Make it make sense

[DrProtonX]

Advertisement - Members don't see this ad

It was only a few years ago that $500k jobs were a rarity, residency stipend? Unheard of! But now I frequently see $500-700k postings with residency stipend (although still in the middle of nowhere). With all the reimbursement cuts, billing codes issues, indications going down, etc. how is this even possible? Is there something that I’m missing? Is this a bubble that’s gonna burst soon?

 

[WildRivers]

It does not make sense to me. I don't understand. Perhaps the income from medonc is so good now that they subsidize radonc?

 

[DrProtonX]

It does not make sense to me. I don't understand. Perhaps the income from medonc is so good now that they subsidize radonc?

Like how NBA subsidize WNBA?😅

 

[Ray D. Ayshun]

It was only a few years ago that $500k jobs were a rarity, residency stipend? Unheard of! But now I frequently see $500-700k postings with residency stipend (although still in the middle of nowhere). With all the reimbursement cuts, billing codes issues, indications going down, etc. how is this even possible? Is there something that I’m missing? Is this a bubble that’s gonna burst soon?

I make twice that. The corporation still clears about $1.5-2M from my clinic. They never visit. As the corporate overlords focus their efforts on FB and IG posts they become more ignorant of how things actually work. In turn, they could throw me a 911 each year and still be fine with how their Excel sheets look. It's about EBITDA. They're good as long as that's positive. All that's happened for hospital-based clinics is that it's slightly less positive, but there's enough C-suite turnover that this is NBD. In the end: capitalism. The hospital's continue to have room to pay more. A cancer doc with a good rep is good for public image as they contract services elsewhere...IMHO

 

[TheWallnerus]

I think hospital based is doing fine, overall. Freestanding is crapping out a bit.

But it is clear, and people, I think, think I’m joking: it is indeed true that falling reimbursement and “rad onc cuts” have been associated with overall increases in salaries. The worse rad onc does, the better rad oncs do.

 

[WildRivers]

Are other specialties also doing better? I feel like normalized to inflation, although salaries are higher, it's not as much a relative increase as just keeping up with inflation.
It appears that my other specialist friends are doing better.

 

[Neuronix]

It was only a few years ago that $500k jobs were a rarity, residency stipend? Unheard of! But now I frequently see $500-700k postings with residency stipend (although still in the middle of nowhere). With all the reimbursement cuts, billing codes issues, indications going down, etc. how is this even possible? Is there something that I’m missing? Is this a bubble that’s gonna burst soon?

Rad onc salaries have always been set by supply and demand. Yes there is a ceiling, but for a busy rad onc it's much higher than most employed rad oncs make.

There are a lot of people taking massive profits to their pockets or other parts of health systems from rad onc clinical labor. Rad oncs are bred to be sheep, taking whatever grass the farmer provides and being afraid to stand out while the wolves stand guard.

Reimbursements get cut 5% or whatever, and the practice owners or health system leadership are the only ones who feel it since that cut comes out of the profits generated by the employed rad oncs.

Nobody has ever wanted rural jobs, so more of the profits from the rad onc clinic labor has to go back to them.

 

[OTN]

"Radoncs are bred to be sheep" is very correct. Just look at what happens when you, like I did, graduate from a Top Whatever residency but decide to go into private practice. The department chair and other attendings were not happy with my decision and had no qualms about letting me know it. Why they thought I would care about their opinion on the matter was beyond me.

 

[TheWallnerus]

"Radoncs are bred to be sheep" is very correct. Just look at what happens when you, like I did, graduate from a Top Whatever residency but decide to go into private practice. The department chair and other attendings were not happy with my decision and had no qualms about letting me know it. Why they thought I would care about their opinion on the matter was beyond me.

Always felt like a “those that can, do; those that can’t, teach” weird jealousy thing to me

 

[NotMattSpraker]

"Radoncs are bred to be sheep" is very correct. Just look at what happens when you, like I did, graduate from a Top Whatever residency but decide to go into private practice. The department chair and other attendings were not happy with my decision and had no qualms about letting me know it. Why they thought I would care about their opinion on the matter was beyond me.

