Job market short term and long term?

[Chartreuse Wombat]

Am I allowed to note that irony of that particular ASTRO board discussion person attacking SDN?

Irony of ironies indeed

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[Phantom1]

So how do other fields regulate the total number of residency spots? How does Derm or Plastic Surgery do it??

 

[Gfunk6]

Am I allowed to note that irony of that particular ASTRO board discussion person attacking SDN?

We can simply dismiss the warnings as tin-foiled hat rantings of a bunch of malcontents and anonymous internet trolls or we can accept the quantitative reality for what it is, sit down, come up with solutions and save our specialty.

Not sure if this is referring to the quote above. If so, it is meant to be in full support of SDN's position that unbridled residency expansion = downfall of Radiation Oncology.

If not, never mind

 

[medgator]

So how do other fields regulate the total number of residency spots? How does Derm or Plastic Surgery do it??

Their academic leadership simply doesn't expand to the same degree, if at all.

No one is holding the collective heads of all these chairs and faculty ransom telling them to create these new (and in many cases, marginal) programs and expand existing ones.

Unlike RO, those specialties have respectable academic leadership that care about the longevity of their respective specialties and quality of the trainees and programs in their respective fields.

 

[RO2019]

I think also it must be pointed out that rad onc is smaller than derm and also much smaller than plastics - so expansions in residency programs have a larger impact on the overall picture.

 

[RickyScott]

I think we have chairs who are motivated by short term greed, not longterm common good of the specialty. They are more than willing to sh-- in the bed, so to speak.
We have historically been the smallest specialty, and in many ways "embattled" in the USA, facing heavy inherent biases against xrt on the part of surgeons and medoncs (vs Europe). Cancer traditionally in the USA has been thought of as a surgical disease. Thats why radonc has always heavily emphasized "quoting the data." to justify our role. As a specialty, we really do need the best possible applicants, to "carry the mantle" and represent our field well as it is constantly eclipsed (and under threat in some ways) by hype and resources put into systemic treatments.

It is pleasantly surprising- and fittingly ironic- that many thought leaders turned the ASTRO discussion into an "echo chamber" of SDN (with a milder tone of course). The "quantitative reality" still counts for something.

 

[deleted18755]

So how do other fields regulate the total number of residency spots? How does Derm or Plastic Surgery do it??

This is just my personal theory based on informal discussions and I'll be the first to admit I've been out of academics for awhile but there appear to be academic attendings who simply cannot or will not work without "resident coverage." Not that long ago, even the most academic of attendings ran their clinical service independently and lectured throughout the year or otherwise always at least informally taught residents throughout the year, but with regard to the clinical service welcomed residents on rotation from time to time, but it was rare, if not unheard of, for an attending to have 100% resident "coverage" all the time (except for call, which is never a big deal in radiation oncology).

Multiple residents on this forum and elsewhere have claimed that almost all of their attendings expect full "resident coverage" 24/7, and in some cases residents cover multiple attendings at multiple sites on the same rotation, cover vacations of other residents, etc. and some have even claimed that their attending will take vacation to match the resident instead of being "alone" on their own service for a week or two. Is it really true that some (many . . . most?) academic attendings go months without independently contouring and planning even a fraction of their own patients or see consults or even follow-ups on their own anymore?

It appears as though over the past 10-15 years academic attendings have come to expect increasing (if not 24/7) resident coverage and so program directors and chairs have increased residency spots to accommodate. This is definitely not the case in other outpatient specialties like dermatology and plastic surgery, etc.

 

[RickyScott]

This is just my personal theory based on informal discussions and I'll be the first to admit I've been out of academics for awhile but there appear to be academic attendings who simply cannot or will not work without "resident coverage."

Is total "resident coverage" being offered as an offset/in place of salary or raises?

 

[deleted774703]

Some residents have made a survey asking current rad onc residents and recent grads whether SDN affects their application decision making

Wonder where this is heading...

 

[evilbooyaa]

This is just my personal theory based on informal discussions and I'll be the first to admit I've been out of academics for awhile but there appear to be academic attendings who simply cannot or will not work without "resident coverage." Not that long ago, even the most academic of attendings ran their clinical service independently and lectured throughout the year or otherwise always at least informally taught residents throughout the year, but with regard to the clinical service welcomed residents on rotation from time to time, but it was rare, if not unheard of, for an attending to have 100% resident "coverage" all the time (except for call, which is never a big deal in radiation oncology).

Multiple residents on this forum and elsewhere have claimed that almost all of their attendings expect full "resident coverage" 24/7, and in some cases residents cover multiple attendings at multiple sites on the same rotation, cover vacations of other residents, etc. and some have even claimed that their attending will take vacation to match the resident instead of being "alone" on their own service for a week or two. Is it really true that some (many . . . most?) academic attendings go months without independently contouring and planning even a fraction of their own patients or see consults or even follow-ups on their own anymore?

