty.

The "I would not work in Cleveland" thought process engages exactly the same neurons as "Telehealth OTVs are bad care" thought process.

You've got some issues.

 

[NotMattSpraker]

The "I would not work in Cleveland" thought process engages exactly the same neurons as "Telehealth OTVs are bad care" thought process... and I wish people would realize that. I remember "The Onion" used to sell a t-shirt that said "I know what is best for everyone." I bought it, but wear it with irony.

Well, I should clarify that there is one place I probably would be happy to work, seems like a lot of people are happy there. The other... NO THANKS.

Yes, my view on Tele-OTV is pretty similar actually. Cleveland and Tele-OTVs generally aren't for me. But I don't think they are objectively bad and people that think they are good are not bad people or doctors.

 

[communitydoc13]

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

To put it another way, I don't think a single person from my friend group in college lives outside of a major city. Yes, I know what that implies about me, but I'm not unique.

I chalk this up to the peculiarities of selection bias. It is difficult to pay someone to move where they don't want to live.

US med studs are who they are.

As @NotMattSpraker says above...location can really matter, and for deep cultural reasons that don't make one a schmuck.

The "I would not work in Cleveland" thought process engages exactly the same neurons as "Telehealth OTVs are bad care" thought process

Cleveland is big and it produces plenty of medstuds. There are lots of people who fit in there. Someone should be seeing patients in person in Cleveland...it doesn't have to be @NotMattSpraker.

Now comparing Cleveland, OH to Paducah, KY is silly. That being said, we should have a system that produces enough doctors interested in making bank in Paducah to see patients in person there...DEI anyone? Actually, my med school tried to emphasize rural medicine (a mid Atlantic state school), but the kids from the rural parts of the state (who were usually stud med studs to be honest) almost always stayed in the big city after graduation.

Of the following three options, which do you think is best in terms of patient care, radonc job market impact, the world in general?

1. Centers in more rural (will often not be defined as rural by ASTRO) are staffed by highly paid physicians who have to live "close enough" to those locations to be there "most of the time". Maybe these docs even become part of the community to some extent.

2. Academic centers start providing virtual consultation services and just transport patients for 5 fraction treatments at one of their facilities, or...as an alternative, offer a skeleton satellite service in these locations with minimal on-site physician presence.

3. BO or similar act as in a similar way to large academic centers (but without academic resources) and provides a mixed APP/Doc model with scarce on-site physician services and predominantly remote physician input.

 

[drowsy12]

Well, I should clarify that there is one place I probably would be happy to work, seems like a lot of people are happy there. The other... NO THANKS.

Yes, my view on Tele-OTV is pretty similar actually. Cleveland and Tele-OTVs generally aren't for me. But I don't think they are objectively bad and people that think they are good are not bad people or doctors.

Yeah agree - the initial rumors of spratt single handedly saving UH are funny in retrospect now. It’s hard to improve a place with rotten fundamentals

 

[NotMattSpraker]

Now comparing Cleveland, OH to Paducah, KY is silly.

I used to go to this little resort town near Paducah for vacation when I lived in STL. It was pretty and they had a bakery in town that smelled like cigarettes.

The best part about America is that there is something for everyone.

 

[medgator]

Yeah agree - the initial rumors of spratt single handedly saving UH are funny in retrospect now. It’s hard to improve a place with rotten fundamentals

Never really heard much of an update, early on I got the sense he was trying to recruit a lot and offering decent packages? But then had to learn to love protons?

Guess it didn't last long.

 

[deleted1180461]

1. Centers in more rural (will often not be defined as rural by ASTRO) are staffed by highly paid physicians who have to live "close enough" to those locations to be there "most of the time". Maybe these docs even become part of the community to some extent.

2. Academic centers start providing virtual consultation services and just transport patients for 5 fraction treatments at one of their facilities, or...as an alternative, offer a skeleton satellite service in these locations with minimal on-site physician presence.

3. BO or similar act as in a similar way to large academic centers (but without academic resources) and provides a mixed APP/Doc model with scarce on-site physician services and predominantly remote physician input.