I wish I had more context about the behavior of academic chairs as a group when I was graduating because its natural to care a lot about what they think.

In general, when measured objectively as a group, they are not good employers. Trainees should care less what they think.

 

[medgator]

"Radoncs are bred to be sheep" is very correct. Just look at what happens when you, like I did, graduate from a Top Whatever residency but decide to go into private practice. The department chair and other attendings were not happy with my decision and had no qualms about letting me know it. Why they thought I would care about their opinion on the matter was beyond me.

Most toxic dichotomy (pp/community practice vs academics) in all of medicine I imagine, only getting worse as time goes on (ROCR hypocrisy, RCT proton Data coming to fruition etc)

 

[NotMattSpraker]

Most toxic dichotomy (pp/community practice vs academics) in all of medicine I imagine, only getting worse as time goes on (rocr hypocrisy, rct proton Data coming to fruition etc)

HEY NOW. I heard directly from the president of ASTRO on Twitter that they will evaluate the prostate proton data and re-evaluate their recommendations. At some point. Later. When the papers come out. Maybe.

 

[Gfunk6]

It was only a few years ago that $500k jobs were a rarity, residency stipend? Unheard of! But now I frequently see $500-700k postings with residency stipend (although still in the middle of nowhere). With all the reimbursement cuts, billing codes issues, indications going down, etc. how is this even possible? Is there something that I’m missing? Is this a bubble that’s gonna burst soon?

I think the missing piece is that these jobs are usually not being priced off “pure rad onc professional collections in a vacuum.”

A $500–700k employed job in an undesirable geography is often a market-clearing wage for a hard-to-recruit physician who keeps a hospital cancer program functional. The hospital may care about the technical revenue, keeping referrals in-system, maintaining a local oncology service line, supporting surgeons/med oncs, avoiding patient leakage, and keeping an expensive linac from becoming a museum exhibit. The rad onc salary is one line item in a much larger institutional ecosystem.

Also, “middle of nowhere” matters. These are not usually $700k jobs in San Diego, Manhattan, or the Bay Area. They are places that have to pay a premium because the alternative is nobody. Residency stipends are the same concept: an early recruiting/retention tool because the vacancy cost is high and the candidate pool is thin.

Reimbursement cuts are real. Hypofractionation is real. Fewer indications are real. But those forces do not eliminate the need for local coverage, chart rounds, consults, sims, SBRT/SRS expertise, inpatient/palliative coverage, QA, tumor boards, and someone legally/clinically responsible for the department. The labor market is not just “fractions went down, therefore salaries must go down.”

Is it a bubble? Maybe locally, in some places. If a hospital is overpaying to prop up a low-volume center, a new admin/CFO could eventually decide the economics do not work. Some postings are also “up to” numbers, productivity-dependent, or include recruitment sweeteners that are not the same as durable base salary.

But I do not think this is a simple bubble in the sense of fake demand. It is more a combination of geographic maldistribution, fewer people willing to live in certain markets, older physicians retiring, hospitals needing coverage, and employers discovering that the old “take $350k and be grateful” model no longer clears the market.

The key distinction is this: a strong salary in a hard-to-recruit location does not mean the specialty is suddenly booming everywhere. It means that if a hospital needs a radiation oncologist in a place most people do not want to live, the price has gone up. That is not mysterious. That is just supply and demand.

 

[ramsesthenice]

"Radoncs are bred to be sheep" is very correct. Just look at what happens when you, like I did, graduate from a Top Whatever residency but decide to go into private practice. The department chair and other attendings were not happy with my decision and had no qualms about letting me know it. Why they thought I would care about their opinion on the matter was beyond me.

This $hit burns me up. I went to a top tier biomedical PhD program before ned school and have since been on a lot of thesis committees. It’s crazy how many academic PhDs take it as a personal failure when their trainees decide to go into industry instead of opening an academic lab.

I’ve mostly been in mid tier rad onc programs with expect about half of the trainees to go into PP. even then, some attendings still manage to get disappointed when a good “research resident” opts for PP. it’s next level narcissism. Making your trainees job choices about you and all.

