M4 thinking strongly about applying to Rad Onc: Why is there so much dissonance between opinions real life and the internet?

[RickyScott]

If IBA or these other places were smart, they’d do what pharma does and start sponsoring trials.

I am not sure that is in iba’s interest.
we all know the results would be devastating to the companies. Their best strategy is to promote registry trials and give grants to certain academics cited above. kick the can down the road and someone else will be there to pick up the pieces when we face deligitimization.

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[medgator]

I am not sure that is in iba’s interest.
we all know the results would be devastating to the companies. Their best strategy is to promote registry trials and give grants to certain academics cited above. kick the can down the road and someone else will be there to pick up the pieces when we face deligitimization.

And keep hoping private equity/investor dollars flow in to fund the next questionable center

 

[deleted941485]

And keep hoping private equity/investor dollars flow in to fund the next questionable center

I have a friend who works for a company underwriting bonds and did so for a major proton center. I told him his company is crazy and shouldn’t do it and gave all he reasons why. It’s a joke but they did it anyway. I said you better budget for all the lobbying expenses you’ll need every time you go to Washington to preserve reimbursements

 

[MegaVoltagePhoton]

The only thing that can save us is a horrible (absolutely horrible) match that leads to immediate action. However, I doubt it will happen as people will just SOAP on in.

So maybe in a couple of years when attendings are forced to decide what's worse, no coverage, or bad coverage. Then, maybe,

 

[deleted941485]

The only thing that can save us is a horrible (absolutely horrible) match that leads to immediate action. However, I doubt it will happen as people will just SOAP on in.

So maybe in a couple of years when attendings are forced to decide what's worse, no coverage, or bad coverage. Then, maybe,

Seriously it’s probably the best news you’ll hear if it happens. Just brace for when the ivy tower turns to blaming sdn.

 

[deleted941485]

We’ve already had an absolutely horrible match. Applications and qualifications dropped across the board. Our PD told all of us to lower our expectations when screening and interviewing applicants.

Nothing happened. People in power are still blaming it on “internet malcontents,” which is of course what academics want you to believe.

7 years ago when I applied, the chorus of online voices wasn’t strong enough to drown out the general sanguineness of most academics I met. Now that I’m on the other side of it, I wish I’d listened.

Just be glad there’s a free forum for those affected to get the word out. Without SDN, there’d be no way to know until it’s too late. Too much social pressure in academia not to speak inconvenient truths.

Did your PD tell your seniors to lower their expectations for the job search too?

 

[deleted941485]

this stuff is scary. I have decided to double apply high tier rad onc and IM

Why give yourself the headaches? Just apply IM and be done with it.

 

[deleted941485]

But there are so many great opportunities at the terrific new satellites we’re opening up!! Why would you want to take home the $600k+ you are billing with an ownership stake in your job when, instead, you can be paid a flat $300k and the rest can go fund administrator salaries in an academic medical complex? You’d be so much worse off without that Chief Wellness Officer to prescribe you Online Wellness Modules.

Now instead of worrying another billing and bonuses. You can devote yourself to writing pointless articles in low impact journals in you “academic” faculty position that’s really like 95% clinical. bathroom breaks are also included in that 5% of academic time

 

[deleted956486]

Why give yourself the headaches? Just apply IM and be done with it.

I'd redo residency in IM if I was 4 years younger, had less debt, and had an iota of faith in the system. Sadly, I'd rather sell fast food than go back and retrain in the medical profession. Just watching these academics makes me sick.

 

[deleted956486]

If I had to criticize the field, right now I think I would cite “the narcissism of small differences”. of course, when more large centers are pushing protons for prostate and start lying about outcomes like Nancy ... we will be on our way to Trump u

Training in radiation oncology is Trump University right now. One big scam. I'd argue it's worse than TU because of the time invested.

 

[deleted941485]

Hey don’t malign all those high impact surveys with 10% response rates. And it would be a tragedy if nobody retrospectively analyzed our institution’s SBRT experience or head and neck toxicity.