#1: Rural centers will not pay enough to get someone to permanently relocate. They offer the same crap median MGMA + "bonus" for 2 years that metro hospitals do. The difference is the volume is not there so you can't "bonus" and just get paid median MGMA to live in rural Dakotas vs. living in a large midwestern city and being busy and making well above MGMA median on production alone. Why in the world would anyone do this except for a sucker new grad they can trick with a large signing bonus who leaves once reality becomes apparent (BTDT). What they do instead is staff with locums paying the locums agency $3k/day and the doc gets $2k. It blows my mind that there are rad oncs who accept this and fly out to the middle of nowhere to work for weeks at a time. But it's true, and there's got to be a reason this is the only work they can get. Just had a convo today with a locums recruiter stuck on a $240/hr rate in the (very rural) upper midwest. Ridiculous. This is horrible care. As long as the locums pool exists to staff with a pulse and a license at these rates, these places are not going to guarantee anywhere near the income needed (900+) to actually get someone to relocate from a metro area for full-time work.

#2: This already occurs in both academic and large hospital systems in the midwest. The quality of care at the satellites (really more like outposts at that point) is dismal, using antiquated equipment with doctors taking turns rotating out to the boonies and funneling anything else to the main site 200 miles away. This leaves rural patients with the option of getting suboptimal treatment locally for basic stuff or having to travel and relocate for 6 weeks for anything complicated. Financial win for the system. Financial and morale loser for the doctors and a lose all around for the patients.

#3: Honestly potentially better than either of the above IF the doctor is competent, takes ownership/continuity of care of the whole treatment course, and attentive AND the on site staff are highly competent and autonomous (a big IF).

But there is another option:

#4: Let a doctor come out 3 days a week, provide housing 2 nights a week and a per diem, and give him the freedom of long weekends or supplementing his income in other ways on the other 2 days. None of the above options realistically allow one to do stereo or brachy. This does. This is obviously far superior to any of the above, am I wrong?

 

[communitydoc13]

are not going to guarantee anywhere near the income needed (900+) to actually get someone to relocate from a metro area for full-time work.

We are all defending what we are doing it seems.

This is a ridiculous expectation IMO and is indicative of us training the wrong people to be doctors.

600K in some of these locations is functionally equivalent to 1.1M (or more) in many major metros. The hospitals aren't that rich. The CEO is usually not bringing in 1M.

We will all contribute to the dissolution of small to moderate sized rural hospitals. They will become hubs of APPs and hospitalists with virtual care dominating specialty services. It's a shame, because I personally believe in the remarkable value of fairly comprehensive local medical systems. (of course...this is what I do).

 

[medgator]

We are all defending what we are doing it seems.

This is a ridiculous expectation IMO and is indicative of us training the wrong people to be doctors.

600K in some of these locations is functionally equivalent to 1.1M (or more) in many major metros. The hospitals aren't that rich. The CEO is usually not bringing in 1M.

We will all contribute to the dissolution of small to moderate sized rural hospitals. They will become hubs of APPs and hospitalists with virtual care dominating specialty services. It's a shame, because I personally believe in the remarkable value of fairly comprehensive local medical systems. (of course...this is what I do).

The issue is you can't recruit a lot of other specialists there either for many of the same reasons, also dosi, physics etc.

It's not as cut and dry as you make it out to be imo. The US has been losing population in rural areas for awhile now and many have rightfully pointed out immigration as being one of the main possible solutions to address this

Immigration can reverse rural population decline.

Increasing immigration by just a couple hundred people each year in each county can erase recent rural population losses.

www.fwd.us

 

[deleted1180461]

We are all defending what we are doing it seems.

This is a ridiculous expectation IMO and is indicative of us training the wrong people to be doctors.

600K in some of these locations is functionally equivalent to 1.1M (or more) in many major metros. The hospitals aren't that rich. The CEO is usually not bringing in 1M.

We will all contribute to the dissolution of small to moderate sized rural hospitals. They will become hubs of APPs and hospitalists with virtual care dominating specialty services. It's a shame, because I personally believe in the remarkable value of fairly comprehensive local medical systems. (of course...this is what I do).

