Job market short term and long term?

[PhotonProton]

I am a third year medical student and thought I wanted to do Rad/Onc until I read some of the experiences some of the people here are posting about. I am not saying that I am applying for something else, but it's scary to hear some PGY-5's not having a single interview and their PD's not touching them with a 5 foot pole. My question is, do you think the job market is terrible just for now, or if there is any chance on the horizon in the next 5-10 years for it to improve?

Also, how would the field need to change to improve the job market besides decreasing the number of residents graduates?

Thanks for your responses!

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[Trollest]

I am not into the field, but life doesn't work that way. Expect it to get worse or stabolize.

My question is, do you think the job market is terrible just for now, or if there is any chance on the horizon in the next 5-10 years for it to improve?

 

[deleted947887]

Two words: internal medicine
I'd kill to be an internist right now.

I am a third year medical student and thought I wanted to do Rad/Onc until I read some of the experiences some of the people here are posting about. I am not saying that I am applying for something else, but it's scary to hear some PGY-5's not having a single interview and their PD's not touching them with a 5 foot pole. My question is, do you think the job market is terrible just for now, or if there is any chance on the horizon in the next 5-10 years for it to improve?

Also, how would the field need to change to improve the job market besides decreasing the number of residents graduates?

Thanks for your responses!

 

[deleted18755]

I am a third year medical student and thought I wanted to do Rad/Onc until I read some of the experiences some of the people here are posting about. I am not saying that I am applying for something else, but it's scary to hear some PGY-5's not having a single interview and their PD's not touching them with a 5 foot pole. My question is, do you think the job market is terrible just for now, or if there is any chance on the horizon in the next 5-10 years for it to improve?

Also, how would the field need to change to improve the job market besides decreasing the number of residents graduates?

Thanks for your responses!

This topic has been discussed in detail multiple times, so I'm not sure why you are asking other than to try to get the response you are hoping for (but doubt yourself) which is everything will magically work out despite all the evidence to the contrary that has already been discussed.

The only relatively new thing that could affect the future job market is the stock market. There were plenty of doctors who planned to retire in the late 2000's in their 60's but after the their 401k tanked they just stayed around another 3-5+ years (this isn't ED or surgery, most people retire from radiation oncology because they have enough money and/or other interests, not because of physical/age related demands so if your investments tank right before planned to go part time or retire at 60 or 65 just work until your 65 or 70 no problem).

So maybe the job market will tighten in the next few years even more with the inevitable bear market (or maybe a bull market will come through in 5-10 year and a bunch of people will retire right before you are looking for a job) . . . who knows?

Otherwise, I'll summarize my position one last time: this field is the best in all of medicine by far, I love it and couldn't imagine doing anything else, there is going to be less revenue with decreased reimbursement per fraction, less fractions per patients, and maybe less patients but I'm still coming to work if I take a 25% pay cut tomorrow and 50% over the next 5-7 years (but I've also already enjoyed 12-15 years of the privilege of being a radiation oncologist and enjoy (or at least don't mind) living in the middle of nowhere in Trump country. If you're a medical student, especially one who cannot stand living outside of a major metropolitan and/or working with a staff and patients that shows up to work in MAGA hats, then enter at your own risk.

PS: the grass isn't always greener on the other side, but of course top medical students have options and there are many excellent careers in medicine.

 

[seper]

Presuming you've already done a prelim year, it's easy enough to re-train.

Two words: internal medicine
I'd kill to be an internist right now.

 

[RickyScott]

I am not into the field, but life doesn't work that way. Expect it to get worse or stabolize.

My question is, do you think the job market is terrible just for now, or if there is any chance on the horizon in the next 5-10 years for it to improve?

it will be much worse. The unique insight that I can offer as a community radonc is how little hypofractionation is found in the community setting by competitors and friends. (There is a selection bias here- the average lifestyle community doc who conventionally fractionates everything is not active on this board or mednet!) When hypofractionation is forced upon the field by bundling/secretary of health/insurance companies, we are really going to see some pain inflicted. Simultaneously, the number of tainees has more than doubled, and we are becoming more selective about radiation in some bread and butter areas like prostate and breast. a perfect storm.

Sure, other fields may face declining reimbursements, but no one else to my knowledge is facing a drop in demand in terms of patients/indications/utilization.

Leaders in the field in a recent editorial have brought up possibly broadening the skills of radiation onocologists to expand our practice into ir/radiology etc with fellowships, but it is not something as a medstudent I would count on, nor do I think it will be effective, unless we can offer some medonc training.

The other fairly unique insight, which has been mentioned, is that I have seen very few (actually none!) docs totally retire- they often will stick around part time or per diem for "coverage."

 

[scarbrtj]

It's tough to make predictions, especially about the future.

- Yogi Berra

 

[KHE88]

I am a third year medical student and thought I wanted to do Rad/Onc until I read some of the experiences some of the people here are posting about. I am not saying that I am applying for something else, but it's scary to hear some PGY-5's not having a single interview and their PD's not touching them with a 5 foot pole. My question is, do you think the job market is terrible just for now, or if there is any chance on the horizon in the next 5-10 years for it to improve?

Also, how would the field need to change to improve the job market besides decreasing the number of residents graduates?

Thanks for your responses!

The answer to your question is absolutely not.

There is not a single indicator suggesting the job market will do anything but get worse. The question is: how much worse? I think the most optimistic you could hope for would stability. Certainly not improvement.