Better yet, let’s run a small phase II trial and conclude that our regimen is safe with comparable efficacy to historical controls.

There’s such a a poverty of leadership and innovation it makes you question why they had such a high bar in the first place. What a sham.

 

[thecarbonionangle]

Giant ruse pyramid scheme is collapsing folks! Save ya money!

 

[Krukenberg]

Hey don’t malign all those high impact surveys with 10% response rates. And it would be a tragedy if nobody retrospectively analyzed our institution’s SBRT experience or head and neck toxicity.

Better yet, let’s run a small phase II trial and conclude that our regimen is safe with comparable efficacy to historical controls.

Agree with your sentiment about survey research, but let’s be fair about prospective trials. Early phase trials are necessary to build the case for a large phase III.

 

[fiji128]

We are pathologically concerned with small differences and ignore the big ones. Leaders in this field wring their hands about how many women or minorities we recruit, and gloss over the fact that the entire workforce is being screwed systematically. We run trial after trial trying to slice and dice some subgroup to omit radiation or give 20% fewer fractions and miss the fact that our specialty is being quickly marginalized by pharma and medonc. Protons have been around for damn near half a century, and nobody has run a major randomized trial? Are you kidding me?!

No leadership, no vision. All we had going for us was good pay / lifestyle and that allowed us to attract some stellar candidates over the years and now we’ve pissed that away so that a few lazy academic attendings won’t have to write their own notes.

I cannot stand listening to these people pontificate about how morally superior because they saved an insurance company a few grand by hypo-fractionating. Try running a clinic where you have to actually pay bills and can’t rely on a resident slave labor force to do all the work while you analyze gender based differences in IMRT billing.

This will continue to be a field with rewarding patient interactions because that is intrinsic to what we do, but that’s about it, and I would argue much less so when we are treating everything single fraction and cannot build longer-term relationships.

This post is spot on.

Just to add my own personal color. I'm working in a rural undersirable location (2 hours from major airport) but am still being paid well for a not very busy medium sized work load. If I left my job, I am sure there would be 80 or so serious applicatants and probably more if they posted the salary. Across the hall the same hospital system has been looking for a med onc for about 1 year with no serious MD/DO candidates as the doc who has been running the clinic for last 30 years is now covering this location only 1 day a week. Rad Oncs are in crazy oversupply at this point relitive to the demand for their services. This type of dynamic will kill what one will be able to do with their career. But some folks out there are still finding acceptable positions via word of mouth/the secret hand shake club so feel free to ignore.

 

[deleted956486]

This post is spot on.

Just to add my own personal color. I'm working in a rural undersirable location (2 hours from major airport) but am still being paid well for a not very busy medium sized work load. If I left my job, I am sure there would be 80 or so serious applicatants and probably more if they posted the salary. Across the hall the same hospital system has been looking for a med onc for about 1 year with no serious MD/DO candidates as the doc who has been running the clinic for last 30 years is now covering this location only 1 day a week. Rad Oncs are in crazy oversupply at this point relitive to the demand for their services. This type of dynamic will kill what one will be able to do with their career. But some folks out there are still finding acceptable positions via word of mouth/the secret hand shake club so feel free to ignore.

The BFF clubs are alive and well.

 

[w00tz]

If this thread doesn't help tank the match, I don't know what will...

 

[medgator]

If this thread doesn't help tank the match, I don't know what will...

Tanked pretty well last year.

Information symmetry is a great thing, whether in residency selection or society at large

 

[MegaVoltagePhoton]

I agree it tanked last year, but in academics there was enough comfort for the "leadership" to talk about crap like a "blip". It needs to tank again, hard, with many programs going unranked etc.

Even then I agree it's likely that no one will do anything. It would be when the first of the SOAPers start rotating that people will realize maybe it was better to have been uncovered.

I think part of the problem is a $280k per year job babying a satellite actually sounds good for the vast majority of med students who would otherwise be considering lower paying specialties etc. And there will be hordes of FMGs that will literally go anywhere. So what needs to happen is that the "leaders" feel the result of the worsening applications.

