M3 considering rad onc....

[ramses99]

Thanks all for your helpful replies. I've learned a lot (it's hard to candidly ask people IRL what salaries look like; also some good context around the oligomet data). Extra thanks to @yesmaster ; that post was really balanced and informative. I think I am leaning towards medicine (and heme onc) given the patient focus, that I enjoyed medicine clerkship so hopefully residency wouldn't be miserable, and the geographic flexibility. I really enjoyed my time with rad onc and you all have an amazing field; I'll always respect what you guys do as (hopefully) the referring doc one day. I get the sense that the field will be fine for all of ya'll who are already in, and probably also for those who train in like ten years, but I feel like I'm graduating med school at a really bad time to enter the field. Thanks to this forum for posting candid information that we med students have a hard time getting in real life.

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[deleted950463]

I tell med students the best specialty is one that gives you the MOST option.

think internal medicine. You can practice like a surgeon with interventional cards/advanced GI or you can live a full outpt lifestyle. You can live anywhere. Hell you can pinpoint the neighborhood in NYC almost.

Radiology is also something similar. As of right now you can practice a near surgical lifestyle to just read at home in your PJs.

Rads also allow 100% geographical flexiblity if you are willing to do telerad.

 

[RadOncDoc21]

I’d say this is taking it a bit far. As an attending I do want to know if the resident knows these numbers, but if they say 10% and the number is 8% that’s fine, and I’m pretty sure your attendings were the same they don’t freak out if you don’t know the exact number. But if they say 30% then yes, that is incorrect and the resident will counsel the patient incorrectly or worse yet they will cop out on the answer with the patient indirectly misleading them. Integrating a ton of info into a synthesis for the patient, It’s one difference between a good physician and a bad one. There are a lot of bad ones out there...and on this board

Somebody is a little “judgy” today.

 

[GapCalc]

I think you're making a wise decision. I think it's very possible a high caliber medical student matching into a top-notch program will continue to have good/reasonable job prospects. That being said, when compared to the opportunities you may have in other fields with respect to geographic flexibility, style of practice, ownership structure, etc, I think there may be even better prospects with other fields of medicine.

Either way, congrats on all the hard work. I'm sure you'll have a great match!

 

[SteelyDad12]

Would only recommend doing radonc if you REALLY love it and can’t see yourself doing anything else

My experience is going through RO residency honestly sucks. Our job description is not intense at all, and actually quite fun! Yet academic attendings like to be overly intense and quiz you on minutia of DFS down to .x%. When me and my coresidents miss, they make it seem like the end of the world and we are dumb for not knowing. Those are the better teachers. The alternative is most don’t teach shiz

Realized too late that I prefer flexibility even more so than money so I would do IM and stop. Could practice anywhere in the US whenever I want. Could even go overseas to cool country (New Zealand hello!) temporarily

Could not agree more with this post. I do love the field, but have been turned down by all places I interviewed at. I'm graduating from a program I'd estimate to be in the top third of programs, but not top five. No other reasonable job prospects unless I move to Nebraska, which was suggested by my exasperated chair. Residency was rougher than described at chipper residency interviews. 5 years is a long time. And now to feel like I'm not qualified for anything is a huge slap in the face....

 

[yesmaster]

I do love the field, but have been turned down by all places I interviewed at.

It doesn't matter how much you love something if it doesn't love you back. Many, including myself, may very well be in your situation in a couple years.

That's what all the "can I tell you how much I love my job!" mid-career attendings don't understand. It's not that trainees don't love the field. That's not the problem.

 

[20181121]

It's still only January - keep in mind that few places are able to align their hiring with the academic year.

 

[deleted18755]

It doesn't matter how much you love something if it doesn't love you back. Many, including myself, may very well be in your situation in a couple years.

That's what all the "can I tell you how much I love my job!" mid-career attendings don't understand. It's not that trainees don't love the field. That's not the problem.