Short-term: More competition and downward pressure on salary and benefits in big cities. More work for less compensation. I would expect this to creep into less desirable cities. Rural areas probably stable for a while. Large numbers of baby boomer rad oncs finally retiring (or dying) will keep it propped up for a little bit. This is still one of the greatest fields in medicine, for now, but only if you are willing to literally move anywhere.

Long-term: Significant numbers of unemployed grads. Fellowships and retraining in different fields common. Look at situation in Canada. Rural areas becoming competitive as people become desperate for any job.

The future is in medical oncology, sadly. It could take decades for this correct. Even if there is a decisive action by ASTRO (don't hold your breath), the cat's out of the bag at this point. Residency spots need to go down by 30%. Instead they're going up by 50%.

 

[scarbrtj]

a perfect storm

IMRT reimbursement, the primary reimbursement driver for radiation oncology, is down about 50% over last ten years. The number of fractions for most indications (radiation is paid per fraction, not per diagnosis, in case you med students didn't know) is down ~40%. The rate of radiation oncologist production (ie trainee slots) is up ~100% over the same period of time. If "x" = the total rad onc pie ~10 years ago, the current pie would theoretically equal x*0.5*0.6*0.5, or about 85% less pie now. My math might be off, probably is. Though like I said it's tough to know the future. New indications might add to versus subtract from the pie.

 

[medgator]

The other fairly unique insight, which has been mentioned, is that I have seen very few (actually none!) docs totally retire- they often will stick around part time or per diem for "coverage."

Qft...

 

[Trollest]

I may have missed this but what's happening in Canada?

Look at situation in Canada. .

 

[deleted18755]

The other fairly unique insight, which has been mentioned, is that I have seen very few (actually none!) docs totally retire- they often will stick around part time or per diem for "coverage”.[/QUOTE]

We all know doctors who were (great) grandfathered in well into their 70’s and even early 80’s who “work” 1 day a week and/or 4-6 weeks a year simply babysitting a linac (or “providing coverage”). These guys aren’t going anywhere.

The other point is much more important with regards to the future job market - at some point everybody is going to be forced to hypofractionate (and appropriately so) most breast, some prostate, etc. it won’t change my practice that much but if there really are still a lot of radiation oncologists who treat every breast to 30-35 fractions and otherwise never hypofractionate and all of the sudden they are forced to do so the bottom will fall out of the demand for radiation oncologists right when the supply is increasing.

Rather than antecdote from our friend somewhere in Florida is anybody aware of national data with regards to hypofractionation administration for breast at least (since data are undeniable at this point) and/or other sites?

 

[evilbooyaa]

We all know doctors who were (great) grandfathered in well into their 70’s and even early 80’s who “work” 1 day a week and/or 4-6 weeks a year simply babysitting a linac (or “providing coverage”). These guys aren’t going anywhere.

The other point is much more important with regards to the future job market - at some point everybody is going to be forced to hypofractionate (and appropriately so) most breast, some prostate, etc. it won’t change my practice that much but if there really are still a lot of radiation oncologists who treat every breast to 30-35 fractions and otherwise never hypofractionate and all of the sudden they are forced to do so the bottom will fall out of the demand for radiation oncologists right when the supply is increasing.

Rather than antecdote from our friend somewhere in Florida is anybody aware of national data with regards to hypofractionation administration for breast at least (since data are undeniable at this point) and/or other sites?

Utilization trend and regimens of hypofractionated whole breast radiation therapy in the United States. - PubMed - NCBI

15.6% for IDC and 13.6% for DCIS across the United States in 2013

On topic - I think the job market will be at best, stable. Increased indications for SBRT may help (Gomez trial, LU-002, SABR-COMET) but will likely not overcome omission of RT in early stage elderly breast, and continued use of active surveillance for early stage prostate and RP for treatable prostate.

However, there is a strong possibility that, uncorrected, continued residency expansion (and lack of residency contraction) will lead to a dramatic oversupply of radiation oncologists in the future, severely depressing job outlooks and salaries, leading to more predatory hiring practices than are already present.

 

[deleted18755]

Utilization trend and regimens of hypofractionated whole breast radiation therapy in the United States. - PubMed - NCBI

15.6% for IDC and 13.6% for DCIS across the United States in 2013

Thanks but a lot has changed in 5-6 years with regards to longer term follow-up data more strongly supporting hypofractionation. I really hope it’s way more than 1 in 6 or 7 now or there definitely is a “hidden” or “unrealized” oversupply since any day now I’m sure most of those 85% of conventionally fractionated patients will go from 30-35 to 15-20 (or zero?) fractions per patient.

 

[fiji128]

When I was applying most of this forum was "what are my chances" and interview gossip threads. From a prospective resident point of view the field has definitely become a "buyer beware" situation due to over supply of capable physicians. Very rural and undesirable (for most not all folks) places in the state were I trained used to come begging to the department for new rad onc grads as little as 5 years ago with a giant guaranteed salary and student loan repayment. Last I heard all these once guaranteed, if you couldn't get a job anywhere else places are now filled and we are talking about centers/hospitals 2-3 hours from a small regional airport. Sure there are still folks out there that have graduated recently that have landed some pretty sweat positions in great top tier metro locations but I find this to be much more the exception.

Currently, I'm a few years out making pretty good money (ie decent amount above the average reported) and not too busy (would like it to be busier) and about 120 miles out from a very major metro area. This type of situation describes just about everyone I personally know who went into rad onc from both med school and residency. I am probably wasting a lot of my potential sitting at a location like this treating bread and butter stuff (yes both breast and prostate are hypofx) but that's just what the fields is now for a lot of people.