Or...the leaders can say that dropping application quality is good for the field! https://www.practicalradonc.org/article/S1879-8500(19)30203-6/fulltext

 

[Mandelin Rain]

So maybe in a couple of years when attendings are forced to decide what's worse, no coverage, or bad coverage. Then, maybe,

I think this is the crux. I always heard attendings claim that residents "slow them down". I call complete BS as it pertains to the current generation (last 15ish years) of residents. These are uniformly top of class, highly self motivated, accomplished, brilliant people that have come in. The amount of effort anyone needed to put in to make these residents good doctors was minimal (and this minimalization of effort definitely showed at most of the programs I toured).

However, the pool can drop to the point where the amount of hand-holding does indeed bog down the clinic. And now, none of the current faculty experienced actual quality teaching themselves, so they may be inefficient/ineffective at providing that support. So you end up with ineffective residents and marginal finished products to become colleagues with. You'd hope that would be enough to convince them it ain't worth it, but I'm not so sure.

 

[w00tz]

Tanked pretty well last year.

Information symmetry is a great thing, whether in residency selection or society at large

This coming match has to be worse. Partly because of more and more alarming being posted Also, I think there's a group of competitive students that had radiation oncology as their goal and invested a lot of time and effort into radiation oncology research and may be struggling to "let go" of rad onc. I think the OP is in this situation. I took a year off to do research and I know I would have a hard time changing course after taking time off to do research and delaying graduation/building interest on my loans. But I'd imagine applicants like these that invest a lot of time/effort into rad onc research will no longer exist pretty soon and if there is any other specialty they like even remotely, that will sound like a better option.

 

[Mandelin Rain]

If site neutrality survives with the rest of the APM, you won't even be able to find a low-volume academic satellite in the middle of nowhere for 280k. Then, if the pending economic slow down hits in the next 1-2 years.... things going to get really tough out there.

 

[TheIllusionist]

This coming match has to be worse. Partly because of more and more alarming being posted Also, I think there's a group of competitive students that had radiation oncology as their goal and invested a lot of time and effort into radiation oncology research and may be struggling to "let go" of rad onc. I think the OP is in this situation. I took a year off to do research and I know I would have a hard time changing course after taking time off to do research and delaying graduation/building interest on my loans. But I'd imagine applicants like these that invest a lot of time/effort into rad onc research will no longer exist pretty soon and if there is any other specialty they like even remotely, that will sound like a better option.

yup that's me. I am scrambling for medicine letters. I have a med onc rotation coming up right before ERAS is due so I'll get one from there.

 

[scarbrtj]

yup that's me. I am scrambling for medicine letters. I have a med onc rotation coming up right before ERAS is due so I'll get one from there.

Ahhhh. Wish I were you like 'The Illusionist' wishes it were 'The Prestige.'

 

[TheIllusionist]

Ahhhh. Wish I were you like 'The Illusionist' wishes it were 'The Prestige.'

I know the references, but I am dense to the logic of your statement. Could you please elaborate?

 

[scarbrtj]

I know the references, but I am dense to the logic of your statement. Could you please elaborate?

witticisms collapse when explained ... suffice it to say the movies are similar, but one is superior because it made better choices

 

[TheIllusionist]

witticisms collapse when explained ... suffice it to say the movies are similar, but one is superior because it made better choices

did you mean to say

"Ahhhh. Wish I were like you like 'The Illusionist' wishes it were 'The Prestige.'"

 

[xrthopeful]

Scarbtj has made boatloads of Money. You’re not going to make that in any field now especially med onc so he’s kidding when he says he will trade with you lol.

 

[xrthopeful]

The people who came out even 7-8 years ago (let alone 10-15) came out to a vastly different world...

I mean the most cliche thing in the world is an older doctor to tell younger people not to go into medicine. Can’t get more cliche.

May as well be a cop eating a donut.

Bottom line anyone going to medical school needs to know this. The corporationization of medicine as well as the rising costs of health care have changed the game

 

[scarbrtj]

did you mean to say

"Ahhhh. Wish I were like you like 'The Illusionist' wishes it were 'The Prestige.'"

