Job Market

[JonJonStick]

This goes out to all the PGY-5s out there or to those who completed their job search past couple of years.

How are you finding the job search so far? Personally it's been kind of miserable with very limited number of interviews compared to what my seniors had the prior years.

I keep hearing that more job postings will come up in January and further out but for those who signed last year or the year before and were keeping an eye on the market, how true is this?

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[medgator]

https://forums.studentdoctor.net/threads/radiation-oncology-job-market.1154501/

 

[DebtRising]

Private practices expenses are usually calculated at the end of the year, not in July. So while Academic centers can be primed for July openings, a lot of businesses (ie private practice) do not always know for sure until end of January.

But yes, as has been said multiple times, this field is primed to devour its young (ie you and me) for a long time coming, and the data is already published from 2 years back. Since then more programs have expanded (and new ones opened, SUNY Stony Brook and 1 other from another thread), reimbursements have gone down.

We picked this field in error, and with faulty information on the job market (when I applied the previous model published said demand outstrip supply up to 25%) and will pay the price with the quality of career we have. And no one cares because more cheap labor makes chairs jobs easier and their senior physicians happy, with not a single person of power seeming to advocate for us.... even though fellowships, a non-accredited entity in our field often 'teaching' things that should be a standard part of any ACGME accredited program, are exploding to help exploit this glut. Enjoy.

 

[JonJonStick]

https://forums.studentdoctor.net/threads/radiation-oncology-job-market.1154501/

I am well aware of the paper (and the thread), thank you very much.

Although it's nice to have general discussions about how horrible the job market direction is, I was asking more specifically about people's experiences in applying this year. I mean I knew it was going to be bad but I had no idea it was going to be THIS bad. I was hoping to hear some other applicant's experiences as well to see if they share the same frustrations or maybe it's just been a uniquely bad experience for me.

 

[medgator]

I am well aware of the paper (and the thread), thank you very much.

Although it's nice to have general discussions about how horrible the job market direction is, I was asking more specifically about people's experiences in applying this year. I mean I knew it was going to be bad but I had no idea it was going to be THIS bad. I was hoping to hear some other applicant's experiences as well to see if they share the same frustrations or maybe it's just been a uniquely bad experience for me.

I'm a few years out and have kept in touch with some people looking this year. The market has definitely gotten worse in desirable areas in just the last few years at least in the southeast where I know things best. I can't remember the last time a GA/NC/FL job made it to the astro site.

As has been said several times on this forum, many of these jobs are filled before even getting there....the only jobs that make it there are the ones that couldn't fill externally first

 

[Fpg1245]

Does anyone care to quantify "worse"? That way some of us have a benchmark.

 

[Gfunk6]

I also have the "pulse" of graduating residents but you have to understand that this is all subjective. Jobs are still plentiful in rural/semi-rural markets in the Midwest and Northeast particularly. Jobs in desirable areas are available but are low in number and come with either high-risk or low-reward features. One example is single specialty groups on the verge of extinction looking for a "warm body" to provide regulatory coverage of radiation patients while the owners/partners take the technical fees.

 

[deleted18755]

I think a big contributing factor is that senior partners and especially academic guys don't retire. I know many radiation oncologists working well into their 70's and two guys in my general area alone who are in their 80s (one is literally 84) who work part-time. The one guy doesn't "do email" but periodically a woman prints off his emails, reads it to him, then he verbally tells her the response that she types up into the email and sends. I don't want to know what his head and neck IMRT volumes look like.

The other guy in his 80's is a professor who makes God knows how much and he has full resident coverage so he will probably "work" (aka blindly sign off on resident work) until he drops dead. When I questioned an acquaintance about this he said it is no secret that he is incompetent but rather than doing anything about it the Chair makes sure that he always has a senior resident to minimize the chances of him hurting anybody. The arrogant old man thinks it's because he is such a good teacher that all the resident want to work with him. It seems like this is increasingly the sad and sorry state of "academics" in our field . . .

 

[seper]

Theoretically, with overall economy doing better now, RadOnc hiring maybe picking up somewhat.

 

[evilbooyaa]

I think a big contributing factor is that senior partners and especially academic guys don't retire. I know many radiation oncologists working well into their 70's and two guys in my general area alone who are in their 80s (one is literally 84) who work part-time. The one guy doesn't "do email" but periodically a woman prints off his emails, reads it to him, then he verbally tells her the response that she types up into the email and sends. I don't want to know what his head and neck IMRT volumes look like.