I believe that also, but it is a fantasy to believe that a place like Kearney, NE is going to find that one special candidate they've been holding out for for years who falls in love with their community and wants to relocate their entire family there for the same or less income than they can earn in Omaha to work with the headaches of a system with minimal ancillary and specialty resources. (and very few rad oncs would ever even consider working in Omaha). The CEO of the last rural hospital I worked at was making around 900. There were some specialists there making into the 7 figures. Pay the rad onc out of tech for recruitment? No, of course not. They need the margin for use elsewhere, obviously. But no problem staffing the hospital with a dozen or so unnecessary admins in the 200-300k range. It's administrative bloat and incompetence that is (usually) killing the rural places, not the doctors being greedy.

So if they can't pay them more and won't let them buy part of the machine because they need the revenue, then what can they do to get someone consistent and competent caring for their patients? Not make them be there 8-5 M-F. That costs them nothing and doesn't reasonably harm patient care like a once-every-two-weeks with virtual OTVs would. It's a win-win. There are (a few) places with good admin who "get" this. Most don't and think the Weatherby basket of misfit toys/locums is a fine solution.

 

[communitydoc13]

like Kearney, NE

Yeah....I think we are using true outliers to describe a larger issue.

Where I live, it is easy to recruit radoncs (because of job market issues). It is fairly easy to recruit orthopods (who tend to be US med studs and are often happy to live where I live). It is hard to recruit medical oncologists, neurologists who are willing to do inpatient stuff or dermatologists.

Still, consolidation at a regional level (and on the east coast, a region can include multiples states or half of a state like PA), combined with recruiting issues, payor behavior and the way that upper management at small hospitals tends to behave, have put community hospitals at remarkable risk going forward IMO.

Believe it or not, I have seen a competent medonc and radonc practice single handedly turn a small rural hospital into a financially viable place by retaining volume for outpatient oncology services.

 

[radoncftw]

Yeah agree - the initial rumors of spratt single handedly saving UH are funny in retrospect now. It’s hard to improve a place with rotten fundamentals

are people at UH unhappy?

I think its interesting to see the exodus of faculty from MSKCC

 

[TheWallnerus]

are people at UH unhappy?

I think its interesting to see the exodus of faculty from MSKCC

There have been many exoduses (exodi?) at MSKCC through the decades fwiw

 

[yesmaster]

You lost me with “Cleveland and Columbus aren’t desirable”. I’ve lived in both and had great experiences in both, and I currently live in semi-rural Illinois and like it more than either of those cities.

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

I’m all for it if most rad onc’s were happy with Midwest big cities and semi rural towns.

More big coastal city patients for those of us that want to be in big coastal cities.

Personally I’d take a less desirable location if pay was attractive for a few years. In real life, not many of my rad onc peers would do that to themselves or their families.

 

[drowsy12]

I’m all for it if most rad onc’s were happy with Midwest big cities and semi rural towns.

More big coastal city patients for those of us that want to be in big coastal cities.

Personally I’d take a less desirable location if pay was attractive for a few years. In real life, not many of my rad onc peers would do that to themselves or their families.

What is your solution for the X percent of patients not on coasts though?

Rad onc really went rotten somwhere along the way, maybe early 2010s where we became the only field that can’t work outside of the ‘elite’ cities.

This is the benefit of FMGs I suppose

 

[yesmaster]

What is your solution for the X percent of patients not on coasts though?

Linacs and vaults are expensive so if you live anywhere smaller than 50k people with normal age distribution, sorry, you should expect to travel for radiation. Even if rad onc’s and physicists worked for free. Patients that live somewhere very remote with low population density make that trade off and if they have no ability to travel and they live in a town of 1000 people, sorry that’s on them.

For population centers 50k and above, it just has to make financial sense. Maybe they get a kind soul with a passion for rural medicine or a local farm boy with deep ties, FMG, or they pay well, or they don’t pay well and get taken over by a PPSE center that can bill high rates, or BO, or perma locums. Longitudinal continuity is important so personally I prefer some hybrid 2-3 day a week presence for a long term rad onc or very good QOL and above market pay. Some judgment or guardrails on what types of procedures/patients to send to bigger center also important.