Bottom line is if I had to do it again no way would I chose this field because of the lack of quality opportunities in places were most of the rest of the country lives. If where you live and want to set up your life is important to you avoid the field. I can not fathom how this will be getting any better over the next 10 years unless the ABR just starts failing 50% of the residents as a matter of policy.

Don't misconstrue this, I know I am in a very fortunate position compared to most other working folks out there. Just saying if I was a PGY 3/4 this is what I would consider.

 

[RickyScott]

Rather than antecdote from our friend somewhere in Florida is anybody aware of national data with regards to hypofractionation administration for breast at least (since data are undeniable at this point) and/or other sites?

I have seen numerous pubs regarding how extremely low the national adoption of hypofractionation has been. There is also not a lot of hypofractionation in palliation. 300x10 is still by far the most common in the community and this is 50% of our pts.

edit- yes I also see docs 15 x 250 routinely

 

[fiji128]

I could definitely see it being very low if the time frame of the survey is like 5 years ago but it seems now most reputable places are doing it for breast if maybe not as much for prostate yet.

 

[medgator]

I have seen numerous pubs regarding how extremely low the national adoption of hypofractionation has been. There is also not a lot of hypofractionation in palliation. 300x10 is still by far the most common in the community and this is 50% of our pts.

Ummmm... The real pp old timers do 37.5/15 or 40/20.

 

[deleted18755]

Ummmm... The real pp old timers do 37.5/15 or 40/20.

I haven’t seen 40/20 in a long time but know at least a few guys in their 70’s around my way who treat whole brain to 37.5/15 regardless of whether it’s a 45 year old woman with a solitary met from breast cancer or somebody with ECOG 3 and uncontrolled systemic disease who lives 45 minutes away ... not sure which one is worse but I’m sure these guys are going to around for at least another 7-10 years working at least part time.

I honestly have no idea how many Rad Oncs keep their linacs full (or barely get by) by ignoring hypofractionation but I firmly believe one by one that they will be required to cut down their fractions and all of a sudden we will have another source of over supply of doctors (who are more difficult for new graduates to compete against for jobs vs other new graduates). I really hope (for patients, society, new grads, and our field as a whole) that at least in breast and other data driven indicatuons it’s now the exception rather than the norm everywhere.

 

[Sheldor]

I'm curious, many threads like this pop up, but no practicing Rad Oncs have mentioned changing careers. Any senior level residents/early attendings who contribute to these threads planning on re-training? Looking for different jobs? Just curious how the "doom and gloom" is effecting those already in practice.

 

[medgator]

I'm curious, many threads like this pop up, but no practicing Rad Oncs have mentioned changing careers. Any senior level residents/early attendings who contribute to these threads planning on re-training? Looking for different jobs? Just curious how the "doom and gloom" is effecting those already in practice.

As others have said, there are still decent jobs out there, just in not so decent locales.

Those of us out a few years are hopefully set, and if not, will learn to love our current situation if it is good enough, since the ability to lateral now seems pretty difficult.

 

[RickyScott]

Additional thoughts
In a lot of the national "chains," there is not a lot of hypofractionation,

Adjusting to hypofractionation and new reimbursement models, by enlarging your residency program as these authors have done
Radiation Oncology Practice: Adjusting to a New Reimbursement Model. - PubMed - NCBI

Send to



J Oncol Pract. 2016 May;12(5):e576-83. doi: 10.1200/JOP.2015.007385. Epub 2016 Mar 22.
Radiation Oncology Practice: Adjusting to a New Reimbursement Model.
Konski A1, Yu JB1, Freedman G1, Harrison LB1, Johnstone PA2.
Author information
1
Perelman School of Medicine, University of Pennsylvania; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Yale University School of Medicine, New Haven Hospital, New Haven, CT; and Moffitt Cancer Center, Tampa, FL.
2
Perelman School of Medicine, University of Pennsylvania; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Yale University School of Medicine, New Haven Hospital, New Haven, CT; and Moffitt Cancer Center, Tampa, FL [email protected].
Abstract
PURPOSE:
Use of hypofractionation is increasing in radiation oncology because of several factors. The effects of increasing hypofractionation use on departments and staff currently based on fee-for-service models are not well studied.

METHODS:
We modeled the effects of moving to hypofractionation for prostate, breast, and lung cancer and palliative treatments in a typical-sized hospital-based radiation oncology department. Year 2015 relative value unit (RVU) data were used to determine changes in reimbursement. The change in number of fractions was used to model the effects on machine volume, staff time, and workforce predictions.

RESULTS:
The per-case marginal reduction in technical revenue was $1,777, $4,297, $9,041, and $9,498 for palliative and breast, prostate, and lung cancer cases, respectively. The physician reduction per case in RVUs was 5.22, 10.44, 43.02, and 43.02 respectively. A department could anticipate an annual reduction in technical revenue of $540,661 and a reduction in workflow of approximately five patients or 1 to 1.5 hours per day from a hypofractionation rate of 40%.

CONCLUSION:
The move to hypofractionation in the United States will lead to increased pressures on departments to address budget shortfalls resulting from the decrease in per-patient revenue. This may be done through a combination of an increase in patient volume, recognition of the increased skill sets required to deliver hypofractionated radiotherapy, delay in capital purchases, and/or reduction in staff. In a value-based environment, these evolutions should improve the value proposition of radiation oncology over a fee-for-service model.

Copyright © 2016 by American Society of Clinical Oncology.

 

[RadOncDoc21]

As others have said, there are still decent jobs out there, just in not so decent locales.

Those of us out a few years are hopefully set, and if not, will learn to love our current situation if it is good enough, since the ability to lateral now seems pretty difficult.