Wellll.... I did say that. But I detest redundancy and rather than use two identical subordinating conjunctions in a row I chose to omit the first "like" and have the reader's mind fill the blank. You can do that (omit them) with subordinating conjunctions, and pronouns, etc., for in essence:
I wish that I were like you like 'The Illusionist' wishes it were 'The Prestige.'
This sentence uses a triple subordinating conjunction structure and can cause seizures; not for routine use except by the boatloadedly well-moneyed.

 

[TheIllusionist]

Wellll.... I did say that. But I detest redundancy and rather than use two identical subordinating conjunctions in a row I chose to omit the first "like" and have the reader's mind fill the blank. You can do that (omit them) with subordinating conjunctions, and pronouns, etc., for in essence:
I wish that I were like you like 'The Illusionist' wishes it were 'The Prestige.'
This sentence uses a triple subordinating conjunction structure and can cause seizures; not for routine use except by the boatloadedly well-moneyed.

would it go

"I wish that I were like you like 'The Illusionist' wishes it were like 'The Prestige.'"

for the parallel structure swag

 

[nkmiami]

I mean the most cliche thing in the world is an older doctor to tell younger people not to go into medicine. Can’t get more cliche.

quite the opposite on this board. Medical students have choices. many rewarding specialties that do not face oversupply and extreme geographic limitations represented by proactive proffessional societies.

 

[xrthopeful]

quite the opposite on this board. Medical students have choices. many rewarding specialties that do not face oversupply and extreme geographic limitations represented by proactive proffessional societies.

Yes residency oversupply is a problem but even if there were exactly the number of trainees we need, two things would be happening (which are also happening in every field)

1) more and more docs becoming employed (rather than their own bosses) because hospitals are becoming conglomerates which obviously has an impact on salary

2) health care costs get more and more attention every day and CUTS WILL COME and have come to every field.


These two things have way more of an impact then supply/demand in 2019.

 

[scarbrtj]

supplyemand in 2019.

Unintended-but-appropriate SDN board emoji auto-correct... or A.I. already infiltrating SDN?!

 

[xrthopeful]

Unintended-but-appropriate SDN board emoji auto-correct... or A.I. already infiltrating SDN?!

Hahah

 

[medgator]

These two things have way more of an impact then supply/demand in 2019.

That's true in many fields of medicine.

That's also your opinion regarding whether it has been worse for RO vs a doubling of slots since the recent nadir last decade.

Many of us feel that oversupply has been far worse and has exacerbated the problems of hospital/corporate employment of docs in 2019, specifically to RO.

 

[MegaVoltagePhoton]

AI is one of the dumbest things our field has ever invested in. A complete and utter joke. I actually don't mind hypofrac or even SBRT for prostate, and hypofrac for breast but at least that stuff might help patients. AI is just a way to make sure we don't have jobs.

 

[Aphtalyfe]

First of all, I'm not trying to start an argument but here's my theory:
Radonc is on a 6-8 year cycle of delayed information. When med students choose radonc during their MS1-3 years they are getting job outlook information from PGY5s. So for the 2019 match many med students were probably scared away by the job market climate from ~2012. Many departments had a hiring freeze during that time due to changing reimbursement, urorads, and the push towards hypofractionation.

The last 2 years nearly all of my radonc friends have gotten pretty decent jobs in locations that are not in the sticks. (unless they wanted to be there) Or they did fellowships in areas that they had a particular interest in. (brachy, peds, protons) I also did a fellowship and got some decent offers in decent locations. I actually can't think of a person who had a serious complaint about not being able to find a job unless they were looking for a very specific type of physician scientist position in a desirable location.

 

[Krukenberg]

Saying “most got jobs” is arguing against a strawman. Nobody is arguing that most people can’t find jobs because that is easily refuted. The question is what is the trajectory in the quality of jobs and I think that is clear at this point. This is exactly what you’d expect early on in an oversupplied market - hiring to remain somewhat stable as there is downward pressure on wages because it’s now cheaper to hire.