 

[radoncftw]

I am not convinced my department chair even knew my name
Senior people in my department stopped caring when I made it clear PGY-2 that I wanted to go into community practice
Fortunately my PD was supportive and told me "i don't care what you do or where you go, but i want you to be the best rad onc at that place"

 

[Neuronix]

Here it is in a nutshell.

 

[ramsesthenice]

I am not convinced my department chair even knew my name
Senior people in my department stopped caring when I made it clear PGY-2 that I wanted to go into community practice
Fortunately my PD was supportive and told me "i don't care what you do or where you go, but i want you to be the best rad onc at that place"

“We need to expand our residency program to train enough rad oncs to treat the diverse population in our very important state. We will, however, harshly judge many of those trainees for opting to work at 70% of the clinics in our very important state.”

 

[medgator]

“We need to expand our residency program to train enough rad oncs to treat the diverse population in our very important state. We will, however, harshly judge many of those trainees for opting to work at 70% of the clinics in our very important state.”

"The demand for radiation oncologists has outpaced the supply. This shortfall of radiation oncologists is especially problematic in the midwestern and southern regions of the United States. As an example, the state of Missouri has only one training program. This shortage has, in part, resulted in an increase in salaries for radiation oncologists in academic programs, as demonstrated by the Association of American Medical Colleges faculty salary survey report"

 

[OTN]

The Kansas University Medical Center is right next to the Kansas/Missouri border, serves the second largest city in Missouri, and does have a residency program, so saying "As an example, the state of Missouri has only one training program" is technically correct but a bit disingenuous.

 

[TheWallnerus]

The Kansas University Medical Center is right next to the Kansas/Missouri border, serves the second largest city in Missouri, and does have a residency program, so saying "As an example, the state of Missouri has only one training program" is technically correct but a bit disingenuous.

People are being disingenuous in rad onc supply/demand analyses?!?!?

 

[medgator]

People are being disingenuous in rad onc supply/demand analyses?!?!?

The Kansas University Medical Center is right next to the Kansas/Missouri border, serves the second largest city in Missouri, and does have a residency program, so saying "As an example, the state of Missouri has only one training program" is technically correct but a bit disingenuous.

Technically it's in KC, MO isn't it? So that's two

 

[OTN]

Technically it's in KC, MO isn't it? So that's two

It's technically in Kansas but literally by maybe a city block.

 

[Neuronix]

Where I used to work in a crazy oversupplied urban east coast market they were always expanding their residency program. When it was pointed out how oversupplied the area was in faculty meeting, the chair stated that it was our job to train more rad oncs for those underserved markets.

There’s always a way that people will spin things that benefit them.

 

[BobbyHeenan]

Where I used to work in a crazy oversupplied urban east coast market they were always expanding their residency program. When it was pointed out how oversupplied the area was in faculty meeting, the chair stated that it was our job to train more rad oncs for those underserved markets.

There’s always a way that people will spin things that benefit them.

It's all just spin. It really is as simple as "our Dept is growing (satellites, capturing more market etc), we can handle more residents." You show the dean you're growing and you're golden.

Absolutely zero thought or care is given to the overall supply of rad onc or training for under served markets.

 

[Neuronix]

It's all just spin. It really is as simple as "our Dept is growing (satellites, capturing more market etc), we can handle more residents." You show the dean you're growing and you're golden.

Absolutely zero thought or care is given to the overall supply of rad onc or training for under served markets.

You're 100% right.

The good news here is that since the competitiveness dropped off, the program routinely has trouble filling and there have been a number of board failures, and so their requests to expand have been mostly denied by the medical school.

The spots still fill outside the match or with foreign fellows, but at least the expansion hasn't continued as much as they'd like.

 

[yesmaster]

Rad onc residencies and their academic parasite hospital systems are truly a dumpster fire. The academic c suite cartel and the hospital system monopolies are about as corrupt and self interested as day trading Congressmen or the AI robber barons

If the physician scientist chairs at various programs had their way, rad onc residents would be perpetual postdocs or instructors slaving away in the chairs’ labs producing papers or IP

500-700k has been the going rate for hospital employed jobs for over a decade, there are just more laws aimed at salary transparency on job listings nowadays

 

[A_DeMichele]

what is a residency stipend?