Silly example I guess but I was a movie addict growing up and loved working at local independently owned movie rental place in high school, which quickly went out of business when a blockbuster came to town but I loved working there even more (I’m kind of old and from a small town so the place had lines out the door on weekends for many, many years).

Needless to say the blockbuster closed down a long time ago and was converted to one of those dollar stores (the staining of the concrete from the letters from the blockbuster sign and facade are still clear) ...man I loved that job and still smile everyday I drive by!

 

[MegaVoltagePhoton]

As much as that sucks that you haven’t gotten jobs, why is it less of an anecdote than me saying all our graduating residents got good jobs?

 

[RickyScott]

Clearly it’s not and just small data pt. Just adds to narrative that there really may be real world consequences to residency expansion in time of hypofract. Not getting a job would have been a huge anomaly 5 yrs ago. Again, This resident was likely aoa with high usmles and had lots of great specialty options open to them.

 

[RadOncG]

As much as that sucks that you haven’t gotten jobs, why is it less of an anecdote than me saying all our graduating residents got good jobs?

Because your anecdote is the expectation. It certainly is great news that all your residents got jobs and we 100% believe you.

What is not expected is that someone completes 5 years of residency and is struggling to find a job anywhere. These are stories that interest more people because it is so unusual compared to other specialties.

But hey don't worry it's only January they say. Pretty soon it'll be don't worry it's only 3 months after you graduated.

 

[OTN]

As much as that sucks that you haven’t gotten jobs, why is it less of an anecdote than me saying all our graduating residents got good jobs?

Getting a good job after 4 years of undergraduate education, 4 years of medical school, and 5 years of post-graduate training should be the absolute default. NOT getting a good job after all of that is an absolute disaster and, as far as I'm concerned, one of the worst things career-wise that could ever happen to a person.

Thus, people will naturally focus on the most terrible outcomes we're seeing (no jobs after graduation) to try to avoid them. Classical game theory (do what you can to avoid the worst possible outcome) in practice.

 

[scarbrtj]

Anecdotes or not. The following is true, unless people are lying:

"Radiation oncology is a medical specialty where residents are occasionally having difficulty finding jobs at and before graduation."

Honestly I don't know if we can we say this about any other specialty in medicine right now?

 

[RickyScott]

Anecdotes or not. The following is true, unless people are lying:

"Radiation oncology is a medical specialty where residents are occasionally having difficulty finding jobs at and before graduation."

Honestly I don't know if we can we say this about any other specialty in medicine right now?

So logically, it will quickly become one of the least desirable or prestigious specialties?

 

[MegaVoltagePhoton]

Very on point replies. I agree, it is concerning that anyone is facing this kind of difficulty.

 

[Mandelin Rain]

Hey, 72% found jobs that suited their desired multistate region (example: south east), job type, OR desired city population size.

That means only 28% had to accept a job that wasn't within multiple states of where they want to live, in a small city/rural, AND in a hospital employed/nonpartner position.

Pretty, pretty, pretty good.

 

[deleted18755]

Hey, 72% found jobs that suited their desired multistate region (example: south east), job type, OR desired city population size.

That means only 28% had to accept a job that wasn't within multiple states of where they want to live, in a small city/rural, AND in a hospital employed/nonpartner position.

Pretty, pretty, pretty good.

The scariest part is that those 28% weren't just random FMG's (most of my family are FMG's who are very smart and hard-working, but have limited options for various reasons and "take what they can get") or even average medical students but the absolute best of the best who could have gone into any number of other specialties or God knows what careers. I really hope this all works out somehow. Otherwise, what an absolute waste of human capital (not too mention time and money training these geniuses for decades)...

 

[20181121]

I highly recommend looking at posts from ten years ago - should really put things in perspective!

 

[deleted774703]

I highly recommend looking at posts from ten years ago - should really put things in perspective!

What’s your perspective? 10 years ago ppl had it better? Or worse?

if worse, then so what? Doesn’t make today not bad

plus shouldn’t those ppl who had it hard fight for the current generation to not have it so bad rather than drink the kool aid?