It appears as though over the past 10-15 years academic attendings have come to expect increasing (if not 24/7) resident coverage and so program directors and chairs have increased residency spots to accommodate. This is definitely not the case in other outpatient specialties like dermatology and plastic surgery, etc.

At certain academic institutions, there are people that have not used a mouse to contour on a 3D plan likely in the past decade, and potentially in their lifetimes. There are people that still look at a DRR as the sole way of evaluating a non-breast plan (including Pelvic IMRT and H&N) and have no knowledge of anterior-posterior or mediolateral borders (depending on which DRR they're looking at) to what they're covering. Basically, people that don't know how to do IMRT and have never bothered to learn. There are people that, if they didn't have a resident to contour their volumes, would likely just have the dosimetrist contour GTV/CTV/PTV (and the dosimetrist would likely do a better job just by following the site-specific contouring atlas). These are generally the people that have been grandfathered in and have no testing to validate their knowledge basis. They still get their yearly SA-CME or whatever, so no harm no foul.

None of this means that all older rad oncs are like this - I imagine the vast majority of them have kept up with the times. But by my personal knowledge, n=3, so I know they exist.

 

[medgator]

. But by my personal knowledge, n=3, so I know they exist.

Rampant in the private world

 

[radiaterMike]

They still get their yearly SA-CME or whatever, so no harm no foul .

They don't even have to do that. The SA means "self assessment" (i.e. a quiz). Most state licensing boards only require CME (which can be credited just by sitting in a lecture, reading an article, etc.)

 

[evilbooyaa]

They don't even have to do that. The SA means "self assessment" (i.e. a quiz). Most state licensing boards only require CME (which can be credited just by sitting in a lecture, reading an article, etc.)

Fair enough. I'm still a resident so no in-depth knowledge of the yearly racket that is CME.

 

[OTN]

Rampant in the private world

Depends on location. In my highly-competitive city, someone like that would get intentionally exposed by competition and wouldn't last long.

 

[KHE88]

Some residents have made a survey asking current rad onc residents and recent grads whether SDN affects their application decision making

Wonder where this is heading...

An incendiary and biased "publication" used to bolster someone's academic career, no doubt. Wouldn't it be great if the academics and ASTRO could just point their fingers at SDN at completely blame the drop in resident numbers and quality on whatever pejorative they can come up with for an anonymous online forum? Will they do that do you think or try to take a look at the issues that are causing us to make such a racket in the first place?

Multiple residents on this forum and elsewhere have claimed that almost all of their attendings expect full "resident coverage" 24/7, and in some cases residents cover multiple attendings at multiple sites on the same rotation, cover vacations of other residents, etc. and some have even claimed that their attending will take vacation to match the resident instead of being "alone" on their own service for a week or two. Is it really true that some (many . . . most?) academic attendings go months without independently contouring and planning even a fraction of their own patients or see consults or even follow-ups on their own anymore?

Highly program-dependent. There are still programs that require residents to cross cover, make them do every last piece of documentation and scutwork/prior auths, etc, such that they end up having to manage 30+ on treats and are working 70 hours a week staying to 9-10 every night to finish notes and contours, restrictions on vacation, etc. On the other end, there are programs where attendings are mostly independent, and residents are in more of a shadowing role. Contours and documentation are split. In some cases I think these programs have swung too far the other way. When you're working <40 hours a week, barely meeting your minimums with mostly palliative cases, and have a year or more of research, I start to worry that some of these people aren't coming out clinically competent enough. There's definitely a sweet spot.

In general, I think programs have mostly moved away from cross coverage and extreme malignancy and will continue to do so as programs need to work harder and advertise resident quality of life to make sure they fill. In more desirable locations/programs, they can probably continue to get away with traditionally malignant program culture, although wouldn't be surprised to see a malignant big name spot here or there go unfilled too.

 

[evilbooyaa]

Depends on location. In my highly-competitive city, someone like that would get intentionally exposed by competition and wouldn't last long.

The issue is, unless you have somebody on the inside of the competition, how would you ever know? Hearsay is a hard thing to use to 'expose' somebody without evidence.

 

[OTN]

The issue is, unless you have somebody on the inside of the competition, how would you ever know? Hearsay is a hard thing to use to 'expose' somebody without evidence.

True, but discussions at tumor board can reveal deficiencies, and a little bit of corporate espionage goes a long way. In our city at least all the radiation therapists know each other and talk. A lot.

 

[RickyScott]

Some residents have made a survey asking current rad onc residents and recent grads whether SDN affects their application decision making

Wonder where this is heading...

Pointless,now that the ASTRO/ROI hub/thought leaders make exactly the same points.
Just the "quantitative reality."
I really sensed a shift (socially) among some of the academic thought leaders that I know after the secretary of health singled out radiation that the party is coming to an end.