The other guy in his 80's is a professor who makes God knows how much and he has full resident coverage so he will probably "work" (aka blindly sign off on resident work) until he drops dead. When I questioned an acquaintance about this he said it is no secret that he is incompetent but rather than doing anything about it the Chair makes sure that he always has a senior resident to minimize the chances of him hurting anybody. The arrogant old man thinks it's because he is such a good teacher that all the resident want to work with him. It seems like this is increasingly the sad and sorry state of "academics" in our field . . .

I think every academic attending (including chairs) should have at least 1 to 3 months every year where they work without ANY resident coverage. A PA/NP to help see patients, whatever. But for them to do at least the PTV contours themselves and have them survive scrutiny at morning conference.

 

[deleted18755]

I think every academic attending (including chairs) should have at least 1 to 3 months every year where they work without ANY resident coverage. A PA/NP to help see patients, whatever. But for them to do at least the PTV contours themselves and have them survive scrutiny at morning conference.

I agree. I'm not sure how it was at the big programs but up until very recently as far as I know all the attendings at small and medium sized programs only worked with residents for 6 to max 9 months per year. With the resident expansion boom came more residents to go around and 100% coverage I guess.

Back to the original post ... I think most jobs aren't posted because, again after the resident boom, most hire their own. People aren't retiring and practices aren't really growing so much as acquiring practices (often along with the physicians who already work there) at the same time that even the smallest programs graduate 1-2 per year. The larger programs graduate 3-4 residents every year!

I think it's fair to estimate that the average private practice or academic center hires maybe 1-2 physicians every 3-5 years while the average program graduates 1-2 residents every single year and the larger programs graduate 2-4 per year ... the math doesn't work out in your favor!

 

[fiji128]

I graduated last year and have an ok job with a private practice group in a big city that doesn't pay that well. Realistically I would need to work about 2.5 year and contribute most of my post tax earning to student loans just to pay them off. The job market is terrible especially for those not graduating from top tier residency programs, positions can be found but good quality positions where you are working with good referring docs are very hard to find.

There are many signs of an over supply of rad oncs such as jobs don't need to be posted and salaries are not what they use to be. I know guys I graduated with who do IM and are making about what I do. A big problem is that the older generation is not retiring but it is also the increasing efficiency of existing rad oncs, which allows everyone to see more patients then in years past.

As I'm typing this I am considering taking a job wherever I can get the most money and get student loan forgiveness (ie non-profit employed for loan forgiveness) putting in 10 years, saving most of my salary and getting out. So far in my early the career the field and the opportunities available are not what I thought it would be and if I had to do it again I don't think I would pick rad onc again for these reasons. (Strictly clinically speaking the field is great but if you can't find a decent position by friends and family its not worth it and there are other things in the world of medicine).

 

[JonJonStick]

I graduated last year and have an ok job with a private practice group in a big city that doesn't pay that well. Realistically I would need to work about 2.5 year and contribute most of my post tax earning to student loans just to pay them off. The job market is terrible especially for those not graduating from top tier residency programs, positions can be found but good quality positions where you are working with good referring docs are very hard to find.

There are many signs of an over supply of rad oncs such as jobs don't need to be posted and salaries are not what they use to be. I know guys I graduated with who do IM and are making about what I do. A big problem is that the older generation is not retiring but it is also the increasing efficiency of existing rad oncs, which allows everyone to see more patients then in years past.

As I'm typing this I am considering taking a job wherever I can get the most money and get student loan forgiveness (ie non-profit employed for loan forgiveness) putting in 10 years, saving most of my salary and getting out. So far in my early the career the field and the opportunities available are not what I thought it would be and if I had to do it again I don't think I would pick rad onc again for these reasons. (Strictly clinically speaking the field is great but if you can't find a decent position by friends and family its not worth it and there are other things in the world of medicine).

Your reply makes me so sad as I'm kind of in the same boat. By this point I'm just considering taking the highest paying job I can find as who knows where our field will be in 3-5 years, by the time I'm supposed to make "partner". It's so sad that after all this work I will put in 10 years only and call it quits but the reality is as you said, if I can't do my job in a place I would be OK with living in then it's not worth it.