Definitely this. I was considering poking my head out to see what’s out there but disappointed in what I’m seeing.

I’ll just have to take my above median salary in a desirable area and yield to the hospital admins who currently own my soul!

 

[Doctorer]

I'm curious, many threads like this pop up, but no practicing Rad Oncs have mentioned changing careers. Any senior level residents/early attendings who contribute to these threads planning on re-training? Looking for different jobs? Just curious how the "doom and gloom" is effecting those already in practice.

I think about it frequently, and wonder when it might be too late. There was a lot of doom and gloom in radiology a few years back and now it seems like the job market is healthier than ever. There's a part of me that hopes whether the same might happen in our field.

I'd think hard about going in to the field if I was a med student though: there are too many good options out there without the restrictions radonc places on you.

 

[medgator]

I think about it frequently, and wonder when it might be too late. There was a lot of doom and gloom in radiology a few years back and now it seems like the job market is healthier than ever. There's a part of me that hopes whether the same might happen in our field.

It won't. Our market is bad for completely different reasons and our leadership is actively contributing to the crisis

 

[PointA]

I think the job market is gradually decaying with each passing year. As it stands, some lucky or well connected grads are still getting good jobs in great locations and there is still really good money in really undesirable parts of the country. I think medical students should think hard about the geographic restrictions of the rad onc market but I wouldn't recommend any current residents to bail on the speciality. The sunk costs are too high and who knows you may still get a job that you like, especially if you are happy with the field clinically.

 

[Neuronix]

I think about it frequently, and wonder when it might be too late. There was a lot of doom and gloom in radiology a few years back and now it seems like the job market is healthier than ever.

The radiology job market was bad for a decade or more. This led to the following summarized here: https://www.redjournal.org/article/S0360-3016(16)33385-5/fulltext

The National Residency Match Program (NRMP) reports that radiology residency positions increased by 23% per year from 1998 until 2009 and by 16 positions per year since 2009, in spite of the job market approaching saturation (7). A total of 1156 radiology residency positions were offered through the NRMP in 2015 despite a projected 840 to 1103 radiology jobs in 2018 (9, 10). Previously a highly competitive field, diagnostic radiology has gone from a 99% fill rate (the positions filled through the NRMP divided by the positions offered) in 2009 to an 86% fill rate in 2015. The number (and percentage) of US medical students filling these positions has dropped from 816 (86%) in 2009 to 579 (58%) in 2015, an absolute difference of 237 fewer US medical students entering radiology residencies, possibly a result of medical students' perception of the diminished job market (7, 10, 11).

Anthony Zietman has always said that the only way to control residency program expansion is medical students will stop going into the specialty when the job market gets bad enough. This happened in radiology, but it doesn't happen overnight. It is a gradual process occurring over many years. Radiation oncology as a specialty has not reached medical student avoidance of the specialty yet, since residencies, even expanding ones, continue to fill with AMGs.

The job market in radiology has apparently recently rebounded: http://www.diagnosticimaging.com/jobs/radiology-increase (you can also look at the SDN radiology forum for discussion). There is a big difference though--demand for radiology services is growing. Meanwhile, residency positions have grown slowly recently with many positions not filling in recent years, limiting supply.

In contrast, for radiation oncology the supply-demand mismatch is increasing. Residency expansion outpaces demand for radiation oncology services. Ben Smith's updated projections (https://www.redjournal.org/article/S0360-3016(16)00233-9/fulltext) show this very clearly. In fact, the growth of demand for radiation oncology services predicted by Smith's 2009 paper was too optimistic, and revised downwards in the 2016 paper, which is probably still too optimistic in my opinion for many of the reasons discussed ad nauseum on this forum. Meanwhile, supply has grown substantially.

Nobody wants to put out a clear number of how many radiation oncology residents are needed because nobody wants to be held to a specific number and it's based on models that could be way off depending on future predictions. I don't think that anyone thinks we need 200 residents per year. If you look at Ben Smith's 2016 appendix (https://www.redjournal.org/cms/10.1...4d1da2b4-601d-4461-b63b-ba27f1a7b0f5/mmc1.pdf), he projects 19% increase in demand for RT services from 2015-2025 (which again I find optimistic for reasons discussed in this forum). To match that demand we'd need ~140 residents per year. There were 193 positions last year, and residencies continue to expand.

Therefore, given the available data, there is no reason at this point to suspect that the job market will improve in the next decade, and every reason to suspect that the job market will continue to decline.

 

[fiji128]

Back when our residency program was expanding (this was done so they wouldn't have to hire more attendings or NP's) we interviewed some off cycle candidates for the new position. I remember interviewing neurosurgery residents, general surgery residents, ob/gyn residents and folks who did not match into rad onc in the previous cycle. I wonder if that happens anymore? I think once you are out of residency and board certified it would be very difficult to go back and do a new residency. I would have to be pretty much unemployable for me to consider going back and doing two more years of IM.

 

[scarbrtj]

Moffitt Cancer Center, Tampa, FL [email protected]
...recognition of the increased skill sets required to deliver hypofractionated radiotherapy

There's a t-shirt hanging at the Folly Beach Crab Shack you can buy that has a picture of a surprised caveman slurping down an oyster. It's captioned "At first disgust... then delight." That's how academic American rad oncs have been with hypofractionation. I remember when Johnstone learned I was doing 16 fraction breast back around 2005 and him commenting "What the hell are you guys doing there?" So it's no skill set per se you need for hypofractionation, Peter; any more than a conversion from Judaism to Christianity* requires a "skill set."
(*-intentional allusion to the Spanish Inquisition)

 

[RickyScott]

I do think the big unknown here is the "hidden bubble" of conventional fractionation that - I believe- is common outside of major centers and by docs who are not active on the internet. Every so often I will come across abstracts pointing this out, but will try to keep them in mind next time I see one.

