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Because a urologist posts here and commented on some of their job market issues
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I think that’s my point though. Totally different. What field with only 5000 physicians in the US gives graduating residents/fellows 5-6 unsolicited quality job offers as was mentioned earlier? Other than maybe interventional cards, though lifestyle sucks.
Not surprising. Small field, can be wild fluctuations year to year. Is there any small field with a good job market, good lifestyle, and good pay?
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Because they are bothn specialties med students consider going into
When I was applying during peak rad onc, alternatives I looked at included gu and ent, both of which rad onc interacted a lot with
Med students should be educated on what it means to go into a smaller residency from the get go and how it immediately limits you. And yes, my point was more that of course the urology job market will be better.
Urology isn't a huge specialty either. They just have much better specialty leadership and stewardship when it comes to residency expansion and not hurting their own demand
Oh for sure agree with the leadership and residency expansion point. Supply and demand still rules all, so allowing supply to go unchecked in a small specialty with declining indications and reimbursement is no bueno.
Doesn’t change the point that the job market isn’t much better for several other small specialties with decent lifestyle/pay, especially for new grads. Tighter workforce planning is so important for small fields, cannot emphasize this enough.
Agree to disagree. Urology and ENT are significantly better esp urology. Rads and med onc insanely better etc
Rad onc more similar to EM in that regard
I tried that with Gemini and got very different answers ..
And Chat gpt and Claude gave pretty different answers from Gemini…
Can you forget about any specialty with more than 6K US physicians for a moment. How many specialties with <6K physicians have a good job market, good lifestyle and good compensation?
At baseline, a specialty with 15K physicians should have more total openings than a specialty with 5K physicians. Are you disagreeing with this point?
EM is a wild case study.
Not really sure why size should matter for a per capita issue. If we were large and expanded resident numbers more than every other speciality, we would still have problems. AI says there are around 4k neurosurgeons in the us. They have never had any issues? Can you imagine them greedily doubling resident numbers in a short amt of time? Culturally, it would never happen in specialty with actual leadership and principles.
You’re talking about workforce balance, while I’m talking about job market liquidity. They’re related but not the same thing. A specialty can have perfectly balanced supply and demand yet still have a tighter job market from an individual physician’s perspective if there are only a few hundred openings nationally each year instead of a few thousand. Small specialties naturally have fewer jobs available at any given time, less geographic flexibility, and are more sensitive to changes in hiring. So specialty size absolutely matters when discussing the physician job market. I agree that if a larger specialty expanded residency positions disproportionately, it could also develop an oversupply problem—but that’s a separate point and doesn’t change the fact that absolute specialty size affects how the job market is experienced by individual physicians.
Neurosurgery is a great example of a specialty with <6K physicians with a good job market overall and great pay! But sadly bad lifestyle. So doesn’t hit all 3. And actually, the market for certain subspecialists (like complex skull base) is pretty tight whereas for others (spine) it’s great. Would love to hear if someone can provide a few examples of small fields with good lifestyle, good pay, and good job market.
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Geriatric physicians have a good lifestyle, excellent job market, but bad pay?
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No even geriatric rad oncs still make good pay 😉
However I guess, at least in urology, size matters
The jokes write themselves
Met some great urologists over the years, jokesters with a sense of humor
I don't think the comparisons are about choosing a specialty, it's more to argue that some of the problems we think are unique to our field may be more a function of the size of the field.
At least that's how I understand where the comparisons began
Just job market comparisons from the individual physician’s perspective. I’m saying that market liquidity is a big factor apart from workforce balance that determines how good the job market is. And specialty size is a big factor in determining liquidity. Can definitely still compare workforce balance, leadership, future of rad onc to other specialties…and even if all these things were perfect in rad onc we’d still have the liquidity challenge that would make the job market worse (from an individual physician’s perspective) than specialties with 2-3x the number of physicians.
There's a lot of context to those numbers depending on how you want to practice:
Take breast surgery. If you want to join a group as a general surgeon who also does breast surgery, covers general surgery call but is the "breast person" in that practice, the world is your oyster. If you want a 100% breast surgery practice, no general surgery, no general surgery call, etc. That is going to be a much tougher thing to find. Definitely exists, or you can build your practice that way, but a much tougher hill to climb. Similar story for a lot of surgical subspecialties.
Some specialties have the problem of hospitals wanting call coverage but not having the case volume to support it. Every hospital wants neuroIR or cardiac surgery to be a stroke or stemi center, but those are often terrible jobs as you're taking a ton of call and they may not have the elective case volume to support your practice.
Urology is in the 200s graduating a year
400 now
Just gonna re-drop one of my (germane) infographics here
Still nowhere close to replacement. Meanwhile as @TheWallnerus pointed out, we've doubled spots in an era where our biggest indications are flat to down, fractions down across the board and things like OA, Radiopharm and oligomet SBRT aren't going to replace 6-8 week courses of breast and prostate XRT.
Not to contradict - was just curious, so just was looking it up. Despite growth, urology still in shortage situation.
Notice my graph is not showing residency spots per se, but it can be correlated maybe… however
It’s only showing total diplomate net percent change in the country over a 20y period
I am a believer that we are training too many rad oncs. I also think we have a major maldistribution problem. When I finished residency and came out a few years ago. Besides the academic center, there was really only 1 job that was available which I took for family reasons as I wanted to stay local. In my midwest metro (we got multiple major sports teams) - we have multiple jobs (1 PP, 2-3 hospital employed, and many academic as the center is hemorrhaging faculty).
I have heard from people in other specialties that the job market in my town is tight. These are people looking for outpatient primary care peds jobs, subspecialty surgeon jobs, etc.
I don't think the problem is unique to our field in 2026 and there are ebb/flows. I think the main specialties that are in crazy demand are rads/anesthesia. Can't run a hospital without them and while mid levels do creep in anesthesia, still need docs.
I have heard from people in other specialties that the job market in my town is tight. These are people looking for outpatient primary care peds jobs, subspecialty surgeon jobs, etc.
I don't think the problem is unique to our field in 2026 and there are ebb/flows. I think the main specialties that are in crazy demand are rads/anesthesia. Can't run a hospital without them and while mid levels do creep in anesthesia, still need docs.
Rads is on fire. Quality of rads is dismal in community, at times. I am shocked. They go way too fast. Too many misses. Not staged well. Have seen 5cm tumors in middle of lung missed. No comments on if a LN appears morphologically malignant vs benign. No differential diagnosis. Etc.
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Good for marketing, not useful for actual analysis. Picking arbitrary single time points that maximize the difference in radonc (okay fine, technically 2018 would have been maximizing it). Still, making a ratio with a single time point doesn't really tell you a meaningful story about what's happening in our field compared to others.
This graph conveys a lot more info. Where does it come from?
I made it using data from the internet and had Gemini make the graph. Then cross checked the numbers with a few sources.
We’ve stabilized thankfully instead of increasing further
This is why I’d like reimbursement to go to zero; as reimbursement appears inversely correlated to our salaries, if we can go to zero the models predict we will all be richer than Elon!
To be fair, cms reimbursement is declining, but overall reimbursement for large hospital systems is increasing, which is why health care costs are increasing and radiation departments in these centers are more profitable than ever. Professional fees could easily go to zero and our salaries and the PRICE GOUGING departments would be fine. Also re salaries- we used to be top 3 in medicine and now a number of specialties have moved ahead of us.
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I think rad Onc is still close to the top per hour worked though. I think only neurosurgery and rads makes more per hour.