 

[Gfunk6]

what is a residency stipend?

A residency stipend is basically an early recruiting payment made to a resident/fellow before they finish training.

In plain English: “Sign with us now, and we will pay you $X per month during the last year or two of residency/fellowship. In exchange, you agree to join us as an attending after graduation.”

It is not charity. It is a recruiting/retention tool. There is usually a contract attached, and if the resident backs out, there may be repayment/clawback provisions.

The fact that these are showing up more often in rad onc is actually telling. Employers are not offering stipends because they suddenly feel generous toward PGY-5s. They are doing it because they want to lock people in early, especially for jobs in places where recruitment is difficult.

So when you see “$500–700k plus residency stipend,” that is not necessarily evidence that rad onc is booming in every market. It means that particular employer may be having a hard time filling that particular job and is willing to pay earlier and more aggressively to secure a body.

Same underlying issue: geography, maldistribution, and market-clearing wages.

 

[Neuronix]

what is a residency stipend?

Any job offering this in rad onc is malignant af and wanting to take advantage of some new grad sucker. These come with several year practice agreements or they claw the money back, and during that time they will act like they own you. During that obligation time you will learn why they couldn’t recruit or retain anyone for that position.

Remember, all rad onc jobs, no matter how remote, can fill for the right price and lifestyle. Instead of something like that, if you’re really interested, tell them you might be willing to take the job if they increase the base salary. But, buyer beware. As a resident you don’t know your worth and may lowball yourself. Also, a lot of these remote jobs don’t pan out after a year or two due to lack of volume, poor equipment, poor staff and collaborations, or other serious issues.

 

[yesmaster]

All rad onc jobs are converging on the average and if the pay structure is average and employed you may as well work in a desirable metro rather than eke out an extra penny or two next to the cow fields or coal mines

 

[A_DeMichele]

so it’s just a form of a signing bonus

 

[Radonky]

Yipes! I got a residency stipend, the academic job I am right now offered it. Its in a competitive location. They got rid of it soon after, but as a dead broke PGY-5, extra 2k per month was helpful, we made it to the last paycheck until attending salary came in. Most stipends I have seen were in the middle of no-where as others have mentioned, but you could get lucky.

 

[ramsesthenice]

I have not had direct experience with these things because none of the departments I have worked in have used them. I think in the right situation they may be fine but the abuse potential is very high. My main concern is most residents don't know enough about physician compensation models to really negotiate. When you are broke, an extra 2K a month sounds like a lot, but it's only $24K over a year. In departments where chairs have salary discretion, if they really want you, it not hard to negotiate more than that in your annual base salary and keep getting indefinitely. The power dynamic when you still have a year (or more) of training left makes it very hard to effectively negotiate the terms of your post-residency offer. And once you sign these things, you lose essentially all of your leverage later.

IMO, these make the most sense in very specific scenarios: someone is where they really want/need to be, at a center where compensation is set by the SOM and not the department, and there is no/limited need to negotiated start up funding (etc).

 

[thesauce]

I would definitely be open to offering a resident stipend for my group which is in a major city and we compensate quite well. It would help us secure a new doc early and plan future projects around them.

 

[DoctwoB]

I have not had direct experience with these things because none of the departments I have worked in have used them. I think in the right situation they may be fine but the abuse potential is very high. My main concern is most residents don't know enough about physician compensation models to really negotiate. When you are broke, an extra 2K a month sounds like a lot, but it's only $24K over a year. In departments where chairs have salary discretion, if they really want you, it not hard to negotiate more than that in your annual base salary and keep getting indefinitely. The power dynamic when you still have a year (or more) of training left makes it very hard to effectively negotiate the terms of your post-residency offer. And once you sign these things, you lose essentially all of your leverage later.

IMO, these make the most sense in very specific scenarios: someone is where they really want/need to be, at a center where compensation is set by the SOM and not the department, and there is no/limited need to negotiated start up funding (etc).