On a different note, since most jobs sounds like are not being posted, what are some good strategies about finding about these under the radar jobs? Since my concoctions are only local I really don't get to hear about job openings elsewhere that go unposted.

 

[medgator]

On a different note, since most jobs sounds like are not being posted, what are some good strategies about finding about these under the radar jobs? Since my concoctions are only local I really don't get to hear about job openings elsewhere that go unposted.

You've basically answered your own question. I got my current long term position through word of mouth via local connections to the area.

You'll need to make connections, bottom line. One way this is accomplished is by providing locums coverage for a place you might be interested in, or by having family connections to the area

 

[metview]

Does the prestige/reputation of the residency you trained at influence finding a job in private practice? ( I know it does in academics but I wasn't sure about PP)

 

[deleted18755]

Does the prestige/reputation of the residency you trained at influence finding a job in private practice? ( I know it does in academics but I wasn't sure about PP)

It definitely helps in that the more "prestigious" programs tend to be larger with more alumna who might be able to help you network and find a job before it is posted (it seems like this is going to be the best or only way to find a good job in the future) and/or tend to be in large cities or otherwise "desirable" locations so again it might help with networking.

On the flip side the "prestigious" programs will definitely require you to do "research" (probably retrospective reviews or SEER analyses instead of more meaningful prospective or lab work) that will at best be viewed by many as low level research that came at the cost of valuable clinical experience. Trust me, few outside of the academic bubble are impressed by a PGY-5 who spent hours and hours a week and then 30-40+ hours/week for 6-12 months during a research block digging through old charts even if his CV has pages of abstracts, poster presentations, etc or even a dozen papers published in low level journals. Alternatively if you somehow managed to publish a RTC in the NEJM one might wonder why you are applying to private practice. In any event a lot of people in private practice wonder how you had the time to master clinical radiation oncology while wasting so much time on "research" with the assumption that you sacrificed the former for the latter.

 

[FistLength]

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[medgator]

Current 3rd year still interested in rad onc, the job market is concerning for me. I am not interested in NYC/Boston/SF/LA et al, but wouldn't mind philadelphia or smaller east coast cities/communities. In the current climate is that still a viable option? I am hoping rad onc market is similar to radiology, where there was a few years of glut but rebounded.

I don't see the parallels to radiology unfortunately. The last time the rad onc job market was in the toilet in the early to mid 90s, that's when they shut down a bunch of programs and lengthened the training from 3 to 4 years which was in part to help the job crunch (so I hear). There seems to be no interest from the academic elites this time around, and programs seem to be forming and expanding even now, along with the proliferation of (sometimes questionable) fellowships which taking advantage of the situation.

Radiology is in much more of a growth mode imo, while rad onc has trends working both for (think more sbrt for medically-inoperable lung cancer being caught on low dose CT) and against (think less treatment of older patients with breast and prostate ca, increasing use of hypo fractionation in many disease sites etc) increased demand for our services.

As has been posted already on this thread, if you can see yourself practicing away from the coasts, I do believe there will be jobs, even down the road. There may be jobs even in the desirable areas but it's no guarantee, and the job that may show up may not be the one you want in terms of hours/pay/lifestyle.....

 

[thecarbonionangle]

One thing that is relevant to people applying this year or people who will be ranking programs within the next few years is to avoid the group think to think a program is "better" because of "research". I see this thinking in many medical students applying to the field and I think it is misguided.
You need to be looking for programs that offer you excellent CLINICAL training in terms of spectrum of pathology, volume, brachy experience, resident autonomy. When you get out and look for jobs, nobody is going to care that you spent 6 months doing "research" and have a bunch of USELESS non-practice changing papers on your CV. They want to know what skills you learned during residency and how you will translate that to taking care of patients. Unfortunately, a good amount of programs, have moved away from prioritizing clinical skills and overemphasize research, imo. It's funny when I hear multiple rumors of graduates of a "top" program which are known to have weaker clinical skills compared to the average graduate. Especially in the future job climate people need to keep these things in mind.