I can imagine any of the above setups working well except perma locums.

Also not much good if the X percent of patients have radiation services but no primary care or other specialty services.

 

[yesmaster]

Rad onc really went rotten somwhere along the way, maybe early 2010s where we became the only field that can’t work outside of the ‘elite’ cities.

Assuming rad onc’s are special snowflakes, not sure how widespread willingness to work in small towns in middle America would help anything? You would still have too many rad onc’s, they’d just be in small towns instead of big cities.

 

[drowsy12]

‘also not much good if the X percent of patients have radiation services but no primary care or other specialty services.’

They do though. Any place not on coasts with rad onc has multiples in med onc, surgery, etc

 

[deleted1180461]

I can imagine any of the above setups working well except perma locums.

This is what most of them do, though.

It's the same ridiculous story at every one of these places in the country's interior. $1600-2000/day geriatric locums agency, LLC while their 2 year MGMA median W2 employed, 5 days a week, 5 weeks of PTO radiation "provider" ad gathers dust for 5+ years. They won't even have a conversation about anything that doesn't conform to either of the above models. It's so infuriating when I present a far superior model to them and they respond with some form of "oh that's cute, you must have thought you went to business school or something."

Every piece of bottom-fishing spam I get from Weatherby, CompHealth, Vista, Locum Tenens and the rest takes a few days off my life from the soul crushing. Because there is such a better way than using these middlemen.

 

[communitydoc13]

Any place not on coasts with rad onc has multiples in med onc, surgery, etc

Not sure about that. Oversupply (relative to other specialties) is real. A practice adjacent to mine services 2 hospitals, has 4 radoncs and has relied on locums medoncs for years.

The bottleneck with care at my place, which has remained relatively comprehensive, is in other specialty care, imaging and medical oncology. We are by far the most prompt in providing services (because we are the best staffed relative to volume).

What's the urology landscape look like in these more remote places?

 

[yesmaster]

I’ve done a fair amount of locums at 14+ practices, 6 have been rural with population 20k-100k including some truly unfortunate places to visit never mind live full time, and in all these places I was covering for a full time rad onc who’d been practicing at that place for years. I’ve never seen a perma locums practice in person.

I guess I ignore the “ongoing coverage” and “long term need” ads though.

 

[elementaryschooleconomics]

‘also not much good if the X percent of patients have radiation services but no primary care or other specialty services.’

They do though. Any place not on coasts with rad onc has multiples in med onc, surgery, etc

This is not true for me and my geographic area.

The hospital I staff has a linac but no Neurosurgery, no Infectious Disease, no PCPs (only private community docs), one Dermatologist, two limited Urologists (no Da Vinci) - you get the picture.

The academic medical center to the east of me currently has no Neuro-Oncologists. I'll get sent local GBM patients who went there for surgery, come back home, and asked if I'll manage the seizure meds etc.

The (different) academic medical center to the north of me flat out refused a patient I sent to them for a prostate biopsy. It's a long story, but I was following him for something else, was the only one who caught his rising PSA - I was told they had "too many patients" and couldn't do it.

I pulled strings and got him an appointment - but it took 6 months and they were big strings I had to pull on. Totally wild.

All day, every day I deal with my patients having little to no options for many things.

This is another big reason I don't like national-level regulations. What works in one place might not work for me, and vice versa.

 

[deleted1180461]

The bottleneck with care at my place, which has remained relatively comprehensive, is in other specialty care, imaging and medical oncology. We are by far the most prompt in providing services (because we are the best staffed relative to volume).

Agreed. It is difficult to have a cancer program without IR and a reliable way to get PET scans locally.

 

[dozitgetchahi]

Yup. Unfurtunately the field attracted a lot of these people during competitive times. They thought RO was a gold mine to make millions working 3 days a week in Manhattan. They are arrogant, elitist, entitled, out of touch, etc. It is repulsing to me how many of them we have in our field. The issues with oversupply, job market, etc are a bit different. I do think the field will be better off with less of these people. I do not care that IMG/DOs will fill spots as long as we are not lowering standards to match anyone like many hellpits. Many programs should be shut down.