There’s no question that if you graduate in the next year or two you’ll more likely than not get a halfway decent job but it won’t be what you hoped for when you started down this path 6-7 years ago, unless you are a really unambitious person or you have no idea what it’s like for an “in demand” resident when they graduate. And it’ll only get worse...

I know a girl who just finished Mohs fellowship and she had multiple $750k+ offers in desirable cities.

Medonc or GI will start at $650k+. Recruiters salivate over them. When I graduated I went to recruiting events where there wasn’t anyone interested in a radonc in a major city.

A lot of people in this field simply don’t have any concept about salaries/partnership in other fields, or they only know academics, where the pay and recruiting are less divergent.

I don’t buy that. Look over at the derm forum and you’ll see that mohs is over saturated. They trained too many and reimbursement went down. Obviously can foreshadow us but 750k starting in a desirable city is hard to believe.

 

[xrthopeful]

Med onc starting at 650 is not the norm lol.

Man some of you act like you don’t think other people here also know other people in other fields

Its a got dang shame if you ask me.

As Hans Landa said: ‘I love rumors!’

 

[medgator]

Not in academics, but in pp it’s not uncommon. Anyone can check MGMA for the real numbers...

I know for a fact savvy med oncs in larger pp groups make well into the 7 figures once they get good in house pharmacy and chemo purchasing contracts and can band together to bring ancillaries in house like imaging, pharmacy, radiation, even pathology.

We just do radiation, but imagine if, as a med onc, you owned a piece of everything you did from the all the biopsies you order, to the the oral agents you dispensed.

Puts us to shame....

 

[bluebubbles]

I always heard attendings claim that residents "slow them down". I call complete BS as it pertains to the current generation (last 15ish years) of residents. These are uniformly top of class, highly self motivated, accomplished, brilliant people that have come in. The amount of effort anyone needed to put in to make these residents good doctors was minimal...

However, the pool can drop to the point where the amount of hand-holding does indeed bog down the clinic. And now, none of the current faculty experienced actual quality teaching themselves, so they may be inefficient/ineffective at providing that support. So you end up with ineffective residents and marginal finished products to become colleagues with. You'd hope that would be enough to convince them [academic leadership] it ain't worth it, but I'm not so sure.

I'm playing the long game.

My hope is that, as the word gets out, FMG's and bottom of the barrel medical students clamor into radiation oncology. Programs fill through SOAP but they fill. I will be getting as far away from academics as possible after graduating residency and I'd encourage anyone with any skill or interest in teaching to do the same. If rad onc & ABR leadership can be counted on for anything, it's that they'll continue to maintain the same standards for written & oral boards. If a significant proportion of residents fail every year, then everybody wins. The academic programs get their cheap labor for 4 years. And the job market isn't beset with ungodly surplus physician labor because, well, a proportion of residents will fail their exams and remain uncertified.

I wish I was kidding but I'm not. This may be the best future we can hope for. Talk about dystopian.

To M1-M4 aspiring rad onc's: Sorry, not sorry. Let's face it, you'll be happier in med onc anyways. You'll be our bosses & employers before you know it!

 

[Krukenberg]

I mean the most cliche thing in the world is an older doctor to tell younger people not to go into medicine. Can’t get more cliche.

May as well be a cop eating a donut.

Bottom line anyone going to medical school needs to know this. The corporationization of medicine as well as the rising costs of health care have changed the game

For many years I’ve heard older docs of all specialties saying they wouldn’t do medicine again, and I’m still loving my job and glad I did it.

 

[RadOncDoc21]

I know for a fact savvy med oncs in larger pp groups make well into the 7 figures once they get good in house pharmacy and chemo purchasing contracts and can band together to bring ancillaries in house like imaging, pharmacy, radiation, even pathology.

We just do radiation, but imagine if, as a med onc, you owned a piece of everything you did from the all the biopsies you order, to the the oral agents you dispensed.

Puts us to shame....