 

[DebtRising]

How do medical students assess if a program offers excellent clinical training? It seems like every program offers exposure to every disease site, ~1.5x the minimum caseload per resident (e.g. 450 -> 675 EBRT cases), prostate/gyn brachytherapy exposure (though certain programs are exceptionally high-volume for gyn). Maybe a better question is how a PP/academic practice assesses a candidate, if not by a combo of residency reputation + letters of rec?

Is Doximity an accurate ranking in regards to clinical strength of programs? It seems to reflect research strength well.

Doximity reflects the amount of alumni a program has, and how active that program is in requiting alumni to rank the program. Doximity adjust for the number of respondents, if one program has 100 and another has 8 it try and balance out, but in reality that is not possible. Even empirically there is no way to make that fair. Otherwise it reflects by name of the program or hospital. It's facebook for physicians - popularity does not equate to quality in all situations or for all parties.

Good clinical training is tough to determine. There are only 2 factors you can reasonably assess:
1) the size of the city / statistical area
2) ask residents at the interview dinner how many brachy cases they have done. Specifically how many seeds or ovoids they have placed themselves.

If you are interviewing in location with a statistical region population of <1 million people, there are only so many cases that are possible. Even less if there is a 'big name' hospital within 3 hours because inevitably number of complicated / pediatric / wealthy cases will migrate. This is a trend that has seemed to accelerate. Make sure the size of the resident class commiserate with population size, or there is an active out of town satellite.
If residents are not giving you a clear number of how many cases they have done independently (they do the case with attending supervision, opposite of sitting there and attending or visiting attending performs the case) then that is red flag. Harder to tell for SBRT, could ask which sites are treated with SBRT. For instance, if a program is ONLY doing SBRT for early stage NSCLC, and the residents at dinner are telling you this, it is a red flag. Harder to seek out numbers for other sites, such as Spine. If there is no CNS SRS, which I can't imagine is the case anywhere, I wouldn't rank the program.


While the biggest programs may make you do (more) research, they also have by far the highest potential case load that can be taken advantage of. Up to you to take advantage.

Case logs are of no value unless person can answer question "how many are palliative EBRT / WBRT'

 

[subatomicdoc]

One thing that is relevant to people applying this year or people who will be ranking programs within the next few years is to avoid the group think to think a program is "better" because of "research". I see this thinking in many medical students applying to the field and I think it is misguided.
You need to be looking for programs that offer you excellent CLINICAL training in terms of spectrum of pathology, volume, brachy experience, resident autonomy. When you get out and look for jobs, nobody is going to care that you spent 6 months doing "research" and have a bunch of USELESS non-practice changing papers on your CV. They want to know what skills you learned during residency and how you will translate that to taking care of patients. Unfortunately, a good amount of programs, have moved away from prioritizing clinical skills and overemphasize research, imo. It's funny when I hear multiple rumors of graduates of a "top" program which are known to have weaker clinical skills compared to the average graduate. Especially in the future job climate people need to keep these things in mind.

I could not agree more. Our private practice asks clinical questions during interviews. We're looking for clinical acumen and professionalism - not pedigree. The residency application process over-inflates the value of research to be accepted for residency, then there's a false assumption that it matters for direct patient care. Critical analysis of the literature is important to decide on what to do for your patients, but lots of published articles doesn't matter that much to the person sitting in front of you looking for help.

 

[thecarbonionangle]

Doximity ranking is a joke imho. As someone already posted, this just reflects the number of alumni who actually care about ranking the program. Programs actually email out alumni to make sure they rank the program. There are many program were one can do research not just the top Doximity programs.

Now that I'm involved with the interview process, I field questions from medical students often. I can tell a good amount of people are looking for softer hours and a good lifestyle. If you're looking for a program with less cases and nice hours, that may seem fine but you will likely rob yourself of an education in some cases. There are definitely programs out there, even some which offer plenty of research months which are weak in gyn brachytherapy. I would be cautious of some programs which have a very homogeneous population. I personally think there is a benefit to having access to the VA, County, and charity population besides the wealthier private population. In the case of advanced cervical cancer, this is primarily a disease of the "third world" or people here in the US who live in "third-world" like conditions, i.e. the poor. Besides T&Os you need a program which has access to advanced cervical cancer cases to learn how to do a Syed inplant proficiently. There are some programs out there where residents don't see as many of these interstitial brachy cases. Besides advanced cervical cancer, think of all the other cancers which are often caught earlier. You may see some very advanced cases of neglected breasts, head and neck cancer, etc with access with this patient population. Most of the programs with complete access to all these patient populations will be in larger cities and have control of multiple hospitals with diverse case loads. I'll emphasize autonomy again, you will find some difference in resident autonomy between some programs. How many of the cases are the residents actually doing?