I wouldn't call it abusive at all. A doctor interviewing for a job is a competent individual who can weigh the pros and cons of a job offer and presumably if they interview for one job they are interviewing for several and can compare offers.

There are legit reasons a stipend makes a lot of sense for both sides. It provides longer term doc/staffing certainty for the practice. It makes a ton of sense for the resident since money now is worth more then money later, especially when you factor in the marginal utility of a dollar is higher when your salary is lower (and fixed expenses may be lower). Also your resident tax bracket is likely much lower then it will be if you got the money as salary or as a signing bonus after your attending job starts.

It's money. Money is fungible. It could be a stipend, a signing bonus, loan repayment, moving allowance, etc. All fair recruiting incentives. Haven't seen them often in urology but know a few residents who negotiated them who knew in advance they wanted to end up in an underserved area.

 

[TheWallnerus]

I wouldn't call it abusive at all. A doctor interviewing for a job is a competent individual who can weigh the pros and cons of a job offer and presumably if they interview for one job they are interviewing for several and can compare offers.

There are legit reasons a stipend makes a lot of sense for both sides. It provides longer term doc/staffing certainty for the practice. It makes a ton of sense for the resident since money now is worth more then money later, especially when you factor in the marginal utility of a dollar is higher when your salary is lower (and fixed expenses may be lower). Also your resident tax bracket is likely much lower then it will be if you got the money as salary or as a signing bonus after your attending job starts.

It's money. Money is fungible. It could be a stipend, a signing bonus, loan repayment, moving allowance, etc. All fair recruiting incentives. Haven't seen them often in urology but know a few residents who negotiated them who knew in advance they wanted to end up in an underserved area.

The “average” urology resident can get—or does get?—about how many job offers? I think it’s a lot more than rad onc. So urology residents may have a little less incentive to lock in long term life choices. A bird/job in the hand is worth two in the bush.

(Edit: related corollary… how do you catch a bird? Pour salt on its tail.)

 

[allseasons]

The “average” urology resident can get—or does get?—about how many job offers? I think it’s a lot more than rad onc. So urology residents may have a little less incentive to lock in long term life choices. A bird/job in the hand is worth two in the bush.

(Edit: related corollary… how do you catch a bird? Pour salt on its tail.)

Is there any data on this number in the past year? At the institutions I have ties to and talked to graduating residents, there’s been many offers in many different areas. Idk the exact number (never asked), but people seemed to have a lot of choices. Good ones too, though I will admit what we think is good is probably different from what you think is good. Graduating residents this year started residency right after rad onc’s collapse after all.

 

[ivybme]

Is there any data on this number in the past year? At the institutions I have ties to and talked to graduating residents, there’s been many offers in many different areas. Idk the exact number (never asked), but people seemed to have a lot of choices. Good ones too, though I will admit what we think is good is probably different from what you think is good. Graduating residents this year started residency right after rad onc’s collapse after all.

You should take a look at the annual ARRO job survey each year, it's usually posted on ARRO day at ASTRO. That's the best data you can expect usually

 

[Neuronix]

I wouldn't call it abusive at all. A doctor interviewing for a job is a competent individual who can weigh the pros and cons of a job offer and presumably if they interview for one job they are interviewing for several and can compare offers.

There are legit reasons a stipend makes a lot of sense for both sides. It provides longer term doc/staffing certainty for the practice. It makes a ton of sense for the resident since money now is worth more then money later, especially when you factor in the marginal utility of a dollar is higher when your salary is lower (and fixed expenses may be lower). Also your resident tax bracket is likely much lower then it will be if you got the money as salary or as a signing bonus after your attending job starts.

It's money. Money is fungible. It could be a stipend, a signing bonus, loan repayment, moving allowance, etc. All fair recruiting incentives. Haven't seen them often in urology but know a few residents who negotiated them who knew in advance they wanted to end up in an underserved area.

As I always tell my patients "Nothing is 100% in cancer."

What I do see are a lot of naive senior residents without a lot of job offers. They often don't realize that there are a lot of sharks on the other side of finishing their residencies.

With the rad onc job market as weak as it is, if a place has to try hard to recruit, something is often seriously wrong.