I’ve seen this and it’s safe to say that it must be nice to be able to bill for all the work up while being the first-second line of the referral chain.

 

[deleted18755]

Med onc starting at 650 is not the norm lol.

Man some of you act like you don’t think other people here also know other people in other fields

Its a got dang shame if you ask me.

As Hans Landa said: ‘I love rumors!’

I known many med oncs in private practice (good friends and family) and none are hiring new grads for anywhere near $650k but it is certainly reasonable to make well over $500k after 2-3 years in many, many parts of the country.

I don’t know what the market is like in big coastal cities but a med onc these days in a decent little city can definitely be making $650k by age 35 if efficient but in the end not working “rad Onc hours” but nothing like a surgeon either.

You wouldn’t know it talking to an older med Onc though since all they talk about is how bad their salary has been cut (yes many of them really did bank seven figures not that long ago ... I guess going from 1,000,000 to 650,000 is a big cut) and how younger people should therefore stay away from medicine!

 

[Krukenberg]

Dermatology having huge, unique challenges of its own. These private equity groups hire armies of PAs and NPs rather than new docs. They’re buying off the academic/professional society leaders to prevent them from doing anything about it. Will surely lead to loss of autonomy for new docs and fewer jobs.

Must-read editorial with some insight into PE calculations. Particularly scary is how PE is joyful that the “branding” of derm practices makes it easier to “transition” out MDs who raise a stink.

Private Equity and Dermatology

Two years ago, one of the world’s largest retailers of children’s toys, Toys “R” Us, filed for Chapter 11 bankruptcy, closing more than 1000 stores across the country.1 Many financial observers trace its demise to the 2005 takeover by private equity firms. The new owners paid themselves handsome...

jamanetwork.com

 

[xrthopeful]

the way PE has been taking over optho is insane too

 

[medgator]

Dermatology having huge, unique challenges of its own. These private equity groups hire armies of PAs and NPs rather than new docs. They’re buying off the academic/professional society leaders to prevent them from doing anything about it. Will surely lead to loss of autonomy for new docs and fewer jobs.

Must-read editorial with some insight into PE calculations. Particularly scary is how PE is joyful that the “branding” of derm practices makes it easier to “transition” out MDs who raise a stink.

Private Equity and Dermatology

Two years ago, one of the world’s largest retailers of children’s toys, Toys “R” Us, filed for Chapter 11 bankruptcy, closing more than 1000 stores across the country.1 Many financial observers trace its demise to the 2005 takeover by private equity firms. The new owners paid themselves handsome...

jamanetwork.com

Some of the larger derm practices hire np and pa to help fill the gap with shortages I thought? They do basic stuff and leave mohs etc to the doctors. At least that's the impression I've gotten from what I've seen in practice

 

[medgator]

the way PE has been taking over optho is insane too

Both derm and ophto aren't really hospital based specialties, so essentially PE is doing the corporatization in the same vein of what hospitals have done to many other more "hospital-based" specialties.

No different than 21C or McKesson/US Oncology owning huge stakes in multiple centers around the country. Personally, I'd rather be owned by PE/fortune 500 company than a hospital in terms of physician autotomy....

 

[xrthopeful]

Both derm and ophto aren't really hospital based specialties, so essentially PE is doing the corporatization in the same vein of what hospitals have done to many other more "hospital-based" specialties.

No different than 21C or McKesson/US Oncology owning huge stakes in multiple centers around the country. Personally, I'd rather be owned by PE/fortune 500 company than a hospital in terms of physician autotomy....

I mean either way you go - someone is telling you how to run your practice and keeps money that you would otherwise be getting.

As I’ve said before - people that are new grads like me are overall more comfortable with this than older docs. A lot of us never went into medicine with the expectation of being able to hang our own shingle.

One of my optho friends found a physician owned setup but that was after a ton of looking - many are getting gobbled up by big investors.

 

[xrthopeful]

New grads - There’s a job in metro St. Louis area right now offering 550-600k. May not be a desirable area for some of you but I would take it.