For prostate brachy, ask the upper level residents how many cases they were able to do during their training in the residency. This is one that you may have less in some cases due to referral patterns and uro-rads. However, the program should have a way to make sure you see some cases, either LDR or HDR, both types would be better.

Pediatrics is one where I think many good programs will send their residents to have a complete experience in another academic centre, St. Jude's, Anderson, Upenn, etc. I think this is fine as long as it is a good experience. Talk to the residents and ask them about the cases they treated during their experience.

 

[JonJonStick]

How do medical students assess if a program offers excellent clinical training? It seems like every program offers exposure to every disease site, ~1.5x the minimum caseload per resident (e.g. 450 -> 675 EBRT cases), prostate/gyn brachytherapy exposure (though certain programs are exceptionally high-volume for gyn). Maybe a better question is how a PP/academic practice assesses a candidate, if not by a combo of residency reputation + letters of rec?

Is Doximity an accurate ranking in regards to clinical strength of programs? It seems to reflect research strength well.

The only way to really know how good clinical training in a program is is to do an away rotation. That is as close as you will get to the real thing as a medical student. However, even that can be somewhat deceiving by the time you put on your own resident shoes (things could be drastically different 2 years later and/or sometimes until you're a resident you don't really know what to look for clinically).

 

[nkmiami]

breaking news; Salina, Kansas is hiring again;

 

[Neuronix]

Taking a peek while I procrastinate for oral boards studying. It's almost like I'm looking at the same career center listings I saw when I was looking for a job last year. You'd think they could clean up the fact that 90% of the postings aren't even for rad oncs.

The funny thing is that a bunch of the same groups are hiring all over again. Did they never hire? Do they churn and burn? Curious minds love to know.

Meanwhile the places I know that hired last year without posting on there are hiring again without posting on there. Strange world. Cold calling and word of mouth is definitely the way to get a good job.

 

[Fpg1245]

Both of our PGY 5s are reviewing their contracts. After talking with both of them, I can't say either was particularly happy about the terms of their employment. Zero bargaining power. The only things they were grateful for were the fact that they didn't have to look for a locums or a fellowship.

 

[JonJonStick]

breaking news; Salina, Kansas is hiring again;

Haha how many years have they been at it now?

 

[JonJonStick]

Both of our PGY 5s are reviewing their contracts. After talking with both of them, I can't say either was particularly happy about the terms of their employment. Zero bargaining power. The only things they were grateful for were the fact that they didn't have to look for a locums or a fellowship.

Same here, I think at the end I'll be grateful to end up in a metropolitan area that has a population in the hundreds of thousands instead of thousands and just with a job in general.

 

[medgator]

Just got an email from a headhunter discussing two pp positions in the Midwest, both with technical opportunities on top of professional. It's all about location and what you are willing to compromise on

 

[johnbeck]

How are you finding the job search so far? Personally it's been kind of miserable with very limited number of interviews compared to what my seniors had the prior years.

It is a VERY tough market this year. I was able to procure a hospital employed job in a reasonable area (rural), but I had little bargaining power. We are way over-training. It is only going to get worse in the coming years, unfortunately. Academic leaders need to pull their heads out and DO SOMETHING! We need to cut residency slots significantly...

 

[thecarbonionangle]

With job market tightening so much, I have heard that it is even more important now to go to residency where you want to end up for jobs in the future as many local jobs are filled by local programs. Are you guys finding this to be the case?

We can only hope that many "old timers" retire and some things open up.

 

[medgator]

With job market tightening so much, I have heard that it is even more important now to go to residency where you want to end up for jobs in the future as many local jobs are filled by local programs. Are you guys finding this to be the case?

We can only hope that many "old timers" retire and some things open up.

Nope. I did residency far from where I ended up. Most important thing is to network early in your preferred long term location if you believe it will be a hard place to land a job.

Don't get me wrong, the statistics back what you are saying but as you well know, you can't pick where you end up matching for residency....