 

[scarbrtj]

I think once you are out of residency and board certified it would be very difficult to go back and do a new residency.

Not only is it difficult, it is not as lucrative for the training programs. Once you've had 5 years of training (in anything), you're not as valuable to training programs (probably one reason why most training programs are 5 years in length now). The federal government subsidizes post-grad GME in the US to the tune of about $100,000/year per resident. However I believe that number goes down substantially after 5 years of training according to formulae outlined in the Code of Federal Regulations.

 

[Irradi8or]

The radiology job market was bad for a decade or more. This led to the following summarized here: https://www.redjournal.org/article/S0360-3016(16)33385-5/fulltext

In contrast, for radiation oncology the supply-demand mismatch is increasing. Residency expansion outpaces demand for radiation oncology services. Ben Smith's updated projections (https://www.redjournal.org/article/S0360-3016(16)00233-9/fulltext) show this very clearly. In fact, the growth of demand for radiation oncology services predicted by Smith's 2009 paper was too optimistic, and revised downwards in the 2016 paper, which is probably still too optimistic in my opinion for many of the reasons discussed ad nauseum on this forum. Meanwhile, supply has grown substantially.

Nobody wants to put out a clear number of how many radiation oncology residents are needed because nobody wants to be held to a specific number and it's based on models that could be way off depending on future predictions. I don't think that anyone thinks we need 200 residents per year. If you look at Ben Smith's 2016 appendix (https://www.redjournal.org/cms/10.1...4d1da2b4-601d-4461-b63b-ba27f1a7b0f5/mmc1.pdf), he projects 19% increase in demand for RT services from 2015-2025 (which again I find optimistic for reasons discussed in this forum). To match that demand we'd need ~140 residents per year. There were 193 positions last year, and residencies continue to expand.

In Ben Smith's original 2010 paper, he stated that there would be a 2% growth in workforce by 2020 but he used a very low estimate of 140 residents per year (2009 class size was 156, and the trend of increasing spots had been happening for years - no reason to use such a low estimate of 140). In the 2016 paper, he used an assumption of 200 residents per year, with a resulting 27% increase in supply (as opposed to the previous 2% estimate his previous paper). An important analysis to me was the sensitivity analysis in his 2016 paper that varies class size and the resulting projected increase in supply. Even if class sizes fell to 160 residents per year over night (20% decrease), there would STILL be a 23% increase in workforce by 2025, due to the delayed effect on workforce. As other posters have stated here, damage of oversupply has already been done over the past several years, and the job market will continue to tighten significantly.

 

[Neuronix]

An important analysis to me was the sensitivity analysis in his 2016 paper that varies class size and the resulting projected increase in supply. Even if class sizes fell to 160 residents per year over night (20% decrease), there would STILL be a 23% increase in workforce by 2025, due to the delayed effect on workforce. As other posters have stated here, damage of oversupply has already been done over the past several years, and the job market will continue to tighten significantly.

So unless I'm misunderstanding you, we should contract back down to something like 140 to rectify recent oversupply.

 

[KHE88]

The radiology job market was bad for a decade or more. This led to the following summarized here: https://www.redjournal.org/article/S0360-3016(16)33385-5/fulltext

Anthony Zietman has always said that the only way to control residency program expansion is medical students will stop going into the specialty when the job market gets bad enough. This happened in radiology, but it doesn't happen overnight. It is a gradual process occurring over many years. Radiation oncology as a specialty has not reached medical student avoidance of the specialty yet, since residencies, even expanding ones, continue to fill with AMGs.

Do we really think residency programs will go unfilled and choose to remain unfilled and contract instead of scrambling foreign grads with the highest board scores? Maybe a couple might, but my guess is the vast majority would keep on going with whatever warm body they can get. I mean, if the ABR keeps going the way they are (and they've given us no reason to think they won't), 40-50% failures could become the norm with a large glut of bottom-of-the-class US grads and foreign grads taking the exams and programs may eventually get shut down for not meeting the 60% first-time pass rate criteria on all 4 exams (which again was a new rule this year), but that process may take a decade or more. And my hunch would be compensated for by further expansion at the big programs, effectively just re-distributing training spots to the large academic machines and their satellites on the coasts, which I feel like was their intention all along.

 

[Irradi8or]

So unless I'm misunderstanding you, we should contract back down to 140 to rectify recent oversupply.

Thank you so much Neuronix. Actually, not exactly what I'm saying. The sensitivity analysis pointed out that even a 20% correction to 160 would STILL project a 23% increase in supply from 2015 (which was potentially already at a higher number of rad oncs than we needed given the oncoming wave of hypofractionation) to 2025, while the demand for RT services from 2015 to 2025 would increase by 19% (which may be an overly optimistic prediction). These numbers did not/could not estimate the impact of improvements in capacity of each Rad Onc from technology, hypofrac, active surveillance, use of non-physicians like NPs, PAs, further declines in cancer incidence, and importantly downward pressure on RT use and cost in APMs. It's super hard to predict those impacts. So even a 20% correction would not be enough of a correction, and although difficult to estimate, that number could be closer to 120-140 per year (but nearly impossible to predict an exact number), given how many young people are entering the market (30+ years of potential worklife) and the impact of factors stated above. Crunching some of those numbers, and the earlier numbers being based on some older publications, the general trend in RO spots looks something like the image pasted below. In the 1990's, such massive cuts in number of residents required comprehensive Rad Onc leadership community support (nice article from Dr. Coleman from SCAROP back in 1996 and Dr. David Hussey from ASTRO Committee on HR also from 1996 regarding this).