Yes, these are adults who can make their own choices in life, just like I can post on here to warn people. It never ceases to amaze me how people walk in with blinders on to churn-and-burn practices that are known to be malignant by everyone who ever worked there or works in that area.

 

[NotMattSpraker]

As I always tell my patients "Nothing is 100% in cancer."

Or 0%!

I say this every day multiple times.

 

[medgator]

As I always tell my patients "Nothing is 100% in cancer."

What I do see are a lot of naive senior residents without a lot of job offers. They often don't realize that there are a lot of sharks on the other side of finishing their residencies.

With the rad onc job market as weak as it is, if a place has to try hard to recruit, something is often seriously wrong.

Yes, these are adults who can make their own choices in life, just like I can post on here to warn people. It never ceases to amaze me how people walk in with blinders on to churn-and-burn practices that are known to be malignant by everyone who ever worked there or works in that area.

Market wasn't amazing when we were graduating 120 a year

It sure as heck didn't get better graduating closer to 200 residents a year now

 

[RickyScott]

Are residents getting multiple unsolicited job offers (like every other specialty)? i probably recived 5 or 6 during my chief year at a hellpit program.

 

[Faol]

My residency stipend was a lifesaver. As a resident, each dollar has a larger impact and the value of 24k/ year was much more than 50 or 100k now. I’d also like to note that people make bad financial choices well outside residency, although the point that new residents are more naive is true. I personally negotiated, had a lawyer review and made amendments prior to signing, which has also helped with interactions while employed as they know I don’t mind having my lawyer involved. So, at least personally, can attest that stipends can work depending on the resident.

 

[TheWallnerus]

Is there any data on this number in the past year? At the institutions I have ties to and talked to graduating residents, there’s been many offers in many different areas. Idk the exact number (never asked), but people seemed to have a lot of choices. Good ones too, though I will admit what we think is good is probably different from what you think is good. Graduating residents this year started residency right after rad onc’s collapse after all.

You should take a look at the annual ARRO job survey each year, it's usually posted on ARRO day at ASTRO. That's the best data you can expect usually

2021 ARRO data, median 2 firm offers per resident

 

[medgator]

2021 ARRO data, median 2 firm offers per resident

View attachment 421308

They always used to say.... You only need one good offer and sometimes it felt like that was literally the case for some people looking to get back to a certain home environment...

 

[Neuronix]

Are residents getting multiple unsolicited job offers (like every other specialty)? i probably recived 5 or 6 during my chief year at a hellpit program.

Never heard of such a thing in the past decade.

They always used to say.... You only need one good offer and sometimes it felt like that was literally the case for some people looking to get back to a certain home environment...

The benefit of only having one offer is that you never have to worry about whether you made a wrong decision.

 

[goodluck1234]

Are residents getting multiple unsolicited job offers (like every other specialty)? i probably recived 5 or 6 during my chief year at a hellpit program.

When talking about the rad onc job market, I'm surprised people don't bring up the points below.

-Need to compare rad onc to similarly small subspecialties. I know several surg oncs, thoracic surgeons, vascular surgeons etc where the job market is tight.
-A common counterargument I see is that these other specialists can just do something else if there is no job for them (surg onc can do gen surg, gyn onc can do general ob) whereas rad onc is stuck. HOWEVER, these other specialists didn't spend many extra years in fellowship to fall back on something they don't love doing, so while this sounds nice in theory, it doesn't hold true in reality.
-Jobs for new grads can be WAY more predatory in other subspecialties than in rad onc. For example, surgical subspecialists need OR block time, robot time, mentorship in the OR, other specialists available to back them up for big cases, much more support staff.
-Why not ask AI? Surely it is more knowledgeable than us and has better perspective. I had AI generate a list of medical subspecialties with <~6K total physicians in the US and place them into tiers of how good the US job market is today and job market outlook over the next 5-10 years. It only included specialties where decent workforce data were available.