Oh I don’t think it’s just a rad onc thing. I’m a rheumatologist and you’ll hear things like that lot in this specialty too. It’s a doctor thing. When I used to tell old med school friends I was training in Indianapolis, they turned their noses up like I’d said I was living in a garbage can. If I told these same people that I live and work in semi rural Illinois now, I’d imagine I’d induce fits and seizures.

It’s this American UMC thing that you *must* live in a city, and not just that - you must live in one of a small handful of hip/trendy “desirable” (read: grossly overpriced and overcrowded) cities, or else your life sucks. I have never been able to understand it for the life of me.

Oh, and by the way re: Cleveland and Columbus: Columbus is now about twice the size of Cleveland. There’s more than a million people in that metro area now. It’s the second largest city in the Midwest (2nd to only Chicago; #3 is Indianapolis, if you were wondering). I think a lot of people talking **** about Columbus have probably never been there. It’s young. It’s clean. It’s actually pretty hip. It’s a nice town and it’s not disgustingly overpriced. Traffic is reasonable.

And Cleveland? It’s cleaned itself up a hell of a lot since I was there for college in 2005. Downtown looks nothing like it used to about 15-20 years ago. Cleveland is like your friends goofy little brother who everyone used to pick on…who then went to college, started working out, got their **** together, and suddenly looks great in a tuxedo.

But if you ask the coastal elitist types, I’m sure they’ll tell you that Cleveland is just a big dirty ghetto, and Columbus is the college town for Ohio State University. Neither of these things are remotely true anymore, but when you view the non-coastal parts of this country as a vast wasteland called “flyover country” and never venture more than 100 miles inland, how would you know?

 

[thecarbonionangle]

.

Oh I don’t think it’s just a rad onc thing. I’m a rheumatologist and you’ll hear things like that lot in this specialty too. It’s a doctor thing. When I used to tell old med school friends I was training in Indianapolis, they turned their noses up like I’d said I was living in a garbage can. If I told these same people that I live and work in semi rural Illinois now, I’d imagine I’d induce fits and seizures.

It’s this American UMC thing that you *must* live in a city, and not just that - you must live in one of a small handful of hip/trendy “desirable” (read: grossly overpriced and overcrowded) cities, or else your life sucks. I have never been able to understand it for the life of me.

Oh, and by the way re: Cleveland and Columbus: Columbus is now about twice the size of Cleveland. There’s more than a million people in that metro area now. It’s the second largest city in the Midwest (2nd to only Chicago; #3 is Indianapolis, if you were wondering). I think a lot of people talking **** about Columbus have probably never been there. It’s young. It’s clean. It’s actually pretty hip. It’s a nice town and it’s not disgustingly overpriced. Traffic is reasonable.

And Cleveland? It’s cleaned itself up a hell of a lot since I was there for college in 2005. Downtown looks nothing like it used to about 15-20 years ago. Cleveland is like your friends goofy little brother who everyone used to pick on…who then went to college, started working out, got their **** together, and suddenly looks great in a tuxedo.

But if you ask the coastal elitist types, I’m sure they’ll tell you that Cleveland is just a big dirty ghetto, and Columbus is the college town for Ohio State University. Neither of these things are remotely true anymore, but when you view the non-coastal parts of this country as a vast wasteland called “flyover country” and never venture more than 100 miles inland, how would you know?

Absolutely. For me higher education was a culture shock in many ways. You go to an “elite” college and medical school and so many people around you are just so wealthy and from very privileged backgrounds. There is a lot of good ole boy country club culture in medicine. RO is not unique here but we do have a lot of these people because of self selection. These people chose the field for the wrong reasons like making millions while working little. They wanted a great “easy” lifestyle. This was never the reality of the field for most but many believed it.
There is so much nepotism in our field. The field is just so small too. These more generalized issues seem more concentrated and the douchebags who run our field have massive power and influence which seems impossible to check.