 

[thecarbonionangle]

Whats weird to me is that a lot of the applicants i have talked to this year are choosing to ignore and write off the “negativity”. Theres a lot optimism that things will get better and that they cannot be as bad as they read.

For me, going back to IM after years away would not be the end of the world but i would do it only if i could not find a single job anywhere. The situation would have to be very hopeless and desperate. The depressing thing is that it seems like making a lateral move will be even harder in the future potentially. That first job you get may be your best shot at things if you assume things can only get worst. It makes people very doubtful to ever want to move. Significantly decreased mobility with your family may be the norm, as job salaries and packages continue to be less friendly for the job seekers. At this point, i can hope things work out but certainly feel sad to read figures and facts that i simply cant ignore. Back then we simply, didnt worry that finding a job would be a worry. Matching rad onc was one of the happiest days of my life back in the day.

 

[Mandelin Rain]

Do we really think residency programs will go unfilled and choose to remain unfilled and contract instead of scrambling foreign grads with the highest board scores? Maybe a couple might, but my guess is the vast majority would keep on going with whatever warm body they can get. I mean, if the ABR keeps going the way they are (and they've given us no reason to think they won't), 40-50% failures could become the norm with a large glut of bottom-of-the-class US grads and foreign grads taking the exams and programs may eventually get shut down for not meeting the 60% first-time pass rate criteria on all 4 exams (which again was a new rule this year), but that process may take a decade or more. And my hunch would be compensated for by further expansion at the big programs, effectively just re-distributing training spots to the large academic machines and their satellites on the coasts, which I feel like was their intention all along.

Part of the issue is, that as the quality of average resident goes down the hassle of running residency will go up.

For about 2 decades, the top tier of medical students were accepted and at many residencies learning and functioning kind of became a self-lead/peer-lead experience. The attendings could rely on them to show up on time and prepared, dictate good notes, draw good contours, treat their patients compassionately, make appropriate treatment decisions, read independently, teach themselves radiation oncology, etc.... They got the perk of doing much less work, without the hassle of actually teaching anyone anything.

Insert some bottom tier MD/DO, Carribean, and/or FMGs into the mix. Not to besmirch every person in those groups. There are some truly excellent ones. There are some truly abominable top-tier grads. But... in my experience doing a TY long-ago along side medicine interns of the makeup I posted, on the whole, I'd have sent my family member to the TY service over the IM service 10 times out of 10. As the need for hand holding increases, I think the desire to be "covered" will be greatly diminished.

 

[fiji128]

Whats weird to me is that a lot of the applicants i have talked to this year are choosing to ignore and write off the “negativity”. Theres a lot optimism that things will get better and that they cannot be as bad as they read.

For me, going back to IM after years away would not be the end of the world but i would do it only if i could not find a single job anywhere. The situation would have to be very hopeless and desperate. The depressing thing is that it seems like making a lateral move will be even harder in the future potentially. That first job you get may be your best shot at things if you assume things can only get worst. It makes people very doubtful to ever want to move. Significantly decreased mobility with your family may be the norm, as job salaries and packages continue to be less friendly for the job seekers. At this point, i can hope things work out but certainly feel sad to read figures and facts that i simply cant ignore. Back then we simply, didnt worry that finding a job would be a worry. Matching rad onc was one of the happiest days of my life back in the day.

That maybe for the ones that are expressing interest in field as of right now but the number of US grads actually applying is way down compared to the peak according to ERAS.

2012 - 250
2013 - 210
2014 - 229
2015 - 229
2016 - 235
2017 - 221
2018 - 190

As long as those still interested are aware and understand that the post residency job search could end up being a huge issue when they have finished training or if they choose to ignore the numerous data and other alarm bells that are flashing, well that is their choice to make. But I would really hope there are not older academic rad oncs who haven't applied for a job in 15 years out there influencing/advising meds students not to worry about or consider these issues.

 

[Neuronix]

But I would really hope there are not older academic rad oncs who haven't applied for a job in 15 years out there influencing/advising meds students not to worry about or consider these issues.

There are rad oncs on this forum trying to advise med students not to worry about these issues. In the real world the vast majority of rad oncs I meet are either willfully ignorant or actually ignorant of this issue.

 

[thecarbonionangle]

That maybe for the ones that are expressing interest in field as of right now but the number of US grads actually applying is way down compared to the peak according to ERAS.

2012 - 250
2013 - 210
2014 - 229
2015 - 229
2016 - 235
2017 - 221
2018 - 190

As long as those still interested are aware and understand that the post residency job search could end up being a huge issue when they have finished training or if they choose to ignore the numerous data and other alarm bells that are flashing, well that is their choice to make. But I would really hope there are not older academic rad oncs who haven't applied for a job in 15 years out there influencing/advising meds students not to worry about or consider these issues.

You must have missed the multiple self identified academics who have come to forum to state just that, that its all fine, some even likely PDs, involved with ABR/ACR, etc. Where else do you think medical students are hearing its fine? Its coming from
Somewhere. Ive discussed with multiple applicants and have been surprised by the positivity

 

[RickyScott]

There are rad oncs on this forum trying to advise med students not to worry about these issues. In the real world the vast majority of rad oncs I meet are either willfully ignorant or actually ignorant of this issue.