 

[Mandelin Rain]

This post from almost exactly 10 years ago does put quite a bit into perspective.

 

[RickyScott]

What’s your perspective? 10 years ago ppl had it better? Or worse?

if worse, then so what? Doesn’t make today not bad

plus shouldn’t those ppl who had it hard fight for the current generation to not have it so bad rather than drink the kool aid?

I was looking for job back then and was not coming from a top program. Not hard to get job in la or nyc, Boston etc but good jobs in prime locations were competitive- best Jobs were pp with expected partnerships in above mentioned cities. Starting pay above 250 for most tier 1 cities then. Anyone could make bank by in a what then was considered a less desirable city like Houston etc. this is why field got so popular!

graduating class had under 100 in 2008 residents and there was no hypofract. Satellite jobs were very unpopular.

don’t let anyone invoke “North Korean” type propaganda that things were always bad and actually improved with doubling of residents and hypofract or that all specialties suck and we are better off than others.

 

[PhotonBomb]

the idea that it was 'not hard' to get a job in LA, NYC, or Boston in 2010 is simply put, untrue. how would that even be possible? If you're saying it was possible, then yes, it is still possible. but it was iffy then and is iffy now that a job would be available to you if you were graduating and only wanted to be in Boston.

the market is worse now, but that doesn't mean people could go anywhere they wanted in 2010. Rad Onc is Rad Onc. there will never be or has never been a guarantee of jobs being open in your city of choice in the year you graduate.

 

[RickyScott]

the idea that it was 'not hard' to get a job in LA, NYC, or Boston in 2010 is simply put, untrue. how would that even be possible? If you're saying it was possible, then yes, it is still possible. but it was iffy then and is iffy now that a job would be available to you if you were graduating and only wanted to be in Boston.

the market is worse now, but that doesn't mean people could go anywhere they wanted in 2010. Rad Onc is Rad Onc. there will never be or has never been a guarantee of jobs being open in your city of choice in the year you graduate.

Much worse now, but back then (a bit before 2010) you could get a crappy job, within 50 miles off almost any city) if you had to. (There are good reasons why this field become very popular and competitive.)

 

[deleted18755]

Much worse now, but back then (a bit before 2010) you could get a crappy job, within 50 miles off almost any city) if you had to. (There are good reasons why this field become very popular and competitive.)

I actually think the bigger difference between 10-15+ years ago and now is not the first but the subsequent job. Non competes definitely existed back then but they encompassed a reasonable distance around the primary center where you worked and they were logical and reasonable and just plain fair: if somebody spent years building a practice and a referral base and then hired somebody who came along and worked there for a few years, cross covered, etc, then another practice across town lured them away, the individual set up a practice nearby, or whatever and a substantial proportion of patients and maybe even staff went along for whatever reason, that could devastate or destroy the original practice so some type of disincentive is reasonable. In any event, it was actually easy in many cases to remove the non-compete, and that was in fact that first thing this very helpful gentleman instructed us to do when he gave advice at ARRO.

Others can verify, but it seems standard these days for the non compete to be a very large radius but more importantly include every satellite center within the system (even the ones hours away that the employee never stepped foot in) so after a new graduate signs up for a job he or she is basically locked out of the entire city or even region!?!

This seems crazy and illegal to me, and not in line with the original intent of the non competes but simply a way to give excessive leverage to the employer (at the direct cost of the employer). I've never actually seen a contract with this type of non-compete in it and I almost don't believe it, can a recent graduate or somebody with direct knowledge verify that non-competes apply to all satellites? So if you work in an office of a place that has many satellites like UPMC your basically locked out of most of PA for years or how about those systems that don't have THAT many satellites but they are really spread apart or even in different states . . . you really can't get a job around or in between?

I really don't want to spread mis-information so please refute this if it is not the case.