 

[DrProtonX]

But if you ask the coastal elitist types, I’m sure they’ll tell you that Cleveland is just a big dirty ghetto, and Columbus is the college town for Ohio State University. Neither of these things are remotely true anymore, but when you view the non-coastal parts of this country as a vast wasteland called “flyover country” and never venture more than 100 miles inland, how would you know?

*THE Ohio State University 😂

 

[DrProtonX]

Yup. Unfurtunately the field attracted a lot of these people during competitive times. They thought RO was a gold mine to make millions working 3 days a week in Manhattan. They are arrogant, elitist, entitled, out of touch, etc. It is repulsing to me how many of them we have in our field. The issues with oversupply, job market, etc are a bit different. I do think the field will be better off with less of these people. I do not care that IMG/DOs will fill spots as long as we are not lowering standards to match anyone like many hellpits. Many programs should be shut down.

I do care about IMGs filling up the spots. Not because I don’t think they’re good physician, most of them are, but because it’s bad for job market. They’re much more likely to take the trash $250-300k offer because that’s still 5-10x of what they would make in their own country. For as long as there is someone taking those bs jobs, they keep popping up!

 

[thecarbonionangle]

I do care about IMGs filling up the spots. Not because I think they’re good physician, most of them are, but because it’s bad for job market. They’re much more likely to take the trash $250-300k offer because that’s still 5-10x of what they would make in their own country. For as long as there is someone taking those bs jobs, they keep popping up!

Thats why i have been posting here for years to shut down all the hellpits. Oh im sorry you who reads this trained there or have a friend there who is “great” or work there and got feelings poo-pooed? Well too bad, gotta close folks!

 

[DrProtonX]

Thats why i have been posting here for years to shut down all the hellpits. Oh im sorry you who reads this trained there or have a friend there who is “great” or work there and got feelings poo-pooed? Well too bad, gotta close folks!

I totally agree the number of residency spots should be cut down. However, we can’t just say program X,Y,Z should close down because … we THINK they’re ‘hellpits’!
I think we need to set a certain critera (enough brachy, in-house peds, in-house rad bio/physics faculty etc.) and if a program fails to meet them, they would lose the spot

 

[thecarbonionangle]

I totally agree the number of residency spots should be cut down. However, we can’t just say program X,Y,Z should close down because … we THINK they’re ‘hellpits’!
I think we need to set a certain critera (enough brachy, in-house peds, in-house rad bio/physics faculty etc.) and if a program fails to meet them, they would lose the spot

In fine with that too although you will find a direct correlation between all these things and being a bad program. I have half jokingly said in past, close all without protons. Whatever it takes, cut down programs by at least 50 percent.

 

[medgator]

In fine with that too although you will find a direct correlation between all these things and being a bad program. I have half jokingly said in past, close all without protons. Whatever it takes, cut down programs by at least 50 percent.

Really easy. Shut down any program that has to send out for brachy or peds. Would solve the problem overnight

 

[DrProtonX]

Really easy. Shut down any program that has to send out for brachy or peds. Would since solve the problem overnight

I think this would be the most logical and practical way. All they have to do is make a clause that “all the minimum requirement case numbers must be met at the home program”

 

[thecarbonionangle]

Really easy. Shut down any program that has to send out for brachy or peds. Would since solve the problem overnight

1) 3:1 or higher CLINICAL faculty ratio. No exceptions or time to “build up” to it. Some of these places have been around since 1980s. You have had plenty of time and you still suck. Time to put them out to pasture.
2) dramatic increase in brachy requirements
3) no counting multiple sites like other residency programs, VAs, satellites etc
4) proton requirements, increase peds requirements.
5) no double or triple coverage
6) stricter criteria for probation and quicker path to getting shut down (ACGME surveys, repeated board failures, history of probation).

Any questions???!!!

 

[NotMattSpraker]

Haha I am so confused by this conversation.

I kind of pick on Cleveland because people seem really sensitive about it and theres this one Rad Onc, I just cant resist. Im sure there are good things.

Im from the place people call Chi-raq. I wish I could rave about it like people do about Cleveland.

Also, believe it or not, I moved to Denver with full knowledge that I am getting ripped off on... existing?... compared to St. Louis. My biggest career regret is not coming sooner.