There are academic pathologists on the pathology forum who post to students that everything is ok. This will just create a lot of angry docs 5-10 years from now that will not be enamored with ASTRO.

 

[deleted18755]

There are rad oncs on this forum trying to advise med students not to worry about these issues. In the real world the vast majority of rad oncs I meet are either willfully ignorant or actually ignorant of this issue.

I bumped into an old attending of mine who is the nicest guy ever and truly went into academics because he loves to teach (back then all attendings were "uncovered" for most of the year) . . . no way this guy would ever screw anybody over, but he was telling me about how his niece is a medical student who was deciding among specialties and how excited he is that she took his advice to apply to radiation oncology.

I think there are a lot of very nice older radiation oncologists who honestly have great jobs they love and just plain don't realize what is going on and figure "I had so many great job offers when I graduated and have had such a great career" without realizing that a lot has and will continue to change between 2002 when they graduated and 2029 when the medical students they are advising will be looking for a job. That particular cohort is especially tough because there was a horrible job market in the 1990's that they all heard about but then the market was on fire so they figure even if things are bad they will surely cycle back just like last time (without realizing the important differences noted on this forum between the 1990's and now).

Heck, I didn't even realize this was an issue until a few years ago when I stumbled upon it by chance while speaking with some colleagues and then noticed the posting on this site. Otherwise I would be blissfully unaware myself.

An additional relatively new generational issue that many older physicians don't realize is that sure many younger graduates want to live only in certain regions for what one could call "elitist" reasons, but many are just stuck because of their spouse. It wasn't that long ago that most physicians were men with stay at home wives so all he had to do was secure a job for himself in a place his wife didn't mind, now that dual professionals are the norm there are so many more people restricted to certain areas because both are professionals with relatively limited places for employment (and of course those areas are the saturated one - I have yet to meet a Wall Street Hedge Manager, pediatric neurosurgeon with sub-specialization in x and lab studying y, or somebody who is a high up at the State Department or Federal Reserve, etc employed in the areas that have shortages of physicians, let alone radiation oncologists).

 

[KHE88]

But I would really hope there are not older academic rad oncs who haven't applied for a job in 15 years out there influencing/advising meds students not to worry about or consider these issues.

Wasn't there a guy in here named "old rad onc" doing just that or am I mis-remembering? I suppose the username checks out?

You must have missed the multiple self identified academics who have come to forum to state just that, that its all fine, some even likely PDs, involved with ABR/ACR, etc. Where else do you think medical students are hearing its fine? Its coming from
Somewhere. Ive discussed with multiple applicants and have been surprised by the positivity

Agree strongly. Also surprised at this optimism and lack of questions about the job market (perhaps just trying to stay positive at the interviews?). I have met multiple applicants who have family members who are rad oncs (big surprise to see that in our field!) -- suppose everything's fine for them and are just unaware? Although if your dad owns a linac, normal job market issues probably don't apply to you.

 

[Burt Radnolds]

The med onc to rad onc ratio 10 years ago was 350:100 (per NRMP data). It is now 500:200.

These are some sobering numbers, particularly given the fact that there is absolutely nothing to indicate it should be trending that way from a need standpoint, and as you so well stated should probably be quite the opposite.

 

[Old rad onc]

Wasn't there a guy in here named "old rad onc" doing just that or am I mis-remembering? I suppose the username checks out?



Agree strongly. Also surprised at this optimism and lack of questions about the job market (perhaps just trying to stay positive at the interviews?). I have met multiple applicants who have family members who are rad oncs (big surprise to see that in our field!) -- suppose everything's fine for them and are just unaware? Although if your dad owns a linac, normal job market issues probably don't apply to you.

Wasn't there a guy in here named "old rad onc" doing just that or am I mis-remembering? I suppose the username checks out?



Agree strongly. Also surprised at this optimism and lack of questions about the job market (perhaps just trying to stay positive at the interviews?). I have met multiple applicants who have family members who are rad oncs (big surprise to see that in our field!) -- suppose everything's fine for them and are just unaware? Although if your dad owns a linac, normal job market issues probably don't apply to you.

I am Old Rad Onc and definitely am not someone who is saying our field is ok. Maybe you are thinking of cyberrad or phantom1. We are a field in turmoil but the devastating effects over resident expansion will take hold in less than 5 years. I have been in PP for 24 years and I can say that it has been a better career than I ever imagined. I got screwed out of a promised partnership after 6 years, but ended up building my own center, 18 years ago in California. It took some crazy risks and my old partner did everything to bankrupt me. But I used the 3 A’s and luckily I have been blessed beyond what I ever imagined.When I started residency in 1991 I had no idea how much anyone in the field made. I was shocked to find the average Rad Onc made over 200 K as I started my job search. I got 2 job offers in Las Vegas or California. I was offered twice as much to go to Vegas but they would have worked me more than 12 hours a day.

I have loved the patients and the work and could not imagine any other field. Even with all the changes in reimbursement it has been a dream to do what you love. When I was a resident many of my attending were FMGs and the residency was not easy as I had to load many LDR brachys by hand. One month I had 200mRem in exposure. But life as a PP Rad Onc has been rewarding in ways far beyond hours and financial. I am now trying to pay it forward to the Med Students and future docs in the field. Warning of the hard times to come is really trying to protect hope. It is an amazing time to be a cancer doc. I consider myself an oncologist first and that helping cancer patients is my primary responsibility.