 

[RadOncDoc21]

I actually think the bigger difference between 10-15+ years ago and now is not the first but the subsequent job. Non competes definitely existed back then but they encompassed a reasonable distance around the primary center where you worked and they were logical and reasonable and just plain fair: if somebody spent years building a practice and a referral base and then hired somebody who came along and worked there for a few years, cross covered, etc, then another practice across town lured them away, the individual set up a practice nearby, or whatever and a substantial proportion of patients and maybe even staff went along for whatever reason, that could devastate or destroy the original practice so some type of disincentive is reasonable. In any event, it was actually easy in many cases to remove the non-compete, and that was in fact that first thing this very helpful gentleman instructed us to do when he gave advice at ARRO.

Others can verify, but it seems standard these days for the non compete to be a very large radius but more importantly include every satellite center within the system (even the ones hours away that the employee never stepped foot in) so after a new graduate signs up for a job he or she is basically locked out of the entire city or even region!?!

This seems crazy and illegal to me, and not in line with the original intent of the non competes but simply a way to give excessive leverage to the employer (at the direct cost of the employer). I've never actually seen a contract with this type of non-compete in it and I almost don't believe it, can a recent graduate or somebody with direct knowledge verify that non-competes apply to all satellites? So if you work in an office of a place that has many satellites like UPMC your basically locked out of most of PA for years or how about those systems that don't have THAT many satellites but they are really spread apart or even in different states . . . you really can't get a job around or in between?

I really don't want to spread mis-information so please refute this if it is not the case.

As always, you are right. I’ve seen and been apart of those types of non competes. Despite my best efforts, I could never get anyone to shake down and was basically told to take it or leave it.

 

[20181121]

This seems crazy and illegal to me, and not in line with the original intent of the non competes but simply a way to give excessive leverage to the employer (at the direct cost of the employer). I've never actually seen a contract with this type of non-compete in it and I almost don't believe it, can a recent graduate or somebody with direct knowledge verify that non-competes apply to all satellites? So if you work in an office of a place that has many satellites like UPMC your basically locked out of most of PA for years or how about those systems that don't have THAT many satellites but they are really spread apart or even in different states . . . you really can't get a job around or in between?

I really don't want to spread mis-information so please refute this if it is not the case.

It depends on the state (enforceable or not) and whether the specific practice or institution actually enforces non-competes vs. waiving them when someone leaves. Some are known to aggressively pursue non-competes. Others are known to put them in the contract but ignore them when someone moves across town. I get the sense that, in terms of whether they are included in the contract language or not, they are essentially non-negotiable for academic centers and theoretically negotiable for others.

 

[deleted18755]

It depends on the state (enforceable or not) and whether the specific practice or institution actually enforces non-competes vs. waiving them when someone leaves. Some are known to aggressively pursue non-competes. Others are known to put them in the contract but ignore them when someone moves across town. I get the sense that, in terms of whether they are included in the contract language or not, they are essentially non-negotiable for academic centers and theoretically negotiable for others.

I assume figuring out state by state laws would be simple, but no idea how one is supposed to know how aggressively an institution has in the past enforced a non-compete, under what exact circumstances, and in any event if the historical actions should mean that it will be the case in the future.

Whatever the case may be, I would strongly encourage anybody who is looking at a new position to carefully factor the non-compete into ones decision.

 

[Neuronix]

As always, you are right. I’ve seen and been apart of those types of non competes. Despite my best efforts, I could never get anyone to shake down and was basically told to take it or leave it.

Second this.

I assume figuring out state by state laws would be simple, but no idea how one is supposed to know how aggressively an institution has in the past enforced a non-compete, under what exact circumstances, and in any event if the historical actions should mean that it will be the case in the future.

Whatever the case may be, I would strongly encourage anybody who is looking at a new position to carefully factor the non-compete into ones decision.

It doesn't really matter. With the job market as bad as it is, why would a practice take a risk on a new hire's non-compete? Also, there are so few job options out there that what leverage does someone have to negotiate the non-compete? When all jobs are basically giving the same lousy terms, what choice will one have?

The only exception in my experience is that some states have banned non-competes. This should be a national thing in my opinion.