I tell trainees to think very carefully about their priorities and be honest about them. If you want to do 15,000 RVUs for $100,000 and live in a Manhattan apartment because that name on the coat is the most important thing. Do it.

Lots of people like tell you what you need to be happy and theyre often wrong.

My favorite thing is when someone finds that happiness and sometimes its surprising where people find it.

 

[communitydoc13]

shut down all the hellpits.

The most repeated mantra on here. But is it a solution?

There is tremendous consolidation in training...at overwhelmingly elitist type places.

Just add up the spots from: MDACC, MSKCC, Joint Center, PENN, Hopkins, Yale, Duke, Emory, UChicago, Vanderbilt...all Cali Schools. What fraction of trainees do you have from these places alone?

There is a strong correlation in most fields with where you train and where you practice. Smaller and smaller community places are trying to participate in their own training programs (not radonc presently...thank goodness) for a pretty good reason...to grow their own doctors.

Shutting down "hellpits" might be just another step towards further consolidation and remote services.

 

[elementaryschooleconomics]

The most repeated mantra on here. But is it a solution?

There is tremendous consolidation in training...at overwhelmingly elitist type places.

Just add up the spots from: MDACC, MSKCC, Joint Center, PENN, Hopkins, Yale, Duke, Emory, UChicago, Vanderbilt...all Cali Schools. What fraction of trainees do you have from these places alone?

There is a strong correlation in most fields with where you train and where you practice. Smaller and smaller community places are trying to participate in their own training programs (not radonc presently...thank goodness) for a pretty good reason...to grow their own doctors.

Shutting down "hellpits" might be just another step towards further consolidation and remote services.

As someone who trained at one of the places on your list, and who now practices in a very small community -

In my opinion (from my...life, I guess), the "secret sauce" is already well known. It's not the location of the training program: it's the location of the birthplace of the Radiation Oncologist in question.

Unfortunately, this is a very hard thing to quantify and create solutions for. So while it's talked about in the literature, the only solution for maldistribution that has arguably "been attempted" is to place med schools and residency programs in underserved locations.

Which is great for something like "medical school". Not great for a niche specialty like Radiation Oncology.

The main solution I see would be to drastically cut spots and then recruit kids from underserved areas while minimizing kids from urban areas which will have enough RadOncs for the next 100 years.

A glaring problem with this is...oh, I dunno, that pesky "free will".

It just so happened I'm from a rural area, decided to leave that area to go to med school (something only one or two kids do every few years), and, at the end of it all, decided to return not precisely to my hometown (because - lol RadOnc) but the general region.

I don't see a real way to ethically recreate my experience without making someone do something they don't want to do, or block someone from doing something they don't want to do.

Very uplifting, I know.

 

[RSAOaky]

You lost me with “Cleveland and Columbus aren’t desirable”. I’ve lived in both and had great experiences in both, and I currently live in semi-rural Illinois and like it more than either of those cities.

Doctors need to give up this idea that if you’re not living in NYC, Chicago, Denver or whatever, that life isn’t worth living. It’s absurd. We really need to get a grip.

I don't think that B-tier cities like Cleveland, Columbus, Detroit, Pittsburgh, San Antonio, etc are undesirable. However, most of us are far less likely to have a strong support network in or around these cities unless we've spent a substantial amount of time there. I did my training in one of these cities and would absolutely have been happy staying there, but I had to take an expensive flight with a connection any time I wanted to see family and friends. Weddings, births, birthdays, holidays, celebratory life events, etc., it all ads up. I got a decent job (that has become a great job) closer to family in a city I love. Most of us don't want to start fresh in our 30s after already sacrificing so much of our lives to medicine. It's absurd to suggest we should.

 

[medgator]

There is a strong correlation in most fields with where you train and where you practice. Smaller and smaller community places are trying to participate in their own training programs (not radonc presently...thank goodness) for a pretty good reason...to grow their own doctors.

Shutting down "hellpits" might be just another step towards further consolidation and remote services.