Protecting patients from treatments with high cost but little benefit is part of my job. Radiation Oncology is of great importance to the field, and no matter what the economic tidal wave that is coming, must not be forgotten. I find the whole hypocrisy of Choose Wisely to be a foreshadowing of the irony with which we now all find ourselves. The academics who have participated in the travesty of residency expansion are playing a game for their own benefit with little thought about the lives that Will injured by the short sighted actions they are doing. The decision makers will be retired long before the destruction of our beloved field will occur.

I hope I am wrong but see it coming as clearly as I saw the potential of the joy of Rad Onc as a young doctor. I am still in my mid 50’s and will stay in the field until I am forced to sell or no longer enjoy helping patients as I still do now. I have been a part of SDN Rad Onc for 10 years now and have found it to be a great resource of ideas and a progression of new clinical trials. The leadership in this forum are amongst the best and brightest that any field in medicine has to offer and I have been proud to be a small part of it.

I had to write this as the thought that I might be someone who was thought of as one who would deceive young docs in this field is sad and appalling. The job of letting Med students know about spending 5 years of residency then fellowship in what may be a very difficult if not impossible job market is commendable. I have watched other fields protect their future: ie Derm , while the academic Vultures in ours clearly care little about anyone but those that will be under their control. Keep up the good fight my friends!

 

[Old rad onc]

Medical students,

Do not be stupid and naive in thinking that the job market will improve. The med onc to rad onc ratio 10 years ago was 350:100 (per NRMP data). It is now 500:200. We are now producing more rad oncs per each med onc that is trained. Do you really think that the indications for radiation have increased in the last 10 years? I can assure you that our med onc colleagues have many more types of immunotherapy now that they can give compared to 10 years ago. Whereas the indications of radiation have decreased for breast (think DCIS and hypofrac), prostate (think active surveillance and hypofrac), lymphoma (think no RT needed), peds (lower does of RT)...the list goes on and on.

I can assure you that my med onc friends are getting offers of $350-$450K in major metros on the coasts and Chicago. Med Onc practices are all having a hard time recruiting new graduates because the job market is so good for our med onc colleagues. Compare this to my situation--I am 5 months away from graduation and still without a single on site interview. Yes, I have geographic restrictions. Yes, I did not pass my rad bio and physics. Yes, I am not the best at taking a useless test. By the way, just wait until the ABR makes failing half the residents their policy. What a joy would that be. My residency program has not done a single thing to help me either. Actually, I've been told by faculty that they "will help me find a job if I do a fellowship with them." WTF!!! Isn't that what residency training is for? Finding a job! I am so pissed at my program and our leadership.

Do not go into rad onc. If you really need to do rad onc, at least do a prelim medicine year so you can bail on the specialty easier.

Sorry for all the misery but do not give up hope. I had to take my oral boards twice and when I got screwed after 6years in practice I thought I would die either a slave to a practice that would never give a partnership or move to an area I had no interest in. You will need a bit of luck, but to have come so far means you are close. You started in an era when getting into the residency was nearly impossible and reading about what the future is would bring many to tears. But my advice is keep searching as their are still a lot of good people in the field. Do locums if you must and wait off cycle for a job to open up. Word of mouth is more important than ever. The job market will still be ok for a few years. Absolutely do not do a fellowship! Contact me directly if you need advice. Hang in there. The fat lady has not sung......

 

[Palex80]

Perhaps we may see US doctors applying for jobs in Europe in the future? However, I believe a US residency is not recognized in most parts of Europe (it doesn't work the other way around either). Less pay here than in the US, but hey, you can't have everything...

 

[Neuronix]

Perhaps we may see US doctors applying for jobs in Europe in the future? However, I believe a US residency is not recognized in most parts of Europe (it doesn't work the other way around either). Less pay here than in the US, but hey, you can't have everything...

I looked into Europe and Canada when I graduated. I have some unique circumstances, and I used to work in the EU in the past. Generally speaking, Canada and Europe are very closed to US grads. There are exceptions, but they are few and far between.

Wasn't there a guy in here named "old rad onc" doing just that or am I mis-remembering? I suppose the username checks out?

I try to encourage SDN to not make things personal. Just to clarify without being specific, there was someone with a similar username to old rad onc recently claiming in another thread that there are no problems with the rad onc job market.

I hope I am wrong but see it coming as clearly as I saw the potential of the joy of Rad Onc as a young doctor. I am still in my mid 50’s and will stay in the field until I am forced to sell or no longer enjoy helping patients as I still do now. I have been a part of SDN Rad Onc for 10 years now and have found it to be a great resource of ideas and a progression of new clinical trials. The leadership in this forum are amongst the best and brightest that any field in medicine has to offer and I have been proud to be a small part of it.

That's high praise. Thank you.

 

[medgator]

Worth repeating:

https://www.jacr.org/article/S1546-1440(18)31473-X/fulltext

With regard to the job search, 21.8% of respondents found their jobs through the online American Society for Radiation Oncology Career Center, while most respondents, 77.2%, found their jobs through other means.

 

[deleted18755]

Worth repeating:

https://www.jacr.org/article/S1546-1440(18)31473-X/fulltext

Definitely worth a read but it's still so tough to really get a good sense since only 1/3rd or so responded and it's not broken down by region, which is probably the most important factor with regards to jobs in our field. The distinction between "academic" and "private" has definitely changed over the past decade or so and appears to be increasingly blurry plus a lot can change between 2012-2017 vs 2025-2030 or whenever current medical students thinking about pursuing a career in radiation oncology would be entering the workforce (and of course I'm sure they care about further opportunities throughout their subsequent 25-35 year career). In any event l this paper provides a lot of valuable information and it is wonderful that this gentleman continues to put forth the effort to gather this information for no apparent reason other than as a service to our field and trainees.