Tier 1 – Excellent

• Breast Surgery (~1,700–2,000 physicians)
• Allergy & Immunology (~5,000 physicians)
• Interventional Cardiology (~4,500–5,000 physicians)

Tier 2 – Strong

• Radiation Oncology (~5,000–5,500 physicians)
• Gynecologic Oncology (~1,500–1,800 physicians)
• Interventional Radiology (~4,000–5,000 physicians)
• Thoracic Surgery (~4,000–4,500 physicians)
• Vascular Surgery (~4,000 physicians)

Tier 3 – Good, but More Competitive or Geographically Limited

• Complex Surgical Oncology (~1,200–1,500 physicians)
• Neuroradiology (~4,000–5,000 physicians)
• Endocrine Surgery (~1,200 physicians)
• Pediatric Cardiology (~3,500 physicians)
• Transplant Surgery (~1,200 physicians)

Tier 4 – Highly Specialized, Very Small Markets

• HPB Surgery (~700–1,000 physicians)
• Orthopedic Oncology (~300–400 physicians)
• Pediatric Surgical Oncology (<300 physicians)

All this doesn't negate the issues with rad onc today - shrinking indications, focus on expensive tech that isn't moving the needle for patients, residency expansion (though maybe getting better?), reimbursement cuts, etc. But it provides perspective.

 

[RickyScott]

When talking about the rad onc job market, I'm surprised people don't bring up the points below.

-Need to compare rad onc to similarly small subspecialties. I know several surg oncs, thoracic surgeons, vascular surgeons etc where the job market is tight.
-A common counterargument I see is that these other specialists can just do something else if there is no job for them (surg onc can do gen surg, gyn onc can do general ob) whereas rad onc is stuck. HOWEVER, these other specialists didn't spend many extra years in fellowship to fall back on something they don't love doing, so while this sounds nice in theory, it doesn't hold true in reality.
-Jobs for new grads can be WAY more predatory in other subspecialties than in rad onc. For example, surgical subspecialists need OR block time, robot time, mentorship in the OR, other specialists available to back them up for big cases, much more support staff.
-Why not ask AI? Surely it is more knowledgeable than us and has better perspective. I had AI generate a list of medical subspecialties with <~6K total physicians in the US and place them into tiers of how good the US job market is today and job market outlook over the next 5-10 years. It only included specialties where decent workforce data were available.

Tier 1 – Excellent

• Breast Surgery (~1,700–2,000 physicians)
• Allergy & Immunology (~5,000 physicians)
• Interventional Cardiology (~4,500–5,000 physicians)

Tier 2 – Strong

• Radiation Oncology (~5,000–5,500 physicians)
• Gynecologic Oncology (~1,500–1,800 physicians)
• Interventional Radiology (~4,000–5,000 physicians)
• Thoracic Surgery (~4,000–4,500 physicians)

Tier 3 – Good, but More Competitive or Geographically Limited

• Vascular Surgery (~4,000 physicians)
• Complex Surgical Oncology (~1,200–1,500 physicians)
• Neuroradiology (~4,000–5,000 physicians)
• Endocrine Surgery (~1,200 physicians)
• Pediatric Cardiology (~3,500 physicians)
• Transplant Surgery (~1,200 physicians)

Tier 4 – Highly Specialized, Very Small Markets

• HPB Surgery (~700–1,000 physicians)
• Orthopedic Oncology (~300–400 physicians)
• Pediatric Surgical Oncology (<300 physicians)

All this doesn't negate the issues with rad onc today - shrinking indications, focus on expensive tech that isn't moving the needle for patients, residency expansion (though maybe getting better?), reimbursement cuts, etc. But it provides perspective.

I still wouldn’t discount the “one trick pony” nature of our “specialty”. We are a residency not a subspecialty and should be compared vs other residencies. I do know neurodaioligists who practice some general rads etc.

 

[HemeOncHopeful19]

Allergy/Immunology is almost always on the far end on the bad side of job market surveys

 

[goodluck1234]

I still wouldn’t discount the “one trick pony” nature of our “specialty”. We are a residency not a subspecialty and should be compared vs other residencies. I do know neurodaioligists who practice some general rads etc.

We should be compared to similarly sized fields. Rad onc is one of the smallest residencies. Why compare rad onc job market to general urology job market, for example?