ESE nailed it. I trained in a smaller, older academic place that didn't send out for anything, it was not the best geography but provided great clinical training

I had zero desire to stay there and instead worked hard to head back to the ever popular SE sunbelt where I grew up. In fact, training at a colder, smaller locale only confirmed my desire to GTFO as quickly as possible (despite being offered a faculty position at graduation).

People will gravitate to their preferred geography regardless of where they train IMO

 

[thecarbonionangle]

The most repeated mantra on here. But is it a solution?

There is tremendous consolidation in training...at overwhelmingly elitist type places.

Just add up the spots from: MDACC, MSKCC, Joint Center, PENN, Hopkins, Yale, Duke, Emory, UChicago, Vanderbilt...all Cali Schools. What fraction of trainees do you have from these places alone?

There is a strong correlation in most fields with where you train and where you practice. Smaller and smaller community places are trying to participate in their own training programs (not radonc presently...thank goodness) for a pretty good reason...to grow their own doctors.

Shutting down "hellpits" might be just another step towards further consolidation and remote services.

Same rationale was used to start programs in Nebraska, West Virginia, etc. i just do not buy it. People go where they want to go after. we are just contributing to problem by believing this fairy tale.

 

[communitydoc13]

It's not the location of the training program: it's the location of the birthplace of the Radiation Oncologist in question.

I totally agree...with some caveats. These may not even be applicable any more.

1. Elite academic places are effective at cultural messaging. You are made to feel like a bit of a loser if you don't continue in academics (although maybe a fair number of people have come to terms with the bargain of remaining in academics while functionally being a community doc in an extended network...I'm sure plenty of people believe these networks are our future).
2. If you went to Harvard (or similar) for med school (even more true for undergraduate), it rarely (not always) matters if you grew up in the Southern Tier of NY state or rural Missouri. You are not going back. Now if you went to a decent state school and worked your way to an elite training program...it's different. This is one of several areas where the absurd competitiveness of peak radonc has done damage. The geographic and undergraduate educational diversity of residents decreased at top places as "meritocracy" got out of hand.

People go where they want to go after.

I think the sum experience of life helps mold where you want to go. You grew up some where, went to the state school, trained in state...different than getting a whiff of Boston and high end academic culture and elite East Coast living,

(Regarding IMGs, location of training likely very important regarding distribution of long term employment).

I'm all for provincialism.

 

[thecarbonionangle]

If what you say is correct, why aren’t Nebraska and WV grads taking Kearney and rural WV jobs i see posted? reason is clear man. The jobs suck or they want to get to a bigger city or both.

 

[communitydoc13]

If what you say is correct, why aren’t Nebraska and WV grads taking Kearney and rural WV jobs i see posted? reason is clear man. The jobs suck or they want to get to a bigger city or both.

I'm not sure that those jobs even mean anything?

Is the country filled with these jobs? Last time I checked, every job in the states adjacent to mine was able to fill (while many centers are in perma-locums world regarding medonc).

I think we are using outliers to define trends.

But on average, is it too much to say that an Ohio State grad is likelier to be happy with any job in Ohio than a UPENN grad?

 

[NotMattSpraker]

ESE nailed it. I trained in a smaller, older academic place that didn't send out for anything, it was not the best geography but provided great clinical training

I had zero desire to stay there and instead worked hard to head back to the ever popular SE sunbelt where I grew up. In fact, training at a colder, smaller locale only confirmed my desire to GTFO as quickly as possible (despite being offered a faculty position at graduation).

People will gravitate to their preferred geography regardless of where they train IMO

You are so elitist, with your desire for sun.

 

[Doctorer]

I'm not sure that those jobs even mean anything?

Is the country filled with these jobs? Last time I checked, every job in the states adjacent to mine was able to fill (while many centers are in perma-locums world regarding medonc).

I think we are using outliers to define trends.

But on average, is it too much to say that an Ohio State grad is likelier to be happy with any job in Ohio than a UPENN grad?

An undergrad or residency grad? Undergrad, perhaps, since the Ohio State grad is more likely to be from Ohio. Residency? Who knows. The Ohio State resident may be from PA and the PA grad may be from Ohio.